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Medical students can be vital in the fight against COVID-19

The COVID-19 pandemic is putting enormous pressure on the health care system. This is partly due to the explosion in the number of cases and partly because health professionals are getting sick, in some cases fatally succumbing to the virus.

While medical students are not full-fledged physicians, we do have a wealth of training and clinical knowledge. As such, we could be used more effectively. We should consider doctors-in-training as welcome partners to the most experienced doctors and nurses, especially given the rate of increase in infection rates in the United States. The only thing that prohibits the use of such valuable and valuable labor is the lack of strategic planning and foresight. To address this need for physicians, some institutions have adopted a reactionary approach by advancing graduation by a few months, making them doctors of medicine somewhat prematurely. However, this approach is not exhaustive.

Taking a lesson from the Italian experience, the United States must avoid partial solutions. The reality is that, even with the first title transfers, most medical institutions have neglected tens of thousands of pairs of hands that are trained and ready to support. While awarding degrees early is a significant approach, it is defensive in nature. To turn that into an offensive strategy, we must use medical students who are further from graduation and put them in roles consistent with their full training. A significant benefit of this would be the ability to reassign experienced physicians to care for patients affected by the outbreak while keeping medical students largely out of danger.

At the beginning of their clinical years, medical students have already been tested on their ability to take a history, identify a differential diagnosis, and perform a basic physical exam. When medical students begin their fourth year, they have learned to identify and manage patients with common problems (eg, high blood pressure, diabetes, COPD). In addition, they can interpret common laboratory results and basic radiological images, and document patient notes and discharge summaries in the electronic medical record (EMR). In fact, in some hospitals, once confirmed by a senior doctor, a medical student can order medications and have their patient notes used for billing.

Also, before medical students graduate, they have passed two of the three exams required to be a board certified physician. These points are important because third and fourth year doctors in training are highly trained but are an underutilized resource in a health crisis.

With that in mind, human resource strategies to address the COVID19 pandemic should involve:

Assignment of medical students to provide care in routine non-emergent scenarios and scenarios consistent with their full level of training. Early clinical training students should provide primarily indirect care, i.e., callbacks to outpatient clinics, telephone sorting for hospitals or clinics, researching updated virus treatment guidelines for clinicians, endowing state and local health departments , until taking the history and physical exams in the clinics. Fourth grade students must provide direct and indirect care in non-emergent routine settings. Duties consistent with management in internal medicine. In addition, medical students should be used as providers of care in non-traditional inpatient settings, such as rehabilitation centers and skilled nursing facilities.

Pairing medical students with experienced and retired doctors, similar to the tactic used by the UK National Health Service. The comfort of EMR medical students and familiarity with clinical sites can increase the efficiency and accuracy of clinicians with advanced clinical insight.

This is how we can execute these strategies:

Hire medical students and categorize them as temporary hospital employees, with specific locations for their full level of training. Hospitals have been open about shortages of materials and medical personnel, and at least one hospital system has offered to temporarily recruit medical students through an accelerated recruitment process for “known and trusted students.”

Write medical students as part of a state health disaster response corps and temporarily deploy them to facilities where they are needed. There are several medical students who are technically enlisted service men and women, but most of us are not. In a global health crisis like this, we really should consider at least one draft voluntary state health service that includes a specific role for the skills of a medical student.

As a fourth year medical student, I am sure I am not alone when I share my frustration at the lack of formal planning on how to safely and effectively take advantage of medical student training. There are some provisions that allow flexibility in licensing requirements and regulations when a wave of healthcare professionals is needed, many initiated after major disasters like H1N1, Superstorm Sandy, and Hurricane Katrina.

Unfortunately, the American Association of Medical Colleges (AAMC) has not included in its resources COVID-19 any formal plans on how to safely and effectively take advantage of the clinical training of even fourth-year medical students. However, there is still time to implement a preparedness plan that enables trained students to support and serve in this growing crisis.

By Ashleigh Peoples, epidemiologist and medical student at Wayne State University School of Medicine. Article in English

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