On March 17th, in a nationwide effort to protect our patients and minimize the overuse of critical primary protective equipment (PPE), the most disposable force in the hospital was removed: our medical students. When I learned of this temporary suspension, I had just finished my first month of inpatient medicine, a defining achievement in the clinical years. My peers and I had endured eight months of clinical rotations, surviving (at times thriving) with a can-do attitude that only sometimes compensated for my vague understanding of hyponatremia or my growing “systematic approach” to AKI. In the month leading up to the clinical suspension, I had finally begun to feel confident in my clinical skills. I was integrating information like never before and took responsibility for more patients than I would have ever dreamed possible. I was sending pages, putting in orders, and calling consults. A patient even mistook me for “her doctor.” During these weeks, the tone on the wards was eerily casual; the hospital seemed removed from the outside chaos, and it seemed like COVID19 was a gross exaggeration of the “common cold” as we walked around our empty emergency department. In this stillness, I recall feeling like I had earned my place in the hospital. I had finally made the cut. But, the situation changed rapidly. Before we knew it, medical students were suspended from clinical rotations, left to weigh the ethics of their suspension and the situation from behind computer screens. Initially, I felt ashamed. A piece of me felt like the vision I had created of my growing place on the hospital team was a lie. How could a “valued” member of the team be dismissed so quickly? But, who was I kidding— “valued?” I was merely a medical student in a shortened white coat uniform wrought with pen stains. A bigger piece of me also understood that the “put me in coach” mentality that I embraced in the months prior no longer served me, my team, or my patients. A pandemic is not the time for hubris. It’s a time for the starting lineup. But, amidst all this, I felt inspired. Inspired by my medical community around the globe, leading the fight of fights to protect its people, our people. Out of that inspiration, I found myself searching for creative ways to stay involved, not as a learner, nor as a wallflower, but as an active participant in this defining moment. For a small group of us third-year medical students, this inspiration manifested as the “Medical Student Virtual Scribe Program.” Surely, we lack the clinical acumen and credentialing to provide direct medical care. But, perhaps it was time to acknowledge the skills we had most finessed in our months on the wards: not suturing, not diagnosing, but charting. Specifically, writing discharge summaries. To most, charting is the cog in the painfully slow wheel that is inpatient medicine. And it is music to a medical student’s ears to be thanked for writing a well-organized discharge summary. Reflecting on our experience on the wards, we rapidly identified this time-consuming task as an opportunity to offload our overburdened physicians on the frontlines. In fact, the electronic medical record was designed for it. Students could be assigned to teams virtually, continue their education, and complete discharge summaries from home. We could not only fulfill our clinical responsibility to our patients and our team, but also comply with our civilian duty to social distance. Within a weekend, our team of students assembled an introductory proposal, an informational YouTube, and recruited over 50 students to join our grassroots effort. Our hospitalists eagerly accepted our offer and helped implement our idea within a few short days. We started small, just a few teams, but have grown steadily, with the added benefit of absorbing clinical skills from remote charting on COVID-19 teams. Within a week, our idea had spread, and we helped over ten student representatives from around the country deploy the virtual scribe program at their own institutions. As it turns out, this was a common theme among medical student activists. As our team of MS3s launched the Virtual Scribe Program, others launched PPE drives, volunteered for hospital screenings, provided student tech support, or contributed to nationwide COVID-19 literature and IRB databases. Students offered blood donation sign-ups and created extensive networks of childcare, pet-sitting, and grocery delivery for our health care workers. Our colleagues at UCSF utilized their Silicon Valley ties to launch a nationwide PPE donation program and supply chain. We united on Reddit, Facebook, Instagram, Twitter. We made student forums on Slack, created #hashtags on social media, and posted nationwide Google Docs. In other words, the social platforms that seemed to “distract us” from coming to class during pre-clinical years, were now the vehicles of a powerful force of medical student initiatives aimed at protecting those who have given us so much: our patients and our mentors. So, we write this, not as one voice, but as a chorus; excited to join a generation of young doctors leveraging technology to serve our patients and flatten the curve. Some initiatives may be larger than others, but no matter the impact, we have transformed our shared darkness into light. Because every team needs a benchwarmer, to learn from afar, to practice with intent, and to be ready when their moment comes. And, while a piece of me looks forward to the day when we are called to action inside the hospital, the deepest part of me aches for the fallen players that came before us that would lead to such a call. So, for now, we sit on the bench, cheering from behind the screen, with hope in our hearts that our starting lineup stays in the game. Acknowledgments: Medical students at the University of California San Diego School of Medicine: Alicia Callejo-Black, Daniella Klebaner, Payton Ottum, Simone Phillips Hospital medicine faculty at the University of California San Diego School of Medicine: Gregory Seymann, Deepak Asudani, Meghan Sebasky Alicia Asturias is a medical student. Source
