Rope in medical students in the COVID-19 battle
Students have acted in a medical capacity both during the Spanish flu of 1918 and the 1952 polio epidemic in Denmark, says Savitha Kuttan
The Coronavirus pandemic has upended the healthcare sector and is forcing us to reevaluate medical education as well. Owing to the uncertainty and disagreement regarding the roles of medical students during a pandemic, the participation of students in clinical care has varied across states. Some argue that students should not be allowed to interact with patients whereas others maintain that students must be recruited for hospital based roles or allow them to graduate early, so that they can join the frontline and serve with other physicians.
According to the central government, there are just over one million doctors registered with the state medical councils. Approximately 80% of them are in active service. This means that we have just one doctor for every 1,500 people. While this is significantly short of the WHO recommended doctor patient ratio of 1:1000, it is even more worrisome considering the fact that we are in the middle of a pandemic.
The traditional roles
We have to acknowledge the role of medical students as physicians-in-training. While their primary role is to learn medicine, they also interview patients, call for consultations, respond to emergency messages, communicate with the patients’ families, assist with complicated procedures, write notes, and help coordinate care and plan discharge.
If medical students act solely as learners during the pandemic, it can create unnecessary risks for the patients and other clinicians. They can act as vectors for transmission, consume PPE kits, and place additional burdens on teaching physicians. However, if they are allowed to serve in a clinical capacity, it may benefit the patients overall.
Such an involvement will not be without precedent. Students have acted in a medical capacity both during the Spanish flu of 1918 and the 1952 polio epidemic in Denmark. Factoring in the proportions the current pandemic has reached, some medical schools in Italy, the United Kingdom and the United States are allowing medical students to graduate early provided they serve in the frontline.
Time to assign clinical roles for students
We should not wait for the healthcare system to reach a breaking point before we invite students to serve. They are adept at many clinical roles and we should make full use of it as long as they are ready. For instance, medical students can surely assist with regular outpatient care. They can help boost the efficiency of understaffed clinics by taking medical histories, calling the patients with their lab results, educating patients, documenting patient visits, and answering questions about COVID-19. Even during a pandemic, patients who suffer from chronic conditions need ongoing care. Pregnant women need regular check-ins, and discharged patients require routine follow-ups. A number of these tasks can be performed with the help of telemedicine so that there is no risk of infection.
Students can also administer care to inpatients who don’t have COVID-19. Under the supervision of attending physicians or senior residents, a lot of upper-level medical students carry a patient load. If medical students are absent, these patients would have to be covered by resident physicians which will only exacerbate the personnel shortage. By staffing the hospital with medical students, we can maximise the availability of other physicians to treat COVID-positive patients. In addition, the risks associated with student involvement are considerably lower than the risks to retired physicians, who are more vulnerable to the infection owing to their age. However, considering the fact that we cannot overlook personal risks, any student participation must be strictly voluntary.
Medical students can also remotely assist with the care of COVID-19 patients. They can monitor patients with mild symptoms who are not yet admitted, review the charts of admitted patients and expedite medical care, draft notes, ensure that tests are performed in a timely manner, and follow up with patients who have recovered and discharged successfully. Although most of the aforementioned roles require physician supervision, mobilising students will definitely reduce the burden on clinical teams.
We should also start training medical and nursing students on how to deal with COVID-positive patients as it will help strengthen the health workforce and keep them from crumbling in the event of a rapid transmission. For instance, online CME platform Omnicuris has already launched a COVID training module in collaboration with Rajiv Gandhi University of Health Sciences and Maharashtra University of Health Sciences. We need to preemptively scale up such measures so that our healthcare facilities, especially in hotspots, are battle ready.
As the state and central governments decide on the appropriate course of action, we should get more used to the idea of students volunteering for service. After all, medical students are physicians who have responsibilities and they should be allowed to perform their duties. Not only will it benefit patients and the overburdened healthcare system, allowing students to lend a hand will instill positive values such as altruism, service to others, and solidarity.
Savitha Kuttan is CEO & Founder with Omnicuris.