An Offcial Publication of the Society of Hospital Medicine Journal of Hospital Medicine ® Published Online Month 2020 E1 PERSPECTIVES IN HOSPITAL MEDICINE Education in a Crisis: The Opportunity of Our Lives Mel L Anderson, MD 1 *, Sara Turbow, MD, MPH 2,3 , Mayumi A Willgerodt, PhD, MPH, RN 4 , Gregory W Ruhnke, MD, MS, MPH 5 1 Primary and Specialty Care Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota; 2 Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; 3 Division of Preventive Medicine, Department of Family and Pre- ventive Medicine, Emory University School of Medicine, Atlanta, Georgia; 4 Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington; 5 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. I n a few short months, the novel coronavirus SARS-CoV-2 has spread across the world, and illness caused by coronavirus 2019, or COVID-19, now affects every corner of the United States. 1 As healthcare systems prepare to care for a wave of affected patients, those with a teaching mission face the add- ed challenge of balancing the educational needs and safety of trainees with those of delivering patient care. In response to concerns for student welfare, medical and nursing schools have suspended classroom-based education and clinical rotations. 2 The Accreditation Council for Graduate Medical Education (AC- GME) and American Association of Colleges of Nursing (AACN) have emphasized the importance of adequate training in the use of personal protective equipment (PPE) for their trainees. 3 The National League for Nursing has called on training programs to allow flexibility for graduating students who may have been re- moved from clinical rotations because of safety concerns. 4 These decisions have precedent: During the SARS-CoV epi- demic in 2003, medical and nursing student education was tem- porarily halted in affected areas. 5-6 Healthcare trainees described concerns for their safety and reported adverse emotional im- pact. 7-9 In the current pandemic, there is variation in how coun- tries around the world are approaching the role of learners, with options ranging from removing learners from the clinical envi- ronment to encouraging early graduation for students in hopes of ameliorating the impending physician shortage. 10-13 The need to balance educational goals with ethical concerns raised by this pandemic affects health professions trainees broadly. Despite the challenges, there are unique educational oppor- tunities at hand. In this Perspective, we will draw on our collec- tive experience, multiple informal interviews with educational leaders across the country, and educational literature to create a framework for health professions education during a crisis. From this framework, we will propose a set of recommenda- tions to assist educational policymakers and those working di- rectly with learners to navigate these issues effectively. KEY EDUCATIONAL ISSUES Patient and Hospital Welfare There are signifcant concerns about nosocomial spread of SARS-CoV-2. Having learners directly see COVID-19 patients can increase the risk of nosocomial spread. In one of the orig- inal case series, 29% of those infected were healthcare work- ers and 12.3% were patients hospitalized prior to infection. 14 Additionally, preserving supplies of personal protective equip- ment (PPE) for healthcare workers has been a commonly cit- ed reason for suspending student presence on clinical rota- tions. Insuffcient supply of PPE has forced hospitals to relax PPE guidelines for those seeing patients under investigation and liberalize quarantine requirements for exposed healthcare workers, so many hospitals have reduced provider-patient in- teractions to only those considered essential. Learner Welfare As educators, we have a duty to keep our learners safe and psychologically well. The COVID-19 pandemic poses a risk of illness, permanent injury, or death among those infected. In some instances, the risks of exposure may be greater than the educational benefts of remaining in that clinical setting; how- ever, health professions trainees at many institutions play such a central operational role that their absence could seriously impair overall care delivery. Furthermore, trainees are usually younger and healthier than supervising clinicians, which could leave them feeling an obligation to conduct a disproportion- ately large share of the direct patient contact. Despite these valid concerns, those being removed from the clinical environ- ment for their safety could misinterpret it as a sign that their contributions or educational interests are not valued. Educational Experience Canceled clinical rotations will have signifcant negative edu- cational effects on undergraduate learners. Depending on the extent of the pandemic’s effects, for example, third-year med- ical students may lack core rotations prior to applying for resi- dency training. Other health professions face similar challeng- es—nursing students in their fnal year are likely missing their last opportunity for hands-on clinical training before gradu- ation. Advanced practice nursing students may not be able to complete the required number of contact hours or clinical experiences mandated for accreditation. Graduate training programs must accommodate and adapt to these disparities when reviewing their applicant pools. Absence from the clinical front lines, though, risks failing to capitalize on the unique educational opportunities presented by this pandemic. Students might miss the chance to learn *Corresponding Author: Mel L. Anderson, MD; Email: Melver.Anderson@ va.gov. Received: March 30, 2020; Revised: April 2, 2020; Accepted: April 2, 2020 © 2020 Society of Hospital Medicine DOI 10.12788/jhm.3431