Medical & nursing students-led response to Covid19 pandemic – notes from an LMIC setting.

Authors:

Be The Change Student QI Collaborative: Ishika Kaul, Shristi Gupta, Ashima Rao, Rachita Sahoo.

Nationwide Quality of Care Network (NQOCN): Jeena Pradeep, Achala Kumar, Rahul Garde, Bani Singh, Harpreet Kaur, Sushil Srivastava,Vikram Datta,

On March 11, 2020 WHO declared COVID19 as pandemic1 highlighting the need for countries across the world to start preparing for the surge of Covid19 cases. Responding to such a pandemic, requires each country to implement specific strategies to manage the surge in healthcare demand which will have to be met, among other things, by supply of frontline health care providers (HCPs). We read with interest the correspondence on medical student involvement in the Covid19 response2.

Currently, the demand is far greater than the supply of HCPs across the world. In response to this, medical education boards or equivalent bodies have suggested various ways to engage medical and nursing students in their country’s response to Covid193,4. We suggest the inclusion of young professional networks in augmenting health systems response to the current crisis. Involvement of such networks can help in making the Covid19 response at a facility-level safe, efficient, equitable, and timely. As a pilot exercise, one such network - “Be The Change”5 has started a Quality Improvement (QI) initiative aimed at improving the HCP’s knowledge towards Covid19 with a special focus on increasing awareness and practice of personal protection and prevention of transmission of the viral infection , in the national capital of India. The preliminary findings shown in the figure highlights the wide gap between information about Covid and protocols for management of biological accidents that occur while caring for a Covid patient. The students are using QI techniques as suggested in the POCQI Methodology6 to address this problem.

These useful preliminary learnings help us to draw some early recommendations which may be adapted by countries based on the situational realities:

· Undergraduate medical and nursing student networks can be mentored by academic faculties of medical and nursing schools at short notice, using online platforms, to formulate a strategy to address the bottlenecks pertaining to HCP and community awareness related to Covid19.

· Depending on Covid19 case load, the networks can be prepared to assist in non-Covid clinical duties so as to relieve a sizeable proportion of staff for active Covid duties.

· Integration of basic QI methodology in the day-to-day work culture at this time would go a long way in creating a cadre of professionals with a strong culture of quality and safety simultaneously sensitizing them regarding the unique requirements and challenges of such pandemic.

While undertaking these roles, students (and their supervisors) must remember that their primary goal is to continue their education, and as such should not undertake tasks which are beyond their competence. Hence, medical and nursing students should be judiciously sensitized to the various challenges of pandemic response to foster in them an understanding of basics problem solving and quality improvement approach. This crisis can be used as an opportunity to impart valuable lessons in crises management and relevance of team work to the next generation of healthcare providers.

References:

1 WHO. WHO Director-General’s opening remarks at the media briefing on COVID-19—11 March 2020. March 11, 2020. https://www.who.int/dg/speeches/detail/ who-director-general-s-opening-remarks-at- the-media-briefing-on-covid-19—11-march-2020 (accessed April 4, 2020).

2 Baker DM, Bhatia S, Brown S, Cambridge W, Kamarajah SK, McLean KA, Brindl N, Lapolla P, Pérez-Ajates S, Raubenheimer K, Xu W. Medical student involvement in the COVID-19 response. The Lancet. 2020 Apr 2. (Accessed Apr 4, 2020)

3 Ministry of Health & Family Welfare, Govt. of India. Advisory for Human Resource Management of COVID-19. https://www.mohfw.gov.in/pdf/AdvisoryforHRmanagement.pdf. Published Apr 2, 2020. (Accessed Apr 4, 2020).

4 Interim Guidance on Medical Students’ Participation in Direct Patient Contact Activities: Principles and Guidelines. Recommendation from Association of American Medical Colleges; https://www.aamc.org/system/files/2020-03/Guidance%20on%20Student%20Clinical%20Participation%203.17.20%20Final.pdf. Published Mar 30,2020. (Accessed Apr 4, 2020).

5 Quality of Care Network. Updates: The Next Gen of Quality Improvers. http://www.qualityofcarenetwork.org/updates/next-gen-quality-improvers. Sep 12, 2018. (accessed April 6, 2020).

6 WHO, Regional Office for South-East Asia. Improving the quality of care for mothers and newborns in health facilities: learner's manual. Version 02.

https://www.pocqi.org/wp-content/uploads/2018/01/POCQI-Learners-Manual.pdf. (accessed April 6, 2020).