As distancing requirements and campus closures upset in-person clinical rotations, state officials and colleges are debating what comes next. Should schools and state licensure boards keep nursing and medical students away from COVID-19 patients or mobilize trainees to assist health care practitioners? Would it be more beneficial to maintain in-person health care education requirements despite delays and disruptions, or relax them, given the unique and urgent challenges posed by the pandemic?
Hospitals and other clinical sites nationwide have canceled hands-on training for nursing students, and at least 165 medical schools have suspended clinical rotations in an effort to limit coronavirus exposure and conserve protective gear for practicing clinicians.
More than 40,000 outgoing medical students, meanwhile, have just matched with their three-year residencies and are poised to help. Currently, guidelines from the Association of American Medical Colleges (AAMC) and Liaison Committee on Medical Education discourage students from providing patient care until their residencies begin in June or July, but AAMC officials have suggested that students may be called upon to voluntarily assist clinicians as the outbreak worsens.
California relaxes some clinical education requirements
With clinical education opportunities paused, California nursing schools in recent weeks had been pleading with legislators to waive certain training requirements that were preventing more than 10,000 California nursing students in their last semester from graduating, obtaining their licenses, and starting to deliver care. State requirements mandated that nursing students must complete 75 percent of their clinical hours in a direct patient care setting.
Governor Gavin Newsom on March 30 signed an executive order that allows the state Department of Consumer Affairs, which oversees the Board of Registered Nursing, to waive professional licensing requirements related to hospitals and other health facilities, opening up the path to employment for students who had nearly completed their clinical training.
In Florida, some clinical partners are asking students to stay on rotation, while others are asking them to leave. “The question is how do we graduate a workforce when we’ve had disruption in our educational process,” poses Ann H. Cary, chair of the Board of Directors for the American Association of Colleges of Nursing and dean of the Marieb College of Health and Human Services at Florida Gulf Coast University. She recommends deepening simulation experiences and considering whether to offer extended time for intensified clinicals when they resume.
The same questions have come to the forefront in Washington state. “The biggest challenge is finding a balance between what faculty say we need and what regulators and accrediting bodies say we need,” said Kelly Green of South Puget Sound Community College (SPSCC). Faculty at SPSCC support lab simulations, while accreditors still require in-person instruction.
Boston and New York schools accelerate student pathways to health care workforce
Some states hit hard by the COVID-19 pandemic are working with medical schools to accelerate students’ path to the workforce. On April 1, the The American Medical Association issued guidance saying that medical students should make voluntary decisions about assisting in direct patient care, and receive proper training and oversight in the proper use of protective personal equipment, reports The Chronicle of Higher Education. It also recommended that medical institutions making use of early graduates grant them full employee status, salary, and benefits during their service—and that loan providers give those graduates a grace period.
After New York Governor Andrew Cuomo issued an executive order allowing early graduation among senior medical students who met all academic requirements, numerous medical schools gave the class of 2020 the option to join the front lines of the pandemic response, reports The Washington Post. Columbia University Vagelos College of Physicians and Surgeons, Weill Cornell Medicine Medical College, New York University (NYU) Grossman School of Medicine, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, the Icahn School of Medicine at Mount Sinai, and the Renaissance School of Medicine (RSOM) at Stony Brook University are all allowing students to graduate early and serve in short-term, nonresident roles before their residencies, reports AAMC. NYU students who choose this option will quarantine for two weeks between their short-term roles and their residencies.
“We’re running into issues of manpower,” says Steven Abramson, M.D., vice dean for education, faculty, and academic affairs at NYU Grossman. “That led us to conclude: Why not graduate students who are interested in serving in hospitals now? They’ve completed their requirements, and they’re prepared.”
In order to meet Massachusetts’ demand for more medical workers, the University of Massachusetts Medical School, Tufts University School of Medicine, Boston University School of Medicine, and Harvard Medical School are all moving up their graduation dates by at least a month, at which point they will receive a 90-day provisional license to work in a COVID-19 service capacity.
For many students across the country, however, early graduation won’t be enough to speed their entry into the medical workforce. In order to practice, they must pass licensing exams and obtain health insurance and malpractice insurance, “a multistep process involving medical schools, state oversight bodies, and workplaces that is not easy to fast-track,” reports BuzzFeed News. “A school can move up its graduation date, but the grads still wouldn’t be able to work the next day.”
Sidelined medical students volunteer to help in other ways
Medical students are also eager to start helping in non-clinical capacities. David Edelman, a fifth-year medical student at Columbia University, recently helped establish the COVID-19 Student Service Corps. Through the corps, medical students can staff coronavirus community hotlines (which requires clinical experience), provide technical support for telehealth platforms, coordinate food deliveries for health care workers, and create educational briefings with up-to-date research and coronavirus news. At the University of Minnesota, a student group called COVIDSitters have organized to provide health care workers with child care, pet sitting, and errand running services. And Harvard Medical School has organized a COVID-19 Student Response Team to develop medical and non-medical support.
Georgetown University Medical School students organizing through MedSupplyDrive are collecting unused personal protective equipment and donating them to hospitals with the greatest need. “We understood that a lot of students like us were suddenly sitting on the sidelines during this crisis, wanting to be involved, and feeling downhearted that they were taken out of [clinical rotations] at a time when it felt essential to help,” said student organizer Zuby Syed (M’22).“We believed that there was definitely something we could do and needed to do.”
Georgetown student contributes to COVID-19 relief efforts through U.S. Navy
Georgetown student Safiullah Rauf (NHS’21), the incoming president of the Georgetown University Student Veterans Association, a junior in the human science major, and an expeditionary medical facility corpsman in the U.S. Navy Reserve, is currently in New York working as a medical assistant on the USNS Comfort.
In addition, Rauf since February has been volunteering with Arlington, Virginia’s Public Health Division to assist with the COVID-19 response. Rauf helped assess the health care and logistic needs of positive cases and monitor community spread. “My education at Georgetown University has been instrumental in my aspiration to provide effective and time-sensitive public health intervention in emergencies,” he said.