All emergency medicine residents are essential members of the work force. Medical students, however, find themselves in a challenging predicament: how to balance their knowledge, attitudes, and abilities with the demands being placed upon them by health systems. Here, we suggest a simplified version of the KNOW-CAN-DO aspects of clinical training to help illuminate ethical issues confronting front-line students.
The “KNOW”
What do trainees know about staying safe and clinically effective?
In general, medical students are fairly unfamiliar with infection control practices. An audit of U.S. medical students showed that only 7 percent of students donned and doffed properly for simulation.1 Perhaps, this is because 59 percent of U.S. medical students did not receive any personal protective equipment (PPE) training. In this same study, only 53 percent of residents, fellows, and attending physicians from 67 medical schools received training in PPE use.2
Can students be trained accordingly?
One study showed that students could be easily trained either with live or video instruction. The mean donning/doffing scores were 84.8/79.1 (live), and 88/73.9 (video) for 19 trainees.3 Another study using fluorescent laundry detergent showed an improvement in contamination while doffing from 31.7 percent to 9.4 percent from first to second attempts in 249 medical students.4
What have pandemics taught us about the role of education?
Approaches to the SARS CoV-2 virus that has caused the COVID-19 pandemic are probably most similar to the educational strategies during the SARS epidemic in 2002–2003 (see Table 1). With sufficient PPE supply, the ability to translate attending competence to resident and student proficiency is important for capitalizing on this situation.
In summary, students have had low knowledge scores about proper PPE and demonstrated poor proficiency, but they can and should be trained to perform better with various modalities, including live or video instruction, simulation, and objective structured clinical examinations.
The “CAN”
How do trainees feel about practicing emergency medicine?
COVID-19 has taken a serious toll on the mental psyche of medical students. Despite undergoing rigorous training for dealing with clinical uncertainty, personal safety, and the care of infectious disease, students feel stressed about practicing emergency medicine.
A recent study containing 316 anonymous surveys from third- and fourth-year medical students showed feelings of anxiety, vulnerability, fear, and moral distress among other attitudes.5 Others have written about the passionate wishes of some to contribute during this crisis.6 Our specialty faces an ethical dilemma: how to engage the youngest members of our workforce with special educational training opportunities while properly balancing their emotional distress.
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