Medical students suspend studies to help in COVID crisis

As India this week passed a grim milestone of more than 20 million COVID-19 cases and a record 3,600 deaths officially recorded in one day, the Indian government said medical students in their final year, doctors preparing for postgraduate exams and hospital interns can be deployed for COVID duties.

The Prime Minister’s Office (PMO) on 3 May said medical students could be brought into service for teleconsultations and monitoring of mild COVID cases after orientation under faculty supervision. Medical interns would also be brought into service under faculty supervision.

As an added incentive, the PMO said medical personnel completing 100 days of COVID duties will have priority in future regular government recruitment.

This will free up a large pool of qualified doctors and make them available for COVID duty, the government said in a statement. States will “seek to persuade such candidates to join the COVID workforce”, it added.

Doctors and nurses in hospitals have been overwhelmed with India’s huge COVID-19 caseload as new cases surged to in excess of 300,000 every day for the past two weeks. Medical organisations said doctors were suffering extreme fatigue and burnout dealing with seriously ill patients without respite. Other doctors have themselves fallen sick with COVID.

COVID-related deaths have now reached 230,000.

Dr Johnrose Austin Jayalal, the national president of the Indian Medical Association (IMA), has said medical and nursing students must be engaged to help out. “We are at the brim of a crisis. Doctors are overstretched and many of them are affected. In the past month, 46 of our doctors have died,” he said.

Around 25,000 doctors who have also finished their postgraduate specialist training but have not yet sat their exams will be told they can skip the exam and have their advanced degrees provided they work in COVID ICUs (intensive care units) for a year, officials said.

The government has already announced that the National Eligibility and Entrance Test for postgraduate courses (NEET-PG) will be delayed for at least four months and will not be held before 31 August. Applicants will be given at least a month’s time to prepare after the announcement of examination dates.

India has some 541 medical colleges and 36,000 postgraduate medical students who pitched in during the first COVID-19 wave last year. A new cohort is being brought in this year amid complaints of incredible workloads, long hours and inadequate supervision, while their studies have been neglected.

Protests over student working conditions

Doctors in at least five hard-hit states, including Maharashtra and Gujarat states in Western India, have held protests against the treatment of postgraduate medical students. Some noted that students were being deployed while senior doctors stayed away from wards or were only involved by teleconference calls because they feared that their age made them more susceptible to serious infection with the virus.

Many postgraduate students said they had no time for studies in their specialism because they were putting in so many hours on COVID wards.

In Bengaluru (Bangalore), Karnataka state, where 400,000 COVID-19 cases have been registered state-wide, the state government announced after consultations with top private medical hospitals that students in the final year of nursing, pharmacy, physiotherapy, dental and hospital management degrees would be brought into service.

“To overcome the shortage of ‘medical human resources’, the government has decided to rope in final-year medical and nursing students for COVID duty and give them grace marks. Their final-year exam will be postponed and they will be given incentives,” a Karnataka state government statement on 1 May read.

It also announced an expansion of facilities, including converting hotels as step-down hospitals with oxygenated beds and converting the existing oxygenated beds into ICU beds, Karnataka Chief Minister BS Yadiyurappa tweeted.

Further, it was decided to enrol doctors with the Karnataka Medical Council who have completed their courses in foreign countries, and put them on COVID-19 duty. Normally there are strict licensing rules for graduates of non-Indian medical institutions to practise in the country, with the Foreign Medical Graduate Exam (FMGE) typically having a low pass rate.

Notably, thousands of medical students who had been enrolled in medical universities in China continue to be stranded in India unable to undertake clinical studies in China, which has still not reopened its borders to foreign students.

‘Adequate stipends’

The All India Medical Students’ Association has said COVID-19 wards should be included in internships but has insisted that students and interns should be given adequate stipends, proper accommodation, food and travel allowances as well as health insurance.

The association pointed to the northern state of Himachal Pradesh announcement on 3 May to deploy final-year medical students but were paying them just INR3,000 (US$41) a month – less than the wage of an unskilled labourer.

At the All India Institute of Medical Sciences (AIIMS) in Raipur, capital of Chhattisgarh state in central India, Yogesh Kumar, a final-year MBBS student welcomed the decision as much needed extra help for doctors working day and night during the pandemic in the state. But he said certain prerequisites had to be ensured before deploying final-year students, including proper training from faculty.

Students at AIIMS-Raipur said interns and students had already been posted in COVID wards for the past year. But Kumar told India’s NDTV news channel that students like him deployed for COVID duty were not being paid.

Mehak Aggarwal, in her final year of the MBBS medical degree, told NDTV she had already been working at COVID wards at Max Hospital, a private hospital in New Delhi, before the announcement, working eight- to nine-hour shifts Monday to Saturday.

She noted the facility only had three doctors on duty at a time to treat 80-90 patients and nursing staff were also overburdened. “With the help of our seniors [doctors] we are trying to help them in any way possible,” she said.

Devi Shetty, a cardiac surgeon and chairman of Narayana Health – a chain of 21 medical centres in India – said 220,000 nurses who have finished their training for the three-year General Nursing and Midwifery (GNM) degree or four-year BSc courses in nursing schools and colleges across the country but are yet to take their final exams, should be given the option to work in COVID ICUs for a year, following which they can get their degree certificates.

He said a similar option should be given to the 90,000 to 100,000 doctors who have graduated from overseas universities but have not cleared the national entrance exam (FMGE), adding that rendering services in the ICUs for a year should make them eligible to get registration certificates.