Dr. Dave Campbell, Chief Medical Correspondent, Morning Joe/MSNBC
Assistant Professor of Orthopaedic Surgery, University of Central Florida College of Medicine
Al Moses, 4th year medical student, University of Central Florida College of Medicine
New York State Governor Andrew Cuomo implored other cities and states to prepare for the worst. The pace of COVID-19 in New York City is accelerating beyond our wildest nightmares.
“This will be an American problem across the board,” NYC Mayor Bill Di Blasio said on Fox News. “It will just take some time to reach full strength in some places.” New York University offered early graduation to fourth year senior medical students to assist in the City and State’s accelerating efforts to combat the crisis. The announcement was sent to medical students earlier this week.
The ethical dilemma engrained in training medical personnel is as age-old as the practice of medicine itself. How do we train incoming medical practitioners while preserving patients’ right to receive equal and adequate healthcare? To complicate matters more, what is the role of the medical student during a healthcare crisis, such as our current situation with COVID-19?
Canadian physician and one of the four founding fathers of Johns Hopkins University, Sir William Osler, is credited with the subtitle to this article. If he were alive today, Dr. Osler may have something to say about accelerating medical school graduation to serve the greater good. He created the first residency program for specialty training and was first to bring medical students from the classroom to the bedside for clinical training.
As healthcare supplies dwindle and patient load increases, our healthcare providers are being overworked and are at increasing risk of becoming ill. This will worsen in the coming weeks. Combined with our already previous shortage of practitioners, our system is in danger of running out of providers. A potential solution to this issue is the early integration of medical students into the field by accelerating their graduation by only a couple months. Medical schools have already canceled in-person classes replacing course instruction with on-line education. How much more do fourth-year medical students need to learn before being allowed to pitch in as physicians?
“With graduation only a couple of months away, fourth-year medical students have the experience and knowledge to help mitigate this crisis,” William Wallace, 3rd year medical student at St. George’s University told us. “However, this young workforce is not being allowed to aid in the fight. I believe accelerating their degrees will permit these young doctors to serve as a valuable extra set of hands, and being on the young side, they should be less susceptible to the more serious symptoms of COVID-19.”
This concept is being implemented in Italy to offset the growing number of sick that are currently overwhelming their healthcare system. In contrast, in the United States, many medical schools have postponed clinical responsibilities for students, leaving them anxious and in fear of the impact this may have on their career.
As expected, there are disparate opinions. “The fourth-year medical student curriculum is designed with redundancy, similar to many third-year rotations we have already completed,” Jake Cotton, a fourth-year medical student in the U.S. told us. “To be exposed to [this pandemic response] and learn what hospital systems are doing could be invaluable should we be faced with this type of outbreak again in our careers.”
“This is an all hands-on-deck situation in the medical arena,” Sirikanya Sellers, another 4th year medical student exclaimed. “Most if not all of us have finished our required medical school training and would normally use this time to celebrate and go on vacations with family and friends. Instead, we are waiting in our social-distancing room as the days blur together.”
There are risks and benefits to consider with the graduation acceleration plan. Adding stress to already overworked house-staff and attending physicians, called upon to train the greenhorns may be counterproductive. That training will be less efficient in a time of crisis when lack of efficiency could cost lives. Patients will receive care from these newly inducted doctors that has less basis in clinical experience and judgment.
Despite the inexperience, new doctors will be compassionate and eager to care for patients and get the experience that might otherwise take years to garner. No matter how you analyze it a fourth-year medical student quickly minted as a physician has much more to learn.
“[Medical students] are way smarter and more helpful than people give them credit for,” a first-year emergency medicine resident told us. “I would not send a brand new [resident] to see new patients in the emergency department unless they have something simple, but [they can be useful by following] up on the other patients labs; they can watch for changes in vitals and they can help us prevent dropping the ball on the super sick ones in the emergency department.”
Even as NYU proceeds with its plan to accelerate medical students into the workforce, the precedent has already been set in Europe. CNN reported that medical students in Italy could start working as doctors immediately. Other countries are following suit.
“Some medical students between the 3rd and 6th year are volunteering in the hospitals,” Francesco Ghiazza, a 4th medical student in an Italian six-year program at the University of Bologna Alma Mater Studiorum, told us. “The students are helping with some paperwork. They are not doing clinical work because they are not graduated, and they are not on a clinical rotation. They are just volunteering.”
Francesco rotated as an international medical student under Dr. Dave Campbell two years ago. Francesco told us, “Even doing just paperwork in a hospital is new for us.”
“Because of the emergency caused by the coronavirus, the Italian government decided one week ago to abolish the state exam for medical graduates,” Dr. Edoardo Morellini, University of Bologna, Alma Mater Studiorum told us. “Normally, the new medical graduates are supposed to take this test more of less six months after the graduation. Because this exam is very simple, a formality in which 99 percent of people always managed to pass it without any problem, the Government decided to abrogate it in order to allow the new physicians to help facing the pandemic.”
The United States healthcare infrastructure will require tweaking to facilitate the mass entrance of the thousands of freshly graduated and licensed physicians. “Many of our classmates, myself included, [were assigned] to programs across the country,” Josh Nims, a fourth-year medical student told us. He brings up one of the many potential difficulties with the early promotion of our medical students. “This creates additional logistical challenges in this time of ‘shelter in place’ where we may struggle to find housing and people to help us move. So, starting early would be more difficult.”
Pandemics are not a new phenomenon and the Novel Coronavirus will not be the last. The potential benefit of accelerating graduation and licensure of medical students seems to outweigh the risks. Current medical students in the United States are suitable to take on this responsibility, even in such short notice. With almost a decade of upper level education and a large fund of clinical knowledge, medical students are some of the most well-qualified individuals in our country to recruit. Military and veteran healthcare workers, as well as tired, hungry, sore and stressed doctors and nurses on the front lines will be glad to have the help.
Not all medical students are prepared to run headlong into the breach of the pandemic. We learned in our reporting of opinions ranging from strong feelings of civil service to feelings of fear, inadequacy, and genuine concern for their own health.
“As physicians we took an oath to take care of our patients,” Lahari Tumuluri, a fourth-year medical student told us. “The threat of contracting an illness is not new. We are exposed to a countless number of infections throughout our careers. I honestly find it frustrating to be home right now when I know I may be of help in a hospital taking care of people who need me.”
In contrast, other medical students who wish to remain anonymous worry their experience leaves them at risk of injuring others and of being manipulating to enter unsafe conditions due to the lack of personal protective equipment.
“As aspiring physicians and healers, we want to start making a difference,” John D. Matz Jr., MD candidate told us. “As Dostoyevsky wrote, “It takes something more than intelligence to act intelligently”. In the case of medical students accelerated to become doctors in the war against Coronavirus “something more” is experience. Our need for healthcare practitioners far exceeds our supply. There is precedent in times of great need. My uncle Ed Zartman, a medical student at The Ohio State University School of Medicine in the 1940’s, was graduated a year early to serve as a general medical officer in the U.S. Navy during WWII. We have options to augment our current healthcare force and historic precedent to back them up.”
Many medical students entered the field with hopes of civil service and will be proud to be part of the war against this pandemic. If called upon, they are willing and able to serve our country in this time of great need. Any day now, the United States will see 4th year’s become M.D.s two months early. John Matz’s uncle was graduated a full year early during World War II. If the shortfall of PPE, ventilators, vaccines, ICU beds and therapeutics takes too many doctors and nurses off the front line, due to disease or death, accelerating 3rd year medical students, while it seems like a crazy idea today, may not seem so far-fetched in 3-6 months. Let us pray that scenario is never played out.
As we win the battles against the virus, these patriotic new physicians will need assistance getting back on track once the war is over. Like all Americans, they have loved ones they care for at home. Like many Americans these physicians will be staring down the barrel of mounting student debt. Individuals and businesses across the country will receive federal and state support as the battles rage. After the fog of war has lifted, so too should we support the greenhorns.