In certain hot spots, the need for amplification of the health care workforce during the COVID-19 pandemic is dire. Putting medical students in roles to help may seem like an obvious solution. But the solution is not that easy.
“Our medical students and residents are important members of the health care workforce in fighting the COVID-19 pandemic. As many physicians-in-training will be enlisted to provide direct patient care during this time, it is our responsibility to ensure that they are being protected and have the support they need to safely navigate the pandemic,” said AMA President Patrice A. Harris, MD, MA.
Medical students and direct patient care
Less than a month ago, the Association of American Medical Colleges (AAMC) offered a recommendation that medical students at any stage of training be removed from direct patient care activities. Where that is feasible, that recommendation should be heeded.
A recent AMA Innovations in Medical Education webinar focused on deploying students in alternate roles during the pandemic.
“If you think about differing degrees of exposure to that risk, you would like to keep students more to the periphery,” said Kimberly Lomis, MD, the AMA’s vice president for undergraduate medical education innovations. “They have a great deal to add in the clinical care of patients without coming into direct contact.”
In instances where students are being used on the front lines, the AMA is aiming to “to remind any organizations that intend to engage students in this way that they are still learners and they do need supervision and guidance,” Dr. Lomis said.
“If we need to use them, they are incredibly valuable, highly trained and quite capable. We just have to ask how we can do so in the safest way possible.” The AMA recently offered detailed guidance on protecting trainees during the COVID-19 pandemic. The Association called for a number of protections, related to students, among them:
- Medical students should be free to make their own decisions about participation in direct patient care.
- Medical students should be included in conversations as these direct patient interaction activities are being explored, developed and implemented.
- Medical students should be provided proper training and oversight in the use and reuse of personal protective equipment (PPE).
- Medical students should not be financially responsible for diagnosis and treatment of their own disease should they become ill due to care of COVID-19 patients through school-approved activities.
For medical students approached by organizations outside the purview of their training institutions to work in the field during the pandemic, the AAMC and Liaison Committee on Medical Education offer some guidance.
Early graduation and trainee safety
An increasing number of schools are graduating medical students early, making them eligible to serve as clinicians fighting against COVID-19. Under a recent executive order from New York Governor Andrew Cuomo, graduates of medical schools accredited by the LCME and AOA, and matched into an ACGME-accredited residency program in or outside New York, may temporarily practice medicine in New York under a licensed physician, during the interval prior to reporting to their matched program. Graduates do not have to apply for a license to do so. Acknowledging the workforce needs, the medical education community, including the AMA, has concerns about protecting learners under such alternate patterns of transition.
The timing for graduating students early to respond during the COVID-19 pandemic is somewhat fortuitous; many students have met all their requirements of training by their final month of training. Still, transitioning medical students into increasing care responsibilities is a process.
“Any brand new intern moving into a new role, often in an entirely new system, is always in need of oversight and onboarding,” Dr. Lomis said. “It’s a routine transition. It’s a challenge in normal situations. Now you have a situation where the people who normally do the onboarding are significantly distracted by other demands for their attention.”
The protections the AMA is advocating for with early graduates emphasize their safety and status as trainees. Among the key points the AMA calls for:
- Early graduation should be enacted on a voluntary basis and founded upon attainment of core competencies.
- To the extent possible, early graduates should serve under the supervision of an approved graduate medical education program.
- Medical school graduates should not be compelled to work for their matched residency institution prior to the intended date of employment.
- Institutions deploying early graduates should grant these providers full status as health care employees with appropriate salary and benefits, while continuing efforts to mitigate their personal risk.
- Institutions and medical school graduates should remain mindful of graduates’ contractual obligations to their matched residencies, including consideration of the potential for quarantine and illness.
The AMA has curated a selection of resources to assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time.