As the coronavirus pandemic fills up hospital beds across the country, the Association of American Medical Colleges (AAMC) issued guidelines stating that unless there is a critical health-care workforce need locally, it is strongly suggested that medical students not be involved in any direct patient care activities. Is this the right move for students and for patient care? A medical student debates with an admissions dean.
YES: Medical students can help alleviate pressure on an overburdened health-care system.
By Ginikanwa Onyekaba
I am a medical student. Only a few weeks ago, I was checking in daily on a patient recovering from a kidney transplant. This week, I barely checked out of my apartment.
Medical education faculty have relieved medical students of all clinical responsibilities in response to the emerging coronavirus crisis. My classmates and I have mixed emotions: fear for the well-being of our vulnerable relatives and patients, frustration with the government’s response, and anxiety about our uncertain future.
But most of all, I am disappointed that my involvement in patient care has been deemed nonessential in accordance with guidelines released by the Association of American Medical Colleges (AAMC), which oversees all medical schools. On the contrary, I believe this is precisely the moment to allow medical students to rise to action and to help defeat this pandemic.
Medical students can play an instrumental role in alleviating pressure on an overburdened health-care system. On the day of our white coat ceremony, we signed up to be on the frontlines, and we made an oath to treat the sick. Now that we can be of help, many medical schools have banned us from participating in patient care.
I feel like my medical education has been put on pause with a subpar replacement. How can a virtual clerkship curriculum compare? And especially at a time when the health-care system needs all the help it can get. What will be our next steps if/when the health-care system becomes overwhelmed?
I worry that schools have inadvertently sidelined an unappreciated workforce, taking away their opportunities to help. Students can relieve the duties of more skilled members of the medical team by assisting in tasks that are non-patient-facing. We can help with triaging patients, writing up medical notes, completing consults, and making phone calls.
I worry that schools have inadvertently sidelined an unappreciated workforce.
Many students have been instrumental in mobilizing efforts to donate personal protective equipment (PPE) to medical centers. Ramie Fathy, a third-year student at Penn, recently started a Facebook group that has been effective in collecting and publicizing funds to assist the less fortunate during this crisis. Another student, Jalen Benson, a first-year at Harvard Medical School, is organizing a national database of medical students who are willing to volunteer and help out with tasks like grocery shopping, child care, pharmacy pickup and delivery, coordination of PPE efforts, and telemedicine triage.
In these unprecedented times, I know that we must prioritize the safety of patients and students. Schools reasonably must regard students both for the potential liability of placing them in harm’s way and as potential spreaders of this disease. But we are adults and should have been given the opportunity to make this decision for ourselves. We have a great deal of relevant practical clinical experience that is not only useful but soon to be in desperately short supply. By participating in non-patient-facing clinical duties, we can still conserve resources. With a little training, we can relieve the more rudimentary medical duties and free up time for skilled medical professionals to fully devote their time to patient care.
COVID-19 is a rapidly evolving situation. I don’t want to look back with regret, wondering: What more could I have done? Let us help.
Ginikanwa Onyekaba is a second-year medical student at the Perelman School of Medicine at the University of Pennsylvania.
NO: As coronavirus care increases, health-care providers need to focus on patient care first.
By Neha Vapiwala
The coronavirus pandemic inspires many adjectives about the times we are living in — unsettling, uncertain, unprecedented. The thing about unprecedented times is that there is no playbook. Amid all this turbulence, one can only hope that high-impact policies are developed with the best available data, with the most transparent processes, and with the purest intentions.
It is from this perspective that the Association of American Medical Colleges (AAMC) issued much-needed guidance regarding one of our nation’s most valuable human resources — medical students. The guidelines state that unless there is a critical health-care workforce need locally, it is strongly suggested that medical students not be involved in any direct patient care activities.
The critical role of frontline health-care providers (HCPs) has become the focus of the public’s hope and support unlike any time in recent history. Although not fully trained or cleared for independent practice, our eager medical students want the opportunity to contribute to patient care during this time of need. However, how students can meaningfully contribute varies, depending on who you ask and what you are willing to risk.
The AAMC guidance statement is ultimately based on considerations for the safety of patients and students. Local institutional officials may choose to issue policies that supersede this guidance, but it is firmly rooted in two principles critical to COVID-19 management: resource conservation and mitigation of transmission.
The frightening shortages of personal protective equipment (PPE) and testing capabilities are significant, but our frontline HCPs are also a precious resource — and not one that can be easily replaced by even the most talented medical students. Our HCPs teach, mentor, and supervise students; doing so effectively amidst the stress of active COVID-19 patient care would be untenable. Non-COVID-19 patient care has been heavily curtailed in an effort to reduce viral spread, rendering the relative value of having extra bodies to assist in clinics rather low. Even non-patient-facing duties performed onsite would require supervision and direction from HCPs, risking exposure of otherwise healthy students.
Our HCPs teach, mentor, and supervise students; doing so effectively amidst the stress of active coronavirus patient care would be untenable.
This connects to the second critical factor of mitigating infection risk. A staggering percentage of documented cases in the U.S. resulted from viral transmission through infected health-care providers. Coupled with the fact that healthy younger members of our population are unwitting asymptomatic carriers, having medical students onsite poses a public health conundrum. Medical students who are willing to see patients may accept the personal risk, but who is willing to accept their risk of becoming vectors for transmission to others? And while volunteering sounds like a nice option, the flipside of that coin is the coercion some of their peers may experience for fear of being seen as less brave, less committed.
The guidelines of today may change based on the circumstances of tomorrow. But in the wake of so much uncertainty, despite the purest of intentions, we must first do no harm and continue to make decisions with the best available data. Should medical students be deemed essential in this fight in the coming weeks, they will be welcomed, and we will find a way to integrate them safely and effectively.
Neha Vapiwala is an associate professor of radiation oncology, vice chair for education, and associate dean of admissions in the Perelman School of Medicine at the University of Pennsylvania.