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.
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.
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 Medicine Medical School. He blogs on Covid-19 at www.pandemicpondering.com.