As hospitals around the United States brace for an ongoing surge in coronavirus cases, one question they are grappling with is whether medical students should be deployed to help care for patients infected with the virus.
For now, the nation’s 90,000 medical students have been largely sidelined from patient care during the crisis. Last week, the Association of American Medical Colleges recommended that medical students end all patient contact for at least two weeks. The reasoning is that sending medical students home helps conserve scarce personal protective equipment — including masks, gloves and gowns. It also gives schools time to educate students on Covid-19 should the students eventually be needed for patient care.
Disappointed by the abrupt halt to their training, medical students around the country have responded with grass roots efforts to secure masks, staff patient call centers and even provide child care for beleaguered doctors.
Students at the N.Y.U. Grossman School of Medicine began using a Slack channel to mobilize volunteers. One of the largest efforts involves creatively sourcing personal protective equipment from a range of businesses, including veterinarians, tattoo parlors, dry cleaners, hardware stores and hair and nail salons. So far, students from N.Y.U. have collected about 8,200 surgical masks and 700 of the more protective N95 respirator masks.
“I thought I’d be learning to listen to the heart and lungs or conduct an outpatient interview, but that’s not what is needed right now,” said Elyse Berlinberg, a second-year medical student at N.Y.U. “Part of the role of being a physician is being part of the community and knowing their needs and responding to them. I think the service we are doing now is part of forming our professional identity.”
Another “mask drive,” held by medical students at the University of California, San Francisco, over the weekend, collected almost 15,000 masks for local hospitals.
At the University of Colorado School of Medicine, student organizers used a GroupMe texting app, Facebook and email to mobilize not only classmates but also area nursing, physical therapy and pharmacy students. Now more than 300 student volunteers are working at nine locations in the area, including hospitals, elder outreach programs and the local Salvation Army.
Some students have been deployed to Covid-19 call centers, fielding questions about people’s symptoms and when to get tested or go to the hospital. Others students stand outside hospital doors, screening visitors.
“I was supposed to start a palliative care rotation on Monday, and I can’t, and I won’t get those skills,” said Jake Fox, a fourth-year medical student who helped coordinate the effort, and who will start his residency at Massachusetts General Hospital in Boston in June. “That said, what we are doing is very purposeful. Doing something meaningful now supersedes that disappointment.”
Students at the University of Minnesota School of Medicine organized Minnesota CovidSitters, a student-run group that created a website to match medical students with health care workers who need child care, pet sitting or errands during the crisis.
Laura Bowman, a second-year medical student there, volunteered and was matched with a medical resident who needed child care for two young children. Ms. Bowman spent a rainy day last week baking chocolate chip cookies, doing a dinosaur puzzle, and coloring a Paw Patrol Rescue Pups coloring book with two young children of a medical resident. “It isn’t exactly what I pictured myself doing, but it’s in line with my idea of health care providers,” Ms. Bowman said. “It’s been a great opportunity to help in a different but meaningful way.”
Opinions are divided and changing as the outbreak progresses. Some argue that students’ lack of experience limits their value in treating patients and puts the students needlessly at risk. Others say they will be needed, can be trained to help safely and will learn valuable lessons from being involved.
Dr. John Prescott, chief academic officer for the Association of American Medical Colleges, said the group will continue to update its guidelines for medical students, but the decision on whether to deploy medical students to the front lines is up to each school, depending on the local situation.
“What was normal a week ago, even two days ago, is not where we are now,” said Dr. Prescott. “The situation continues to evolve and change.”
Boston Medical Center has decided to keep medical students away from patients with suspected or confirmed coronavirus infection, Dr. Ravin Davidoff, the center’s chief medical officer, said.
“Our primary emphasis is to protect them from unnecessary exposure,” he said, but added that the shortage of personal protective equipment was also a major reason for limiting the students’ roles.
Vanderbilt University Medical Center has also decided that medical students should not treat coronavirus patients. But Dr. William Schaffner, an infectious disease expert there, said it could be valuable training.
“They’re going to have to deal with this as medical professionals, as practicing physicians, whatever their specialty turns out to be,” he said.
At the same time, Dr. Schaffner said, concerns about the supply chain for personal protective gear were also leading Vanderbilt to limit the number of people entering isolation rooms to the minimum number truly needed to take care of the patient.
Dr. Shanta Zimmer, senior associate dean for education at the University of Colorado School of Medicine, said the school decided that 184 third-year medical students would not return to their clinical rotations starting last Monday, for at least four weeks.
“The most important reason is actually to help preserve PPE,” she said, referring to masks and other protective equipment, “and to let the important front-line providers have access to that.”
Other factors, Dr. Zimmer said, included the fact that elective procedures have been scaled way back at the hospitals where University of Colorado students do their rotations, and that the students are needed at call centers and to check in with primary care patients. All students are also taking an online elective that the medical school just created about Covid-19.
“Not everyone is destined to be a front-line provider in situations like this,” Dr. Zimmer said. “But it doesn’t mean they can’t be super helpful right now.”
As for whether the medical school would agree to deploy its students to the front lines in the event of a surge of patients, Dr. Zimmer said, “We are having this debate back and forth on my team right now. The fourth-year students, they’re almost doctors — graduation is in May. For the third-years, we are trying to prioritize their safety and keep them busy with virtual training.”
Cyrus Ghaznavi, a second-year medical student at Washington University School of Medicine in St. Louis, said a child-care service organized by students to support hospital workers received more than 100 requests in the first 24 hours.
“Anything we can do to relieve burden on the real heroes,” he said. “We can enable them to work at peak performance and that is more helpful than having us there when everyone is overworked.”
Denise Grady contributed reporting from New York.
Source : Nytimes