Fighting COVID-19: Enabling Graduating Students to Start Internship Early at Their Own Medical School – Annals of Internal Medicine

As the United States is gearing up nationwide for the surge in patients from the COVID-19 pandemic, a major question on everyone's mind is, Will we have enough doctors, nurses, pharmacists, and other health care providers? Meanwhile, medical and other health profession schools have sent students home to keep them out of harm's way; to save precious personal protective equipment; and to decrease the number of persons who might function as vectors, especially those who are young and healthy.

Academic medicine nationally might take another approach. We could quickly prepare our graduating students for meaningful work at their home medical schools in anticipation of a time in the next few months when many health care providers will become ill. For the first time since World War II, we are having major societal disruptionbut there is one major difference. Then, it was all hands on deck; now, we have more than 30000 almost-qualified future interns mostly under stay-at-home orders.

Further, delays in transition to residency for this year's students due to chaos, credentialing, and other barriers might generate more problems for graduating students and short-staffed health care systems. We should urgently prepare these all-but-graduated students to help us address the looming workforce shortage as junior physicians during the next few weeks. However, they also should get credit for the experience they will gain and the service they will provide.

The last big advantage of this plan is that the new junior interns would be working on home turf rather than adjusting to a different hospital or place, as happens for many interns who move across states, or across the country, to start in different health systems. Starting at their home institutions would vastly decrease credentialing and barriers to electronic health record access.

We would have to rapidly address financial and logistic issues. Potential guarantees for loan repayment and tuition refunds would be key to success. Health profession schools would have to signal which students have the competency to begin working with more independence and agree to supervision requirements similar to those for residents. Supervision might be expanded to appropriate recently retired physicians or those whose health risks due to COVID-19 make them unable to work on the front lines. Health systems would need to authorize access so that competent students could write orders and access electronic medical records from home. Graduate medical education (GME) leaders would need to discuss potentially giving participating students credit toward residency completion.

These are bold but relatively straightforward requests, which I am certain academic medicine could tackle nationally in concert with GME leadership. Breaking down bureaucratic barriers must be a prioritya national effort could save many thousands of lives, not to mention being a substantial uplift for exhausted health care providers. Despite the logistic challenges, definitive and organized collective action now may give the United States an edge that we desperately need in this fight.