What About The Other 80%? Medical Students At All Levels Of Training Can Help Beat COVID-19.

The global pandemic of COVID-19 presents a serious threat of overwhelming our health care system’s capacity. With the lack of a clear, decisive response from the federal government to minimize early virus transmission, it’s becoming rapidly clear that the spike in critical patients flooding the health care system within Italy will likely soon be a problem that the United States will face as well. As our medical infrastructure rises to this challenge, policymakers and clinicians alike have turned towards medical students as a potential surge workforce.

Last week, the Liaison Committee on Medical Education released guidance in line with this anticipation, outlining recommendations on early-graduation for final-year medical students. This comes on the heels of medical schools across New York and Boston announcing optional or mandatory early graduation policies for their most senior students.

These institutions of medical education have determined that our country’s need for additional health care workers is at a crucial junction, and consequently, our most knowledgeable medical students are being called up from the reserves.

The entire population of medical students in the United States accounts for about 120,000 (both Allopathic and Osteopathic), and of these, about 26,000 will graduate this year, early or not. We expect that in the coming weeks, calls for early graduations of these students will increase across the United States.

This early-graduation workforce could be beneficial, but it has limitations. For one, some have recently pointed out that brand new doctors may not have adequate supervision and training during COVID-19. For another, while some students have advocated for the merits of participating in the COVID-19 response, others may not feel comfortable facing the prospect of potential infection, especially in light of limitations on personal protective equipment and a growing realization that youth does not confer immunity from the virus. Beyond matters of personal choice, similar to problems in our existing workforce, some newly appointed doctors will be unable to help clinically due to pre-existing conditions.

And of course, this effort excludes at least 94,000 non-graduating medical students, or about 80% of the total medical student population, who may be willing and able to help otherwise.

While the greatest attention has been focused on importing a new cohort of doctors into our hospitals, there has also been a well-described need for support to the existing workforce. Stories from China and Italy describing collapsed and overwhelmed health care workers provide a vivid picture of the strains that could await our own doctors and nurses.

Moved by this possibility, patchwork efforts across the country have seen medical students of all experience levels striving to support the efforts of frontline health care workers. Whether through childcare, grocery shopping, or call center work, our colleagues have sought every opportunity to organize and help their communities.

Currently, though, medical schools vary widely in their approach to medical students volunteering for COVID-19 relief. While some schools are extraordinarily receptive, others have discouraged certain volunteer activities or limited coordination with student groups. Such differences in response can likely be attributed to variation in tolerance to risk and liability across institutions.

In light of these challenges and the continued recommendation for medical student clerkships and clinical activities to be suspended through April 14th, we advocate that the Association of American Medical Colleges (AAMC) release a central inventory of guidance for medical schools on how to best utilize medical students as volunteers, outside of direct contact with COVID-19 patients. Such guidance may ideally address how to limit concerns of ethics and liability, and how to utilize students in a crisis without an interruption of academic standards.

Medical students are at different stages in their training, with many, but not all, positioned to provide near-direct patient care to those with COVID-19. And many students and schools may tolerate varying amounts of potential risk to students. With this in mind, we propose an inventory of ancillary support activities, stratified by risk of exposure, by which fellow medical students could be integrated to bolster our health care system’s capacity.

Many support activities are “low-risk,” outside of hospitals, and suited to almost all students. Examples include providing childcare or grocery deliveries for frontline workers, creating or gathering personal protective equipment, or participating in phone hotlines and helping to support research efforts.

Other support activities may be “medium-risk” and suited to most students. Such activities occur at the interface of hospitals and the public, and include sanitizing hospital areas, assisting with drive-through screenings, or participating in local health department efforts to track and contain COVID-19.

And finally, some efforts may be “high-risk,” within hospitals, and suited to experienced students. These activities include hospital entry screening, patient triage, and mask distribution, non-COVID-19 clinical work, or ancillary support in emergency department intake processes.

As our hospitals brace for a wave of patients, there is a mounting need for such central guidance from the AAMC to outline how medical schools can and should most fully utilize volunteering students. In the fight against COVID-19, students on the cusp of graduation may be graduated onto the battlefield. Even with our focus towards this cohort of new physicians, it’s critical that we fully utilize students at every stage of medical education. Regardless of training, we all have an important role to play in response.

Matthew A. Crane, Tiffany Lian, Suraj A. Dhanjani, Daniel Y. Liu, Richard Liang, Luis E. Cortina, George S. Corpuz, and Diviya Gupta are medical students.

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