Updated Guidance Through May 4
It is important to note that we are providing the following while being mindful that the federal CDC guidance is calling for continued social distancing through the end of April. We will continue to update this guidance as facts and local conditions warrant.
The COVID-19 pandemic continues to unfold across the nation and the world, impacting nearly all aspects of life. Heterogeneous conditions exist across the country, with some areas still heavily impacted, some beginning to see a reduction in new cases, and some relatively untouched by the virus.
Our teaching hospitals continue to work under unprecedented conditions to address the challenges related to COVID-19. Many are dealing with shortages of trained medical personnel, personal protective equipment (PPE), and supplies critically needed to assure delivery of patient care.
Regular communication across stakeholders remains essential. Our medical schools report communicating with their teaching institutions to better understand these conditions. In many locations, they have distributed supplies (including PPE) from simulation centers and clinics to help with shortages, and clinical faculty are playing a role in local responses.
Interest in an on-site medical student presence remains variable, affected by the teaching hospital’s ability to assure a safe and stable learning environment as the number of COVID-19 patients increase, and other hospital and ambulatory services are potentially limited. Clinicians note challenges to delivering clinical education while meeting the increased demands of clinical care caused by the volume of patients diagnosed with COVID-19.
On March 16, 2020, AACOM called upon on its member institutions to institute a ‘pause’ in medical student clinical education activities intended to allow our COM leaders, clinical faculty, and hospital partners the opportunity to find a meaningful way forward at this unprecedented time. The message was jointly issued by AACOM and the Commission on Osteopathic College Accreditation (COCA), and developed in close communication with our colleagues at the American Association of Medical Colleges (AAMC).
This memorandum will provide an important update about the pause.
During a meeting of the AACOM Board of Deans on April 9, 2020, the osteopathic medical education community provided updates regarding implementation of COVID-19 training for students, efforts to review proper use of PPE, availability of PPE, efforts to prepare medical students for a role responding to the pandemic, and on-the-ground conditions impacting the clinical learning environment.
In response to information shared during the Board of Deans meeting, AACOM offers the following:
Continuation of the pause: Depending upon local conditions and responses that may already be in place, AACOM suggests the pause continue at a minimum for an additional three weeks.
AACOM also offers the following as principles to guide decision making by Deans of the Colleges of Osteopathic Medicine regarding use of the phrase ‘local conditions and responses’ as referenced above:
- Assess community impact – consideration should be given to the impact of COVID-19 in the communities where your students are training, as well as the demands currently being placed upon the health care system. Where possible, data about the predicted peak in these communities should help to guide decisions. Conservation of PPE for front-line responders remains critical, as does availability of widespread testing.
- Communicate – it is essential that COM leaders communicate clearly and regularly with students, staff, and the involved communities, including leaders of teaching institutions, clinical faculty, and public officials. Dialogue should address the appropriate roles for medical students while responding to the public health crisis.
- Maintain safety – student education addressing COVID-19 should be provided before any return to the clinical learning environment. This education should include a review of proper use of PPE. PPE should be available for medical students returning to the clinical learning environment before beginning direct patient care; otherwise, non-patient care assignments should be made.
- Provide supervision – faculty and other licensed health care professionals acting within their scope of practice should be able to provide medical students returning to the clinical learning environment with the necessary supervision and education.
- Be equitable – decisions regarding medical students returning to the clinical learning environment should be made in a manner that will ultimately create an equitable learning experience for all, with the intention of preparing students for an immediate role on the health care team and for future practice. Consideration should be given to personal and family situations that may limit participation in the clinical learning environment.
- Address volunteerism – medical students demonstrating necessary competence may choose to participate in direct patient care of those suspected of or diagnosed with COVID-19, and should be provided with as much protection, guidance, and training as possible and practical when doing so. The medical student remains first and foremost a learner, focused upon the continuation of their medical education.
The needs of the local community, state, or region must determine each COM’s response. Unless a critical health care shortage exists, and appropriate training and precautions can be assured, the guidance offered by this message remains the same as prior communications—medical students should not be involved in any direct patient care activities. There is opportunity for our COMs and their hospital partners to work together to develop plans for how medical students contribute to a response.
Please refer to prior Memoranda for additional details.
Robert A. Cain, DO, FACOI, FAODME
AACOM President and Chief Executive Officer