As PA programs continue to decide which actions to take to protect PA students from the spread of Coronavirus, we reflect on a hypothetical scenario to consider what we can learn.
As the Coronavirus was spreading university administrates were unsure how to respond. Woodcreek University* had a class of second-year PA students they needed to consider. They decided, like many others, keeping students on rotations would be reasonable and, in the absence of state recommendations, appropriate. In fact, they didn’t want to overreact and put their PA program in jeopardy from an accrediting viewpoint. Thus, the class of 40 students worked together, studied together, and socialized together as usual. These students had been together for a year and a half; they were a close-knit group, soon to be graduating in May.
Mary* went to her clinical rotation for an overnight shift at Silverwood Community Hospital*. Her shift involved working with a physician assistant who reviewed case, x-rays, and charts with her on Tuesday and Wednesday night. The review session was held in a small room with little air circulation. Mary noticed the PA coughed and sneezed several times, but he said he simply had allergies. Mary wondered if she should be concerned, but since the PA was confident it was allergies, she didn’t believe the symptoms were related to the virus. Throughout her rotation, Mary noticed there wasn’t any personal protective equipment (PPE) available for PA students to use in the hospital.
Several days later, Mary had developed a cough and fever, along with an upper respiratory infection (URI). Later, she received a call from her preceptor, informing her the PA she worked with during her rotation tested positive for Coronavirus. Now Mary needed to go to a virtual care center to get tested. The following week, she received a call: she indeed tested positive.
Immediately, Mary told her two roommates, one of whom had already developed the same symptoms and decided to get tested a couple days before Mary’s results came in. Her second roommate fortunately had not shown any symptoms; she wanted to distance herself, but she had no other place to go. Thus, all three roommates stayed in the apartment, putting the second roommate at risk of infection.
Now, the PA program at Woodcreek University is bracing itself to hear about more confirmed cases among their second-year class.
*University, hospital, and student names are all fictional and do not resemble any real universities, hospitals, or persons.
What can PA programs learn from the Coronavirus?
Student safety is a top priority
We must recognize the danger of sending our students on clinical rotations when a pandemic is spreading. Living in crowded dorms and apartments puts PA students at an increased risk of contracting and spreading the virus. Additionally, PA programs are accepting younger students who may not recognize the danger and thus may not take the right precautions. It is important for decisions and actions to be taken that will keep students safe and at low risk.
Government offices have announced a “shelter in place” mandate to slow the spread. As a result, clinics are not seeing the number of patients they normally do, and many offices are closing. A major question PA programs are grappling with is whether and how PA students are getting the clinical experience to meet the competencies of the program.
Clinical rotations may look different right now
Clinical rotations are being cancelled, while other PA programs are allowing students to stay on their clinical rotations. Those who are continuing rotations are being placed in a risky environment yet are not seeing as many patients. Many rotations are not providing protective equipment to students because of a nationwide shortage; employees are given protective equipment before clinical students, putting students at higher risk. Unfortunately, PA programs have no way to monitor who is provided protection or not; they only hear from students what occurs during their rotation.
Our responsibility as per our accreditation standards reads: ARC-PA Standards A1.02g—“The sponsoring institution is responsible for documenting appropriate security and personal safety measures for PA students and faculty in all locations where instruction occurs.” Certainly, we need to ensure there is an adequate number of PPE for our students to ensure they are safe during their rotations.
It may be time to rethink students being classified as “essential workforce”
Students are considered part of the “essential workforce” because they can provide assistance. Though they aren’t licensed practitioners yet, many will be within the next few months. Some medical schools, in fact, are graduating students who have met their program competencies early so they can get licensed and join the workforce. Certainly, there is a need for additional healthcare providers, and this is one way they can help.
Yet, students are being told not to see high-risk patients during the pandemic—how, then, are they considered as part of the workforce? Instead, PA students who are placed in the clinic to gain experience but avoid high-risk patients will simply be “in the way.” Is this truly the best action we can take?
Students deserve the right to choose safety
More, students are not easily able to turn down rotations without penalization, even if they are saying no to avoid being at an increased risk of infection. Some are even being threatened to go back on their rotation or they will not graduate on time. Certainly, students are fearful of not graduating on time, considering their student loans and living expenses that will increase with the delay.
We must consider which decisions students can make for themselves. Can a PA student refuse to go out on their clinical rotation? We believe they should be allowed the right to determine if it is in their best interest to go back into the clinic during a pandemic. Some students may live with a vulnerable family member and ought to decline, for instance. In cases where a student chooses not to attend rotations, PA programs ought to work with the individual to complete their rotations in another way, within a timely manner.
Protecting our students needs to be our first and top priority during this pandemic. We must consider which measures will ensure student safety while continuing student learning. These decisions are difficult, but we owe it to our students.