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With limits on procedures that can be done in medical facilities, hospital visitation and general disruption to educational institutions, there is concern about the future education and careers of medical students.

In March, campuses across the state shut down, leaving medical students to do their studies online. Lab classes were limited and many were unable to do onsite training.

Deanette Sisson, chief nursing officer at Saint Agnes Medical Center, said that over the course of a semester there are around 500 students in nursing and other disciplines doing onsite training at its facilities.

“We ended our clinical rotations around the end of March just because of the continued escalation of Covid-19 and the concern of wanting to keep students, patients and staff safe,” Sisson said.

In addition, Sisson said the hospital is working on plans to bring students back and is reaching out to local schools that had students in the process of completing their education to see if there are ways to support them.

Around mid May, Sisson said some students were allowed to finish their onsite training, and a plan is being developed for the fall to support the process if the schools are ready.

With the delays in medical students’ completion of their education, there may be delays to the start of their careers.

When the nursing on-site training rotations were discontinued, Sisson wrote a letter to the California Board of Nursing to support the idea to allow students to finish their clinical training through simulations. The board allowed the Fresno City College nursing program to finish about 50% of its clinical rotations through simulations.

The simulation training did help stave off delays in the education and careers for some students, but those yet to complete their on-site training could still see delays.

Though some students were prohibited from working at certain hospitals, students that have the chance to work in a facility are doing so at a time of unprecedented medical history.

“I think this will create an opportunity for them to think about health care a little differently,” Sisson said. “Only because what we have seen is that some of the work has become more remote, where they are using Telehealth. Its also important for them to understand the changes that are required in health care now, giving them a different preparation than people who will experience this for the first time later on.”

There are around 300 students in undergraduate nursing at Fresno State that are most impacted by limits to onsite training.

Right around when shelter in place orders in California were announced in March, the college moved courses online and also started looking at simulation training and other alternative assignments to meet the needs for completing the courses.

Dr. Sylvia Miller, chair of the School of Nursing at Fresno State, said that because of the anticipation of a possible second wave of Covid-19 cases, there are no plans to return to onsite training during the fall semester. Telenursing, and simulations are the most likely course.

Miller said the department is developing plans to make different avenues of training just as effective, if not even more effective, than onsite training.

“At least for the last ten years, there’s always been a shortage of nurses, so I think that shortage is going to continue. That’s why it’s important for us to make sure our students are able to complete their practicum, move forward in the program and graduate. The profession is in need of nurses.”

Not only at the university level, but also at high school and grade school, Miller said education will look different from this point on.

Keisha Lewis-Nesbitt is director of nursing at Clinica Sierra Vista, a health care organization serving Kern, Fresno and Inyo counties with primary medical, dental and behavioral health needs.

Lewis-Nesbitt had it set up where students from Fresno City College and Fresno State could complete their community based training at Clinica Sierra Vista facilities. When Covid-19 hit, students who were supposed to complete their training at Community Regional Medical center, but weren’t allowed to, were able to complete their training at Clinica Sierra Vista’s eight clinics.

Two cohorts, each consisting of about 30 students, are completing their onsite training this way.

“My goal for the students was to make sure they weren’t short hours, so I was able to accommodate FCC so they were able to wrap up their rotation and hours. Now we are doing San Joaquin Valley College so they can continue on,” Lewis-Nesbitt said.

Lewis-Nesbitt is still certain that students will be able to take their tests and pass their boards, but they may not be allowed to be present during certain medical procedures.

Tim Calahan, director of public relations and community development at Clinica Sierra Vista, said he tries to put himself in the mindset of a student who still chooses to continue their education during this unprecedented health crisis.

Calahan said there will be a point where they can get back to normalizing the process of getting students into onsite training and get them to work to support a future medical workforce that could be close to exhausted.

“This is the best on the job pre-employment training that you could ever ask for, good or bad,” said Calahan. “These kids are getting a real dose of what the future of medicine is going to look like, not only mid-Covid, but also with new technology and precautions — just the culture of medicine is changing as we go, day by day.”