key: cord-341698-k5leys8j authors: Park, Seung Won; Jang, Hye Won; Choe, Yon Ho; Lee, Kyung Soo; Ahn, Yong Chan; Chung, Myung Jin; Lee, Kyu-Sung; Lee, Kyunghoon; Han, Taehee title: Avoiding student infection during a Middle East respiratory syndrome (MERS) outbreak: a single medical school experience date: 2016-05-27 journal: Korean J Med Educ DOI: 10.3946/kjme.2016.30 sha: doc_id: 341698 cord_uid: k5leys8j PURPOSE: In outbreaks of infectious disease, medical students are easily overlooked in the management of healthcare personnel protection although they serve in clinical clerkships in hospitals. In the early summer of 2015, Middle East respiratory syndrome (MERS) struck South Korea, and students of Sungkyunkwan University School of Medicine (SKKUSOM) were at risk of contracting the disease. The purpose of this report is to share SKKUSOM’s experience against the MERS outbreak and provide suggestions for medical schools to consider in the face of similar challenges. METHODS: Through a process of reflection-on-action, we examined SKKUSOM’s efforts to avoid student infection during the MERS outbreak and derived a few practical guidelines that medical schools can adopt to ensure student safety in outbreaks of infectious disease. RESULTS: The school leadership conducted ongoing risk assessment and developed contingency plans to balance student safety and continuity in medical education. They rearranged the clerkships to another hospital and offered distant lectures and tutorials. Five suggestions are extracted for medical schools to consider in infection outbreaks: instant cessation of clinical clerkships; rational decision making on a school closure; use of information technology; constant communication with hospitals; and open communication with faculty, staff, and students. CONCLUSION: Medical schools need to take the initiative and actively seek countermeasures against student infection. It is essential that medical schools keep constant communication with their index hospitals and the involved personnel. In order to assure student learning, medical schools may consider offering distant education with online technology. In outbreaks of infectious disease, healthcare personnel (HCP) are at increased risk of contracting emerging infections in the process of patient care [1, 2] . The rate of HCP-related infection with Middle East respiratory syndrome corona virus, Ebola virus, and severe acute respiratory syndrome (SARS) virus has been reported to be around 1% to 27%, 2.5% to 12%, and 11% to 57% of total cases, respectively [3] . It has been suggested that early and rapid detection of suspected infected patients with contagious diseases along with adequate infection control practice, education, and global and national preparation guidelines could help prevent disease transmission to HCP [3] . Due to their participation in clinical clerkships, medical students should be considered to be at-risk HCP during infectious disease outbreaks. When SARS struck Hong Kong in 2003, a number of medical students contracted the disease as a result of exposure to SARS patients [4] . Despite the fact that protecting medical students from infection exposure is important, the literature on infection control practices for HCP appears to focus mostly on healthcare professionals other than students [3, 5] . During the MERS outbreak, mainly students in Year 4, 5, and 6 were exposed to risk of contracting MERS. Besides performing clinical clerkships, students attended lectures held in classrooms located at the main teaching hospital (SMC). Thus, SKKUSOM students faced a greater risk than those of other medical schools with a school building separate from their teaching hospital. In this study, we examined SKKUSOM's efforts to avoid student infection during the MERS outbreak and scrutinized the rationale behind the decisions made. Through a process of reflection-on-action [6] , we identified the necessary actions taken to ensure student safety and derived practical guidelines that medical schools can take to protect students in the face of outbreaks of infectious disease. Three principles guided the decision-making processes: (1) ensuring student safety, (2) minimizing loss of student learning, and (3) reducing anxiety and concern on the part of staff and students. Details of SKKUSOM's actions are discussed below. At the end of May 2015, the first Korean patient with MERS was reported at the SMC, and several nearby patients were subsequently identified as having MERS. One doctor also acquired the disease from the index patient. SKKUSOM was immediately notified of these cases. Out of concern for the safety of our Year 5 and home. Because many classes were taught in small group-based learning formats such as problem-based learning, students had closer contact with instructors and peer students than they would in large lecture classes. In addition, given the fact that many medical students spend a great amount of time and share living spaces (e.g., living in a dormitory) with their peers, infection of one student could readily spread to multiple students. With continuous assessment of all these risk factors, the school leadership admitted an imperative need to completely restrict student access to the hospital, which amounted to closure of the school. While agreeing to the closure of the school, the faculty council expressed a concern that students would lose legitimate learning opportunities owing to the cancellation of classes. In order to minimize such loss for the students, the emergency committee declared the school closure period (4 weeks) to be the summer break and to continue the remaining courses after the break. This strategy was particularly practical because the regular summer break at SKKUSOM was scheduled to begin only 3 weeks ahead after the MERS outbreak occurred. By moving up the summer break, although interruption in the regular curriculum was inevitable, the courses could still be carried out as originally planned, and most class times were retained. With concern about possible spread of the disease at the SMC after the break, the school also prepared remote lectures and classes so that students could continue their education without the risk of exposure to infection. Considering the need to balance student safety and continuity in medical education, the school declared an early summer break and closed the school temporarily. One alternative to closure of the school is the use of In an outbreak of infectious disease, the risk of transmitting a disease to HCP is unavoidable [14] . Medical students are also at risk of becoming infected mainly due to clinical clerkship rotations at affiliated hospitals, but they are often overlooked in plans to prevent HCP infection [15] . Although students are not yet professionals, they should be considered as HCP and Middle East respiratory syndrome coronavirus (MERS-CoV): summary of current situation, literature update and risk assessment-as of 5 World Health Organization World Health Organization. Ebola situation report [Internet]. World Health Organization Risks to healthcare workers with emerging diseases: lessons from MERS-CoV, Ebola, SARS, and avian flu A major outbreak of severe acute respiratory syndrome in Hong Kong BC Interdisciplinary Respiratory Protection Study Group. 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