Lessons from the Wilderness Fill the Gaps of a Pandemic Medical Education

Will our generation of medical students be the most introverted yet? Every Monday morning since medical school started in the fall, I sit down at my desk and settle in for a day of Zoom lectures. I log in to my first class of the day and watch as my classmates’ names, written on small black boxes, populate the screen. Most of us don’t turn our cameras on, and even fewer of us dare to “unmute” to ask a question of the professor, opting to type it out in the chat box instead. We are learning, yet there is a sense that this type of learning is changing us. I haven’t seen a patient outside of Zoom in months. Even planning a study group for exams has become an awkward conversation about how to navigate social distancing. I’m afraid that with all of this learning behind screens, we are losing the very skills needed as future physicians: communication, teamwork, flexibility, and stamina. Tufts medical students are hoping the wilderness will fill the gap.

As my partner and I venture out into the White Mountains of New Hampshire, I can’t help but notice parallels between the skills I use to stay safe in the backcountry and the ones my classmates and I must develop to become successful physicians. While travelling in avalanche terrain, we keep an open dialogue, constantly chirping back and forth: “Did you notice that whumpfing sound coming from the snow beneath your skis?” “What direction is that slope facing?” “How are your feet?” “I think we should get some water and calories.” We talk about our needs, our physical condition, our surrounding terrain. We evaluate the risks and rewards, then re-evaluate, then re-evaluate… and we must feel comfortable enough to speak up when we notice something, because our safety depends on it. Small details can be the difference between life and death. I imagine this is true in the wards, too. My classmates and I know how each patient’s condition must be monitored, but behind our Zoom screens, we haven’t yet had the chance to practice the art of speaking up when we notice a patient’s changing condition.

A few weekends ago, as my partner and I were climbing up a steep gully out of Tuckerman Ravine, we noticed the snow change beneath our feet, crumbling away where before our crampons had stuck to its surface. It was a perfect sunny day, the kind that seem to only happen in ski movies, but the weak layer of snow collapsing beneath us made us nervous. Despite our intention to ski the gully from the top, we made the decision to change plans and turn around, appreciating the consequences of a misstep in avalanche terrain. Flexibility and openness to change are key elements of backcountry travelling, just as they are to patient care. We don’t often send patients home on a medication regimen expecting it will never need to be tweaked, and we cannot freeze in the operating room when a surgery goes awry. I fear the monotony of online medical school causes our muscles of adaptation and flexibility to atrophy, and I know I’m not the only one reaching for the outdoors to fill this gap.

The parallels between venturing in the wilderness and training to become a physician start before we even get to the trailhead. The most effective treatments are often preventing disease in the first place: we bring a rain jacket on backpacking trips even if the forecast is for sun. I’m grateful that time spent outdoors has taught me to be organized and prepared, to foresee the unexpected and avoid mistakes instead of fixing them. I hope to bring this same approach as I enter the clinic.

With the pandemic forcing many pre-clinical medical students to learn from home, more of us are seeking time in the wilderness. The outdoors have become more than an escape from school; they have inadvertently become the schoolhouse for learning critical lessons in communication, flexibility, and preparation, lessons put on hold by an online education. At Tufts University School of Medicine, we’ve witnessed the increasing demand for connection through the outdoors, with 126 student members on our Wilderness Medicine Interest Group mailing list. Limited by social distancing guidelines, we’ve had to make waitlists for in-person skills sessions and host speakers on Zoom, but most of us, independently, can be found outside on the weekends. Covid-19 has also increased the demand for wilderness medicine knowledge as more people, with limited travel opportunities, look to the outdoors as an escape. 2021 has seen the deadliest avalanche season in years, with 33 fatalities in the U.S. as of February 28th (CNN) and 15 deaths between January 30th and February 6th, the worst week for avalanche deaths on record since March 1, 1910 (CNN). Our generation of medical students will need to respond to the demands of more Americans venturing in the backcountry. While Covid-19 persists, our pre-clinical medical education may have its gaps, but for now, time in the wilderness helps us develop the skills we need to become successful physicians.

References:

1. Elassar, Alaa. “It's the US' Deadliest Avalanche Season in Years. Experts Say Covid Is Partially to Blame.” CNN, Cable News Network, 28 Feb. 2021.
2. Moshtaghian, Artemis, et al. “At Least 15 People Died in Avalanches Last Week, the Deadliest Week of US Avalanches on Record.” CNN, Cable News Network, 9 Feb. 2021.

Madison Hayes-Lattin, MS1
Tufts University School of Medicine