Medical Students Are Not Essential Workers: Examining Institutional Responsibility During the COVID-19 Pandemic.

In light of the evolving COVID-19 pandemic, the Association of American Medical Colleges (AAMC) and Liaison Committee on Medical Education (LCME) released a joint statement in March 2020 recommending an immediate suspension of medical student participation in direct patient contact. As graduating medical students who will soon begin residency, the authors fully support this recommendation. Though paid health care workers, like residents, nurses, and environmental services staff, are essential to the management of COVID-19 patients, medical students are not. Students' continued involvement in direct patient care will contribute to SARS-CoV-2 exposures and transmissions and will waste already limited personal protective equipment. By decreasing nonessential personnel in health care settings, including medical students, medical schools will contribute to national and global efforts to "flatten the curve."The authors also assert that medical schools are responsible for ensuring medical student safety. Without the protections provided to paid health care workers, students are uniquely disadvantaged within the medical hierarchy; these inequalities must be addressed before medical students are safely reintegrated into clinical roles. Although graduating medical students and institutional leadership may worry that suspending clinical rotations might prevent students from completing graduation requirements, the authors argue the ethical obligation to "flatten the curve" supersedes usual teaching responsibilities. Therefore, the authors request further guidance from the LCME and AAMC regarding curricular exemptions/alternatives and adjusted graduation timelines. The pool of graduating medical students affected by this pause in direct patient contact represents a powerful reserve, which may soon need to be used as the COVID-19 pandemic continues to challenge the U.S. health care infrastructure.

Testing for Chlamydia Reinfection Among Adolescent Patients in Different Clinical Settings: How Are We Doing?

INTRODUCTION: Chlamydia trachomatis is the most frequently reported infectious disease in the United States, with high reinfection rates and highest prevalence among adolescents and young adults. National guidelines suggest testing for reinfection 3 months after chlamydia treatment, and 3 to 4 weeks after treatment during pregnancy. Our needs assessment evaluated retesting rates among adolescent and young adult patients across several clinical settings within one community. METHODS: We performed retrospective chart reviews to examine chlamydia retest rates among 14 to 21-year-old patients treated for chlamydia within three different settings: an academic primary care site with family medicine and pediatrics clinics, an adolescent health center, and a group of school-based health centers (SBHCs). Per CDC guidelines, the goal treatment window was defined as retests conducted between 60 to 183 days after documented treatment for nonpregnant patients, and those conducted within 21 to 42 days posttreatment for pregnant patients. RESULTS: Overall, 77/134 (57.5%) of patients were retested, with 59/143 (44%) retested within the goal time frame. Site rates of retesting within guideline timeframe were as follows: 38.5% at the academic family medicine site, 46.2% at the academic pediatrics site, 42.7% at the adolescent health center, and 55.0% at SBHCs. The reinfection rate among those appropriately retested was 22.0% (13/59). Of patients not retested appropriately, 25.3% had return visits at which they were not retested (a missed opportunity). CONCLUSIONS: Our results indicate a need for interventions that encourage patients to return for retesting, and that trigger retesting during unrelated return visits.