The Role of Medical Students During the COVID-19 Pandemic
Authors: Michele A. Riva, Maria E. Paladino, Michael Belingheri
Journal: Annals of Internal Medicine (2020)

Letters17 November 2020The Role of Medical Students During the COVID-19 PandemicFREEMichele A. Riva, MD, PhD, Maria E. Paladino, MD, and Michael Belingheri, MDMichele A. Riva, MD, PhDUniversity of Milano-Bicocca, Monza, Italy (M.A.R., M.E.P., M.B.)Search for more papers by this author, Maria E. Paladino, MDUniversity of Milano-Bicocca, Monza, Italy (M.A.R., M.E.P., M.B.)Search for more papers by this author, and Michael Belingheri, MDUniversity of Milano-Bicocca, Monza, Italy (M.A.R., M.E.P., M.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1194 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Miller and colleagues' commentary (1) on the role of medical students during the coronavirus disease 2019 (COVID-19) pandemic with interest. The authors disagreed with the Association of American Medical Colleges' recommendation to suspend student clerkships during the outbreak and instead suggested that medical schools offer students clinical opportunities. They reported several benefits of this choice to patients and the health care system.In our country of Italy in April 2020, more than 16 000 health care workers tested positive for severe acute respiratory syndrome coronavirus 2. In addition, at least 110 physicians have died after contracting it, confirming the high risk faced by health care professionals (2). The Decrees and Regulations adopted by the Italian government in March initially permitted health care student clerkships. Regardless of this position, most Italian medical schools have not allowed students to work in the wards—a decision shared by most hospitals despite a workforce shortage. In April, the Italian government therefore partially modified its position, decreeing that student clerkship could be taken remotely.We do not believe that medical students are clinicians with duties as Miller and colleagues state. We agree with the Association of American Medical Colleges' position that “current medical students are students, not employees” (3). We also do not believe that Miller and colleagues reported any important consideration about the role of students in the pandemic. Here, we explain our concerns.First, some students live with their families and cannot afford to live alone. Alongside concerns for their personal safety, medical students could be anxious about passing the infection to elderly parents or grandparents or to young siblings.Second, we still do not know the long-term effects of COVID-19 and wonder whether it is ethical to expose young persons to a disease whose effects are not fully known. Working in the medical profession requires a psychophysical integrity that could be damaged by the infection, compromising the future careers of these students. It should be considered that any disability that these students incur could affect their progression to graduation. Moreover, the risk for post-traumatic stress is high (4); therefore, psychological support should be guaranteed to these students.Finally, we believe that the historical examples reported by the authors (that is, the Spanish flu outbreak of 1918 and the polio epidemic of 1952) are outdated according to a modern conception of medical education, which does not consider students simple members of the workforce in hospitals.References1. Miller DG, Pierson L, Doernberg S. The role of medical students during the COVID-19 pandemic [Editorial]. Ann Intern Med. 2020;173:145-6. doi:10.7326/M20-1281 LinkGoogle Scholar2. Belingheri M, Paladino ME, Riva MA. Beyond the assistance: additional exposure situations to COVID-19 for healthcare workers [Letter]. J Hosp Infect. 2020;105:353. [PMID: 32243947] doi:10.1016/j.jhin.2020.03.033 CrossrefMedlineGoogle Scholar3. Whelan A, Prescott J, Young G, et al. Interim guidance on medical students' participation in direct patient contact activities: principles and guidelines. Association of American Medical Colleges. 30 March 2020. Accessed at https://lcme.org/wp-content/uploads/filebase/March-30-2020-Interim-Guidance-on-Medical-Students-Participation-in-Direct-Patient-Contact-Activities.pdf on 31 March 2020. Google Scholar4. Belingheri M, Paladino ME, Riva MA. Working schedule, sleep quality and susceptibility to COVID-19 in healthcare workers. Clin Infect Dis. 2020. [PMID: 32339218] doi:10.1093/cid/ciaa499 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Michele A. Riva, MD, PhD; Maria E. Paladino, MD; Michael Belingheri, MDAffiliations: University of Milano-Bicocca, Monza, Italy (M.A.R., M.E.P., M.B.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1194. 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