The Forum

The right (and wrong) ways to enlist medical and nursing students to fight Covid-19

by Daniel Dellaferrera

At the start of the Covid-19 pandemic, health care systems turned two main populations to alleviate workforce shortages: retired clinicians and soon-to-be medical graduates.

Starter list: How you can support frontline staff during the Covid-19 crisis

While the discussion around reintegrating retired clinicians centred on concerns about how their age also makes them potential high-risk patients, organisations deploying those studying to become clinicians faced two key challenges:

  1. The steep learning curve and the higher risks associated with an ongoing pandemic have an immediate and quantifiable impact on the safety of novice clinicians, their experienced colleagues, and the patients to whom they provide care; and

  2. Lifelong repercussions for the generation of clinicians who start their careers during this pandemic may exceed the response capabilities of both health care and academia, giving us a 'lost generation' of doctors, nurses, and professors unable to help prevent the next pandemic or shape a better response to it.

Lessons for early deployment of clinical students

Now, as providers continue to assess how to expand clinical teams when so many employees are sick or burnt out, it’s important to know how to safely and efficiently use this younger workforce to support care—now and in the future. The lessons below are a quick summary of our conclusions after conversations with members and a review of experiences covered by media.

  • Make it voluntary: Avoid the temptation to forcefully "draft" students to join the clinical workforce before graduation. Readiness to provide care during a pandemic cannot be forced or manufactured. Anyone who feels coerced into joining an effort for which they believe they are unprepared is more likely to harm patients, colleagues, and the operational capabilities of their employer.

  • Create a clear compensation scheme: Health care has a long and dismal history of treating students as cheap or free labor. Whereas that is not advisable under normal circumstances, it is unacceptable in the context of Covid-19. If possible, organisations should pay students salaries that approximate the income level of recent graduates. If that is financially prohibitive, other alternatives include (but are not limited to) offering tuition waivers, loan repayment or forgiveness, free health insurance and coverage. It is advisable to discuss options with student representatives before announcing the chosen compensation scheme.

  • Guarantee safe working conditions: If PPE shortages are a key concern of experienced clinicians, imagine the impact on novices who expected their first year of residency to be a relatively safe learning exercise. Redouble your efforts explaining what the organisation is doing to protect frontline clinicians; ensure the availability of expert-colleagues, self-help tutorials and other ways to decrease novice anxiety about safety; and involve them in your innovation initiatives.

  • Ensure emotional support: Time and effort devoted to coach and support novices is always among the first casualties in a crisis. Preventing emotional fatigue of the entire workforce is a strategic priority, but exponentially more important for those who never had the chance to prepare for a critical situation. Make emotional support interventions opt-out only for students and recent graduates, facilitate frequent meetings between them and chaplains or spiritual advisors; and emphasise that acknowledging emotional fatigue and asking for help signal strength, not weakness.

  • Teach beyond the crisis: Covid-19 has revealed different breaking points in every health care system in the world. The worst disservice to those who died during the pandemic and to those who sacrificed to provide care is refusing to learn from this experience. Medical and nursing students deployed as frontline clinicians during the pandemic are also the next generation of health care leaders. Even though we are in fire-fighting mode, do not deprioritise giving them time to reflect and opportunities to discuss what they went through. Their first-hand experience caring for patients and the lack of deeply rooted habits makes them uniquely qualified to redesign health care infrastructures that are more agile, more functional, and more equitable.

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