As the novel coronavirus (COVID-19) makes its way across the country and globe, I have been thinking about how we fourth-year medical students fit into the picture. Not quite out one door, yet not quite in the other, our liminal perspective is liable to be overwhelmed by the many other considerations that predominate the public discourse. To that end, I offer three humble proposals relating to the fourth-year student experience: 1) testing symptomatic medical students for COVID-19, 2) accelerating the Match process; and, 3) allowing fourth-year students to graduate early to join the global effort to contain and mitigate the pandemic.
1. Allow symptomatic medical students to be tested for COVID-19
First and foremost, I worry about the safety of my community, my loved ones, and myself. To that end, I would propose that medical students with coronavirus symptoms be tested, without regard to previous travel or contact.
Medical students spend significant amounts of time a) with hospitalized patients and b) with other medical students who, in turn, are frequently in inpatient settings. If a medical student has any constellation of symptoms similar to those of COVID-19 like fever, cough, or dyspnea, it behooves health authorities to allow us to be tested. Since community spread, with no identifiable source, has begun, it would make sense to employ a “low threshold” for testing.
Relying on travel criteria to limit testing ignores the real possibility of community spread, and the fact that senior medical students are in close contact with sick patients day in and day out. This testing would help mitigate spread to the hospital setting and help administrators to make decisions regarding clinical rotations during this time of pandemic.
2. Accelerate the Match process
Match Day, when many senior medical students learn their residency placements, is currently scheduled for Friday, March 20, 2020. The SOAP process for un-matched or partially matched candidates is currently scheduled to start on Monday, March 16, 2020. While Match Day is often ceremonious, anecdotal evidence points to cancellation or restriction of medical school Match Day festivities to students only (i.e., no guests).
If Match Day events are being canceled or curtailed, serious thought should be given to releasing Match results early, perhaps as soon as possible. First, it would give matchees and their loved ones a chance to celebrate in whatever time remains before more severe restrictions on movement and gathering take place. If the situation becomes akin to Italy, where the entire country is under lockdown, it would make celebration more difficult with venue closures and travel restrictions.
Moreover, the National Residency Match Program (NRMP) is headquartered in Washington, D.C., which, like much of the world, is experiencing fear of community spread and concomitant recommendations to restrict group activity. If COVID-19 impacts the ability of NRMP staff to be present for management and technical support of the Match process, we could find ourselves with disruptions to the Match process. The fear of logistical kinks is real, as the Supplemental Offer and Acceptance Program (SOAP) process (by which non-matchees can attempt to secure a position) experienced technical difficulties just last year in 2019. By accelerating the Match to occur before key technical support staff face movement restrictions or personal illness, we would be getting ahead of these potential problems.
Lastly, getting results early will allow matched graduates to begin the licensing process earlier. Earlier licensing would then allow graduates to start working sooner, especially if paired with early graduation, my final proposal described below.
3. Allow fourth-year medical students to graduate early and begin working to fight COVID-19
Many of us senior medical students have completed graduation requirements for our M.D.s or D.O.s and are spending our final months of medical school on electives or vacations. Given that we were drawn to medicine out of a desire to do good, the current crisis offers the chance to offer our modest skills to help contain and mitigate the crisis. I would suggest that medical schools consider granting fourth-year students their degrees early, and that state licensing boards allow these newly-minted physicians to help in the fight against coronavirus.
This surge of new doctors, while admittedly green in their new role, would provide valuable extra hands in a potential situation where health care facilities are short-staffed. Other healthcare workers will increasingly find themselves quarantined due to illness or exposure, or potentially caring for loved ones such as children whose schools have closed. Why wait a few months into the summer, when senior medical students will start practicing as resident physicians anyway, when this workforce is ready and able to assist now as the crisis peaks?
An additional benefit of early graduation is that these new doctors are more likely to be on the younger side. They will thus be less susceptible to the more serious presentations of COVID-19, which appears to have a low death rate for those under 40. These younger physicians, armed with strong generalist medical educations, could be the first line of contact with patients and report in (possibly remotely using telemedicine) to more senior physicians who would remain in charge. The influx of younger physicians could thus help keep seasoned physicians out of the line of fire, improving overall capacity to treat and protecting veteran practitioners, whose experience makes them especially valuable.
I am not alone in the idea that senior medical students could contribute to efforts against COVID-19. In fact, our British colleagues in medicine are considering drafting medical students in their final year of school. To be clear, I am suggesting voluntary early graduation for those who are able and willing to help. I also propose that state licensing boards help new graduates get out to the workforce as soon as possible, especially in cases where graduates will be staying in-state for residency, in which case it would be the same medical board.
I recognize that I am a fourth-year medical student, and there is much I have yet to experience and learn. With that in mind, I put forth these three modest suggestions to the medical community in an effort to find the courses of action that best serve those who entrust themselves to us for care in these turbulent times.
Lee Hiromoto is a medical student and served as a judge advocate (JAG) in the U.S. Navy from 2013-2016.
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