Back when I enrolled at Boston College in pursuit of a lucrative bachelor’s degree in Islamic studies, my motley group of friends included a number of students on the pre-medical track.

This dynamic seems to be repeating itself in Morocco, where I have lived on and off since late 2019. About half of my Moroccan friends attend the Faculty of Medicine and Pharmacy of Rabat (FMPR). Over the course of these friendships, I have seen how COVID-19 impacts not only public health in Morocco but also the kingdom’s medical education.

I first befriended a Moroccan medical student during Ramadan last year when I met Meryem Makhon. Her aunt—my landlord at the time—had invited me to the family’s house in the Rabat suburb of Harhoura to break the Ramadan fast.

In addition to introducing me to Morocco’s vegan subculture, Meryem told me that she was studying medicine at FMPR. The many demands of medical school kept her busy, but we always found time to hang out and talk. A fifth-year medical student at the time of our first meeting, Meryem soon became my closest friend in Morocco. She, in turn, introduced me to her friends, including the 25-year-old medical student Amina Bellouch, who started her seventh year at FMPR this month, and her 24-year-old classmate Mehdi Salhi, who is already undertaking his seventh year at the school.

The more time I spent with Amina, Mehdi, and Meryem over the following months, the more I wondered how the ongoing pandemic was affecting Morocco’s next generation of doctors. I sat down with Amina at the cafe attached to the Mohammed VI Museum of Modern and Contemporary Art in Rabat to learn more about how medical education works in the kingdom.

Moroccan medical students begin their studies right after high school.

Amina informed me that Moroccan medical students begin their studies right after high school. These future doctors spend most of their time in the classroom their first two years before doing a mix of rigorous coursework and clinical clerkships at hospitals from the third year to the fifth.

The composition of the final years of medical education depends on the students’ paths. After the first five years, students can take the competitive so-called “Internat” (internship) test that, if they pass, enables them to intern at university hospitals for two years, then skip the challenging residency exam that other students have to take to specialize in a particular field of medicine in Morocco. Students who fail or decline to take the “Internat” test do two years of less intensive internships at hospitals, and, thereafter, must take the residency exam if they want to specialize.

Amina and Meryem are following the latter track. Mehdi, on the other hand, is participating in the “Internat” program and interning at a university hospital for dozens of hours a week. This position placed him on the front lines of the pandemic during the several COVID waves that have struck Morocco over the last two years. I decided to speak with him so that I could better understand how the pandemic is changing every aspect of medical students’ lives.

Mehdi, who is furthest along in his medical education, recounted how the pandemic reshaped his time in the classroom and at the hospital.

“The effect of COVID on my studies was very intense in the early days, namely the lockdown,” Mehdi said of Morocco’s initial COVID restrictions, which began in March 2020. “At that time, I was still in my fifth year of medical school and I still had exams, so my studies consisted of theoretical classes as well as my internship in the hospital, for practice.”

According to Mehdi, the pandemic provided some benefits in the short term. Classes shifted online, offering a more flexible schedule to medical students who had little time to spare.

Classes shifted online, offering a more flexible schedule to medical students who had little time to spare.

“In terms of my theoretical classes, I liked the effect of COVID because we could study over Zoom,” he told me. “This way was appropriate for me since I could study when I wanted. Because the lessons were recorded, I could just pause and search for something I didn’t understand.”

Many Moroccans share my friend’s sentiments. A summer 2020 survey of 111 students at the Faculty of Medicine and Pharmacy of Marrakech (FMPM) found that “68.5 percent of the students would recommend continuing distance learning after the pandemic.”

The study’s authors concluded, “Despite the emergency to start distance learning imposed by the COVID-19 health crisis, it appears that students were generally satisfied.” The authors urged FMPM to “institutionalize online education” and “promote hybrid online and face-to-face teaching.”

Outside the classroom, the impact of the pandemic on medical education in Morocco has proved far more damaging. Mehdi noted that “internships stopped during the time of the lockdown, and, when they restarted, only a limited number of students could return to the hospitals at a given time.” He lamented that he and his classmates “only spent a short time in the hospital,” their most important venue for hands-on experience and engagement with practicing doctors.

Mounia Bouattane, a 24-year-old medical student and the cousin of one of my and Meryem’s friends, had a similar story to tell. Mounia is now completing her seventh year at the Faculty of Medicine and Pharmacy of Casablanca. She recalled that her internship at Ibn Rochd University Hospital in Casablanca stopped altogether from March to July 2020. Even when “things had somewhat returned to normal” by December 2020, she and her colleagues were only doing rotations for seven weeks at a time instead of the usual nine.

“Internships are the best way to learn to be a good doctor.”

“What was hard for students was making the most of their time at the hospital because they learn more during their internships by seeing patients and discussing cases with doctors,” Mounia told me over WhatsApp. “Theoretical studies aren’t everything. Even if the resources on the Internet were better during the pandemic—like courses, videos, and free access to educational platforms—internships are the best way to learn to be a good doctor.”

COVID’s calamitous effect on medical education extends beyond future doctors.

Roaa Layach, a 20-year-old nursing student in Tétouan, recounted over Instagram how the pandemic hindered her classmates: “Because of COVID, we were studying online but didn’t understand many things that we needed to practice. When we began our internships in the hospitals, we didn’t practice a lot of services since COVID prevented large groups of interns from gathering. Therefore, the period of the internship was lessened, which will affect our development.”

Even Moroccans who intended to pursue their medical education overseas must wrestle with the consequences of the pandemic. Zineb Benmman, a 22-year-old studying pharmacy at Zhejiang University in China, has found herself trapped in Morocco because of COVID-induced travel bans. She has been taking classes online, which she described as “the worst thing for medical students because medical studies depend on practice more than on theory.”

Zineb outlined the potential havoc that the pandemic can wreak on the next generation of Moroccan doctors, nurses, and pharmacists, who are finding fewer chances to practice their craft before they finish their studies: “Ultimately, studying during a pandemic will make medical students less prepared while we need doctors more than ever since we are in a health crisis. Therefore, doctors must also be more prepared than ever before, but online classes and the reduction of hours of practice are going to yield the opposite result.”

COVID-19 may exacerbate issues already affecting medical education in Morocco.

In addition to creating problems, COVID-19 may exacerbate issues already affecting medical education in Morocco. A 2020 article in the academic journal The Medical Teacher by three doctors from Oujda and one from Fes cited “out-of-date teaching methods,” “the lack of adequate training for medical teachers,” “the lack of a sufficient number of teachers,” “insufficient training for research leaders,” and “an alarming situation regarding [the] mental health of medical students” as long-standing issues within the kingdom’s medical schools.

The same three doctors from the Faculty of Medicine and Pharmacy of Oujda offered another critical assessment in a 2021 article in The African Journal of Primary Health Care and Family Medicine: “The current medical school curriculum is not fully in harmony with the real health needs of the population.”

The authors of the article added that “health issues dealt with in primary care are rarely encountered, or almost never seen,” during medical students’ rotations. The doctors called for “the introduction of quality teaching in the sixth and seventh years of medical studies.”

Compounding difficulties with the quality of medical education in Morocco, medical students have often taken issue with their working conditions. In 2015, medical students demonstrated against an initiative that would have allowed the kingdom’s education and health ministries to determine where they worked for two years following graduation. Four years later, medical students boycotted their exams in protest of the increasing privatization of medical education in Morocco.

Because COVID has added to the burden on Moroccan medical students over the last two years, these preexisting issues will continue to simmer in the background. In the meantime, however, medical students have tried to take advantage of the pandemic’s academic bright spots.

Mohammed Ouasmine, a 22-year-old, fourth-year FMPR student, described COVID-era classwork as “more flexible,” adding over WhatsApp: “The courses are now registered in a drive where we can watch them at all times. This gives us the time to do other activities.”

“The courses are now registered in a drive where we can watch them at all times.”

Some medical students view the pandemic as an opportunity for professional development as well as self-betterment.

“This pandemic has shown that we could do a lot more than focus on just our career,” Malak Ouadrhiri, a 19-year-old, third-year FMPR student, said over WhatsApp. “We enlarged our horizon of possibilities, and some of us have taken up arts while others have started side businesses. It helped them on the professional side as well as on the educational side.”

Malak and Mohammed hardly seem alone in finding the silver lining of the pandemic. The authors of the article in The Medical Teacher argued that Morocco’s COVID-inspired switch to distance education for medical students “could be a good start towards a generalization of the distant academic learning in order to make a better use of the precious professors’ time in active learning facilitation.” This conclusion echoes the recommendations drawn from the 2020 survey of FMPM students, who likewise benefited from the greater availability of online classes.

In the more immediate term, the COVID era has included a handful of positive moments for Morocco. Last year, Moroccan officials opened a new medical school in the city of Laayoune, assisted by funding from Saudi Arabia. The same year, the medical student Saad Uakkas became the first Moroccan national to receive the Diana Award, founded after the late Diana, Princess of Whales, which recognizes “outstanding young people selflessly creating and sustaining positive social change” according to its website.

Mehdi, the seventh-year FMPR student, highlighted the pros and cons of the pandemic for the development of Morocco’s next generation of doctors: “The pandemic can make you a better doctor in the sense that it’s good to experience. You always benefit on some level from experiences. In this case, it teaches you how to deal with a large number of patients. That said, you also waste a lot of time and energy on the same illness, namely COVID, and don’t see other illnesses.”

Since 2020, COVID has upended how medical students train for their jobs in the classroom and in the field. Given that the pandemic seems set to last well into the future, the issues affecting Morocco’s medical education—whether old and systemic or new and derived from COVID—will likely take years to address. At the same time, the pandemic has drawn attention to the ways in which doctors in the kingdom and across the world support healthcare and our society as a whole.

Whatever obstacles COVID creates for Morocco’s medical students, they seem eager to adapt.

“This pandemic has given us more access to courses, more health awareness, more life skills, and more friends,” said Malak, the third-year FMPR student. “Maybe it was hard on us when it first started, especially since doctors are a big part of this community and a big influence on it, but we have learned a whole lot from it.”