By now, we've seen plenty of stories about medical students being allowed to graduate early(www.aamc.org) to enter the fight against the COVID-19 pandemic. These learners represent the next generation of physicians, and the pandemic is likely to provide them with real-world training they'll be able to use throughout their professional careers.
But as the familiar adage goes, there's no substitute for experience. Students, early medical school graduates and even residents don't yet possess the knowledge that comes from years of working in the clinical setting. There's a certain level of risk involved -- but then again, treating patients in the middle of a pandemic is an inherently risky job for anyone.
Under these circumstances, ensuring the physical and emotional well-being of medical learners working on the front lines of care is paramount. That's why the AAFP has created a policy(307 KB PDF) designed to protect medical learners during public health crises such as the current pandemic.
"The AAFP supports prioritizing the safety and wellness of learners," said Clif Knight, M.D., the Academy's senior vice president for education. "It is important for the learner to feel safe and not be asked to function without appropriate support and supervision. Optimizing patient outcomes in the short term is important, as is the sustainability of learner wellness through an extended, successful career in medicine."
- Increasing numbers of medical students and residents are playing crucial roles in patient care during the ongoing COVID-19 pandemic.
- The AAFP has developed new policy to safeguard the physical and emotional well-being of medical learners during the pandemic and similar health crises.
- The policy addresses topics such as provision of clinical services, appropriate supervision, and educational timelines and requirements.
The policy consists of 10 principles covering various topics that must be consistently applied to ensure optimal safety and wellness for medical learners. Among them are
- Clinical services. Including learners in the provision of services beyond the educational requirements of their training must occur on a voluntary basis.
- Personal protective equipment. PPE and training on how to use it must be provided for all learners in accordance with best practices.
- Supervision. All trainees must be appropriately supervised when providing clinical services, and supervisors must ensure that learners adhere to applicable work hour regulations.
- Decision-making. Medical learners should be included in decisions regarding their roles and informed about any decisions that affect their responsibilities and opportunities.
- Education. Every effort should be made to protect learners' educational timelines and requirements. If adjustments are necessary, every consideration should be made to ensure they have fair and accessible opportunities to complete requirements effectively and efficiently.
- Quality of care. Patient safety and high-quality care must be maintained. Patients should have access to learners who possess the appropriate medical knowledge, skills and expertise to serve their needs, along with the ability to consult with other care team members.
"This policy is important because there is so much fear and uncertainty in medical education right now," said Margaret Miller, student member of the AAFP Board of Directors. "Every level of training has been affected by what is happening in hospitals around the country. As a fourth-year medical student who will become a resident in early June, I feel more confident about joining the front-line fight knowing the AAFP is promoting adequate safety measures for me and my patients."
"I believe that this policy is important in that its aim is to protect the improved yet still imperfect aspects of graduate medical education as it relates to medical learner wellness and safety," agreed Kelly Thibert, D.O., M.P.H., the Academy's resident Board member.
Weighing Whether to Involve Learners
Knight has considerable experience with medical learners from his tenure as a family medicine residency director at the Community Health Network in Indianapolis from 2001 to 2007. He's also no stranger to public health crises, having served as the chief medical officer of Community Health Network during the 2009 influenza A (H1N1) pandemic.
"Our learners were involved in some of our temporary sites of care under the direct supervision of their preceptors," Knight recalled. "My sense is that it was an excellent learning experience for them."
Regarding the current pandemic, he listed some reasons learners should be involved in treating coronavirus patients, starting with the matchless learning opportunities it offers them.
"Depending on their level of training and expertise, they can significantly assist as members of the care team," Knight said, adding that trainees also "may be able to provide services that allow other health care professionals the capacity to provide care at a higher level."
At the same time, he acknowledged that there are situations where it may be best for learners to not be involved.
"If the learner isn't materially contributing to patient care, the risk of harm may outweigh the benefits of participation," Knight said. "If there are limited PPE supplies, it may be better to prioritize those resources for the care team and not involve learners who would need appropriate PPE as well."
Regardless of their level of involvement, he added, "It is critical that learners be involved in the decision-making that impacts their safety and wellness."
Learners on the Front Lines
Miller, who attends Quillen College of Medicine at East Tennessee State University in Johnson City, told AAFP News that students in her part of the country are not currently seeing high numbers of coronavirus cases -- certainly nothing that would affect residency timelines. But they're staying involved, nonetheless.
"Our students … are contributing by babysitting children of health care workers, running drive-through testing centers, organizing medical equipment drives and donating blood," she said.
Miller's greatest concern is for friends who are moving to areas where large numbers of cases have been reported.
"Other resident and student leaders are working in hospitals without enough PPE, being pulled off elective rotations, skipping vacations and working furiously on the front lines," she explained. "These trainees, including early graduates, are making huge sacrifices, including risking their health and the health of their families, and they should be protected and fairly compensated for doing so.
"Physician trainees are the front line in many of our hospitals, and policies from organizations like the AAFP help us fight for what we need."
Residents May Face Unique Challenges
Thibert, a family medicine resident at the Grant Family Medicine Residency at the OhioHealth Grant Medical Center in Columbus, said that residents may encounter distinctive situations based on their professional standing.
"Resident physicians are in a unique position during this pandemic in that we are physicians and trainees," Thibert said. "We are still learning, no matter what postgraduate year we are in, and we are being challenged with balancing expanding our medical knowledge while trying to stay up to date and care for an influx of severely sick patients during a pandemic."
In addition to expanding their clinical skills, she added, residents are also being tasked with learning skills specific to family medicine at a time when in-person educational opportunities have been greatly reduced.
"On top of the clinical challenges and changes comes the behavioral health component," Thibert said. "Not only are we asked to care for patients with increased depression and anxiety, but we ourselves must deal with a new set of ever-present emotions."
The pandemic, she said, has left many residents wondering how they can protect their health so they can care for patients, help other residents and be ready to assist as needed.
"The physical and emotional impact is real and we need to be certain now, more than ever, that we do not roll back any advancements that have been made by our governing bodies and that we continue to protect the well-being of our medical learners," Thibert said. "Having organizations like the AAFP create policy statements such as this is a reminder that we do have support and that we can and should continue to advocate for what we need as learners."
Related AAFP News Coverage
AAFP Eases CME, Dues Deadlines so FPs Can Focus on Pandemic
ABFM Also Announces Changes in Response to COVID-19
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