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The devastating coronavirus pandemic is highlighting the dedication and courage of health care communities in the United States and around the world. Many aspects of the pandemic worry me, especially one related to the education of medical students and medical staffing in the U.S.

Last month, the American Association of Medical Colleges (AAMC) and the Liaison Committee on Medical Education decided to “pause all student clinical rotations,” essentially removing all medical students from clinical activities. This action was taken “to allow the medical education community, including learners, to develop appropriate educational strategies and alternative clinical experiences to best assure safe and meaningful clinical learning for students.”

Some of the interns and residents at the University of Michigan Medical School, where I work, and other institutions are now also allowed to opt out of inpatient Covid-19 care.

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I believe that these decisions are sending the wrong message to medical students and young physicians and will, in the end, undermine medical professionalism and the ability of these physicians to perform under difficult conditions.

The first duty of any physician is to provide medical care wherever and whenever it is needed. While many versions of the Hippocratic oath exist, all carry some reference to this commitment. In the modern oath, the phrase, “I will remember that I remain a member of society, with special obligations to all my fellow human beings,” reinforces this duty.

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In many cities across the U.S., health services are overwhelmed. Every type of caregiver, from retired nurses to partially trained medical assistants, are being recruited to provide care and support. Well-trained medical students and residents would add significant expertise at this difficult time.

Excluding physicians in training and medical students from caring for Covid-19 patients, or making their participation optional, sends a message that when things get bad physicians can be excused. It also deprives trainees of the important experience of providing medical care under crisis, especially when resources and options for patients are limited.

Treating individuals for a disease where you have no real medical therapy is a challenge that needs to be experienced. Only through knowledge gained in times like the Covid-19 pandemic can young physicians realize they can operate in difficult environments, providing care and compassion to patients regardless of the technical ability to cure a disease.

I may be an outlier in my opinion. Many younger physicians view the profession differently than I do, and I trained in the military, where there were no opportunities to make decisions on whether or not to participate in patient care.

I was a resident and attending physician during the early days of the AIDS epidemic, where I diagnosed and cared for patients, but provided only support, knowing that they would eventually die of the disease. Caring for those patients also carried significant risk from being exposed to their bodily fluids, because there was no treatment for HIV infection at the time. That experience made me a better physician and gave me confidence that I can provide medical care in any situation.

I am reassured by the fact that 250 University of Michigan medical students have volunteered to care for Covid-19 patients. They had to do this outside of their student status because of the AAMC mandate, but it shows a strong desire to be in the fight. It also will give them perspective on every other aspect of their careers moving forward.

I have volunteered to provide inpatient care for those with Covid-19 during the coming days. I hope fourth-year medical students and physicians in training will do the same. I believe that the benefits to them of participating in the serious work of fighting this pandemic far outweigh any risk they might have from caring for these patients.

James R. Baker Jr., M.D., is professor of allergy and immunology at the University of Michigan Medical School. He blogs on Covid-19 at www.pandemicpondering.com.

  • Reply to Constance:
    “The doctors, nurses, lpns, cnas, transporters, radiologists, radiology techs, etc do NOT get that “choice”.“
    Actually, they all have a choice, but they all also work for pay and with insurance – if students gets sick, while they’re paying for tuition, and without insurance and other protections, who will take care of them?

  • I am clinical faculty at the same institution as the author, currently on the front lines of COVID care. I strongly disagree with this article, and find it insulting to the medical students and residents I’m working with. A lot of COVID care is happening beyond the hospital bed. The residents have had an extensive role in assessing labs/imaging, talking to/updating families, documentation, and (along with medical students) calling discharged patients to continue monitoring remotely, and to encourage patients to return to hospital at any signs of decompensation.

    It is a waste of PPE, a precious, limited resource currently, to have multiple people do a physical exam on a COVID patient, when the attending physician must perform these exams. Additionally, this puts trainees, who have little autonomy, at unnecessary risk. Interns and residents nationally are left in the impossible situation that if they feel they are working in unsafe conditions, they either risk their life [more than one resident has died nationally], or in trying to protect themselves, be at risk of getting fired and never being able to become a practicing physician.

    • I totally understand the concern over having the ppe to deal with this crisis. With that said, I guess I get NOT having AS MANY students in the hospital. The way they are making it optional though really does seem like “when things get scary and tough, because you’re younger, you’ll be able to chose if you want to help” is being said. The doctors, nurses, lpns, cnas, transporters, radiologists, radiology techs, etc do NOT get that “choice”. I’m sure those students who are serious about this profession and want to go far in their careers, will absolutely STILL volunteer to help out. That leads me to think maybe its also weeding out who can handle a long term crisis situation in the hospital and who is too “scared” or “anxious” to help. Imo, I don’t want a scared or nervous healthcare professional involved in my care at ALL. That sends TONS of red flags to me!

  • Amen to the benefits of participating in the serious work of fighting this pandemic far outweigh any risk they might have from caring for these patients! Thank you!

  • Medical students and interns not adequately trained in hospital procedures (e.g infection control) and treatment protocol will only serve as a hindrance. Medical residents in my hospital are pushing against the hiring of medical students. Actually, nurses with 3+ years experience will be better than any intern.

  • Whatever happened to balanced approach and wisdom? People who get into medicine are only people – what’s wrong with wanting to help others, but also taking care of yourself?

    Physicians and nurses are only human and deserve respite and protection. I’m sure many will be not only exhausted by this crisis, but also legitimately scared. “Ol’ school” ways while sometimes productive have also contributed to high rates of medical student/resident/physician depression and suicide.

    Our healthcare system is completely broken, and I’m hoping that we are able to rebuilt it in a way that puts great importance on wellness of its workforce.

  • Ridiculous, short sighted stance. Most institutions have limited medical student interactions with COVID-19 patients given the lack of PPE, why have a med student and a resident evaluate the patient when just the resident can do? The hippocratic oath is what administration uses to cut our pay (not to mention no hazard pay), and guilt us into seeing the patients without adequate protection, while they profit on our backs. You said you trained in the military? So I imagine you didn’t have 300k+ of debt hanging over your head at any point? Imagine being forced to pay outrageous amounts of money to risk your own life, with minimal educational value, in the name of some oath. That’s what your advocating. We need doctors, we don’t need medical students dying.

    • I am a medical student and agree with you in terms of PPE and exposure. I and my classmates, however, wonder at what point we will be allowed to return. I am a rising 4th year. In 2021, I will be expected to serve as an intern. If I can’t be in the hospital until then, are we also sacrificing patient care in that way? Not saying there’s an easy solution, but wondering what the end point is for keeping student out of the hospital.

  • I agree completely. Medicine has drifted and been driven by insurance, administrators, CMS from a calling of caring to one more 9-5 piece work job. Excluding students and others in training perpetuates the image of clock stamping and leaving if it gets tough, risky, or unpleasant. If I were not at a critical access rural hospital, I would have volunteered for “the front”, but that would be a significant hardship for the people in my county. I cannot abandon them. Placing students especially 4th year on break is a disservice to them and the country.

    • Yes, “4th years” – if you graduate them early and pay them and provide them with insurance. I don’t see why being paid and having some insurance is so bad. Whatever happened to “take care of yourself so you can take care of others.”

  • correct the tagline at the bottom of the article – and then delete this comment.

    I suspect that Dr Baker is a professor at the University of MICHIGAN medical school – not the University of MEDICINE medical school ?

  • Not true at all. The fat check of years ago are not what is occurring now. Additionally when you finish all your training in addition to the $300,000 in debt you are 30 years old. You have not owned a car, a house nor started a family. Physicians delay their lives to care for people. 4 years of college, 4 years of medical school and a minimum of 3 years of internship/residency. Physicians give their lives to others starting in college.

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