Case: The role of medical students during an emerging pandemic

In a series of memoranda, The Association of American Medical Colleges (AAMC) has issued guidelines for medical schools in the setting of the COVID-19 pandemic. On March 30^th, the AAMC issued “Interim Guidance on Medical Students’ Participation in Direct Patient Contact Activities: Principles and Guidelines.” This guidance generally discourages clinical care by medical students:

“Unless there is a critical health care workforce (HCW) need locally, we strongly suggest that medical students not be involved in any direct patient care activities for the next two weeks, through April 14, 2020. The primary goals of this guidance are bending the curve for the public health of North America, conserving limited PPE supply to keep HCW and patients safe, and maintaining public and HCW safety given current testing availability.”

The guidance offers additional criteria for involving medical students in clinical care during this period including (summarized):

• Medical students’ participation in direct care of patients should be voluntary, not required and should be motivated by for public service or humanitarian reasons only and will not be compensated. Such voluntary activities should not disrupt students’ continued participation in any core, ongoing learning activities. Core curriculum academic credit should not be offered to students volunteering to participate in direct care of patients

• “The school should also confirm and document that student volunteers have been informed, to the extent possible based on current knowledge, of all risks associated with the clinical care of patients in the pandemic, particularly of patients with known or suspected COVID-19, including (a) the procedures for care and treatment and a definition of financial responsibility should exposure occur and (b) the effects of subsequent infectious and environmental disease or disability on future medical student learning activities and progression to graduation.”

Of note, this guidance removed the previous contingency that “Sufficient and appropriate personal protective equipment must be available for all student volunteers in all health care settings.”

Questions:

1. Do you agree or disagree with this guidance on the role of medical students during the COVID-19 pandemic? Why or why not?

2. How should we think about PPE for students? In settings in which the PPE supply chain is disrupted, should students be able to work under the same conditions as health professionals in the hospital/region, or should they only be allowed to work if “full PPE” is available? How should the “volunteer” designation impact safety considerations for students?

3. Some medical schools have announced plans to graduate 4th-year medical students early, to allow them to begin their postgraduate medical training on an expedited schedule in order to provide direct clinical care services needed during the pandemic. Is this an ethically sound plan? How does this compare to the AAMC’s recommendation that medical students perform direct patient care duties purely on a volunteer and uncompensated basis?