Protecting Medical Trainees on the COVID-19 Frontlines Saves Us All

any fourth-year medical students who have met requirements and normally would be enjoying time off until graduation in May and June are being called to the frontlines to fight the coronavirus disease 2019 (COVID-19) pandemic.Massachusetts became the first state to encourage this practice, enacting plans to issue 90-day provisional licenses to early graduates of all 4 medical schools, transitioning 700 residents and fellows into supervised patient care at least 8 weeks ahead of schedule.Several universities have followed suit in an all-hands-on-deck effort to stop this insidious virus that is cutting a path across the globe, claiming tens of thousands of lives and sickening more than 2 million more.The issue is that dispatching doctors-in-training to perform patient care outside their clinical competencies is a risk.This is further complicated by the contagion of COVID-19, evolving knowledge about the virus and its behavior in the environment, and a critical shortage of personal protective equipment (PPE).If the outbreak in China is any indication, healthcare workers are 3 times more likely than the general population to contract the disease and be vectors of transmission.For example, more than 600 hospital workers in Massachusetts, both clinical and nonclinical, are infected to date.Some were infected through exposure at work and others through community spread.Residents and fellows-whether because of lack of experience, poor preparation, or lack of training-are particularly vulnerable.Although they receive training, it is unclear whether it is evidence based, standardized, or adequate.The position of the American Heart Association is clear: Protect medical trainees on the COVID-19 frontlines, or do not send them in: "All medical professionals want to help, but fellows and residents are being asked to do things they are not fully trained to do and that take them longer to perform than attending physicians," said Mariell Jessup, MD, chief science and medical officer at the American Heart Association."At the very least, we need to ensure they are protected with proper PPE."The Accreditation Council for Graduate Medical Education agrees.As the nation's principal accreditor for residency and fellowship education in medicine, the council has focused on ensuring the safety and supervision of trainees during this crisis."Without adequate PPE and access to sufficient viral testing, our physician faculty and residents and fellows now risk becoming vectors of this deadly virus, endangering their patients, fellow health care workers, and all those they contact," the Accreditation Council for Graduate Medical Education states."The pledge to 'first do no harm' becomes meaningless under these circumstances." 1,2