Training and Deployment of Medical Students as Respiratory Therapist Extenders during COVID-19

Abstract

Background: Early experience during the coronavirus disease (COVID-19) pandemic and predictive modeling indicate that the need for respiratory therapists (RTs) will exceed the current supply. Objective: We present an implemented model to train and deploy medical students in the novel role of "respiratory therapist extender" (RTE) to address respiratory therapist shortage during the COVID-19 pandemic. Methods: The RTE role was formulated through discussions with respiratory therapists. A three-part training, with both online and in-person components, was developed and delivered to 25 University of Michigan Medical Students. RTEs were trained in basic respiratory care, documentation, equipment preparation, and equipment processing for clinically stable patients. They operate in a tiered staffing model in which RTEs report to a single RT, thereby extending his/her initial capacity. Results: The first cohort of safely trained RTEs was deployed to provide patient care within 1 week of volunteer recruitment. Conclusion: Our experience has demonstrated that healthcare professionals, including medical students, can be quickly trained and deployed in the novel RTE role as a surge strategy during the COVID-19 pandemic. Because we urgently developed and implemented the RTE role, we recognize the need for ongoing monitoring and adaptation to ensure patient and volunteer safety. We are sharing the RTE concept and training openly to help address RT shortages as the pandemic evolves.

Mechanical-Ventilation Supply and Options for the COVID-19 Pandemic. Leveraging All Available Resources for a Limited Resource in a Crisis

“…Anesthesia technicians may also be able to augment some of these functions as surgical cases are deferred. Others have also suggested training medical students to assist and extend the RT role ( 81 ).…”

Questioning medical competence: Should the Covid-19 crisis affect the goals of medical education?

“…EPAs for the work needed to deal with the crisis can be articulated, training can be provided (the nature and extent of which would vary depending on the individual and their existing skill sets), and assessment can be organized. Ventilator management, for example, could well be shaped as an EPA (Hester et al 2020). Digital badging, a formalized and externally retrievable recognition of competence in an area, has recently been recommended to create a more individualized profile of competence (Norcini 2020;Noyes et al 2020), a development that would perfectly fit with the use of EPAs (Mehta et al 2013).…”

“…vi. Should schools, institutions, professional organizations, and working groups create 'rapid deployment' modules or bootcamp activities and offer them when needed (Hester et al 2020)? Should there be a repository where such curricula can be shared nationally or internationally around emerging topics?…”

Mechanical ventilation for the non-critical care trained practitioner. Part 1

“…Over the last decade, there has been a shortage of critical care physicians, 1 and respiratory therapists 2 which has been markedly accentuated during the COVID-19 pandemic crisis. Hospitalists find themselves confronted by taking the lead of caring for such complex patients especially the ones suffering from respiratory failure requiring mechanical ventilatory support.…”