key: cord-0996406-21vwdbe3
authors: Raikhel, A. Vincent; Blau, Kevin D.; Redinger, Jeffrey W.
title: From Panic to Promise: Harnessing Medical Student Leadership in COVID-19
date: 2022-02-04
journal: Am J Med
DOI: 10.1016/j.amjmed.2022.01.030
sha: c8ccbf6c25e3647b9c3ff6907d70a101f7f1194a
doc_id: 996406
cord_uid: 21vwdbe3

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Dr. Raikhel is the Chief Resident for Quality and Safety and the VA Puget Sound and receives his salary from the Veterans Health Administration.

Dr. A. Vincent Raikhel has no conflicts of interest to disclose.

Dr. Kevin Dr. Blau has no conflicts of interest to disclose.

Dr. Jeffrey W. Redinger has no conflicts of interest to disclose.

Dr. Raikhel, Dr. Blau, and Dr. Redinger all worked together to write this manuscript. All three had access to utilized data. Dr. Raikhel and Dr. Blau wrote the first draft of the manuscript. Dr. Redinger was deeply involved in brainstorming the manuscript outline and editing subsequent drafts.

Response.

The emergence of the novel SARS-CoV-2 has significantly disrupted the training experience of medical students throughout the United States. The rapidly evolving situation in early 2020 resulted in considerable variability in the involvement of medical students in clinical care. The outcome was a diverse patchwork of responses with most medical schools removing students from clinical environments entirely to mitigate the spread of disease while others fast tracked their involvement into frontline staff. These solutions were initiated at a time of profound uncertainty, when the luxury of determining an ideal level of medical student involvement was unattainable.

Medical student and medical educators' reflections on the early pandemic response reveal a surreal and chaotic environment. For the students, there was a palpable tension between the fear of a new contagion, coupled with a moral and ethical sense of responsibility to help in this crisis. 1 Medical educators wrestled with unease at trying to balance medical student safety and education simultaneously. 2 Despite the desire to engage in the pandemic response, the sheltered role of medical students in the early pandemic left many feeling sidelined and uninvolved in this pivotal medical moment.

The development of COVID-19 vaccines coupled with masking policies in healthcare settings has ushered in the transition from a state of emergency to a crisis with defined risks. In this context, medical students have largely returned to their pre-pandemic roles in clinical settings. Despite their reintegration, the role of medical students in relation to COVID-19 is far from clear. And while their education regarding COVID-19 has been limited in formal settings, their lived experience with COVID-19 has been profound as the disease touched their families, friends, and communities while also upending their medical education. As our relationship with COVID-19 evolves, so too must our understanding of the ways we can optimize medical student education and involvement in clinical care, so they can be prepared to understand and care for patients with COVID-19.

While addressing our hospital's COVID-19 response we noticed medical student leadership emerge spontaneously when given the opportunity. Our hospital had a problem:

there were tens of patients admitted to the hospital who had unknown COVID-19 vaccination status. Local limitations in nursing staffing levels necessitated that any intervention aimed at screening admitted patients for COVID-19 immunization be delegated to physicians. In Vax the Max was created to engage already task-saturated interns and residents on COVID-19 vaccination with a novel gamification strategy. To our surprise, we observed that the highest performing teams in the competition were propelled by highly motivated 3 rd year medical students. These highest performing teams reached an ideal state of patient care regarding COVID-19 vaccination screening with 100% of their patients being screened for COVID-19 vaccination status. Additionally, these teams administered a substantial number of COVID-19 vaccinations. One of the most prolific teams administered 18 COVID-19 vaccines over the course of 4 weeks. The 3 rd year medical students driving the success of these teams developed self-directed structures and organization to obtain these results. The leadership role of these medical students resulted in increased rates of COVID-19 immunization at our hospital.

The endeavor also tapped into the intrinsic motivations within the medical students to have a meaningful and concrete role in combatting this pandemic.

Nationwide, hospital censuses and healthcare worker burnout have swelled simultaneously, leading to a quagmire in efforts to create new systems of task completion.

Despite the importance of COVID-19 vaccination counseling, the congestion of clinical tasks is a barrier to having these discussions. Seeing an opportunity to make an impact, the medical students emerged to become primary advocates for inpatient vaccination counseling.

COVID-19 has impacted our world so forcefully as to become a great equalizer of our traditional medical hierarchies. We have all become learners in the effort to care for patients with this novel disease. This was clearly exemplified at our hospital with the leadership displayed by our rotating medical students. Our intervention provided more than an educational opportunity for students to participate in a meaningful way in the COVID-19 response. It also enabled them to harness their passion, energy, and creativity to improve the quality of care provided to our patients. The COVID-19 pandemic is a defining pillar of all clinicians' careers, students and teachers alike. It is our responsibility to invite these early trainees into the discourse of pandemic care, not only to improve outcomes for our patients but also to empower the next generation of leaders in medicine.

We Signed up for This! -Student and Trainee Responses to the Covid-19 Pandemic

We sent them home