To the Editor:
We read with interest the introduction of a new series of articles exploring medical education by Bond et al. (
1
). Due to the competitiveness and difficulties faced by medical students in applying for speciality jobs, particularly emergency medicine (EM), the authors explored clerkship structure and careers advice to optimize students for speciality matching (1
). However, although optimization for speciality training is important, we question whether in light of the current coronavirus disease 2019 (COVID-19) pandemic, medical curriculums should first prioritize introducing disaster management teaching to all students.The COVID-19 pandemic has resulted in a shortage of EM and intensive care medicine (ICM) staff in many centers, requiring colleagues from other specialities and health care students to be called to support these roles. However, unlike their EM and ICM colleagues, many of these staff and students have not received formal disaster medicine training. This training is required to prepare health care professions for the variety of challenges that occur during a crisis, including communication difficulties, uncertainty around patient prioritization, and management of clinician's own emotions (
2
). We therefore face a dilemma of whether to deploy staff without training or delaying their mobilization in a crisis by organizing additional training.Unfortunately, this is also not limited to the COVID-19 pandemic response, with literature describing similar training deficiencies in other disasters (such as the 2005 Kashmir earthquake) and from reports of responses by disaster management experts (
2
,3
). In response to these previous events, some countries have made efforts to introduce disaster management training into some medical curricula (such as Germany requiring medical students to be familiar with disaster medicine principles); however, the uptake of standardized or widespread disaster management teaching has yet to be reported or observed (4
). A recent search by Ingrassia et al. found that although numerous disaster management educational and training initiatives exist in Europe, most were only at a postgraduate level and not widely available in all European Union countries (5
).As a result of these deficiencies in training, and the high potential for further disasters to occur (such as contagious infections, natural disasters, and war), we argue that a standardized level of disaster management training should be provided to all undergraduate health care students. The training program should be based on successful courses, such as those described by Pfenninger et al. and Kaji et al., which use a mixture of theory and skills-based teaching to cover key principles (including communication, decontamination procedures, mass casualty management, and response coordination) (
4
,6
). These comprehensive, interactive approaches should provide all students with broad principles for disaster medicine, meaning that if called on in their future careers, they should be better equipped for safe active involvement and earlier mobilization.In conclusion, we thank Bond et al. for their recent publication, and we look forward to reading their series on best preparing students for speciality training (
1
). However, we believe that a bigger and earlier priority for medical education is the introduction of disaster management training for all health care students. Although we hope that further large disasters do not occur, given the high likelihood of natural or manmade disasters, we must train and prepare our health care staff, to allow safer, more efficient, and earlier mobilization of human resources in disaster situations.Acknowledgments
J. S. Minhas is supported by the National Institute for Health Research (NIHR Clinical Lectureship in Older People and Complex Health Needs). The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, the Department of Health, or any of their other institutions.
References
- The Medical School Years.J Emerg Med. 2020; 58: e177-e178
- Why medical students should be trained in disaster management: our experience of the Kashmir earthquake.PLoS Med. 2006; 3: e382
- Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training.Prehosp Disaster Med. 2014; 29: 364-368
- Medical student disaster medicine education: the development of an educational resource.Int J Emerg Med. 2010; 3: 9-20
- Education and training initiatives for crisis management in the European Union: a web-based analysis of available programs.Prehosp Disaster Med. 2014; 29: 115-126
- A disaster medicine curriculum for medical students.Teach Learn Med. 2010; 22: 116-122
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- The Medical School YearsJournal of Emergency MedicineVol. 58Issue 3
- PreviewMedical school can be very challenging, especially when students are considering applying to competitive specialties, like emergency medicine. Once medical students know that emergency medicine is the field they want to specialize in, a multitude of other questions arise, including how many EM rotations should they do? How can they shine during their EM rotations? When should they schedule their rotations, electives, and sub-internships? How can they get the strongest letters of recommendation? What are residency program directors looking for? Therefore, we are going to present in the Medical Student Forum section of the Journal of Emergency Medicine a series of six articles covering this and more.
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