Debate: Should there be a policy at UMHS preventing learners from caring for patients with Ebola infection? October 23, 2014 Timothy Kaselitz Med/Peds- PGY3

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Position Statement The University of Michigan should not hold a policy that a priori excludes learners and trainees from caring for patients with Ebola

Assumptions Any involvement of learners would: Include comprehensive training on EVD, its diagnosis and management, and infection prevention protocols, including the proper use of PPE Be aimed at providing the best possible care to the patient Not jeopardize the obvious goal of limiting infection exposure and disease transmission

Premise A As care providers, we all have a moral duty to care for the infirm »“I will apply, for the benefit of the sick, all measures that are required” »“I will remember that I remain a member of society, with special obligations to all my fellow human beings” –Can’t find caveat, “once I am an attending”

Premise B Trainees are not just learners: we provide services to the patient’s we care for, the health system, and the wider community –This care has real consequences, both good and bad –This scope of practice mandates that we uphold the principles in the Hippocratic Oath

Premise C There are no sound explicit or implicit reasons why trainees should not care for patients with Ebola

Explicit Reason “Learners should be excluded because they lack the same skill and experience as faculty in caring for patients with Ebola” –With rare exception, we all certainly have the same experience caring for patients with EVD, virtually ZERO!

Implicit Reason “Learners need special protection from risks they may encounter during training” –Shouldn’t faculty be afforded the same level of protection? –Trainees arguably put themselves at more risk than faculty in many cases (i.e. procedure) –What if there is a real outbreak at UMHS?

ACGME Statement Authorities predict that the EVD will represent an important public health concern in the U.S. for some time ACGME expects that residents and fellows be both aware of, and able to appropriately respond to, this viral disease.

ACGME Guidelines All residents and fellows in the U.S. know the basic signs and symptoms of patients with Ebola infections and the correct protocols in all care settings. Additional knowledge, training, and skill around Ebola prevention, surveillance, diagnosis, and treatment, together with adequate protective resources, will be provided to residents and fellows

ACGME Guidelines Any resident or fellow who provides care to patients will do so under the direct supervision of faculty members who have been trained in the treatment and infection control protocols

VA Policy Trainees who participate in VA-based clinical educational experiences should not be subjected to excessive or unusual risks in their learning capacity… …because of their relative inexperience, trainees should not be tasked with participating in the care of Ebola virus patients in VA settings

Summary Learners vow to uphold the same ethical and professional principles as all medical providers Our current practice requires that we uphold these expectations The care of patients with EVD falls within these expectations

Thank You!