(Potential) National Embargo on Away Rotations

[hellanutella]

VSAS is officially suspended for the next two weeks.

Here's the email for anyone interested:

We recognize that the visiting student process has been greatly impacted by COVID-19 and as a student, you are concerned about the timing and impact on away rotations you may be considering. Away rotations, particularly in the coming months normally play a role in the residency application process. We are also aware that travel restrictions and variations in rotation availability may create inequity among students as you seek elective experiences in a compressed timeline.

The AAMC wants to assure students are given equal consideration in an academic and clinical training cycle that may be different in the months ahead. Therefore, after broad consultation with the academic medicine community, we will suspend access to the Visiting Student Application Service (VSAS) from Wednesday, April 15th until Wednesday, April 29th. During this time, students, Home and Host institutions will not have access to the system.

This two-week suspension will allow the many stakeholders within the medical education community – medical students certainly among them – to have important discussions about the complexities of providing away rotations considering COVID-19's impact on education, patient care, learner safety and travel.

Obviously not going to constrain all the non-VSAS programs, but it looks like a "slow your roll" measure for the programs soliciting apps.

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Members don't see this ad.

 

[AnatomyGrey12]

Not going to lie, I think the decision has already been made. This email reads more like a "warning shot" to soften the blow when it ultimately does come down. I have a hard time seeing how non-VSAS programs will not follow suit eventually. It would be a bad look not to.

 

[Doggeronie]

IMO aways will be cancelled for the year.

F to pay respex

 

[LutGholein]

VSAS is officially suspended for the next two weeks.

gg. This decision has already presumably been discussed and made.

 

[Scrubs101]

Ive given a lot of F’s in the chat in my career ladies and gentlemen. Many sarcastic, and many from the bottom of my heart. But never once in my life did I ever think I’d have to drop an F in the chat for such a historic and unprecedented issue.

With all that I have left to give, I just want to leave a heartfelt and sincere message to all my fellow colleagues. Whether you be reddit or sdn fans, zanki or brosencephalon, dorian or docs, MD or DO. We must band together, to pay respects to those who have fallen, those who have lost their jobs, family, friends, and those who fear of an uncertain future.

what we have in store i do not know, how many IVs youll need to match i do not know, your chances of matching IM at harvard with a 290 and 57 pubs i do not know..... but what i do know is id like to say one thing

F.

 

[Iz_FtB]

ABCDEFGHIJKLMNOPQRSTUVWXYZ

 

[libertyyne]

f.

 

[Neopolymath]

Welp

 

[efle]

Update: VSAS frozen for the rest of April to give time for "the many stakeholders within the medical education community – medical students certainly among them – to have important discussions about the complexities of providing away rotations considering COVID-19's impact on education, patient care, learner safety and travel."

Not lookin good boys

Edit: See y'all beat me to it!

 

[order66.exe]

This needs a re-quote

 

[Prehealth1011]

step 1 : Delete personal statement for speciality you were moderately competitive for but still reaching
step 2 : Open new word doc. "I have always been passionate about IM..."

 

[libertyyne]

step 1 : Delete personal statement for speciality you were moderately competitive for but still reaching
step 2 : Open new word doc. "I have always been passionate about IM..."

Step 3, become paralyzed with confusion and apathy and do neither.

 

[boolin_1]

i'm getting to the point of apathy here. I worked so hard last fall/winter for making a timeline and what I needed to do and when. Now it's all gone to hell. It's hard to study for step2 not knowing when I can even take it or where i'll be in 3 months.

whatever

back to COD warzone

 

[Spectreman]

F this...

Seriously though I already had my whole audition season booked.

 

[deleted393595]

 

[Espressso]

If aways get canelled for the entire year my school is f*cked. We have no legit rotation availabilities for our fourth year students in the state. Fourth years always go back home out of state except for the few in-state students. The majority of our students complete their entire fourth year as aways. That was my plan. I'm not sure what is going to happen but now I'm freaking out a little.

 

[Espressso]

I guess I'm just confused because from a national stand point, it's pretty clear we're reaching an inflection point in cases and deaths. Obviously some areas like TX and FL are lagging behind and will hit it soon after, but come August, Sept, so on, we should be in a better spot as a health system. That's not to say there isn't a good chance for a second big wave in the fall. I just think cancelling all away rotations for the entire academic year is a bit of a stretch. But I can't tell if that's me being salty or being objective.

 

[Spectreman]

I guess I'm just confused because from a national stand point, it's pretty clear we're reaching an inflection point in cases and deaths. Obviously some areas like TX and FL are lagging behind and will hit it soon after, but come August, Sept, so on, we should be in a better spot as a health system. That's not to say there isn't a good chance for a second big wave in the fall. I just think cancelling all away rotations for the entire academic year is a bit of a stretch. But I can't tell if that's me being salty or being objective.

I think the biggest thing is how each school is handling making up the missed core rotations. If you missed your core IM rotation should you be allowed to go audition somewhere that specifically says “must have completed core rotation and passed IM shelf” and what if only some schools figured out a proper workaround for it? The process of getting back to the regular schedule is going to be tricky.

 

[Espressso]

I think the biggest thing is how each school is handling making up the missed core rotations. If you missed your core IM rotation should you be allowed to go audition somewhere that specifically says “must have completed core rotation and passed IM shelf” and what if only some schools figured out a proper workaround for it? The process of getting back to the regular schedule is going to be tricky.

I agree with that and see your point, although since away rotations are such a major part of a fourth years schedule and year in general, I would argue that the topic of missed third year core rotations should be eased and they should make exceptions to those requirements.

Looking at it now, the missed third year rotations for us occurred during the quick and steep rise in the epidemic here in the US, while away rotations and visiting rotations for our fourth year will be occurring during the downslope of the epidemic, so I would think it makes sense to be more lenient on the part that occurred during the chaotic phase. If that makes sense.

In my opinion, it should be a hospital/school-specific decision. Like, if a hospital in NC says we still want to have visiting audition rotations, they should allow it. And in terms of "fairness", I think that's so ridiculous. Since when does the AAMC or VSAS or any med ed governing body care about fairness.

 

[Mass Effect]

I guess I'm just confused because from a national stand point, it's pretty clear we're reaching an inflection point in cases and deaths. Obviously some areas like TX and FL are lagging behind and will hit it soon after, but come August, Sept, so on, we should be in a better spot as a health system. That's not to say there isn't a good chance for a second big wave in the fall. I just think cancelling all away rotations for the entire academic year is a bit of a stretch. But I can't tell if that's me being salty or being objective.

I don't think you're seeing it objectively. No one knows what's going to happen in August and September. Realistically, regardless of what the politicians say, I have yet to see any evidence that outside a vaccine, things will be better this summer. There may be a few less cases by sheer luck because of the sunshine and warm weather, but there is no reason to think that as soon as the country opens back up, we won't be right back where we started particularly as there's debate whether or not people already infected are immune.

 

[libertyyne]

I don't think you're seeing it objectively. No one knows what's going to happen in August and September. Realistically, regardless of what the politicians say, I have yet to see any evidence that outside a vaccine, things will be better this summer. There may be a few less cases by sheer luck because of the sunshine and warm weather, but there is no reason to think that as soon as the country opens back up, we won't be right back where we started particularly as there's debate whether or not people already infected are immune.

I mean the flip side of that is there is no real true penetrance data available either. We could already have widespread asymptomatic infection where it would not be necessary to remain closed.

 

[Mass Effect]

I mean the flip side of that is there is no real true penetrance data available either. We could already have widespread asymptomatic infection where it would not be necessary to remain closed.

We do have data about that in the form of new daily infections. Some states are just now catching up. I think when the new daily numbers dwindle, the economy will open up little by little, but will shut down again, just like some places in China and Italy, particularly as we half-assed our shutdown. If this thing had been handled from the start with a national shut-down, this may not have been the case, but when you have states still open, hosting mass gatherings, and going about daily life without a care in the world due to conspiracy theorists believing this is all made up, it's hard to make the case that the virus will somehow be extinguished on its own. Unless states shut down their boarders, if KS has a problem, so do the rest of us.

 

[libertyyne]

We do have data about that in the form of new daily infections. Some states are just now catching up. I think when the new daily numbers dwindle, the economy will open up little by little, but will shut down again, just like some places in China and Italy, particularly as we half-assed our shutdown. If this thing had been handled from the start with a national shut-down, this may not have been the case, but when you have states still open, hosting mass gatherings, and going about daily life without a care in the world due to conspiracy theorists believing this is all made up, it's hard to make the case that the virus will somehow be extinguished on its own. Unless states shut down their boarders, if KS has a problem, so do the rest of us.

not really, we dont have IGG data to see if people had already been infected and recovered. New infection data only speaks to active infections. Not asymptomatic infections that may have already resolved. So it is completely possible that we are nearing the point where we have heard immunity. But we dont have that information.
I agree that we half assessed shutdown.

 

[Mass Effect]

not really, we dont have IGG data to see if people had already been infected and recovered. New infection data only speaks to active infections. Not asymptomatic infections that may have already resolved. So it is completely possible that we are nearing the point where we have heard immunity. But we dont have that information.
I agree that we half assessed shutdown.

New infection data speaks to new active infections. If you're still having high numbers of new active infections, I don't think you necessarily need data to realize that opening your economy will lead to higher numbers of new active infections (though data would likely prove it), regardless of the asymptomatic population. Another thing that was handled poorly was testing, which would answer this question.

 

[libertyyne]

New infection data speaks to new active infections. If you're still having high numbers of new active infections, I don't think you necessarily need data to realize that opening your economy will lead to higher numbers of new active infections (though data would likely prove it), regardless of the asymptomatic population. Another thing that was handled poorly was testing, which would answer this question.

you are still missing the point.
Not necessarily ,new infection data just means increased number of testing and testing more asymptomatic patients.
I agree that everything about the handling of this was suboptimal.

We dont know enough because we dont know what the true incidence and prevelance of the covid is, what the actual cfr, how far away are we from heard immunity. All of these questions are pertinent to reopening.

 

[Mass Effect]

you are still missing the point.
Not necessarily ,new infection data just means increased number of testing and testing more asymptomatic patients.
I agree that everything about the handling of this was suboptimal.

We dont know enough because we dont know what the true incidence and prevelance of the covid is, what the actual cfr, how far away are we from heard immunity. All of these questions are pertinent to reopening.

I'm not missing your point. I'm just disagreeing with it.

None of those questions will be answered before we reopen.

 

[libertyyne]

I'm not missing your point. I'm just disagreeing with it.

None of those questions will be answered before we reopen.

I dont know how you can disagree with it without any evidence. And its just straight up false that IGG population studies cant occur before we reopen considering they have already started to do that at this time.

 

[VA Hopeful Dr]

I dont know how you can disagree with it without any evidence. And its just straight up false that IGG population studies cant occur before we reopen considering they have already started to do that at this time.

You're not new to SDN, this shouldn't be a new concept to you

 

[Mass Effect]

I dont know how you can disagree with it without any evidence. And its just straight up false that IGG population studies cant occur before we reopen considering they have already started to do that at this time.

I'm not disagreeing with the facts you stated (that we don't have IGG data yet, etc). I'm disagreeing that we will have this prior to re-opening. Specifically, this is what I'm disagreeing with based only on my opinion "So it is completely possible that we are nearing the point where we have heard immunity." Yes, I guess it's possible, but I don't think we're nearing the point of herd immunity (nationwide) going by the numbers of active infections in each state. I just think some states haven't caught up. In states that have already peaked, we might, but in states that barely have any cases based on existing testing and hospital admissions, I think we have a ways to go. That's just my opinion because we don't have evidence either way yet.

I also didn't disagree that we don't have IGG studies beginning. I just said we won't have the data before re-opening. Some states never even closed. Others will likely reopen (unfortunately) before that data exists, unless somehow we can remove the politics from the science.

 

[FindersFee5]

not really, we dont have IGG data to see if people had already been infected and recovered. New infection data only speaks to active infections. Not asymptomatic infections that may have already resolved. So it is completely possible that we are nearing the point where we have heard immunity. But we dont have that information.
I agree that we half assessed shutdown.

This seems VERY optimistic. South Korea has probably done the best, most widespread testing of asymptomatic patients and contact tracing and their numbers are not that reassuring: 10591 infections/534552 tests (2% infection rate). Even if you're saying that 5 times that many people were actually infected, that's 50 thousand cases. For a country like SK to gain herd immunity would require at least 20 MILLION people to have it and recover.

But that's South Korea. They've done a great job stemming this, so obviously they're going to have less cases than us. They've held it to 4 deaths/million. We're 20 times higher than in death rate, so we clearly have more infections. Let's extrapolate that to mean 20 times the infection rate here, which would give us about 12 million cases.

How many cases will the US need to get herd immunity? VERY CONSERVATIVELY, at 40% recovered to gain immunity, we need 131 million cases, or more than 10 times the current amount. That's not going to happen in the next 3 months.

 

[ace_inhibitor111]

This seems VERY optimistic. South Korea has probably done the best, most widespread testing of asymptomatic patients and contact tracing and their numbers are not that reassuring: 10591 infections/534552 tests (2% infection rate). Even if you're saying that 5 times that many people were actually infected, that's 50 thousand cases. For a country like SK to gain herd immunity would require at least 20 MILLION people to have it and recover.

But that's South Korea. They've done a great job stemming this, so obviously they're going to have less cases than us. They've held it to 4 deaths/million. We're 20 times higher than in death rate, so we clearly have more infections. Let's extrapolate that to mean 20 times the infection rate here, which would give us about 12 million cases.

How many cases will the US need to get herd immunity? VERY CONSERVATIVELY, at 40% recovered to gain immunity, we need 131 million cases, or more than 10 times the current amount. That's not going to happen in the next 3 months.

We don’t need herd immunity though. The virus has no known reservoir in the US and clears after 15 days in almost 100% of people. With strict self-quarantine for 15 days the prevalence of the virus should decrease to almost zero. Of course, the quarantine in the US is anything but strict, so maybe triple that time. 45 days and the virus will be almost completely removed from the population. We just have to make sure we don’t import Pangolins or new travelers from areas with rampaging infection.

 

[libertyyne]

This seems VERY optimistic. South Korea has probably done the best, most widespread testing of asymptomatic patients and contact tracing and their numbers are not that reassuring: 10591 infections/534552 tests (2% infection rate). Even if you're saying that 5 times that many people were actually infected, that's 50 thousand cases. For a country like SK to gain herd immunity would require at least 20 MILLION people to have it and recover.

But that's South Korea. They've done a great job stemming this, so obviously they're going to have less cases than us. They've held it to 4 deaths/million. We're 20 times higher than in death rate, so we clearly have more infections. Let's extrapolate that to mean 20 times the infection rate here, which would give us about 12 million cases.

How many cases will the US need to get herd immunity? VERY CONSERVATIVELY, at 40% recovered to gain immunity, we need 131 million cases, or more than 10 times the current amount. That's not going to happen in the next 3 months.

I agree that its optimisitic, but it is within the realm of possibility. the problem with referring to the south korean data is that it is still reliant on active infection and PCR results. So you could have someone who has already recovered and is not currently shedding the virus test negative on PCR.
Seropositivity is realistically the only thing that can give us information about true infections in the population.
If you want your mind really blown search pubmed for population studies in africa with seropositivity for Ebola.

We don’t need herd immunity though. The virus has no known reservoir in the US and clears after 15 days in almost 100% of people. With strict self-quarantine for 15 days the prevalence of the virus would decrease to almost 0. Of course, the quarantine in the US is anything but strict, so maybe triple that time. 45 days and the virus will be almost completely removed from the population. We just have to make sure we don’t import Pangolins like China or new travelers from areas with rampaging infection.

I agree theoretically, but it is going to be impossible to not have reintroduction of the virus without stopping all travel abroad. Especially considering asymptomatic shedding is possible.

Another thing that could happen is reopen and then do aggressive contact tracing and mandatory quarentine once the number of new infections is under control. I dont think the federal government or state governments have the resources to perform that level of control. There is this article in JAMA proposing exactly that level of contact tracing and public health controls but making medical students do it to augment resources on state and local level.
Edit :
A Bold Response to the COVID-19 PandemicMedical Students, National Service, and Public Health

doi:10.1001/jama.2020.6166

 

[Mass Effect]

We don’t need herd immunity though. The virus has no known reservoir in the US and clears after 15 days in almost 100% of people. With strict self-quarantine for 15 days the prevalence of the virus should decrease to almost zero. Of course, the quarantine in the US is anything but strict, so maybe triple that time. 45 days and the virus will be almost completely removed from the population. We just have to make sure we don’t import Pangolins or new travelers from areas with rampaging infection.

It actually clears between 2 - 6 weeks in people. Only the milder cases clear within 15 days.

I agree that with strict self-quarantine we would have been in a much better place, though I doubt that only 15 days would have done it, looking at Italy which had strict self-quarantine and national shutdown. I also disagree that only 45 days of half-assed quarantine will be sufficient. It's already been a month. You really think that by May 1st, the virus will be "almost completely removed from the population"?

When they write the book on this chapter in history, the half-assed shutdowns will likely be the most scruitinzed and most blamed for the infection/death rate.

 

[boolin_1]

I have a feeling that step2 is going to be huge this cycle.

 

[libertyyne]

I have a feeling that step2 is going to be huge this cycle.

Why ?

 

[efle]

I have a feeling that step2 is going to be huge this cycle.

...why? If anything they're going to have to relax requirements for Step 2 CS and CK, not increase emphasis on them

 

[efle]

My prediction:

We pass the inflection and start coming down the other side of the curve.

Fed and stupid state governments then reopen everything a little to soon.

COVID explodes again as soon as all the restaurants, bars, workplaces, schools, concerts etc start up again.

Additional hotspot shutdowns start occurring to deal with the above.

 

[Scrubs101]

I have a feeling that step2 is going to be huge this cycle.

I have a feeling step 2 isnt going to happen for most this cycle

 

[Scrubs101]

My prediction:

We pass the inflection and start coming down the other side of the curve.

Fed and stupid state governments then reopen everything a little to soon.

COVID explodes again as soon as all the restaurants, bars, workplaces, schools, concerts etc start up again.

Additional hotspot shutdowns start occurring to deal with the above.

Agree with the bolded. Saw a video of a semilarge in person protest in ohio (not a single person i saw in the video was wearing a mask) to reopen the state....

 

[FindersFee5]

My prediction:

We pass the inflection and start coming down the other side of the curve.

Fed and stupid state governments then reopen everything a little to soon.

COVID explodes again as soon as all the restaurants, bars, workplaces, schools, concerts etc start up again.

Additional hotspot shutdowns start occurring to deal with the above.

Yeah I think we're going to have like 3 month cycles for the next year or so. Month 1: opening, few cases but spreading. Month 2: spreading, people get worried again, piecemeal shutdowns. Month 3: Complete shutdown with drastic decreases in rates.

 

[libertyyne]

My prediction:

We pass the inflection and start coming down the other side of the curve.

Fed and stupid state governments then reopen everything a little to soon.

COVID explodes again as soon as all the restaurants, bars, workplaces, schools, concerts etc start up again.

Additional hotspot shutdowns start occurring to deal with the above.

I think large gatherings , sports, school, concerts etc will be closed for the remaining year.

Small gatherings will probably be restricted to 20-50 people , but this will mostly be state government specific. Restaurants and bars will open again.

We will have large scale outbreaks and different states will have different capabilities in contact tracing vs stay at home orders again so the responses will be dependent on those capabilities.

Nursing homes will remain on lock down.

Some states have thrown around the idea of seropositivity to go back to work. But im not sure how feasible that is going to be.

This will continue to happen until a large portion of the population is seropositive or we get a vaccine. 12-18 months.

 

[efle]

I think large gatherings , sports, school, concerts etc will be closed for the remaining year.

Should. They should stay closed. But the orange guy is 100% going to be reopening arenas so he can have rallies all throughout election season. Churches will certainly be packed full again. I'd be shocked if he even kept people working from home past May, he'd rather "let it wash over" the country than suffer the economic damage under his watch.

 

[Mass Effect]

Agree with the bolded. Saw a video of a semilarge in person protest in ohio (not a single person i saw in the video was wearing a mask) to reopen the state....

That's exactly the problem. These idiots are not going to wait for the science. Politicians are going to play politics and more people will die before these same people realize WTF is happening.

 

[Mass Effect]

Yeah I think we're going to have like 3 month cycles for the next year or so. Month 1: opening, few cases but spreading. Month 2: spreading, people get worried again, piecemeal shutdowns. Month 3: Complete shutdown with drastic decreases in rates.

I don't see Month 3 happening with the current political climate. Keep in mind many people, including some currently running for office, still think this is a hoax. I think short of seeing people close to them getting very, very sick, these people will continue to cling to that belief. Even national leaders who acknowledge the problem want to start opening sports stadiums ASAP. If that isn't denial, I don't know what is.

 

[efle]

I don't see Month 3 happening with the current political climate. Keep in mind many people, including some currently running for office, still think this is a hoax. I think short of seeing people close to them getting very, very sick, these people will continue to cling to that belief. Even national leaders who acknowledge the problem want to start opening sports stadiums ASAP. If that isn't denial, I don't know what is.

Or them getting sick themselves. All the prominent names this election on both sides are in the danger zone age groups. They're all definitely getting COVID at some point and it'll be a miracle if no household name politicians retire or die because of it.

 

[You shall know the Truth]

So is VSAS giving my money back?

 

[sunshinefl]

This seems VERY optimistic. South Korea has probably done the best, most widespread testing of asymptomatic patients and contact tracing and their numbers are not that reassuring: 10591 infections/534552 tests (2% infection rate). Even if you're saying that 5 times that many people were actually infected, that's 50 thousand cases. For a country like SK to gain herd immunity would require at least 20 MILLION people to have it and recover.

But that's South Korea. They've done a great job stemming this, so obviously they're going to have less cases than us. They've held it to 4 deaths/million. We're 20 times higher than in death rate, so we clearly have more infections. Let's extrapolate that to mean 20 times the infection rate here, which would give us about 12 million cases.

How many cases will the US need to get herd immunity? VERY CONSERVATIVELY, at 40% recovered to gain immunity, we need 131 million cases, or more than 10 times the current amount. That's not going to happen in the next 3 months.

Yes, we are more likely to have/get herd immunity simply because the shutdowns have been so piecemeal, late, half-effort, etc.

Should. They should stay closed. But the orange guy is 100% going to be reopening arenas so he can have rallies all throughout election season. Churches will certainly be packed full again. I'd be shocked if he even kept people working from home past May, he'd rather "let it wash over" the country than suffer the economic damage under his watch.

There is a lot of suffering related to the shutdowns, beyond the stock market. This isn’t just a matter of “lives saved from COVID19 vs orange man stock market”.

 

[efle]

There is a lot of suffering related to the shutdowns, beyond the stock market. This isn’t just a matter of “lives saved from COVID19 vs orange man stock market”.

Elaborate? Besides the economic damage what other big motives could force us to end quarantine too soon?

 

[fldoctorgirl]

There is a lot of suffering related to the shutdowns, beyond the stock market. This isn’t just a matter of “lives saved from COVID19 vs orange man stock market”.

This is an important point. I feel like it's easy for a lot of us to say we should keep the world shut down when we're sitting at home and not really affected. I mean, yes it sucks if there are no audition rotations or interviews, but none of you are losing your income. So many restaurants in my neighborhood have announced that they are suddenly closing, without warning. Same with other small businesses. This is not sustainable for months on end, even if it means we end up with a higher # dead. Things aren't so black and white. People can't survive without their jobs.

 

[efle]

This is an important point. I feel like it's easy for a lot of us to say we should keep the world shut down when we're sitting at home and not really affected. I mean, yes it sucks if there are no audition rotations or interviews, but none of you are losing your income. So many restaurants in my neighborhood have announced that they are suddenly closing, without warning. Same with other small businesses. This is not sustainable for months on end, even if it means we end up with a higher # dead. Things aren't so black and white. People can't survive without their jobs.

Other wealthy western countries seem to be on top of supporting their population much better than ours. Let's not blame COVID as if this kind of economic damage on an individual basis is inevitable.