Scientific Perspectives

“Non-essential personnel should go home” my senior resident said, looking at me and giving me permission to leave the clinical rotation. I was torn between the much-needed studying time to excel on my impending internal medicine shelf exam and being part of what is arguably one of the most exciting times to be a medical student.

 

For the past week, our large team room has been used for meetings and training regarding the COVID19, and I have been privy to some of the most important conversations as the hospital’s game plan unfolds. As a second-year medical student on clinical rotation, I have been as fascinated by the medicine as how public health measures translated to the state, local, and departmental level at my institution. It’s no exaggeration that I have received about 100+ emails from the medical school on our ever-evolving plan and policy regarding medical care and student involvement.

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Our current policy insists that clinical clerkships should discontinue and prohibits medical students from being involved with COVID-19 patients. While I understand the risks involved, the school’s hesitancy to put medical students in danger, and scarcity of protective equipment, I believe it’s also a rather paternalistic approach. Medical staff in the hospital are reduced as those who traveled are quarantined, those who are are moved to different services or stay home, and as sick personnel are asked to not come in for work. Given that limited medical staff are diverted to COVID-19 patients, I believe it’s an opportunity for medical students to step up. 

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Similar to how the military is on a volunteer basis, career in medicine meant an implicit acceptance of its unique occupational hazards. We should be able to decide for ourselves if or how we want to become involved. In addition, medical students are often young and healthy and statistically less likely to have complications with COVID19. I’d argue that many of our faculty are at greater risk due to age, yet they are at the front line. It seems almost contradictory and selfish for medical students to retreat when we could be most helpful. I have been told by multiple residents and attendings how impressed they are with our ability to contribute to patient care; be it ability to put together a cohesive plan, researching into the latest treatments, or devoting extra time to gather critical information from patients and family, we have been able to fill the gaps when attendings and residents are less able to do due to time constraints. Though it’s true that we are early in our training, we have the most time and given how brilliant my classmates are on the wards, I know we can add value during this crisis, medically and otherwise.

 

At the same time, people are understandably fearful of taking care of COVID patients; I recognize there are those who have personal reasons to not be involved, and they should be free to make that decision without consequences. For example, medical students who prefer to not be on service should be able to voice their concerns without consequence on their grades. I have been fortunate in that both senior resident and attendings made it clear that leaving the hospital for social isolation would not negatively impact their clerkship evaluations on my performance. However, this is easier said than done and I think part of the reason for a school-wide policy is to spare us from these conversations laced with power dynamics and to avoid unfair “time-offs” among students.

 

In an uncertain time like this, I look back in our history for lessons learned from the past. I can’t help but draw parallels to the pervasive institutional and professional fear (and resistance) to caring for patients with HIV during the early 1980s. Yet, there were health professionals and medical students then that delved into the challenge in and multiple studies have shown that in retrospect, most of them find it to be the most rewarding and formative times of their professional careers. This is a unique time for us to see policy and public health response in action, and be part of the response team.

 

Rather than a blanketed decision made for us, I would like my peers and myself to have the opportunity to forge our own paths. For me personally, I want to look back and be able to say, I was there for our patients when they needed me the most. I argue that witnessing and partaking in the hospital’s response is an important part of my medical education. Someday I would be a resident, attending, or a public official who will have to take charge in my own community. What better time to gain experience than now so that I can be best equipped for the future? I want to be at the very forefront of the line, learning from mistakes made, obstacles overcame, and most importantly, strength and courage during this crisis. In many ways, our service is a testament to the social mission ingrained in our profession. I may not be essential, but I do have a deep sense of duty — of the doctor's moral responsibility to bear witness and to serve.