Article’s categorie: Theme Event Article
Authors: Vinícius Lima de Souza Gonçalves¹, Maria Luísa Cordeiro Santos².
¹ Principal author, Universidade Estadual do Sudoeste da Bahia, [email protected]
² Coauthor, Universidade Federal da Bahia.
NMO: IFMSA Brazil
Conflicts of Interest: the authors declare that there is no conflict of interest.
The pandemic caused by the disease of the novel coronavirus 2019 (COVID-19) has generated an emergency health situation worldwide, after all, the knowledge about the characteristics of the virus, as well as the plan to combat it, are poorly established. In this scenario, until the third week of June 2020, Brazil had officially registered more than 1,106,470 cases and 51,271 confirmed deaths 1.
Until then, the strategies implemented to combat the disease in the country have not yet been fully effective, since there is an inadequate and continuous lack of tests for COVID-19, coupled with the exhausted and overworked public health workforce, lack of sophisticated integrated public health and clinical health information technology and substantial cultural issues. Currently, the COVID-19 crisis is forcing healthcare professionals to make difficult decisions that can directly oppose their ethical and moral principles. Such options include how to distribute inadequate resources to equally deserving patients, how to align their duties with patients and family and friends, and how to provide assistance to all critically ill patients with limited or inadequate resources. Furthermore, faced with confused leadership in the national government, it is up to the governors and mayors to make their own coping decisions 2.
In this scenario, the question arises as to how medical students can act in this current emergency situation. After all, it is assumed that these students are an available resource during a public health crisis, even if on a voluntary basis. This inclusion of students at this time can be fundamental in combating the pandemic, since health teams have lost their workforce, having to reallocate resources that are already scarce and deal with bed saturation to support patients 3.
Accordingly, a 2019 study of medical students at the National University of Ireland, Galway, showed that 59% of participants were willing to volunteer in the event of an infectious crisis. Most respondents agreed that health professionals have a moral obligation to volunteer during a pandemic, with 81% believing that students should be encouraged in the same way. Still, 98% indicated altruism as one of the main motivating factors for these volunteers in emergency situations 4.
Given the high risk of infection with COVID-19, however, would altruism be enough to justify the frontline performance by students? And are these students prepared to deal with emergency situations? After all, while these motivations are laudable, they cannot replace adequate clinical skills. Thus, extra care should be taken not to force a level of preparation on these students that is different from their actual capacity at the moment, after all, during practical internships, students are subjected to health environments in a supervised and controlled manner.
In this perspective, Gouda et al. reported that only a minority of students (4%) believed that they were prepared in terms of their current skills and experience 4. These findings are in line with other studies that highlight that while the will to help persists, the lack of knowledge and ability puts these students and patients at risk in disaster situations 5,6. In addition, in Belgium, a study indicated that students are not fully aware of the implications of care during a pandemic and, as such, are not adequately informed to make a decision 7.
In this sense, in the current pandemic situation, this lack of adequate knowledge and preparation generates potential risks for patients, the students themselves and the entire health team, since students can act as vectors of viral transmission, consume individual protective equipment and overload teaching doctors. Thus, the need for adequate preparation of this student for such performance is evidenced, as demonstrated by a study on an elective disaster preparedness school in the USA, in which 70% of the participants felt unprepared to participate in an emergency before starting the preparatory classes. Subsequently, only 11% said they felt unprepared after training 8.
Given this, there are two goals to be established. The first is the inclusion of specific content to cope with emergencies and pandemics in the curricula of universities. Educational restructuring after the pandemic by COVID-19 can generate benefits that will certainly foster better personal and professional training for medical students. Thus, it must involve a curriculum that provides a robust theoretical preparation, combined with education on specific logistical challenges for crisis situations, leadership courses in response to situations of health stress, problem-based learning with multidisciplinary participation and practical exercises that simulate emergency situations. Usually, this is not present in the medical school grid and the professional ends up acquiring this in practice over the years.
The second goal is to offer, at the present time, a coping strategy that is compatible with the students’ preparation, that does not expose them inappropriately, and that preserves their mental health. This, without a doubt, must be extremely relevant, given the damage to mental health for working during a pandemic.
In view of this reality, it is a fact that ways can be found to offer medical students knowledge to health care in emergency situations and ensure the maximum possible safety. In this sense, the Government of Bahia, together with the Federal University of Bahia (UFBA) and Fiocruz Bahia, established, on 03/24/2020, the “TeleCoronavirus” operation. This project was created based on telemedicine, in order to reduce the unnecessary displacement of people to health units at this time of pandemic, in addition to avoiding more outbreaks of transmission, seeking to flatten the infection curve, and then preventing the collapse of the health system.
First, all students undergo an online training course and follow a protocol established by the organizing institutions, in order to guarantee a standardized service. The students then receive on their own telephone sets, directed by a central line, the call of individuals from all over the state who want to ask questions about their symptoms or clarify other health issues. Then, they perform a screening that can follow two paths: when there are warning signs, the orientation is for the patient with suspected Covid-19 to go to the health unit in their neighborhood, being instructed on how to proceed during the trip; when there are no warning signs, guidance is for good hygiene, social distance and remote monitoring, if there is any change in the condition, the patient returns the call. Each information is recorded and the information is sent in real time to the Secretary of Health of the State of Bahia. The service is free and available from 7 am to 7 pm through the number 155, with students divided into work schedules. Currently, the “TeleCoronavirus” has more than 1,200 medical students in the fifth and sixth year and 70 doctors, from all eleven medical schools in the state, these participations being on a voluntary basis. In 42 days of operation, more than 24 thousand calls were provided, with an average of 532 calls per day 9,10.
Thus, strategies such as “Telecoronavirus”, as shown in Fig. 1, represent an attempt to balance the medical student’s potential and challenges against COVID-19. In addition, these modalities of assistance through telemedicine represent important tools for valuing voluntary activity, understanding its civic value in combating the pandemic and highlighting the individual responsibility in the extermination of SARS-CoV-2.
Fig. 1: Telecoronavirus: a strategy to balance the medical student’s potential and challenges against COVID-19
- BRASIL, Ministério da Saúde. “Painel Coronavírus”. Last modified June 22, 2020. https://covid.saude.gov.br/
- Bauchner, H., & Sharfstein, J. (2020). A Bold Response to the COVID-19 Pandemic: Medical Students, National Service, and Public Health. JAMA, 10.1001/jama.2020.6166. Advance online publication. https://doi.org/10.1001/jama.2020.6166
- Krieger P, Goodnough A. Medical students, sidelined for now, find new ways to fight coronavirus. Last modified March 23, 2020. https://www.nytimes.com/2020/03/23/health/medical-students-coronavirus.html
- Gouda, P., Kirk, A., Sweeney, A. M., & O’Donovan, D. (2019). Attitudes of Medical Students Toward Volunteering in Emergency Situations. Disaster medicine and public health preparedness, 1–4. Advance online publication. https://doi.org/10.1017/dmp.2019.81
- Mortelmans, L. J., Bouman, S. J., Gaakeer, M. I., Dieltiens, G., Anseeuw, K., & Sabbe, M. B. (2015). Dutch senior medical students and disaster medicine: a national survey. International journal of emergency medicine, 8(1), 77. https://doi.org/10.1186/s12245-015-0077-0
- Mortelmans, L. J., Dieltiens, G., Anseeuw, K., & Sabbe, M. B. (2014). Belgian senior medical students and disaster medicine, a real disaster?. European journal of emergency medicine : official journal of the European Society for Emergency Medicine, 21(1), 77–78. https://doi.org/10.1097/MEJ.0b013e3283643874
- Mortelmans, L. J., De Cauwer, H. G., Van Dyck, E., Monballyu, P., Van Giel, R., & Van Turnhout, E. (2009). Are Belgian senior medical students ready to deliver basic medical care in case of a H5N1 pandemic?. Prehospital and disaster medicine, 24(5), 438–442. https://doi.org/10.1017/s1049023x00007287
- Patel, V. M., & Dahl-Grove, D. (2018). Disaster Preparedness Medical School Elective: Bridging the Gap Between Volunteer Eagerness and Readiness. Pediatric emergency care, 34(7), 492–496. https://doi.org/10.1097/PEC.0000000000000806
- Universidade Federal da Bahia. “TeleCoronavirus served approximately 24 thousand people in 42 days of operation”. Last modified May 11, 2020. http://www.saude.ba.gov.br/2020/03/24/tele-coronavirus-155-comeca-a-funcionar-para-atender-a-populacao-gratuitamente-na-bahia/
- Governo do Estado da Bahia. “TeleCoronavirus 155 starts operating to serve the population for free in Bahia”. Last modified March 24, 2020. http://www.saude.ba.gov.br/2020/03/24/tele-coronavirus-155-comeca-a-funcionar-para-atender-a-populacao-gratuitamente-na-bahia/