AACOM Message on Medical Student Participation in Clinical Activities

Updated Guidance Through April 13

(It is important to note that we are providing the following guidance mindful that the Federal CDC Guidance is calling for continued social distancing through the end of April. We will update this guidance as facts and local conditions warrant.)

The COVID-19 pandemic continues to rapidly impact all aspects of our private life as well as within our schools, the local community, the nation, and the world. As our medical schools and teaching hospitals work to address the steadily mounting challenges, including balancing the demands of clinical care with those of education, collaboration and constant communication across institutions remain essential.

In our last communication, AACOM called upon our member institutions to maintain a very important and urgent effort to create a ‘pause’ in medical student clinical education activities intended to allow our COM leaders and faculty and hospital partners the opportunity to find a meaningful way forward at this unprecedented time. This memorandum will address the continuation of the pause.

The original message of March 17, 2020, was jointly issued by AACOM and COCA following direct communication between the leadership of both entities. AACOM has since continued to work closely with the COCA to address numerous concerns arising from the current public health crisis and the institution of this pause.

AACOM also remains in regular contact with our colleagues at AAMC so that a coordinated response that aids all of our respective students and colleges can be maintained and to present a consistent approach as we work with public and private officials to determine the best way we can contribute to the current crisis.

I. Update as of March 30, 2020

During a meeting of the AACOM Board of Deans on March 28, 2020 updates were heard from the community regarding implementation of COVID-19 training for students, efforts to review proper use of PPE, and efforts to prepare medical students for a role responding to the pandemic. Previous notices are also attached below for your reference.

In response to information shared during the Board of Deans meeting, this statement is offered:

• Continuation of the pause: It is suggested the pause continue at a minimum for an additional two weeks for the reasons described in bullets number 2, 3, and 4 of the Memorandum of March 16, 2020. Additional time is needed for student education regarding COVID-19 and PPE use to be completed, for PPE to become available, and for dialogue to occur with teaching institutions and public officials addressing the roles for medical students in responding to the public health crisis.

In addition, we have developed some common principles that each college may apply as it makes decisions with consideration to both national and local conditions.

Principles: The following are offered to guide decision making:

•  Communicate – it is essential that our leaders communicate clearly, regularly and rapidly to our staff, students, and respective communities.

•  Maintain safety – education addressing COVID-19 should be provided during the pause and 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.

•  Provide Supervision – medical students returning to the clinical learning environment should receive the necessary supervision and education by faculty and other licensed healthcare professionals acting within their scope of practice.

•  Be Equitable – decisions regarding medical students returning to the clinical learning environment should be made in a manner that will create an equitable learning experience for all with the intention of preparing them for an immediate role on the healthcare team and for future practice. Consideration should be given to personal and family situations that may limit participation in the clinical learning environment.

•  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.

II. Summary of Memorandum 1 Issued March 16, 2020

The original rationale and goals of this urgent effort are summarized below:

1.  Local Conditions: Depending upon local conditions and responses that may already be in place, a minimum two-week ’pause’ of medical student participation in any activities that involve patient contact is suggested. Local conditions and resources may determine that a longer or shorter pause is indicated.

2. Student Education: This ‘pause’ will allow medical schools a window of opportunity to develop and implement appropriate programs to fully educate all their students for their return to clinical rotations with 1) up-to-date information on COVID-19; and 2) appropriate steps in place to ensure their and their patients’ safety.

3. Student Health and Safety: This ‘pause’ will contribute to the conservation of personal protective equipment (PPE) across our institutions while the full extent and likely trajectory of COVID-19 becomes better understood and more widespread testing is implemented. While some localities remain relatively unaffected, it is fully conceivable that in the near future there may be acute shortages of PPE in some localities and such resources may have to be pooled across institutions.

4. Student Training: During this ‘pause’, the AACOM will organize efforts by our medical education community, including our learners, to compile and disseminate information and resources for alternative clinical learning approaches, including the identification of critically important learner roles in their institutional response to COVID-19 that support patient care but may not necessarily involve direct patient contact.

III. Summary of Memorandum 2 Issued March 23, 2020

During a meeting of the AACOM Board of Deans on March 20, 2020 updates were heard from the community regarding various efforts to prepare medical students for a role responding to the pandemic, some requested by hospitals in need, some requested by student wishing to volunteer, and some arising from COMs that have implemented COVID-19 training for students in preparation for an active role as part of the healthcare team.

In response to concerns raised during the Board of Deans meeting, the first bullet above is further clarified:

•   Community Need: Local conditions and resources may determine the practicality of a pause. While the intention to allow our COM leaders and faculty and hospital partners opportunity to find a meaningful way forward at this unprecedented time remains unchanged, the needs of the local community, state, or region must determine each COMs response. Unless a critical healthcare shortage exists and appropriate training and precautions can be assured, the guidance offered by this message remains the same—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.

•  Alternative Clinical Education: In reference to the fourth bullet above and as shared during the Board of Deans meeting, AACOM continues to work with our community to describe alternative approaches to clinical education and clinical and non-clinical roles for our medical students. Importantly, the pause allows students to contribute to the national effort to ‘flatten the curve’ while gaining additional knowledge and skill to better prepare themselves for this challenging environment. These efforts can and should be conveyed to local, state, and regional officials as meetings occur to address responses to COVID-19