Updated February 1, 2021
This article is part of a series of COVID-19 articles and resources on medical education.
In their efforts to meet workforce demands in response to COVID-19, medical schools and health systems must make responsible decisions regarding the engagement of medical students. There are many opportunities for students to contribute to the clinical care of patients without engaging in direct physical contact with patients. However, in some institutions, labor demands may be great enough that it is appropriate to consider including medical students in direct patient care.
Some students may be permitted to graduate early from medical school and may subsequently contribute as employed members of the medical staff before undertaking their planned residency training. Some students may be enrolled while maintaining student status, on a voluntary basis, with appropriate supervision and attention to infection control.
It is the AMA’s responsibility to support and protect medical students as we rely on them during this time. We stand with key stakeholders across the continuum of medical education, including, but not limited to, Association of American Medical Schools, Medical Education Liaison Committee (LCME), Accreditation Council for Higher Medical Education, American Osteopathic Association, American Association of Colleges of Osteopathic Medicine and the Pedagogical commission for foreign medical graduates in support of careful oversight of medical student deployment. the AMA Council on Medical Education recommends compliance with the following principles:
- Thoughtful planning will allow for the safe re-engagement of students in direct patient care and thus support the continued education of students. For required courses involving direct patient contact, schools must provide reasonable accommodations for learners who cannot attend.
- Medical students should be included in conversations as direct patient interaction activities are explored, developed, and implemented.
- Medical students should receive appropriate training and supervision on the use and reuse of personal protective equipment (PPE). This includes fit testing for N95 or other respirators, donning and doffing of enhanced PPE, and institutional policies related to using one’s own PPE to supplement hospital-provided PPE.
- Appropriate COVID-19 testing protocols for students and healthcare workers should be in place to reduce the risk of transmission and monitor disease burden trends among students.
- Each clinical environment in which students will come into direct contact with patients should be assessed for safety and educational readiness, including:
- Burden of exposure to COVID-19
- Stability of care protocols and clarity of roles
- Appropriate mix of patients to support learning goals
- Ability of faculty to provide supervision, instruction and feedback
- Health systems and medical schools should support the well-being of all providers and recognize that learners face an additional stressor related to uncertainty about their educational path.
- Medical students should not be financially responsible for the diagnosis and treatment of their own illness if they become ill as a result of caring for patients with COVID-19 through school-approved activities.
- Medical schools should use a competency-based approach to redesign teaching and assessment activities, considering alternatives to direct patient contact to achieve desired learning outcomes.
- Medical schools should work with the LCME to identify viable options for assessing student competencies and meeting program requirements to avoid, where possible, any delays in student graduation or progression in medicine.
- Early graduation should be enacted on a voluntary basis and based on the acquisition of basic skills.
- Whenever possible, first graduates should serve under the supervision of an approved program of postgraduate medical training.
- Medical school graduates should not be required to work for their paired residency facility before their intended date of employment.
- Institutions that deploy early graduates should grant these providers full status as healthcare employees with appropriate pay and benefits, while continuing efforts to mitigate their personal risk.
- Medical school institutions and graduates should keep in mind graduates’ contractual obligations to their corresponding residencies, including consideration of the potential for quarantine and/or illness due to the care of COVID-19 patients.
- Financial institutions that oversee all loans, public and private, for medical school graduates deployed to the workforce between graduation and the start of residency should exercise a forbearance and/or remission of debt during this period.
- Organizations using commercial test centers for the administration of computer-based exams should ensure that these test centers follow appropriate local, state-mandated, and Centers for Disease Control and Prevention (CDC) public health guidelines. to reduce transmission and exposure to COVID-19.
- Organizations responsible for conducting standardized exams should explore the possibilities of remotely invigilating computer-based exams.
- Tests that require travel to a limited number of remote testing centers should be postponed until local, state-mandated, and CDC public health guidelines indicate that travel no longer poses an increased risk of transmission for the learner.
- Learners should not be required or encouraged to travel to testing sites that recommend or impose quarantine periods due to local and/or state restrictions, as this will negatively affect participation in educational activities at their schools or clinical sites .
- Tests that require assessment of standardized patients should follow all appropriate guidelines to reduce transmission and exposure to COVID-19 between standardized patients and test takers, including postponing in-person exams when public health guidelines reflect significant risks.
- Organizations should assess opportunities for local administration of exams that require clinical skills assessments, to reduce the need for learners to travel to take these exams.