States that have overloaded health systems—or anticipate a deluge of incoming patients—during the COVID-19 pandemic are graduating medical students early to address a potential workforce shortage.

On March 24, the NYU Grossman School of Medicine became the nation’s first training institution to advance medical students into residency early to assist with the COVID-19 response in New York, the city that has been hit hardest by the pandemic. Days later, three medical schools in Massachusetts followed suit.

“In response to the growing spread of COVID-19, and in response to Governor [Andrew] Cuomo’s directive to get more physicians into the health system more quickly, NYU Grossman School of Medicine and NYU have agreed to permit early graduation for its medical students, pending approval from the New York State Department of Education, Middle States and the Liaison Committee on Medical Education (LCME),” a statement NYU submitted to the AMA reads.

NYU taking all interns

Medical students typically complete their four-year training in May and begin working as residents in July, in light of the pandemic, which has led to temporary suspension of direct contact between medical students and patients, the LCME offered guidance for schools that are seeking early graduation for students.

“If a school can demonstrate a student has met, by looking across the curriculum, the school’s objectives for the medical education program have been met, and the plan has been approved by the medical school’s curriculum committee and student promotions committee, then the LCME has no issue with a student graduating early,” said Barbara Barzansky, co‐secretary of the LCME.

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NYU has created an opportunity for those students who graduate early to work as interns in its internal medicine and emergency medicine residency programs to help to meet the clinical demand. Students who accept the offer, according to an email from the school to its fourth-year students, will be compensated at an intern-level salary and may participate whether or not they are matched to NYU residency programs. Those who matched elsewhere will head to their residency placement in July.

Massachusetts schools following suit

Boston University School of Medicine (BU) has moved its graduation date up from May 17 to April 17, in response to a request made to each of the state’s medical schools from the office of Governor Charlie Baker. The medical schools at Tufts University and the University of Massachusetts have also agreed to expedite graduation.

At BU, 55 of the school’s nearly 200 upcoming graduates matched with residency programs in Massachusetts. Most the school’s upcoming early graduates have already met all requirements for graduation. The school anticipates the few who have yet to do so will have those requirements completed by April 10, according to Karen H. Antman, MD, dean of BU’s school of medicine.

Upon graduation, students aspiring to work in Massachusetts hospitals who matched with residency programs in the state can apply for temporary licenses from the state that will last 90 days. How those students will be utilized, and whether they will actively treat patients impacted by the COVID-19 pandemic, is going to be up to the individual institutions.

The students’ early graduation will take place during a time frame in which the Massachusetts health care system is anticipating a surge of COVID-19 cases, Dr. Antman said.

“We live in unprecedented times,” said Dr. Antman, an AMA member. “Medical schools did move up graduation during World War II for similar reasons, they needed more doctors to care for the troops. So, it certainly makes sense, and we were glad to respond to the state’s request to consider it.”

Rohan Rastogi, a fourth-year BU medical student who matched with NYU’s internal medicine program last week, is waiting to hear when—and if—he can join that program early. At present, NYU has only addressed how early graduation will apply to current NYU fourth-year students. He said he has reached out to his program director and offered to start as soon as possible.

“This is an incredible opportunity for [medical students] to fulfill the oath we took when we entered med school,” said Rastogi, an AMA member. “It’s a professional privilege to contribute to the greater good. This is why I chose medicine, to help others especially when they need it most.”

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Graduation and the element of time

The AMA and member schools of its Accelerating Change in Medical Education Consortium have long advocated for medical school graduation to be based on competency attainment rather than time. Initiatives like the Program to Accelerate Competency-Based Education (PACE) at Oregon Health and Science University (OHSU), a consortium member school, have worked to follow a competency-based approach to medical education advancement that includes frequent and rigorous assessment of readiness.

As a result of the COVID-19 outbreak, OHSU will graduate 104 medical students in the next few weeks because they have already met their graduation requirements. At least five of them will enter OHSU residency programs in April.

George Mejicano, MD, OHSU’s senior associate dean for education, believes the reaction to the pandemic could cause medical schools to re-evaluate how and when students graduate.

“In some ways it’s a forced marriage because of circumstances. The COVID crisis, which is an urgent workforce problem, has forced people to ask how much [time] is really needed?” said Dr. Mejicano, AMA member.

“The big opportunity here is there could be a frame shift. It’s not that we need early graduation. It’s that we need graduation when people are ready.”

An ongoing discussion in the AMA Accelerating Change in Medical Education Community (registration required) has been tackling the challenges of the pandemic for students and faculty members and how some schools are addressing the situation.

The AMA has developed a COVID-19 resource center as well as a physician’s guide to COVID-19 to give doctors a comprehensive place to find the latest resources and updates from the Centers for Disease Control and Prevention and the World Health Organization. The AMA’s COVID-19 FAQ will help physicians address patient concerns and offers advice on key issues such as how to optimize PPE supply.

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