A lack of clarity and collaboration has hampered final year medical students seeking to help with the US’s response to covid-19, says Keerthi Gondy
Two months ago, I was on my internal medicine gastroenterology rotation. My supervising clinicians had informed me of a new patient to be seen. I gathered my stethoscope and my poorly fitted white coat and headed down to the emergency department to see our fifth admission that day.
Yellow rectangular signs appeared on every other room. Droplet. Contact. Droplet. Contact. As I made my way through the maze that is the emergency room, I was stopped by the sight ahead: stretchers rolling past me, groups of nurses crowded around the main monitor, and every single staff member wearing pasty yellow gowns, dark blue gloves, and N95 face masks. I knew we’d had our first case of covid-19 earlier that week, but like so many others, I had no idea of what was about to ensue.
As students, we pursued medicine in order to make a difference to our patients’ lives. Although we have a sincere desire to be a member of the team, under current circumstances our presence serves as an unnecessary source of transmission. Despite not being able to be in the hospital, medical students across the UK and US have found other ways to support the healthcare system in the past few months, including calling local businesses for personal protective equipment (PPE), delivering meals to senior citizens, or converting in-person clinics to virtual visits.
While these are incredibly useful efforts, there is still a critical shortage of medical workers as current physicians are severely overworked, with many having gone into quarantine after being exposed. On 25 March, various UK medical education bodies, including the General Medical Council (GMC) and the Medical Schools Council (MSC), stated that final year medical students who had completed the GMC’s outcomes for graduation would be offered the opportunity to become doctors on the NHS frontline.
It was a unified approach by all four UK nations to respond to the extreme pressures of covid-19. The expectations of medical schools and their students was clearly outlined: the GMC would provisionally register any final year medical student who voluntarily opts in, provisional registration fees would be covered by the UK Foundation Programme (UKFPO), and doctors would sign foundation year 1 (FY1) contracts in order to be paid. Additionally, students would be appropriately supervised and employers would decide where to best deploy FY1s.
Usually, UK final year students undergo a strict qualification process, including several months of clinical electives and apprenticeship-style work placements, in order to become a practicing medical professional. However, these processes have been efficiently fast tracked to meet the urgent demand in the healthcare workforce. University College London, for instance, was one of the first medical schools to graduate its cohort after final exams were administered in a modified virtual form. Other UK medical schools rapidly worked to facilitate their own fast tacking of final year students.
Medical students in the US have faced a uniquely different situation. On 17 March, the Association of American Medical Colleges (AAMC), the equivalent of the GMC and MSC in the UK, declared that all medical students were suspended from clinical rotations until further notice. The reasoning for the guideline was twofold: to allow medical schools to develop programs to educate their students on covid-19 and to conserve PPE during a national shortage. No guidance was provided on the status of fourth year medical students and what their roles could be during this time.
Since students matched into their residency programs on 20 March, thousands of fourth year students across the US have therefore found themselves in limbo, as they have completed their graduation requirements but are waiting until the official start date of 1 July to begin practicing medicine. In New York, which quickly became the epicenter of covid-19 in America, such a prolonged waiting period seemed ill advised. In response, New York University’s (NYU) Grossman School of Medicine became the first in the US to officially allow senior medical students to graduate early and enter the workforce in April. Sixty nine of the school’s 122 fourth year students agreed to volunteer as interns at NYU’s emergency rooms and medicine floors. Columbia, Tufts, and Boston University similarly followed suit and asked their fourth year medical students to graduate and volunteer early.
In the wake of the AAMC’s initial statement, and with no further advice from them as to what the rest of the nation’s hundred plus medical schools should do, schools have been left to individually decide whether they offer fourth year students the option to graduate early. Additionally, unlike in the UK, even if students have completed their requirements and would like to opt in, some are facing obstacles to doing so because of their own institutions’ rules and regulations. Back in April a fourth year student at the University of Michigan Medical School commented, “Students are used to feeling like a part of the medical team, especially at Michigan, and I can’t help but feel sidelined during all this. I’m not able to help patients for another three months even if I’ve finished my requirements.”
Unlike in the UK, where medical students must spend their first year of practice in specific training posts with a provisional license to practice, US students are immediately licensed to practice medicine after graduation. If the UK’s GMC can accelerate their national procedures in such a short period of time, US medical schools should work to collaboratively create a system to do so as well. Unfortunately, independent actions from American states and their respective medical schools has led to a significantly disparate response to this pandemic.
While the UKFPO will be paying their FY1s, US medical schools have asked their students to volunteer. Salary is not provided and any fees, such as those related to registration, travel, or housing, are not covered. Although it is not yet clear how many students are directly taking care of covid-19 patients or helping those who are non-covid and low risk, students are still working in the hospital setting, increasing their risk of contracting the virus. They, along with other essential healthcare professionals, should be compensated fairly for the work they are doing under unique pressures.
Compared with the rest of the world, the US was one of the slowest countries to roll out testing for covid-19 and to issue stay at home orders. At this point, we must learn from our colleagues in the UK and the need for speed. We should encourage guidance from our AAMC and open collaboration between medical schools in order to create a unified front and a transparent framework that efficiently allows students to graduate early. If we do not act, we will once again lag in our response to this pandemic and the impact on our healthcare system will continue to be far reaching.
Keerthi Gondy is a rising fourth year student at the University of Michigan Medical School.
Competing interests: None declared.