What will I learn in medical school?

Many medical schools organize their training into two parts: pre-clinical and clinical. In a traditional four-year curriculum, the pre-clinical phase includes two years of science training when you learn about basic medical concepts, the structure and functions of the body, diseases, diagnoses, and treatment concepts. Youll also learn the basics of doctoring, such as taking medical histories and other essential competencies. The clinical portion of the training, traditionally the last two years of medical school, involves clinical rotations, during which time you will receive basic instruction and hands-on experience with patients in the major medical specialties. The curriculum varies for each medical school, and some medical schools have a more integrated, multidisciplinary program and begin clinical training and patient interaction during the first week. You can review each medical schools About the Curriculum section in the Medical School Admission Requirements.

How students are graded varies from school to school. Some medical schools use a pass/fail system or an honors/pass/fail system, and others use a letter-grading system. There are even some that use a combination of a pass/fail system for the first year or two then switch to another system for the final two years. There are a small number of schools using a competency-based evaluation system that measures student progression in learning a certain set of competencies throughout the course of medical school. To see individual medical school policies on grading, see the Education section of theMedical School Admission Requirements. Regardless of which approach your school uses, its important to keep grades in perspective. Grades do matter in certain instances, but they are only one criteria by which you are evaluated during medical school.

Traditionally, medical students havent had many experiences with patients until their third year, but this is changing. Some schools introduce patient interactions early on (some in the first week!) or may have incoming students receive EMS or EMT certification before the beginning of classes.

Typically, you do clinical rotations, also called clerkships, during the third and fourth year of medical school. Rotations give you firsthand experience working with patients in various specialties under direct supervision of a faculty member, fellow, or resident. The types, number, and length of rotations vary from school to school, but training usually includes clerkships in internal medicine, family medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery. Your school may have different requirements. However, in your final year of medical school, you will be given the opportunity to take electives in different specialties and at different institutions according to your interests. TheMedical School Admission Requirementswebsite features information in the Education section about when students begin patient interaction and how clinical rotations work at each medical school.

Exploring your future career as a physician begins early in med school, with an ongoing examination of your interests and goals in the practice of medicine along with an exploration of the many specialty options available. Your third-year rotations will give you an opportunity to experience a number of specialties and determine how your interests, values, and skills fit with those specialties. There are also extracurricular opportunities for exploring specialties, such as specialty interest groups and student sections of medical specialty societies.

By the end of the third year, most students have chosen a specialty area (e.g. primary care, surgical care) or patient population (i.e., adults, children, or both) and begin preparing to apply for residency training to support that career direction. If youre not confident in a career direction, you may choose to take time to complete research, complete a dual degree (e.g., MD-MPH), gain further clinical experience, or otherwise spend time exploring your career options prior to choosing your specialty and applying for residency.

Choosing your specialty and applying for residency are not solitary activities. Work actively with career advisors at your medical school and find mentors to help guide you. Also, once you're in medical school, youll likely have access to AAMCsCareers in Medicinewebsite for more information and a detailed timeline (sign-in required).

Youll start the licensure process during the second year of medical school with the United States Medical Licensing Examination (USMLE) Step 1 exam. Step 1 covers the sciences fundamental to the practice of medicine. The Step 2 exam, which measures clinical knowledge and skills, is usually completed during the third or fourth year of medical school. The final exam for initial licensure, Step 3, occurs during the first or second year of residency training, after you have completed medical school and received your medical degree.

All medical schools share the goal of preparing their students for residency training and practicing medicine, and are required to adhere to national accreditation standards. However, each school has its own specific mission, curriculum, course format, and academic schedule. Before you apply to a school, research that schools mission statement to see how it aligns with your own goals. Also review the graduation requirements, such as community service, research experience, and specific coursework. You can find this information on each schools website or on theMedical School Admission Requirementswebsite.

Its okay to admit you need help managing the stress that comes with being a med student. In fact, its completely normal to reach out to a faculty member, dean, mentor, counselor, or spiritual advisor when youre feeling overwhelmed. Many medical students often cite the famous analogy that learning in medical school is like trying to drink from a fire hose. It sounds intense, but these same students also speak about learning new study techniques along the way that help them manage time better, integrate new knowledge, and excel as med students. Admitting that something is difficult, but doable, can really improve your outlook.

Rest assured that, yes, as a medical school student you are entering a demanding process, but every successful doctor was in your place at some point. Those anxious feelings are normal, temporary, and manageable.

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What to Expect in Medical School - AAMC for Students ...

Long before Azan Virji entered medical school, a college counselor back home in Tanzania tried to dissuade him from coming to the U.S. to pursue a medical degree. The odds, he was told, would not be in his favor. Fewer than 3% of medical school applicants in the U.S. are international students, and only 0.5% of all medical school enrollees are from abroad.

But because Virji, now a second-year student at Harvard Medical School, had always aspired to become a physician and knew the quality of the schools here in the U.S., he kept on. Now he and several other international medical students have launched a mentorship network that helps prospective and current international medical students wade through the application process, tackle the logistics of financing their education, and handle the pressures of school once theyre enrolled in a program.

In the three months since the start of F-1 Doctors named after the visa type that most international students need in order to study in the U.S. nearly 80 mentors from more than 30 countries have signed up to be a part of the program, as have more than 60 mentees.

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A lot of the mentees are so happy to speak to someone who is an international student at a medical school they see themselves represented, Virji said.

U.S. citizens who are prospective medical students often have networks to tap into to navigate the difficult medical school application process, from premedical advisers at their undergraduate institution to family members or peers who have applied before. And while international students may also have these resources, the added complexities that they face due to their visa status often mean they dont have many others to turn to for guidance.

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Virji, who earned his undergraduate and masters degrees from Yale University, said he constantly felt like his credentials werent good enough to get him into a U.S. medical school.

The anxiety of not knowing whether or not youd be able to get in was a lot, Virji said. And thinking that not getting in is due to your foreign-born status is the biggest anxiety factor.

Beyond that, Virji didnt feel like there were others whom he could ask for help.

I couldnt find anyone to speak to who would tell me that I would be OK, that I still had a shot, Virji said.

The stressors international medical students face were further heightened last month when U.S. Immigration and Customs Enforcement issued a now-rescinded rule requiring those on F-1 visas to leave the country if their school planned on only having classes online in the fall as a result of the Covid-19 pandemic.

Even without these uncertainties, however, international students who come to the U.S. with the hopes of attending medical school often have an uphill climb. Of the nearly 175 medical schools in the U.S., only 48 indicated in 2019 that they accept international students.

I would have students who are great candidates but wouldnt get accepted into [U.S. medical] schools because they had limited options, said Jennifer Kimble, who was a health careers adviser at Emory University and at Georgia Institute of Technology. Kimble, whos now the director of admissions at Vanderbilt University School of Medicine, also explained that most state medical schools dont accept international students because of how state funding is allocated. This, she said, drastically narrows the pool of schools that foreign-born students can apply to.

A lot of the mentees are so happy to speak to someone who is an international student at a medical school they see themselves represented.

Azan Virji, F-1 Doctors mentor and Harvard Medical School student

Some mentees said that simply wanting to know their chances of getting into medical school which can be a gamble regardless of citizenship status is a major reason why they signed up with F-1 Doctors.

Even something as easy as finding statistics, theres really not a lot of resources online about your chances, said Ziad Saade, a rising senior at Columbia University who is being mentored by Virji. Saade said Virji has already offered tips on preparing for medical school interviews, including how the topic of medical ethics may come up during those conversations.

Saade, who is originally from Lebanon and on a premedical track, said he heard about F-1 Doctors through a friend and that hes since felt much less alone in the application process.

I had never met an international student in medical school, but F-1 Doctors helped me do that. Ive met three different people who are currently in medical school or have been accepted to medical school, and one of them happens to be from Lebanon, Saade said.

Mentoring through F-1 Doctors looks different for everyone, which is why the program has prospective mentees look through a directory of mentors and reach out to those with similar backgrounds and interests. Some, like Saade, want to get a sense of the kinds of scores and qualities they should highlight in the application process. Mentors have also offered feedback on admissions essays.

For international students to be able to talk to others [like them] is always a good thing, said Kristin McJunkins, director of health careers advising at Yale University who now shares information about F-1 Doctors with any international students she works with.

But the process doesnt end when these students enter medical school. Figuring out how to pay for school which is also a big task for domestic students is especially complicated for non-citizens. Theyre not eligible for loans through the federal government because of their citizenship status, for instance, and many schools dont have big endowments to support students fully.

Larger institutions such as Harvard and Vanderbilt often have the funds to partially or in some cases fully support international students. Some smaller schools, however, not only have policies that deem international students ineligible for financial support, but also require students to pay multiple years of tuition upfront. That was the case with Pranav Somasekhar, a third-year medical student at Saint Louis University School of Medicine.

I had to pay all four years upfront, Somasekhar said. The total about $250,000 had to be put in a third-party escrow account before Somasekhar could begin his schooling.

One of F-1 Doctors goals is to be a resource for students such as Somasekhar who are navigating thorny financial issues. The groups website has information for students on different loan options, and is in talks to partner with at least one company that will host webinars on financing a medical education in the U.S. F-1 Doctors has also created a spreadsheet with different schools financial aid policies for international students.

Somasekhar, who mostly grew up in India, moved to the U.S. in 2008 and went to both high school and college here. But because of massive delays in immigration processes in recent years, Somasekhar aged out of being listed as a dependent on his parents green card application, and had to reapply to stay on in the U.S. as an international student.

There are very few people who have fallen through these cracks and are in a similar situation as me, Somasekhar said. But since joining F-1 Doctors as a mentor, Somasekhar has had a few others like him reach out for advice. The three or four mentees Ive talked to all say that Im the only person they know who is in a similar boat, which is exactly why Im doing this, he said.

Somasekhar is himself looking to take advantage of mentoring through F-1 Doctors, since the programs mentors include medical residents and attending physicians. Theres no information on matching [with residency programs] for medical school seniors on an F-1 visa, Somasekhar said.

F-1 Doctors now wants to expand to other health professions, including nurses and physician assistants. Already, there are some dental students in F-1 Doctors, and the group recently added its first mentor who is pursuing a doctor of osteopathic medicine degree (versus an M.D.). The program, which is currently based out of Brown University, is also looking to set up local chapters at other universities, so that mentors and mentees at the same school can get together in person after the pandemic. Brown University currently helps fund F-1 Doctors activities, including webinars for students across the globe. In future, F-1 Doctors may also consider hiring an immigration lawyer to help navigate visa rules.

Virji is hopeful that as more international students go through the medical school application process, theyll connect with F-1 Doctors.

It has been easy to get mentors so far because you know how hard it is, he said, and you want to be able to help those on the other side.

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International med students ease the path for others with new mentor group - STAT

August 7, 2020 | :

by B. Denise Hawkins

In June, most historically Black colleges and universities were racing against the clock to come up with a plan for what the fall semester would look like or rolling out and then revising strategies to safely re-open. But at Atlantas Morehouse School of Medicine (MSM), faculty, staff and most future physicians were already back training, teaching and learning virtually and in person.

Online learning only, school officials said, was never the plan for medical education. To master their craft, those studying to become medical doctors, physicians assistants and scientists at MSM need to touch their patients, listen to beating hearts, peer through a microscope and see those in the community who will depend on them for care. But during a pandemic, they said, a hybrid approach is needed. These are reasons that Dr. Valerie Montgomery Rice, MSMs president and dean, offered for bringing her students back to campus.

A medical student orientation at Morehouse School of Medicine.

We have not made the choice to return to campus lightly, Rice said, but we must live out our unique mission to give our students the hands-on instruction they will need to care for the people we are committed to serve. That kind of training, she added, will supplement her students virtual learning and will be delivered through small, in-person sessions.

For Stephen Green, a first-year medical student from Atlanta, adapting to virtual instruction so far, a mixture of Zoom and video lectures has been a stressor for him and his classmates, he said. But learning, like teaching in the COVID-19 era, is uncharted territory. Despite the struggles, Green said, it matters that the faculty are definitely trying their best, even as they navigate some of the same technical hurdles. Weve just got to push through.

Alternating workdays

Campus leaders like Rice and her team have mostly been on their own to devise plans for a safe re-entry and teaching and learning at an uncertain time in higher education. For two weeks in May, the medical school did a test run of its re-opening plan for faculty and staff. It offered COVID-19 testing, staggered start times for work and alternated days to be on campus or work remotely, said Dr. Monique Guillory, MSMs chief of staff and chief administrative officer. She is also helping to lead the medical schools fall re-opening.

The colors green and blue are being used to tag faculty and staff and to guide a physically distant work week. Those who are blue work on campus on Mondays and Wednesdays. Those who are green come on Tuesdays and Thursdays. And, on Fridays, they alternate, said Guillory of the plan MSM devised to help maintain low-density circulation when people are on campus.

That process went pretty smoothly, but Guillory told Diverse they had to pivot on the approach to COVID-19 testing, which at first was voluntary and only for faculty and staff. To try to keep the campus safe and the virus from spreading, MSM decided to make testing mandatory for all returning to the campus, including students, Guillory added. Mandatory testing was an important shift for us, she said.

However, in late June, as campuses wrestled with how to safely re-open, the Centers for Disease Control and Prevention (CDC) released updated guidance on COVID-19 for institutions of higher education. In it, the federal agency did not recommend testing for returning college students and issued an explicit statement of non-recommendation. Ahead of MSMs June 1 re-opening for everyone and a phased-in student return, 1,000 faculty, staff and students were tested. When asked, Guillory said seven tested positive, with most being clinical faculty and hospital staff a finding that didnt come as a surprise to her.

The importance of testing

COVID-19 testing at MSM continues to be the centerpiece of the plan for keeping those on the campus safe. Daily screenings for symptoms of coronavirus infection and temperature checks are essential to the process. Guillory said these are things that campuses have to do to stay vigilant during a pandemic. At MSM, the changes across the campus are visible. Chairs in classrooms and conference rooms, for example, are now roped off to create physical distancing. And signs on every door and in every room announce the maximum number of people allowed inside at one time. There is no way you can be on campus today and think that it is business as usual, Guillory added.

First-year medical students got their first introduction to the new normal before they arrived. Orientation for them took place over Zoom.

They are eager to get started and come to campus in July, Guillory said, but no

Dr. Monique Guillory

one can return or come to campus without first being tested. This is our approach to bringing our people on campus in the safest way possible.

Still, public health experts say that the process of screening and testing everyone on a campus cant guarantee safety from infection or prevent the rampant spread of the coronavirus. While Guillory agrees, she also credits mandatory and early COVID-19 testing at MSM for revealing seven positive cases and mitigating a possible virus outbreak.

Guillory, a veteran higher education administrator, began her new position as chief of staff in March, just as the virus forced MSM and campuses nationwide to close and operate remotely.

I started virtually, said Guillory, whose first big project was a plan to bring people back. We were among the first schools in the country to come back and to announce our plan.

But taking on that urgent task, she said, was as unexpected as the coronavirus pandemic. It was also serendipitous. She had practice. Before coming to MSM, Guillory had developed new health sciences degree programs, including those in nursing, that have launched.

Closing healthcare disparities

In July, as COVID-19 battered the South, Atlanta, like elsewhere in Georgia reported record high cases. This kind of news puts MSM on alert and makes Guillorys work on campus testing and screening more critical. Since the onset of the pandemic, COVID-19s grip on the majority Black city that is home to Morehouse School of Medicine has been tight and deadly. Elsewhere across the nation, the disease has also taken an uneven toll on those who are Black and burdened with chronic health conditions.

As doctors and academicians, we know that there are many systemic challenges to health care delivery in minority communities with higher incidences of heart disease, diabetes and obesity that may be contributing to more COVID-19 deaths among African Americans, says Rice.

Increasing the number of healthcare providers of color, she added, is a way to eradicate those health inequities. Looking nationally, though, the pipeline has been leaky, the Association of American Medical Colleges found. For decades, the country has struggled and failed to significantly increase the number of physicians from underrepresented communities. But for three consecutive years, MSM has been able to move the needle forward. In the middle of a pandemic, MSM admitted Stephen Green and 104 others, for its largest class. Nearly half of them are Black men and more than half of the class of 2024 is from Georgia.

This article originally appeared in the August 6, 2020 edition of Diverse. You can find it here.

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Amid COVID-19 Pandemic, Morehouse School of Medicine Welcomes Its... - Diverse: Issues in Higher Education

COVID-19 has delayed NYU Long Island School of Medicines expansion plansbutis allowing students at the regions newest medical school a rare opportunity to study a pandemic as it unfolds.

NYU Long Island opened a year ago with 24 students, tuition-free and with a focus on preparingstudents to become primary-care physicians. Those students are now starting hospital rotations, and 24 new students started in the program last weekwith lectures online.

This is a pandemic that is happening in real time, said Dr. Steven Shelov, the Mineola school's dean. Its not in a book theyre reading about.

NYU Long Island had held only online classes for the past few months and, with the state now allowing in-person classes with precautions, shifted discussion groups to a large conference room when first-year students began classes July 27, Shelov said. Likewise, students at other medical schools on the Island had been studying remotely, with plans for the upcoming term for a mix of in-person instruction and virtual learning.

Students at NYU Long Island are learning about vaccine and treatment development in their classes as they occur. Epidemiology classes will include COVID-19 cases. Students will assist with COVID-19 research by, for example, crunching numbers or helping sign up patients for clinical trials, Shelov said.

Second-year student Meenakshi Krishna, 25, who grew up in Williston Park, said entering the field at this time makes us appreciate the sacrifices of physicians and makes us realize how much goes into being a physician.

For Megan Bader, 26, a second-year student who grew up in Garden City, studying to become a physician during the beginningof the pandemic was humbling because students saw how doctors and scientists struggled to understand COVID-19 and how to best treat patients.

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Shelov said a key lesson from thisisthat doctors dont always have all the answers and, in the case of COVID-19, We learned from our mistakes.

First-year student Nabilah Nishat, 23, of Jamaica, Queens, said COVID-19's disproportionate effect on people of colorillustrates the toll of health disparities. Conditions such as diabetes and high blood pressure, which leavepeople more vulnerable to severe cases of COVID-19, stem in part from a lack of access to health care, especially preventive care, Nishat said. As a primary-care physician, Nishat wants to work to reduce disparities.

Mustapha Touray, 24, an immigrant from The Gambia and a first-year student, said the pandemic reinforced why we need diversity in medicine, and it highlighted my personal goals of going into medicine, to serve underserved communities.

People are more likely to adhere to physicians advice, and reduce their risk of conditions like high blood pressure, if they can relate to doctors, and coming from the same racial and economic background, their experiences will be similar, Touray said. So at the patient-doctor level, the interaction will be smoother.

Santiago Luis, 26, a first-year student who grew up in East Meadow and in Florida, said his only frustration with studying during the coronavirus era is that he cant yet start treating COVID-19 patients.

Most people who come into this profession are coming in with a want or desire, almost a biological desire, to help people, he said. Thats where my feelings are right now. I really want to get out there and start helping.

Luis is one of 24 new students who started classes last week, joining the 24 students from the schools inaugural class beginning their second year. NYU Long Islands original plan was to increase the size of this year's incoming first-year class to 32 and move to 40 first-year students in 2021, Shelov said. Long term, the school plans to have 40 students in each of the three graduating classes in the three-year program, for a total of 120. But increasing the number of new first-year students by eight this year would have made social distancing for in-person classes more difficult, he said.

Another barrier to expanding the first-year class by eight students is that it was unclear if enough money would have been raised to keep the school tuition-free, in part because revenue from NYU Langone physician practices that help fund the school have fallen during COVID-19, Shelov said.

NYU Long Island and the NYU Grossman School of Medicine in Manhattan are believed to be the only medical schools in the country to waive tuition for students, said Julie Fresne, senior director for student financial and career services at the Association of American Medical Colleges.

The pandemic also has changed the way students at Long Islands three other medical schools study.

At the New York Institute of Technology College of Osteopathic Medicine, the 280 first-year students will split into pods of 20 to 25, so they can attend discussion groups and labs in person while practicing social distancing, said Dr. Jerry Balentine, the colleges dean. In anatomy classes, there will be one student per cadaver rather than several, he said.

Pods will attend all in-person classes together, so if one student becomes infected with the coronavirus, only members of that pod would be quarantined, not the entire college, Balentine said.

At Stony Brook Universitys Renaissance School of Medicine, the 136 first-year students will learnonline through the end of the year, with a mix of online lectures and in-person, socially distanced discussion groups starting in January, said Dr. Kenneth Kaushansky, dean of Renaissance. Some labs will be in-person; others will be remote.

At the Zucker School of Medicine at Hofstra/Northwell, the 103 first-year students will for the first few weeks study two days on campus, three days remotely, and then transition to full-time in-person classes, with masks, social distancing and other precautions, Dr. Samara Ginzburg, the schools associate dean for case-based learning, said in an email. Second-year students will have all courses in-person.

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David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.

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COVID-19 changing study of medicine on Long Island - Newsday

Need to stay updated on coronavirus news in Texas? Our evening roundup will help you stay on top of the day's latest updates. Sign up here.

Last week, Gov. Greg Abbott moved to block local health authorities from shutting down classrooms before the school year has started. Since then, he has repeatedly said he is trusting local school leaders to decide whether and how to bring students back to classrooms this fall.

Those actions have left local officials confused about the limitations of their authority as the debate over reopening schools in the state continues. Abbotts decision to curb the role of local health authorities has added to the ongoing conflict between the governor and local governments during the pandemic, with mayors and judges across the state voicing frustration over having their hands tied by the states response.

Some superintendents say that despite Abbotts statements to the contrary, their ability to respond to the pandemic is still limited, and many of their questions have gone unanswered even as school is slated to start in the coming weeks. They are worried their decisions could result in consequences from the state, including cuts to funding, and some say they would prefer high-stakes decisions affecting student and employee health to stay with medical experts.

Were going to make our decisions based on local scientific data, and were working with the health authority. Thats our guide, said Juan Cabrera, superintendent of the El Paso Independent School District. Nobody on our board, including myself and my administration, are medical doctors, so Im going to try to take their advice.

After about 18 local health authorities issued orders delaying in-person instruction because of coronavirus concerns, Abbott said last week that those health officials cannot issue blanket orders preventing all schools in their jurisdictions from opening classrooms before the academic year begins. His statement backed nonbinding guidance from Attorney General Ken Paxton released earlier that week.

Abbott also said school districts could ask for more time to limit the number of students learning in classrooms, on a case-by-case basis, beyond the current eight-week maximum set by the Texas Education Agency. And he reminded school officials that they could move their start dates later in the year with a school board vote, as long as they make up the time. This, he said, gives local school boards the most authority to determine when and how its safe to have kids back.

The Texas Education Agency has not yet released any specifics on which districts will be able to receive waivers to limit in-person instruction beyond eight weeks or under what circumstances. But it said it will not fund school districts for unlawful school closures, worrying superintendents who want more certainty of state support while handling an unpredictable pandemic.

After the eight weeks, theres a threat to withhold funding if schools dont have in-person learning. Theyve offered a waiver opportunity but it takes it out of the hands of the local school district beyond the eight weeks, and that is not local control, said Kevin Brown, executive director of the Texas Association of School Administrators and former superintendent of Alamo Heights ISD in San Antonio.

A spokesperson for Abbott, when reached for comment for this story, referred to the governors previous statements on the issue. Abbott has said that school boards are welcome to consult public health authorities as they make their decisions. And he said local health officials could shut down schools that have COVID-19 outbreaks after they reopen.

Some superintendents, especially in areas where the virus is rampant, balked at the idea of waiting for kids and teachers to get sick before shutting down their campuses in the middle of the year, instead of working with local health officials to close classrooms if cases spike again. And some still wondered: What options do they have if cases are still high after eight weeks?

Districts, I think, are very concerned about creating these rolling situations where people come back on campus and then get sick and then everybody has to leave again, said Joy Baskin, director of legal services for the Texas Association of School Boards, on a recent podcast explaining the states guidance.

Paxtons guidance and Abbotts subsequent statement were a boon for school leaders who wanted to open but were blocked by local health orders. Some of those that celebrated were private schools, with smaller class sizes and more resources.

Others were districts that straddle multiple counties: Boerne ISD has two schools in Bexar County, home to San Antonio, a hot spot for the virus, but most are in more rural Kendall County, where COVID-19 transmission is low. After Paxtons letter, Boerne ISD announced it would open those two schools in mid-August, going against the Bexar County order.

But school superintendents in regions where the virus is spreading quickly are balancing the fear of infection with concerns about how much vulnerable students will fall behind learning from home. Theyve run into some roadblocks with state guidance.

Once El Paso ISD schools open for in-person instruction, parents will be able to choose among entirely in-person instruction, entirely virtual instruction, or a hybrid version of in-person two days and virtual three days. Cabrera said that keeping school capacity to 50% would be the best way to keep kids safe, at least until a vaccine is available. Like many school superintendents, he is prioritizing younger students, those learning English and those with disabilities for in-person learning, groups otherwise at risk of falling behind.

Cabrera said hell roll out the plan to all the schools in his district, but TEA only allows that flexibility in limited circumstances, potentially putting Cabrera at odds with the state guidelines.

Whats driving my decision is requests from parents for social distancing. Im not forcing people into schools if I cant social distance, Cabrera said. That might be a contravention [of state guidance].

The frustration local leaders have voiced in recent weeks has been a nearly constant thread throughout the pandemic. At first, Abbotts response to the pandemic was to defer to local officials, and many issued their own versions of stay-at-home orders. Abbott resisted the growing number of calls to issue a statewide mandate before announcing at the end of March that he would order one.

A month later, the governor was overseeing the reopening of the state and in the process blocked local governments from being able to implement stronger restrictions, such as requiring people to use masks while in public. For weeks, the back and forth over masks continued, with local officials asking the governor for the power to require them or to issue a statewide order mandating them.

Eventually, one local official tried something new: Instead of requiring people to wear them, Bexar County Judge Nelson Wolff ordered businesses to mandate them. Wolff, the governor said in an interview soon after, had finally figured that out. The comment earned Abbott criticism from both his right and left about why he wasnt clearer about what locals had the power to enforce.

Then in early July, Abbott reversed himself, ordering Texans across the state to wear masks in public.

The friction between Abbott and local officials has continued into this latest debate over the reopening of schools. San Antonio Mayor Ron Nirenberg, in a July 31 tweet thread, criticized the statement on school reopenings from Abbott and other GOP leaders, saying that local leaders implement health-based protocols, the AG threatens them, and the State capitulates.

Every time [Paxton] issues an opinion, it confuses the guidance at the state level or attempts to roll back protections that have been proven to work at the local level, Nirenberg told The Texas Tribune earlier this week. And that seeds the kind of chaos that youve seen play out in this school situation that ultimately leads to the feeling that weve lost control of the virus.

Some health experts say it makes sense for local health authorities, who will be responsible for quashing outbreaks on campuses, to have outsized say in how schools can reopen. Theyre going to be the ones who are collecting the data and need to process it, said Michael Chang, an infectious disease pediatrician at UTHealths McGovern Medical School and UT Physicians.

I get it, theres a lot of questions about who has authority and whos got jurisdiction ... but ultimately I think the local health officials are best positioned to respond and best understand whats going to be the impact on local schools.

Its still unclear whether local health officials will enforce their orders to delay school. After Abbotts statement last week, Harris County Judge Lina Hidalgo continued to urge schools to keep their classrooms closed. No gathering should be taking place, much less a gathering in school. We are working with superintendents to figure out: When would it be okay and how would it be done? But whats relevant right now is right now, not any time soon, she said at a press conference this week.

Going the opposite direction, McLennan County, home to Waco ISD, rescinded its school order after Paxtons legal guidance. Athletic directors of school districts in the county moved to start strength and conditioning training right away.

At a San Antonio press conference this week, Abbott was asked whether hed make his authority on the matter clearer by issuing an executive order, rather than just a statement. If they want me to issue an executive order, I can cut and paste what weve issued and sign it, Abbott said, jokingly. If they just show up with a copy of it, Id be happy to sign it.

In the meantime, some local health officials and school districts are working together to come up with plans to open safely and address the needs of their most vulnerable children. In a virtual town hall Wednesday night, San Antonio Medical Director Junda Woo suggested using a few metrics, including the number of days cases have declined, to assess the risk of reopening schools. At a time of the highest risk, like now, schools would only be allowed to bring in small numbers of vulnerable children, such as those with disabilities or those who arent safe at home, she said.

Northside ISD Superintendent Brian Woods, who was at the meeting, told The Texas Tribune that superintendents want clarity as they plan for the upcoming year. And they want certainty that the state will support the decisions they make in order to keep students and staff safe as the pandemic continues beyond the first eight weeks of school.

What if, in some parts of the state, as we approach week eight, the public health situation is not good? he said. What ought to be the solutions? And it seems like we ought to be working on them now instead of waiting on a crisis.

Disclosure: The Texas Association of School Administrators and the Texas Association of School Boards have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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Texas schools reopening mandate sets off another local control debate - The Texas Tribune