As the COVID-19 pandemic grows, some countries, overwhelmed by healthcare demands that exceed any ordinary disaster-preparedness, will need to convene personnel ready to support direct patient care, public health surveillance, and education efforts. Health professional trainees are an untapped source who have the potential to become an essential part of this workforce.
However, an update on March 17th from the Association of American Medical Colleges (AAMC) recommended that medical schools suspend their students’ participation in any activities involving patient contact for at least the next two weeks. As a result, many medical schools are cancelling their students’ clerkships, or clinical year experiences.
At Columbia University Vagelos College of Physicians and Surgeons, all clinical student activities were suspended on March 15. Perelman School of Medicine at the University of Pennsylvania has suspended clerkships for at least the next two weeks.
Medical schools have an ethical duty to students, to provide supervision and protection during their training years. Given the unique nature of this pandemic, one or both of these duties may be compromised. Increasingly, medical schools have come to realize that it would be challenging to put students on the front line in this pandemic. Therefore, the current plan at these schools is to remove medical students from many in-hospital training responsibilities.
But there is another option.
At Harvard Medical School the plan is to also suspend clerkships, but then transition students to a COVID-19 “student workforce.” This option is also being investigated by New York Governor Andrew Cuomo, who emailed all New York higher-education health institutions saying that, “in the event that the novel coronavirus crisis worsens, we need to be creative in finding back up assistance.”
This is a promising alternative for two reasons. First, health professional students in later stages of training have already received hands-on experience that allow them to be useful to existing healthcare professionals. Second, many day-to-day health maintenance tasks outside of the COVID-19 pandemic – rescheduling appointments, helping manage patients’ chronic diseases, ensuring that prescriptions for medications are refilled – can be done virtually by students at all levels of training, without undue exposures.
Almost unanimously, students matriculate to medical school in the hopes of serving their community. There is no greater calling, and no greater need, for such dedication than during a pandemic. Medical students want to help; they should be allowed to do so. We should therefore create a volunteer, supervised workforce of medical students to help during this crisis.
As COVID-19 spread across the country, working in clinical environments has become increasingly rare for students, for understandable reasons. While being conservative with hospital resources is a valid strategy, thinking of medical students only as trainees leaves a potentially valuable resource untapped. Pursuing a proactive strategy to transform medical students from observers to supported-respondents could help meet the medical man-hour demand this pandemic will soon require.
Even novice trainees have learned how to obtain a medical history and provide basic counseling for patients. Additionally, many have had careers as EMTs and paramedics prior to matriculating to medical school. More advanced trainees, particularly third- and fourth-year medical students, have completed at least half of their training, including rotations in medicine, surgery, and intensive care. The skills gained during those experiences have the capacity to meaningfully advance patient care.
As physicians find their time increasingly taken up with responding to COVID-19, medical students could be enlisted to help lighten the workload. For example, students can provide virtual support for patients with low-acuity concerns and questions, such as a medication refill. This would help ease some responsibilities from providers at the front-line of the pandemic.
One such model is currently being implemented at Yale School of Medicine. A group of medical students, under the guidance of residents and physicians, has created the Yale Medical Student Task Force (MSTF). In partnership with the Yale Department of Internal Medicine, student volunteers have been trained to reach out to patients who have had their in-person appointments cancelled due to COVID-19. Patients are asked if they have any urgent medication refill needs, new or worsening healthcare concerns, and any other health-related questions. All information is then relayed to providers. Our hope is that Yale MSTF will streamline the rescheduling of these patients to virtual visits, as well as reduce the workload for Yale Internal Medicine providers.
As hospitals become increasingly overwhelmed, providers will need more individuals who can respond quickly to change and follow local clinical champions. Health professional students are well-versed in clinical environment norms, from how to use electronic health systems and navigate clinical team dynamics, to interacting with patients.
By using the knowledge and skills they possess, students may help provide some care to some patients—which would allow supervising physicians more time for higher-level work.
Implemented properly, students would not become “mini-clinicians” and the standards of care would not be lowered. They would still be members of a larger clinical team, guided by supervising physicians. Rather, students could be utilized as force-multipliers to increase the efficiency of trained health care experts and to mitigate their risks of burnout; all while gaining valuable experience and education during a once-in-a-lifetime public health crisis.
It’s also important to remember that even as COVID-19 spreads, the healthcare system will still need to continue the management of the normal load of patients with chronic diseases. Many of these conditions (i.e. COPD, hypertension) are diseases that students learn how to manage during their primary training. Therefore, a student workforce, with the support of physicians and healthcare staff, could expand capacity to care for both patients with, and without COVID-19.
But even outside the clinical setting, medical students could be useful. They have received training in epidemiology, public health education, and biostatistics—meaning that they could support the ongoing surveillance, contact tracing, and public education elements that are crucial to all mitigation and suppression efforts.
For instance, as hospital phone lines are increasingly overwhelmed, students with simple training and a script can easily assist in providing information to the general public.
When developing a “student workforce” several factors must be considered. It should be completely voluntary and even as students indicate interest to serve, careful consideration and protections should be given for students with preexisting conditions, sick family members, or both.
Many healthcare systems, such as Yale’s, are experiencing severe shortages of personal protective equipment, such as masks and surgical gowns. Students’ involvement in care must not be organized in such a manner as to contribute to these shortages.
Finally, students who choose to engage in these ancillary services could receive some form of compensation, perhaps in the form of temporary loan forgiveness. But, more than money, they would receive the fulfillment that they sought when they applied to medical school: to serve individual patients and society at a time of greatest need.
Medical school is training for future service, and students want nothing other than to be of service to their communities. However, given this unique moment, such a dogma needs to be met with flexibility. We are living through a time that requires an all-hands on deck response.