The covid-19 pandemic has changed almost all aspects of our world, necessitating rapid and flexible adaptation. Medical schools are having to deal with the pandemic as organizations responsible for teaching students, but also as a bridging point between medical students and the healthcare system. In complying with the physical distancing guidelines issued in many countries, medical schools turned rapidly from teaching in lecture halls and classrooms in the pre-clinical education programmes, to online remote lectures and small-group discussions. This was the case at the Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, in Safed, Israel, where the pre-clinical studies transitioned to fully online studies during the course of a single weekend in the middle of March.

The issue of clinical studies and students’ continued education in hospitals and community clinics was a more complex decision. After initial debate, many medical schools worldwide suspended this part of medical education in face of the covid-19 pandemic, while following the course of disease spread. Accordingly, in March, we decided to suspend studies at clinical sites, thereby effectively suspending educational activities for students in the upper years. The main consideration in this decision was not to expose the potentially most vulnerable patients to asymptomatic, but possibly coronavirus-infectious students in a non-essential interaction.

Other considerations included conserving the limited personal protective equipment (PPE) available, mitigating significant risks of SARS-CoV-2 infection among medical personnel, associated liability issues, and limited time and resources of clinical medical educators. The closure of schools and childcare facilities also played a part as staff and students needed to be on hand to help look after their families. The Forum of Deans of Faculties of Medicine in Israel (comprising the deans of the five faculties of medicine in Israel teaching clinical education) published a joint statement on 13 March, 2020, suspending, until further notice, medical education at clinical sites. On 17 March, 2020, the Association of American Medical Colleges (AAMC) issued a similar guideline. [1] The AAMC also stated that if the need to include medical students in direct patient care arises, due to critical healthcare worker shortage, medical student participation should be voluntary, not mandatory. [2] The Medical Schools Council (MSC) in the United Kingdom issued updated statement regarding medical student volunteers on 2 April 2020. [3] The statement differentiates between paid, structured part-time work that clinical-years students may volunteer to undertake in the National Health Service (NHS) and the general national call for unpaid volunteers to assist the NHS, suitable for medical students in the early years of their course.

At the Azrieli Faculty of Medicine, the Galilee Medical Student Association started enrolling student volunteers independently, as a unique initiative, in parallel with the decision to suspend clinical education on 13 March, 2020. This initiative enrolled volunteers to work in the healthcare system via students’ social media. The Student Association approached the 300 students in clinical years. The initiative proved to be a rapid success with over 100 students signing-up immediately, later expanding to other medical faculties in Israel as a joint mission with over 2000 students signing-up shortly thereafter. Students started volunteering on 16 March, 2020. Just three weeks later, we estimate that around 1500 students from all medical schools in Israel were volunteering in various roles, related to patients with chronic medical conditions and to covid-19 patients. The first activity was a nation-wide training session for medical students on appropriate use of PPE and correct sampling technique for SARS-CoV-2, administered by the Israeli equivalent of the Red Cross organization (Magen David Adom [MDA]). The spectrum of student volunteer activities have ranged from active collection of samples for SARS-CoV-2 from persons under investigation (PUI) and participation in performing SARS-CoV-2 diagnostics in laboratories, to telephone calls to senior citizens in order to assess their medical and social needs. Over 50% of the students in clinical years at the Faculty are currently volunteering. 

Medical student volunteer activity at MDA contributes substantially to daily sampling for SARS-CoV-2 of target populations at designated coronavirus testing drive-ins, home visits, and in long-term care facilities and retirement homes. MDA is the primary organization responsible for most of the SARS-CoV-2 sampling in Israel. Indeed, it is estimated that on some days, medical students from all faculties performed the majority of Israel’s daily sampling. Our students report feeling solidarity with the medical profession and deep satisfaction, not dimmed by the tiring and long hours wearing PPE. Furthermore, students feel that they contribute significantly to the fight against coronavirus, the biggest challenge that they have faced nationally during their lives, whether by working at the frontlines taking samples from ill individuals or by reducing the solitude of the elderly by calling to enquire how they feel. 

At the same time, the Faculty’s leadership supported and encouraged the students in their activities. The Faculty approached the affiliated community clinics and hospitals in the Galilee region in order to understand their needs and coordinate volunteering. Health and employment insurance was organized by Bar-Ilan University and provided to volunteers, and an infectious diseases expert from the Faculty’s academic staff (one of the authors) was available to answer enquiries regarding covid-19 in general (for students and their families) and safety issues relating to volunteering in particular. The Faculty also verified that students participating in clinical work have sufficient PPE while volunteering and acquired PPE for student use. 

There are, however, also unresolved issues. For example, should there be any form of academic recognition of such volunteer activity? The Faculty understands the many merits in volunteering, but we also realize that due to health and social factors not all students can volunteer. Other debates relate to the correct balance between volunteering nationally (close to the student’s living area) and helping at the Faculty’s geographic catchment area (under-privileged area in northern Israel). Additionally, the interplay between time dedicated to volunteering and the time needed for studies, as online clinical teaching sessions are to commence shortly for students, is another aspect to consider. As some of the volunteering opportunities are transitioning to compensated temporary employment positions for some (but not all) of the students, new issues may arise requiring creative solutions. [3-5] 

This is the first pandemic that combines an extremely capable virus and an ultra-technological world, necessitating flexible, rapid, out-of-the-box thinking and action. Our students, already well adapted to the digital era, were ahead of us at the Faculty’s leadership in initiating and executing volunteering at the frontlines of the pandemic. We salute them and need to use our experience and time-honored wisdom to support them and steer the efforts towards the perfect balance between medical education and professional values in the times yet to come in this unprecedented era.      

Daniel Glikman, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, and Infectious Diseases Unit, Padeh-Poria Medical Center, Israel

Competing interests: None declared

 

Lilach Malatskey, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, and Clalit Health Services, Sharon-Shomron district, Israel

Gai Aviv, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel

Omri Cohen, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel

Yotam Pelleg, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel

Johnny S Younis, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, and Reproductive Medicine, Padeh-Poria Medical Center, Israel

Eric S Shinwell, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, and Department of Neonatology, Ziv Medical Center, Safed, Israel 

Karl Skorecki, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel

References:

1. Important guidance for medical students on clinical rotations during the coronavirus (COVID-19) outbreak. Press release. Association of American Medical Colleges. Published March 17, 2020. Accessed April 10, 2020. https://www.aamc.org/news-insights/press-releases/important-guidance-medical-students-clinical-rotations-during-coronavirus-covid-19-outbreak
2. Interim guidance on medical students’ participation in direct patient contact activities: principles and guidelines. Association of American Medical Colleges. Published March 30. 2020. Accessed April 10, 2020. https://www.aamc.org/system/files/2020-03/meded-March-30-Interim-Guidance-on-Medical-Students-Clinical-Participation_0.pdf
3. Medical Schools Council, Statement of Expectation, Medical Student Volunteers in the NHS. Published April 2, 2020. Accessed April 16, 2020. https://www.medschools.ac.uk/media/2627/updated-volunteering-guidance-020420.pdf
4. Miller DG, Pierson L, Doernberg S. The role of medical students during the COVID-19 pandemic. Ann Intern Med. Published online April 7 2020. doi: 10.7326/M20-1281.
5. Rose S. Medical student education at the time of COVID-19. JAMA. Published online March 31, 2020. doi:10.1001/jama.2020.5227.