At the beginning of the SARS-CoV-2 pandemic in early 2020, the commitment of medical students as supporters of health care staff and their possible roles in the system were discussed more than ever before (8–13,19,27). This discussion led us to perform a survey of medical students voluntarily working in a large-scale SARS-CoV-2 cohort study. Most of them had the feeling of participating in the fight against the pandemic due to their commitment. In addition, most of the students recognized it as a chance to improve their skills. However, they did not feel well prepared by medical school and demanded dedicated preparation courses on crises and pandemics.
The idea of student commitment during crises is not new; students successfully supported health care staff during the Spanish flu epidemic in 1918 in Pennsylvania and the Polio outbreak in 1952 in Copenhagen (28,29). During times of increased fear of health staff shortages, the advantages of the commitment of medical students to supporting the health care system are obvious, as medical students represent a group that knows the health care system well due to mandatory internships. Depending on their progress in medical school, the students may also already have knowledge of basic skills needed for clinical patient care, such as taking histories and doing blood draws (10). Furthermore, as most of the students are young and healthy, Thomson et al. argued that they are a low-risk group regarding infection with SARS-CoV-2, especially in contrast to reactivated retired health care staff (13).
Nevertheless, not only the challenged health care system may benefit: For the medical students the help during the crisis can be seen as project problem-based learning (project-PBL) (15). Project-PBL not only broadens students’ metacognitive competencies, but fosters skills relevant to medical problems and research (30). This means that the CPM study work enabled the students to further develop organizational, communication, and basic medical skills (e.g., blood or swab sampling) during a time when medical schools are closed and most courses held online without the possibility of hands-on training. Furthermore, actively taking part in the fight against the pandemic can strengthen the “sense of cohesion”, which can increase the motivation of the group and further improve their performance (31). In addition, the “social connectedness” of the students may be strengthened, which is an integral part of mental health, especially in a time when contact restrictions constrain social interactions (32).
Despite all of these advantages of student commitment during the pandemic, there are some drawbacks that have to be addressed. As the students are clearly not permitted to perform all tasks, their work has to be regularly supervised or even repeated by professional staff. Some authors argue that, through this redundant work, the transmission rate may be increased (27). Furthermore, this may lead to a waste of personal protective equipment, for which a shortage has already been reported (3).
Another possible source of mistakes to consider may be the insufficient preparation of the students for the pandemic by their medical school. Dedicated preparation courses are lacking. Our study underlined that the students did not feel well-prepared for dealing with the pandemic. Even though overextending situations occurred rarely, the goal has to be to further minimize them, especially as today’s medical students may be first-line fighters in the next crisis. Thus, the demand for special courses is great. To solve this problem, several training and recruitment initiatives have emerged during the current crisis (14,15). However, single-center initiatives can only be the beginning. To be better prepared for the next crisis, systematic and nationwide standardized preparation courses may be the solution. Such a program in association with a dedicated database would also allow for faster, more extensive, and especially more specific recruitment. High motivation and a feeling of preparedness are the basis of the commitment, but not enough to make the students an indispensable support during the crisis.
Our study has several limitations. First and foremost, the students were only recruited at a single center for a dedicated SARS-CoV-2 cohort study to perform limited and clearly defined tasks. However, the students signalized their assistance before even knowing their exact task within the study, so the influence of this bias on students’ motivation and attitude towards their commitment can be expected to be low. Secondly, the recruitment of the questionnaire participants could have led to a response bias, interested students may be more likely to have completed the questionnaire. To minimize this potential bias, we sent a reminder to the students, which eventually led to a very high response rate of more than 80%. In addition, the SARS-CoV-2-prevalence in Germany was moderate (33). A higher prevalence in a region may lead to a higher chance of having relatives and friends directly affected by COVID-19, which could lead to a more negative psychological impact and possible anxiety towards a commitment. However, it may also further increase motivation to help in the fight against the pandemic, as experiences from greater affected countries also report highly motivated students (13,14).