Medical Student COVID-19 Policy

Rationale

The Wright State University Boonshoft School of Medicine (BSOM) shall create and enact evidence-based administrative controls, procedures, and guidelines necessary for the optimal prevention and control of the spread of the COVID-19 pathogen—or any similarly classified pandemic agent(s). The established processes must be applied consistently to all students unless, due to a validated preexisting medical condition, a student is given an exemption by the BSOM Associate Dean of Student Affairs and Admissions.

To ensure that student rights, responsibilities, and opportunities are transparently considered as subsequent COVID-19 procedures and guidelines are developed, medical student representation will be included in the development of such processes.  

Student Responsibilities

It is the responsibility for every enrolled BSOM student to attest an understanding of the COVID-19 policy and strictly follow all published procedural components. Failure to do so will result in an appropriate institutional action.  It is also the responsibility of every BSOM student to have adequate personal health, disability and life insurance.    

Global COVID-19 epidemiological evidence is fluidly evolving. Therefore, COVID-19 related procedures, processes or guidelines are subject to change as additional evidence-based public health information is obtained from federal, state, and/or local government agencies. It is the student’s responsibility to read and understand published BSOM COVID-19 updates. 

Reporting and Tracking

The BSOM will create a medical student COVID-19 exposure protocol led by an appointed BSOM faculty designee whose responsibility it will be to provide students with COVID-19 symptom assessments, conduct contact tracing, order referrals for necessary testing, and report active COVID-19 cases to the appropriate public health authorities.  A confidentially transmitted list of students being tracked for COVID-19 will be provided to the BSOM Office of Student Affairs and Admissions (OSAA) with need to know information only.  No student medical records are to be shared with the OSAA. 

Clinical Experiences

High-quality clinical care, including student and patient safety, must remain paramount during the educational training endeavor. Therefore, all trainees participating in the direct patient care must be educated regarding the proper application, removal and disposal of assigned personal protective equipment.  Every student must also be appropriately supervised when providing clinical services, including education related to the appropriate personal protective equipment (PPE) required in a particular clinical situation or location. In partnership with BSOM, sponsoring institutions will provide students with the appropriate level of PPE for higher-risk COVID-19 situations.

If a student is included in the provision of direct patient clinical services beyond the scope of their educational requirements, or is asked to participate in clinical services that are deemed to be at high risk of exposure to pathogens, it must only be done on a voluntary basis.  No student will be penalized academically for refusing to participate in a high-risk clinical experience. In accordance with LCME element 10.9, students are afforded the opportunity to request an alternative rotation assignment (see Doctoring Scheduling policy).

Curriculum

The BSOM administration will make every effort to protect the student’s educational timelines and requirements for graduation.  If, due to the COVID-19 pandemic, it becomes necessary to adjust timelines or curricular requirements the impacted student(s) will be informed of such decisions in a transparent and timely fashion. If the circumstances causing significant delays in advancement requirements are beyond the control of the BSOM every effort shall be made to ensure fair and equitable opportunities are provided to complete necessary requirements.

Policy Conflicts

The BSOM Associate Dean of Student Affairs and Admissions will serve as the point of contact for resolving issues that may arise if a student or faculty is confronted with clinical partnership COVID-19 policies that conflict with established BSOM policy and/or procedures.

Approved by FCC on June 24, 2020

Student Responsibilities

Rationale

The Boonshoft School of Medicine (BSOM) will maintain necessary partnerships with students and faculty to optimize a safe medical education environment. Each student must understand and adhere to recommended policies and procedures to keep both themselves and the community they serve, safe and healthy, in adherence with the honesty and integrity outlined the honors code.

The procedures highlighted below are the expected responsibilities of each BSOM student currently on clinical rotations. This is in conjunction with all other policies and procedure regarding clinical duties during the time of COVID-19.

The BSOM will continue to work with its student body on providing the most up to date recommendations based on current medical experts and governmental recommendation/mandates.

Procedures

Student Reporting of Health Concerns

If a student has a concern with their risk of morbidity at it relates to COVID 19, they must report this to Dr. Kim Gilliam (Office of Student Affairs & Admissions) for central documentation that a concern has been submitted.

Students who have a concern regarding their risk of morbidity as it relates to COVID 19 should also report this to the appropriate module/clerkship/elective directors.

Reporting of Suspected COVID-19

Student are expected to be aware of symptoms of COVID-19 including but not limited to: Fever, chills, new onset of cough, shortness of breath, diarrhea or vomiting, loss of taste or smell, fatigue, or myalgias. If the student experiences a constellation of symptoms consistent with COVID-19 infection, they are expected to immediately contact BOTH the clerkship director and the designated BSOM faculty contact, Dr. Bruce Binder [see Reporting & Tracking procedure document].

If the student is advised that they must be tested for COVID-19, they must immediately report to a designated testing facility. During the time prior to testing results, the student should not engage in any additional exposure to the public and should self-monitor/management at home as appropriate.

Health Maintenance

If a student is diagnosed with COVID-19, they will continue to seek proper medical attention for management of symptoms. They will not return to clinical duty until cleared by Dr. Binder. Once the student is released back to duty, the student will work directly with their module/clerkship/elective director to make up the missed time.

Students are also recommended to have a home temperature-monitoring device available for use if needed.

Student must be responsible in maintaining adequate health/infection control standards in and outside the clinical environment. Frequent hand washing (greater than 20 seconds), antiseptic hand sanitizers, prevention of touching face or other mucus membranes, cough/sneeze into a tissue or your sleeve; disinfect frequently-touched objects and surfaces; avoid close contact with those who are sick; proper PPE and social distancing must be performed at all times.

Students are strongly recommended to not engage in social activities that put them in higher risk of exposure after hours, during weekends or holidays. Student should also maintain good health practices (adequate sleep, healthy diet, meditation and exercise). If needed, students should seek out proper health services (including mental health), which are highlighted in each clerkship BAMS page.

Procedures for Clinical Sites & PPE

Students should be expected to maintain the appropriate number of masks necessary for use, in cases when the clinical site does not provide them. They must be clean and stored per manufacturer recommendations. If recommendations are not provided, then assume that they must be cleaned daily and left to air dry. Students are expected to wear masks at all times. If necessary, additional PPE, other than cloth masks, will be provided by clinical sites. Hospital provided PPE should only be used within the health care setting.

BSOM and its partners are committed to provide a robust clinical experience. Due to fluctuation of patient census and other mitigating factors, the clinical experience may be altered from its original structure. Student should maintain composure and be flexible with the determination of clinical assignments and procedures.

Student must maintain proper infection precautions for each clinical encounter and refrain from divulging protected health information in accordance to HIPAA guidelines.

Reporting and Tracking

Procedure

Medical Student COVID Triage Process

  1. The COVID Response Team’s (CRT) email will be shared with student body and placed on back of ID badges to contact with questions regarding COVID-19: bsom_covid_students@wright.edu.
  2. Students should email their questions with expectation of response within 24 hours regarding the following potential scenarios and remain home from clinical duties until reviewed:
    1. Student has been exposed to a known COVID-19 positive patient or family member/friend without appropriate PPE and has questions regarding testing and/or quarantine recommendations.
    2. Student has symptoms of concern for COVID-19
    3. Student must visit the BAMS COVID Resource community page to download and complete the Screening Questionnaire and include the completed form in their email to the CRT (bsom_covid_students@wright.edu)
  3. Students should address the following in their email and cc their clerkship director-coordinator/elective director/module director:
    1. What clerkship and team/rotation/class they are currently in and at what site
    2. A brief clinical description of the case
    3. The specific question/concern the student has
    4. The best phone number/way to contact
  4. Students should NOT report to clinical duties/in-person didactics until the question has been further triaged and resolved with the CRT and/or the clerkship director/elective director/module director.
  5. Upon review of the email the CRT will respond directly to let the student know next steps which can include:
    1. Registering within Wright State Physicians (WSP) Family Medicine/Student Health to generate a chart for further communications and documentation related to care.
    2. Determining if/when/how/where student is tested for COVID-19 and/or COVID-19 antibodies and generating that order with further instructions.
    3. Communicating with student and clerkship director/elective director/module director and Office of Student Affairs the basic recommendations for COVID risk mitigation when needed to include estimated “return to duty” dates.
    4. Determining if/when/how/where an in-person appointment is needed.
  6. Students have the responsibility to follow through on plan of care recommended by the CRT and to communicate effectively with their clerkship director/elective director/module director on potential time needed to follow plan of care. Time missed can be highly variable depending on the situation and will need to be reviewed on a case-by-case basis to determine appropriate make up time/activities.
  7. Students who initiate a COVID-19 question with the CRT and communicate effectively with their clerkship director/elective director/module director will NOT have their “triage time” count towards official absence.  For example – From the time a student initiates contact with the CRT and a test is deemed necessary, ordered, completed, and resulted – a total of 1-3 days may pass during which time a student must remain in quarantine at home. The student can work with their clerkship director/elective director/module director to remain engaged in virtual/remote learning if possible while waiting for completion of this triage process.
  8. Student’s private health information will be treated in the same way per WSP’s general patient privacy policies in accordance with HIPPA. Dr. LeRoy and the clerkship director/elective director/module director will be notified of students who are tested for COVID and the results only to ensure appropriate tracking/tracing can be accomplished.
  9. Conflict of Interest: Any student who is required/recommended to see a clinical provider at WSP to further evaluate their concerns will be working with WSU Student Health or Family Medicine. If the student is currently or recently working with one of these healthcare professionals during clerkship/elective, it is the student’s responsibility to report this to the CRT so that he may alert appropriate clerkship administration.

Clinical Experiences

Rationale

Direct participation in patient care by students is encouraged and will be possible relative to the fluctuating health risk in the community and related protocols for health care delivery set forth by area hospitals and ambulatory care centers.  Hospital and BSOM protocols may also change based on the availability of PPE, use of COVID-19 testing, and COVID vaccination.  Students will be informed of their assigned site’s PPE/safety regulations.

The following overarching guidance intends to make the learning environment safe for students while also minimizing chances that students will contribute to the spread of COVID-19.  Students must wear a face covering to enter any hospital site, ambulatory facility, or educational site.  A personal cloth face covering is acceptable when walking in hallways, going to cafeteria, or being present in other non-direct patient care areas such as conference or class rooms.   Students will be expected to cooperate with health screenings upon entry just as all other visitors or health care professionals (HCP) are required to do. This may include a statement of self-monitoring, answering questions, having their temperature taken, or logging their own symptoms or temperature on a daily ledger.

When engaging in direct patient care, face masks continue to be required in all settings.  Eye protection may also be recommended for close contact.   Hand sanitizer will be provided and should be used upon entry and after leaving a patient’s room and after PPE is removed.  Medical grade face masks may be offered at some sites. Medical grade face masks can be re-used all day long and discarded at the end of the day. Appropriate PPE will be provided. If a student is fitted for a N95 mask, the student should write their name on this mask and be prepared to save it in their own plastic bag for reuse as necessary.

Higher risk settings for contracting COVID-19 include procedures that create more aerosolization of respiratory droplets. Examples include thoracic or ENT surgeries, GI endoscopies, surgery of bowel with gross contamination, intubation time for surgery or CODE Blue situations. If the COVID-19 test status of the patient is unknown or pending, then enhanced PPE is required for these high-risk procedures. If caring for a patient with symptoms of COVID-19, and testing is pending, enhanced PPE is required and provided by the site. Enhanced PPE includes a medical grade mask, gown, eye protection, and gloves.  In some cases, an N95 mask or PAPR (powered air purifying respirators) may also be used. The level of enhanced PPE may differ between hospitals.

Procedure

If a student’s site provides them with the appropriate PPE, students may engage in direct patient care of COVID patients without restriction. The student should discuss the situation with their supervisor and if both parties agree, then student involvement may proceed. If a student is NOT provided the appropriate PPE for higher risk settings for contracting COVID-19, students should abstain from engaging in direct patient care and discuss the situation further with their supervisor and clerkship/elective director.

Categories of patients:
1. COVID-19 Positive: students may participate in direct patient care, only if the student is comfortable participating and is provided appropriate PPE.
2. COVID-19 Pending/Suspicion: students may participate in direct patient care, only if the student is comfortable participating and is provided appropriate PPE.
3. COVID-19 Negative: students may participate with appropriate PPE without restriction.

Curriculum

Procedure

Recommendations for BSOM student curricular policy changes due to the COVID-19 pandemic must be reviewed and approved by the Faculty Curriculum Committee (FCC), including any necessary changes to WrightCurriculum phase completion and/or graduation requirements. Once approved by the FCC, these revisions to the Student Success Policy, which includes BSOM graduation requirements, will go to the Executive Committee for additional review and approval.

The Office of Student Affairs & Admissions and the Department of Medical Education will provide management to ensure policies are appropriately implemented.

Policy Conflicts

Procedure

If a BSOM student encounters policy or procedural concerns or conflicts, at an assigned clinical site or institution that conflict with the BSOM Medical Student COVID-19 policy, the student is to report this concern to the Dean of Students at 937-775-3319 (gary.leroy@wright.edu). Drs. Bruce Binder and John Donnelly and Genessa Merritt, NP, the clinicians on the COVID Response Team (CRT) (bsom_covid_students@wright.edu) serve as an alternative contact.

A representative of the BSOM administration and the clinical institution’s designated contact for medical student education will adjudicate conflicting COVID-19 policy concerns on a case-by-case basis. The student will be informed, as soon as possible, of the negotiation resolution and of any action(s) they much take to reconcile the policy conflict.

Required Immunizations

Tuberculosis 

Although tuberculosis generally is prevented by proper infection control, transmission in health care settings can occur. Upon entering medical school, students are required to have a negative Two- Step PPD (second PPD is administered between 1-3 weeks after the initial negative PPD) or a negative Interferon-gamma release assay (IGRA). Either of these must be within six months of arriving at BSOM. Students must receive an annual screening for tuberculosis including one of the following:

  • PPD (Mantoux) skin test or Interferon-gamma release assay (IGRA) if previous skin tests have been negative, or
  • Evidence of chest x-ray if PPD skin test is positive, or
  • Evidence of chest x-ray if a student has received BCG and PPD is positive or evidence of chest x-ray if student has had appropriate prophylaxis treatment.

Varicella (Chickenpox)

Students are required to have a quantitative varicella titer. If serologic result shows no immunity, vaccination followed by a repeat titer 6-8 weeks later.

Rubella (German measles) 

Students are required to have a quantitative rubella titer. If serologic result shows no immunity, vaccination followed by a repeat titer 6-8 weeks later.

Rubeola (Measles)

Students are required to have a quantitative rubeola titer. If serologic result shows no immunity, vaccination followed by a repeat titer 6-8 weeks later.

Mumps

Students are required to have a quantitative mumps titer. If serologic result shows no immunity, vaccination followed by a repeat titer 6-8 weeks later.

Hepatitis B Vaccine

Students are required to have a full vaccination series and a quantitative Hepatitis B surface antibody titer demonstrating immunity. If documentation of the vaccination series is not available, a positive surface antibody titer AND a negative surface antigen is acceptable. If immunity is not demonstrated, a repeat 3-dose Hepatitis B vaccination series is required followed by a repeat titer 6-8 weeks later.

Tetanus, Diphtheria, Pertussis

The Tetanus-Diphtheria-Pertussis (Tdap) booster is required and must be received within 5 years of matriculating to BSOM.

Influenza 

Influenza vaccination is required annually and is received no later than October 31st of each year of medical school.

COVID-19

An FDA approved COVID-19 vaccination series (or a vaccine approved for emergency use authorization) must be completed and documented prior to November 1, 2021. 

Pregnant Students

All pregnant students should consult their obstetrician before receiving any required vaccinations.

Medical Contraindication for Immunizations

If a medical contraindication exists for any required immunization, the student must provide documentation from a healthcare provider with details of the contraindication. During clinical rotations, special requirements may be required by the site.

Last edited on 09/09/2021.