Expecting the Unexpected: Guidelines for Medical Education Disaster Preparedness

June 2, 2020

By Vivian Altiery De Jesus, MBE, and Marielle Gross, MD

Health crises inevitably force us to struggle between maximizing scarce resources, safety, and patient care, typically at the expense of longer-term priorities such as medical education. While crises are characterized by unpredictability and range in form from pandemics to natural disasters, we can expect for these events to periodically occur. Making the most of medical education in these settings requires a thoughtful strategy.

 Crises Offer Unique Opportunities for Education

In 2017, Hurricane María devastated Puerto Rico while I was a third-year medical student. First, we were pulled from clinical rotations for three weeks. On our return, however, the crisis had drastically changed our healthcare system. There were unprecedented challenges for scarce resource allocation—we rationed everything from power plugs to ICU beds. As students, we found ourselves performing tasks well outside of our usual scope: both above and below our paygrade. For example, we sorted supplies and transported patients, but we also coordinated care and were charged with communicating bad news to patients’ and their families.

Despite these moments of heightened responsibility, the feeling of our education being sidelined after years of training and hard work, was a frustrating and difficult to process emotion. Where we were involved, it was often for duties that we would ordinarily have classified as “scut “ (i.e. delivering a blood test to the pathology department). While these were essential for patient care, and it was nice to be “useful,” these tasks had become verboten for millennial medical students. The unexpected nature of the changes, the lack of expectations and unknowns regarding how long they would last characterized the challenge.

Through all of this, I started to recognize positives: unique opportunities to build my character and fine tune my skills as a future practitioner. Our cases were unusual and complex. When we had the privilege of responsibility well beyond third year, such as being trusted to present and discuss a patient case with the radiology department, we felt the value of being essential care providers at a time when we would have ordinarily been merely observing.

I was proactive and embraced these positives, helping me get thorough the crisis with medical education intact. Indeed, the experience led me to pursue additional training in bioethics prior to proceeding with my clinical training. However, it would have been beneficial to have a framework or guidelines for what was expected of me and what I should expect from my medical education amidst a crisis.

History Repeats Itself

Three years later, I am a bioethics master’s student, embedded in an academic medical setting when COVID-19 struck.  The emotions, concerns and frustration shared among my peers and fellow medical students are very similar to the ones I felt during Maria. As before, there were mixed reactions, from feeling helpless to being entitled as a “paying customer” to proactive reactions1-4.

Again, the lack of a framework or guidelines for how to adjust medical education during a health crisis has imposed an additional challenge as public health needs yet again trumped medical education. Seeing this medical education crisis reoccur, I want to advocate for need a coherent strategy for how to make the most of the opportunity to strengthen the development of future physicians whose medical training coincides with a health crisis.

Medical Education should be Prepared for Health Crises

Preparedness is key for successful navigation during crises, however flexibility is key since each crisis is unique. However, most crises have a degree of predictability in what to expect regarding their impact on medical education and how to effectively respond. Having general guidelines and flexible protocols, rather than relying on ad hoc improvisation, would create structure for students where they need it most. This would support allow a better integration of medical education across the crisis and beyond, and may inspire students to take the positive side of training amid a crisis5.

For example, protocols could outline the different roles and duties of medical students during crises (i.e. understanding the logistic of being temporarily sidelined, what to expect and what is expected from them). These guidelines and protocols should be revised periodically with inputs from all training levels and sensitivity to individual circumstances. Medical students in the current crisis have been instrumental in providing insight and feedback for the advancement and implementation of tele-education technology.

Unfortunately, pandemics and natural disasters will continue to occur in the future. Just as we prepare our healthcare systems to handle and respond to these future events, so too must we prepare our medical educators and programs, particularly given their aligned long-term missions. A crisis like COVID-19 is an opportunity to learn from the experience and challenges of medical education amid a health crisis to optimize preparedness of this critical component of the healthcare system for the future.


  1. Health crises sporadically take over healthcare systems with significant consequences for medical education.
  2. During a health crisis, medical students and their education are side-lined from clinical settings, compromising medical education and creating moral distress among students, but also creating a unique learning opportunities.
  3. Preparing for the unexpected via pre-set but flexible protocols for medical education during a health crisis may ease distress and support students to make the most of the crisis learning moment5.


  1. D. Cara. How Medical Student May Help Fight COVID-19. Gizmodo, March 18,2020, https://gizmodo.com/how-medical-students-may-help-fight-covid-19-1842385023
  2. Dev. Medical students feel sidelined in fight against COVID-19: ‘We want to help’ Crosscut, March 31, 2020, https://crosscut.com/2020/03/medical-students-feel-sidelined-fight-against-covid-19-we-want-help
  3. Krieger and A. Goodnough. Medical Students, Sidelined for now, Find New Ways to Fight Coronavirus. The New York Times, March 23, 2020 https://www.nytimes.com/2020/03/23/health/medical-students-coronavirus.html
  4. Rose. Medical Student Education in the Time of COVID-19. Journal of the American Medical Association. Published online March 31, 2020. Doi:10.1001/jama.2020.5227. [Accessed 8 April 2020].
  5. Blake A. ‘The Future Is Today’: Medical Students In the COVID-19 Pandemic. Health Affairs Blog, March 31, 2020 https://www.healthaffairs.org/do/10.1377/hblog20200326.510173/full/