Jordan Lane was in his third year of medical school when the covid-19 pandemic officially hit the state last March.
Overnight, the once elbow-to-elbow hallways became a ghost town at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University in Jonesboro.
"No one was on campus," Lane said. "But we were in a very good position to be able to handle this, which was a major advantage. We had everything already electronically. We were given an iPad the first day of school. We can get all our books on iPad, we had access to any resource that we needed and all our lectures were posted online anyway."
The virus's spread forced hospitals to carve out space for hundreds more beds and created an unprecedented staff shortage to care for critically ill patients. It also required Arkansas' medical schools and their students to adjust to dramatically different learning methods.
Lane saw the emotional and physical toll that caring for coronavirus patients had on his former colleagues at St. Bernards Medical Center in Jonesboro.
Lane -- who had worked two years as a registered nurse in the hospital's intensive care unit before deciding four years ago to go to medical school -- felt helpless.
In January, after completing vital parts of his medical education, Lane -- coming up on a spring graduation -- took a leave from school and returned to St. Bernards' intensive care unit to lend a hand.
"They were just happy to have me here," Lane said. "There is a huge shortage of staff, in particular ICU nurses, right now everywhere across the country. It was a fairly dire need."
He was raised to do his part to better the community around him. His grandfather, Joe Lane, is a long-time mayor of the small Missouri town of Senath, about half an hour from Jonesboro.
"I have always felt a calling to serve," Lane said. "Seeing all of this around me, I wanted to help. I had to do something."
"We work to recruit students who have the heart for servant leadership and a sense of duty to the community and the patients they care for. Jordan is representative of the type of student we want graduating from our program," said Dr. Shane Speights, dean of the Jonesboro medical school. "When I heard of what he was doing during this pandemic, I thought to myself, 'Of course, he is.' Using the talents and skills you have to make your community a better place, that's the ultimate calling we all have. I'm proud that Jordan is doing just that."
Married with two small children, Lane gets up before dawn most days of the week and works 12-hour shifts.
"When I was here before, the ICU was rarely full," Lane said. "Now it's full every single day. It's nonstop."
LEARNING ONLINE
Paula McClain, the University of Arkansas for Medical Sciences College of Medicine class president for 2022, was in the classroom for her second year of medical school when the pandemic struck.
"Immediately, on March 12, our classes got shut down and everything was online," she said.
The first covid-19 case in the state was reported on March 11. By the next day, Arkansas had six cases -- which included a UAMS resident doctor who came in contact with that first patient at Jefferson Regional Medical Center in Pine Bluff.
All of the UAMS colleges -- medicine, nursing, pharmacy, public health and health professions -- were immediately shut down and students were told the college would contact them with further instructions, said Stephanie Gardner, UAMS provost and chief academic officer.
"We were going to have to very quickly convert much of our instruction to a virtual format," Gardner said. "Luckily, we have a good reputation at UAMS in distance learning. We were early adopters in teaching remotely, but then we had to move all of our education online, at least in the short term."
Adapting to change comes with the territory for health care workers, but this was beyond what anybody -- students or faculty -- had experienced, McClain said.
The administration, faculty and staff worked together to create virtual lesson plans, set up dozens of web cams, and record lectures or learn how to broadcast from their home or office.
A one-stop shop website was created for faculty, staff and students with resources for working and studying remotely.
"We have an Office of Educational Development that normally helps faculty improve their teaching skills. And from March 10th through the 20th, they responded to more than 500 emails or phone calls to support that transition," Gardner said.
There were 22 training sessions on Blackboard, an educational technology system for remote teaching. Some of the instructors had never before taught a remote class or used interactive video.
"That was a Thursday. By Friday, most UAMS academic programs were starting online education or were making plans to move online when their students returned from spring break," Gardner said.
Skills that might have taken years to learn and perfect were accomplished in weeks by the faculty.
The UAMS College of Medicine quickly developed a two-week online covid-19 course for students that covered the basic science aspects of the virus, such as virology and epidemiology as well as its clinical aspects: how it affects patients, treatment, infection control and other factors.
The course was a requirement for all students in order to return to campus.
Gardner said the covid-19 pandemic reminds her of the early 1980s when she was getting her pharmacy education at the University of North Carolina at Chapel Hill.
At that time, the AIDS epidemic was fairly new.
"Courses were developed around AIDs, much like today we're developing these courses around covid-19," she said.
PLANNING AHEAD
At Arkansas College of Osteopathic Medicine in Fort Smith, the administration there began monitoring the pandemic situation in February.
"By early March we started to formulate contingency plans as the pandemic began to create more concern over the current state of personal protective equipment (PPE) supplies," said Rance McClain, the dean of the college. "At this point we started to communicate with our community affiliates to gain their thoughts on maintaining or removing our third year students from their clinical rotations."
And by March 13, the college told all their students that the curriculum would be converted to a virtual platform for the immediate future.
"Our campus remained closed until June, with only select administration personnel coming to campus to maintain operations and education," Rance McClain said. "The remainder of the campus community worked remotely during these months. Plans were put in place for operation of the campus during the summer months in preparation for reopening the campus to students in late July for the fall semester."
IN-PERSON TRAINING
The training for first- and second-year medical students takes place mostly in lectures and labs.
"We're incredibly fortunate that our institution is very technology driven, so we already had the infrastructure in place to transition to virtual learning pretty seamlessly," said Speights, dean of the college in Jonesboro. "In a 'non-pandemic year,' we stream live lectures from Long Island, N.Y., to our Arkansas campus and vice versa. Since last March, we've delivered all of our lectures virtually, and while we'd certainly prefer to be in person, the transition has gone as well as it possibly could have."
Still, some of the basics of those first two years can only be accomplished hands on.
"You can't dissect a cadaver or perform a physical exam virtually," Speights said. "You can't learn osteopathic manipulative medicine without physical contact."
Typically each fall at UAMS, students gather five at a table in the morgue to dissect a cadaver -- a body donated to science.
"Putting 174 students in a confined space for three or four hours a day was not going to be safe, so we changed our anatomy program to what the anatomists call a 'pro-section model,'" said Dr. James Graham, executive associate dean for academic affairs in the UAMS College of Medicine. "That is, the faculty or graduate assistant actually did the dissection and dissected out the structures. There were small groups of people in the lab doing that work."
The medical students were then brought to the lab in socially distanced small groups so they could examine the dissection and learn the anatomy of the cadaver without actually doing the technical procedure.
"It was safer because it was small groups and less time in the lab," Graham said.
SEEING PATIENTS
Having enough personal protective equipment -- which was hard to come by back then -- was one of the biggest issues in getting junior and senior medical students back to patients' bedsides.
Still, other than for a few weeks when the pandemic first arrived, the junior and senior medical students have continued to provide patient care every day.
In addition, some programs were able to use simulation education or have students treat patients through telehealth opportunities in place of clinical experiences.
The UAMS dental hygiene program was moved to the Freeway Medical Tower off the main campus to create space for social distancing of patients. The number of treatment stations were reduced, but clinic hours were extended to accommodate the patients and students.
NYIT third- and fourth-year students were kept on their clinical rotations, whether it was at a hospital or a rural clinic.
"This is important not just for the education student but for the betterment of the community. Many of our students are rotating and learning in small and mid-sized towns all across the state of Arkansas," Speights said. "Many of these communities are in health care shortage areas. Our students help fill that gap in the workforce. They are not only learning, they are positively contributing to the health of the community. We expect that of them. We expect them to positively impact the health care system long before they graduate."
At the Arkansas College of Osteopathic Medicine, the class schedule was rearranged to reduce the number of students on campus. Lecture halls were set up for social distancing and classes were broadcast live on campus.
Lab sessions were divided into small groups to allow social distancing and the use of PPE during any session in which students practice a doctoring skill that requires contact with a fellow student.
"Our inaugural class, who were off campus in third year clinical rotations had their curriculum converted to multimodality virtual experiences," Rance McClain said. "During the roughly three months they were out of the clinical learning environment, they participated in targeted research, journal clubs, board examination preparation sessions, interactive virtual case presentations, and telemedicine sessions with practicing physicians."
SERVING OTHERS
After being pulled off rotation last spring, Paula McClain said she and her classmates were itching to help.
"At that point, I think we were just like everybody else," she said. "We were apprehensive, but we also felt a little -- especially my class -- we felt like we really would like to be out there, we want to be helping, we want to be doing something."
The students staffed a call center to conduct contact tracing of positive covid-19 cases and when, hospitals in the state were desperate for PPE, the UAMS students -- including McClain, Nick Shumate, Haylee Hardgrove and others -- started a collection drive.
The students located PPE from different sources such as construction contractors, schools and colleges. They personally delivered the safety supplies to rural hospitals and clinics all over the state.
The students volunteered for vaccine clinics. They called and visited elderly patients experiencing excessive isolation during the pandemic.
"While they're in medical school and learning all this stuff, they are volunteering because they see that they can make a difference," Graham said.
Medical students like being together and learning together, Gardner said.
"I think that's been the hardest part of all of this," Gardner said. "They like that interaction with faculty that you can have standing next to them or sitting in a small group. This has been an adjustment, but the learning continues, the attitudes remain very positive, the outlook is good and we're continuing to try to make it as normal as possible."
Paula McClain said that when she looks back 20 years from now, she hopes she remembers how the pandemic brought her class together.
LASTING IMPACT
For the first time, the pomp and circumstance of spring graduation wasn't held at a large-venue arena, but was held virtually for UAMS.
Graduates were pinned by their family members who also helped them don their doctoral hood.
"As I watched some of the virtual commencement events, it was even clearer that despite the challenges, we found a way to make the day meaningful for our graduates," Gardner said. "I saw moms who were able to pin their daughters with the lapel pins given by our College of Nursing for completing the [bachelor's of science in nursing] program. I saw families get to place the hoods signifying completion of a doctoral education on their loved one's shoulders. It was heartwarming."
Some of the changes will continue after the pandemic's gone, Gardner said: more virtual instruction, students will be more involved in telehealth and the experience of creating virtual platforms in a matter of days will prepare them for future public health emergencies.
Graham said the pandemic entitles this generation of medical students to bragging rights.
"I think absolutely they will look back and say, they were the folks that went to medical school in the middle of a pandemic," he said.