Editor's Note: Alicia Asturias recently detailed her experience as a medical student during the COVID-19 pandemic in a first-person piece published on the web's leading physician site, KevinMD.com. Click here to read her piece.

Alicia Asturias walked out of her infectious disease clinical rotation and into the San Diego sunlight, surprised at how empty the streets looked.

At the front of the UC San Diego Owen Clinic outpatient building, a screening booth had popped up. Booth attendants peppered the people in line with questions.

"Do you have a cough?"

"Have you developed a fever recently?"

"Are you sneezing?"

"Is your throat sore?"

Visitors. Patients. Nurses. Even Doctors. Anyone who answered yes was turned away out of precaution.

"There was this very eerie feeling of, 'Whoa, things are changing.'," Asturias said. "At the time, I had no idea."

It was March 17, 2020 – St. Patrick's Day, but just another day of clinical study for the third-year UCSD med student and former California gymnast.

Across the world, the COVID-19 pandemic was spreading rapidly, and her team in the clinic's infectious disease unit was adapting to meet the growing needs of its patients. Just that week, nearly half of the clinic's patients had been transitioned to virtual care. That day, doctors launched their first set of video visits. Asturias observed the new shift in outpatient care as a wallflower, eager to soak in knowledge through the transition. She listened, enthralled as the clinic's leading infectious disease doctor laid out a plan of how the staff and clinic would adapt to help flatten the curve while continuing to deliver care.

"I got to see such a coming together of people whom I so respect," Asturias said. "It was this moment that called for leadership, organization and thoughtfulness, this really cool coming together like I had never seen before. This is why we get into medicine – to see people react to challenges. This is what we train for."

Her sense of awe and humility was short-lived. A text arrived from a classmate, notifying Asturias that all clinical rotations would be suspended immediately.

In a multifaceted decision to help protect its students and patients while conserving medical supplies, including personal protective equipment, the Association of American Medical Colleges and the UC Regents had collectively decided to suspend field study for all med students.

"I got to see it at such a pivotal moment…and then it was like, 'You're cut. You're done. You're out.' Suddenly it was like, 'We see the value in the education but your safety is important and our patients always take precedence.' That's the truth and that's OK," Asturias explained. "That's what I signed up for, too. So it was this really tough balance between learning and sitting out, but ultimately my goal is to take care of patients and the doctors who are taking care of them and right now that means I stay at home."

Relegated to her apartment and the transition to online classes, Asturias, who was an All-American gymnast in college, suddenly felt like a benchwarmer watching from the sideline.

"What was partially my draw to medicine is that you are on this amazing team of doctors, of nurses, of respiratory therapists, of administrative staff, of your own medical student peers - all working together for and with each patient," Asturias said. "The athlete in me, when a crisis hits, immediately thinks, 'How can I help? How can I help my team? What can I do? Put me in, Coach. I'm ready to be on the front lines and help my team.'."

Thinking of the doctors with experience beyond her years and the opportunities she was missing in assisting them, Asturias initially felt sorry for herself and her classmates. But within three days of the rotation shutdown and through dozens of text messages between her classmates-turned-close friends – Alicia Callejo-Black, Daniella Klebaner, Payton Ottum and Simone Phillips – Asturias recognized that she could still find a way to offer to help from home.
 

Together, the group of five friends put together a plan to help ease one of the most time-consuming burdens for doctors in the hospital: charting, specifically the discharge summary. Depending on a patient's length of stay, discharge summaries can take up to several hours to complete, transcribed in a specific format that details every single event, symptom, diagnosis and course of action taken with a patient for the duration of their hospital stay.

"You have to backtrack and figure out what happened so that when you release a patient from the hospital to their primary care doctor, their follow-up care is carried out smoothly," Asturias explained.

The quintet designed a Medical Student Virtual Scribe Program in which UCSD students were assigned to clinical teams virtually to help write discharge summaries. As medical students, they were already afforded access to some electronic medical records to assist doctors in the hospital. The Virtual Scribe program transitioned their work from physically charting in-person in hospital wards to providing support from anywhere in the world, giving doctors more time to actually tend to their patients.

"It was this realization that, 'OK, you're still valuable. And we still are going to need you and there still are things to learn from the bench.'," Asturias said. "I think that's where the athlete experience in me was recognizing my limitations, but always recognizing that there's an opportunity to train."

Not even a week after their rotations were suspended, the group had put together a full proposal and YouTube video guide, which was quickly approved by lead hospital medical staff and deans from the UCSD School of Medicine. From there, the five friends put out a call to third and fourth-year UCSD students on Facebook and quickly garnered more than 50 volunteers for the program.

"Being on a team means knowing your role and having faith that your teammate will know and execute theirs. That's how these past few weeks have felt, as we have stepped up when needed and supported each other in our goals for this program," said Callejo-Black, who herself was a collegiate volleyball player at Lewis & Clark College in Oregon. "We were able to seamlessly establish a successful program within a short amount of time because we knew each other's strengths after three years of friendship, and knew what part or position we each could play."

The group didn't stop there. Interest in the program grew rapidly across the country, spreading via Slack channels and nationwide med school forums, to the point where Asturias has since created a starter pack Google Drive full of proposal information to assist students at other universities in creating a virtual scribe program for their local hospitals. Currently, schools such as Duke, Northwestern, Michigan, OHSU, Minnesota, Wake Forest, Rutgers, Boston University and many more have successfully implemented some version of the Virtual Scribe program since its inception less than three weeks ago.

"Hospitalists were extremely appreciative of the work of the scribes, and impressed with the level of detail and nuance they were able to infer from chart review and include in the discharge summaries," said Dr. Gregory Seymann, hospitalist and chief of Hospital Medicine at the UCSD School of Medicine. "We are all so inspired by this industrious group of students, who certainly were able to make lemonade out of the lemons they were handed.  Most importantly, they were clever enough to find a way to contribute to the COVID response, and at the same time further their medical education. This is the kind of leadership that inspires our confidence in the next generation of physicians, and it's so refreshing to witness."

It may not come as a surprise to hear that even prior to creating the Virtual Scribe program, Asturias and her group of four friends were all nominated and inducted into the Gold Humanism Honor Society earlier this year. The award, which is determined through peer nominations, "recognizes and celebrates the integrity, compassion, altruism, respect, empathy and service that must be combined with clinical excellence to provide optimal patient care."

"The thing about Alicia is that when she has an idea to get something done, she won't rest until she sees it through," Callejo-Black added. "Her passion galvanizes us into action, because it's clear that her drive comes from a deep love for others and for doing the right thing, wherever she can."

For Asturias, the global coronavirus pandemic and the subsequent response and events of recent weeks are a reminder that whether we're in the starting lineup or assisting from the bench, we're all fighting on the same team.

"I think with every challenge, there's opportunities to grow – grow as a society, grow together – and it's been really heartwarming to see that the social connection is so strong, even amidst the social distancing, and I really do hope in my heart that we all come together better out of this," Asturias said. "In the collective spirit of being a medical student and being in the medical field, I think the world needs to see the light that comes out of this and that people are working really hard on the front lines, but I think that we also need to give credit to the whole community that's behind them, rooting for them."