Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol

Abstract

IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

“You’re actually part of the team”: a qualitative study of a novel transitional role from medical student to doctor

“…Our study was nested within a larger realist evaluation of the AiMs program [ 24 ] and aimed to provide detailed contextual findings across three sites and two time points. The first interview was designed to occur mid-way through the initial AiM placement.…”

“…The de-identified transcripts underwent initial coding by NE to identify experiences of the AiM role and the responsibilities and opportunities attached to the role. This initial familiarization and exploration used an inductive approach, to allow exploration of lines of inquiry and theory as described in the realist protocol [ 24 ]. The research team met again and discussed the themes identified, before progressing to a deductive approach using Activity theory.…”

Novel student roles in health care delivery: An example emerging from the COVID‐19 health care crisis in 2021

“…These included reduced numbers of health care staff as a result of COVID-19 infection and/or furlough of health care workers, deployment elsewhere (such as vaccination clinics) and reduced numbers as a result of lack of international travel and recruitment. Around the world (and in Australia) medical, nursing and allied health care students stepped up in many volunteer [1][2][3] and paid roles, 4,5 such as vaccinators, quarantine officers and public health roles to fill service delivery needs.…”

Medical students: a potentially sustainable solution for our workforce crisis and future reforms in health care

“…CAs were directly supervised by the medical and nursing staff of the teams within which they worked, and tasks were aligned with Medical Deans Australia and New Zealand core competencies for final year medical students 3 to ensure CAs worked within their scope of practice (Box 1). Since being pioneered at Western Health, similar models have been adopted by many health services in Victoria and throughout Australia, such as the Assistant in Medicine role in New South Wales; 4 however, there is otherwise limited literature in the Australian context.…”