Reasoned action is needed to restart clinical training for medical and nursing students, ethicists say

April – May, 2020

May 28, 2020

The disruption caused by the spread of COVID-19 has created kinks in the pipeline for medical trainees eager to join the frontline efforts against the pandemic.

Medical school students, for example, can't complete requirements for their degrees and certifications because hospitals have closed many wards, putting rotations on hold. The delays are causing uncertainty and anxiety, said David Miller, associate director for academic programs and administrator for the Edmund D. Pellegrino Center for Clinical Bioethics at the Georgetown University Medical Center.


Miller offered ideas for how students, schools and health organizations can respond to pandemic-caused challenges to education and training during a webinar May 21 titled "The Role of Medical and Nursing Students in a Pandemic." The webinar was the sixth in the series "Catholic Ethics and the Challenge of COVID-19" that is being presented on consecutive Thursdays by CHA and Georgetown University.

Competing obligations
With the help of fellow presenter Sarah Vittone, a clinical bioethicist for the Pellegrino Center and an assistant professor at Georgetown School of Nursing, Miller discussed how best to keep the health care trainee pipeline flowing while serving the interests of students, schools, health organizations and patients.


"Students are not employees of our organizations," said Vittone, who also works in clinical nursing administration at Suburban Hospital – Johns Hopkins Medicine in Bethesda, Maryland. "They belong to the academic institutions, so we want to make sure that they're safe and that they are well-educated."

On March 17, the American Association of Medical College released guidance strongly suggesting that schools remove students from direct patient contact to help staunch the virus's spread and conserve dwindling personal protective equipment.


"Within days, schools were loading course materials online, and within weeks, the vast majority had developed ways to teach at least some clinical skills from afar," according to a report on the association's website.

Miller noted that while all stakeholders have the primary goal of caring for patients, they also have priorities that are both separate and overlapping that may shape their views on how to best pursue that goal. Students, for example, want to finish their training and enter their desired professions; schools want to keep them safe from the deadly infection and health organizations want to tightly control their use of scarce resources and reduce the risk of contagion by keeping wards clear of anyone but essential personnel.

"They (stakeholders) may prioritize competing goals differently and that may affect their relationships and the way that they treat one another," he said.

Developing resiliency
Vittone stressed the importance for those doing the training to teach health care students how to be resilient, especially in the face of a virus of which little is known and for which many adjustments have been made within the health care system.

"Some of the stresses that happen when you step into those professional roles, we want to make sure that these students are ready for when they go forward," she said.

Trainers can develop resiliency, Vittone said, by showing students how to be reflective and resourceful in their decisions and how to work as part of a team. "Some of that teaching also might lend itself to reminding these health care professionals to keep a good lifestyle – to eat and sleep and rest and do the things that you can to take care of yourself because unless you take care of yourself you're not going to be helpful taking care of others," she added.

In addition, she said that resiliency is grounded in ethics, so students need to be taught about basic principles such as human dignity that should inform their decision making.

The takeaways
Miller and Vittone offered "three key takeaways" for students, schools and health organizations to shape their response to training amid the pandemic.

One is to rely on reason to determine the best course for all the stakeholders. "While our ethical principles do not change, our ethical analysis depends on facts about potential treatments, risks, benefits, conditions and threats," Miller said. "Policies need to keep pace as best they can but it's a constant process of practical reasoning."

The next is to exercise emotional intelligence, which Miller defined as "the capacity to be aware of, control and express one's emotions to handle interpersonal relationships respectfully, judiciously and empathetically."

Lastly, he said, all parties need to sustain relationships and communication.

Tough decisions
Vittone said currently tough choices are being made in health care education about whether classes will be held on campuses or remotely, how what is normally hands-on training with patients will be taught and whether some graduation requirements can be waived.

"We are literally in the crux now across the country of schools making decisions and organizations making decisions and so everyone is working together very closely to help generate our next generation of health care providers," she said.

Prior coverage of this webinar series

Surveillance tools offer great promise, perils amid pandemic, ethicist says

Constraints of pandemic care are potential triggers of moral distress, ethicists say

Crash course: Sully offers inspiration for applying organizational ethics in a pandemic

Resuscitation considerations go beyond patients amid pandemic, Catholic ethicists say

Putting workers first for some treatments amid pandemic is justifiable, ethicists say

View the webinar recording

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