Skip to content
Indiana University School of Medicine

Medical Student Portal

/ Support Services  /   COVID-19  /   Phase 3 COVID-19 Updates

Phase 3 COVID-19 Updates

Last updated July 21, 2020, 2:53 pm EDT


Clinical Re-Entry Guidelines


  1. In order to minimize potential exposures, students are not to have direct contact with  patients who are known or highly suspected of having COVID-19. This applies to all settings, both inpatient and outpatient settings.  Many patients seeking care for other health problems may be tested for COVID-19 and are appropriate for student involvement and learning with input from your faculty.
  1. Surgical masks are to be worn at all times within clinical settings (inpatient and outpatient). This includes during rounds, teaching rounds, teaching sessions, etc., as well as direct patient care. Maintain social distancing of at least 6 feet when eating or drinking.
  1. Students are to abide by local healthcare facility protocol/rules and infection control measures in each of their clinical settings. 
  1. Students are expected to provide good stewardship of their use of PPE in all clinical settings to help facilities preserve their supplies.
  1. Students are not to come into clinical settings if they feel ill. Contact IU School of Medicine Student Health at healthsv@iupui.edu or call (317) 274-8214 immediately, notify your clerkship coordinator or preceptor as soon as possible and note the following procedures:
    • If symptomatic, please use the IU Health virtual hub with CAS credentials.
      • If testing is appropriate, you will be guided to closest testing facility.
        • If positive:
          • Let program director, staff physician, and rotation coordinator know.
          • Isolation duration is 10 days minimum and individual must be afebrile (not feverish) for 72 hours with improving symptoms before returning to work/class. This process will be guided by the IU Health virtual hub. Retesting is not required and is discouraged.
          • It is the learner’s responsibility to notify Occupational Health at the facility (e.g. Eskenazi Health or VA) where they have been assigned.  If assigned to IUH, the notification occurs via the IUH Virtual Hub.
        • If negative
          • Let program director, staff physician, and rotation coordinator know.
          • Should remain off rotation until you’ve been 24h fever free (off antipyretics such as ibuprofen or aspirin) with improving symptoms.
  2. Alternative experiences and options to complete clerkship requirements will be determined with the clerkship team. Please refer to the time away policy for illness or absence. Coming to clinical settings while feeling ill places colleagues and patients at risk and should not happen in any circumstances.

Time Away Requests


As you’re aware, your time on your clinical rotations is mandatory, and you should make every opportunity to be present. However, we recognize that there are times where that won’t be possible.

Illness: As outlined in the clinical re-entry guidelines, students are not to come into clinical settings if they feel ill. If this occurs, notify your team immediately and when time allows, fill out a time away form, and your team will work with you to make sure you can complete all requirements. Follow the procedures for virtual screening if you have any symptoms concerning for Covid-19.

Emergencies: Emergencies happen. If something occurs, always remember to notify your team immediately. Please fill out a time away form for official documentation when time permits. Your clerkship team will work with you to ensure that you can complete any missed elements if needed.

Special Events: We know that there are special events that occur in everyone’s lives, and some may require travel. The COVID-19 pandemic necessitate that you consider multiple elements as you contemplate travel:

  1. Business / school travel is prohibited by Indiana University at this time. The University will provide periodic updates on these restrictions.
  2. Always check with your facility where you’re about to be working next, prior to making personal travel plans. Healthcare systems may require self-isolation with any travel. Such exclusions from the hospital systems would require rescheduling and potentially delay your clinical experiences.
  3. International travel is prohibited at this time. Any international travel would require rescheduling and potentially delay your clinical experience.
  4. Even if initially cleared for travel, if regulations change while you’re traveling, you may require self-isolation upon your return due to changes. This would require rescheduling rotations and potentially delay your clinical experiences.

If you request time away from your team due to a special event, please recognize that, depending on the impact on your rotation, it may not be able to be granted or the time away will need to be made up to ensure that your requirements can be met


FAQs

Will Phase 2 and 3 students now see patients who have tested positive for COVID-19?

Yes, IU School of Medicine students will now be fully integrated into our Indiana COVID-19 Response Teams and may participate in the direct care of patients with known or suspected COVID-19 when clinically appropriate and with appropriate access and use of personal protective equipment (PPE). This step forward in our full return to the current clinical environment will allow IU School of Medicine students the best opportunity to have robust clinical experiences in all clerkship disciplines that will keep their training schedules on track for completion of their graduation requirements and to be fully prepared for their residency training programs, which we expect to involve continuing SARS-Co-V2 infections for months and possibly years to come.

What is the rationale for allowing students seeing COVID-19 positive patients as part of clinical rotations?

At the beginning of the pandemic, all medical schools in the U.S. paused clinical rotations due to the unpredictable conditions and lack of personal protective equipment (PPE) access in clinical settings. By late June, our clinical partners were able to supply a stable learning environment and meet the CDC guidelines for protecting their own staff and our students. Rotations restarted at that time but retained the precautions on student involvement with known or suspected patients with COVID-19 based on AAMC recommendations at that time and rapidly changing conditions. By August, the AAMC determined:

“that to address ongoing national physician workforce needs, the clinical education of our medical students — including their involvement in direct patient contact activities (which may involve patients with and those without known or suspected COVID-19) — must continue, with appropriate attention to safety, in the context of the constantly evolving conditions that define the COVID-19 pandemic in the United States. Close and ongoing collaboration between medical schools and their clinical partners is particularly critical to ensure that these national workforce needs continue to be addressed.”

Over the last few months, the national and Indiana COVID experience have shown that following the CDC guidelines for precautions in clinical settings was extremely successful in reducing transmission risk of SARS-CoV-2 among healthcare workers and patients. This observation of a high degree of safety over time, along with high penetrance of COVID-19 in Indiana patient populations and rising hospitalization rates, have led to the decision to allow students to work with COVID-19 patients with appropriate use of PPE.  View this helpful review of the evidence behind our current PPE recommendations.

The number of patients with proven or suspected COVID-19 often constitutes a large proportion of patients in hospitals and some ambulatory settings (Emergency Departments and Urgent Care Centers). This is the new “normal” that we will be dealing with for months to come. This is particularly true for disciplines like internal medicine, inpatient family medicine, critical care, and emergency medicine, but also impacts other disciplines to variable degrees in both inpatient and outpatient settings. 

Care of COVID-19 patients will be a key aspect of clinical medicine in all disciplines for at least the next 8-24 months and perhaps longer. Therefore graduating physicians entering residency training in 2021 or 2022 will be expected to have familiarity with the management of this disease in the context of other illnesses. Rotations in disciplines that have a high proportion of COVID-19 patients are very important parts of the required medical education of all U.S. graduates. There are no adequate non-face-to-face replacement options for these rotations to meet the graduation requirements and prepare graduates for residency. Additionally, the conditions in these rotations, related to COVID-19, are unlikely to change dramatically in the next several months or even years ahead.  Many other U.S. medical schools are currently allowing, or have plans for allowing students to care for patients impacted by COVID-19.For these reasons, all Phase 2 and 3 students will soon (currently estimated to be January 4, 2021 for Phase 3 and January 7, 2021 for Phase 2) be expected to care for patients on their team/service/clinic regardless of COVID status when clinically appropriate and the CDC guidelines can be met by the facility (surgical masks and gowns, gloves and face shields as indicated). Students will be provided with appropriate PPE in all of their clinical rotations, including access to N-95 masks for use in aerosol-generating procedures (operating room or procedural areas). We are confident that adherence to these protocols will minimize risk to the extent possible at this point in time.

What if I have concerns about moving forward in my rotations?

Students who have any concerns about moving forward in these rotations under these conditions are encouraged to discuss their concerns with their Lead Advisors and Career Mentors to consider the alternative options and the impact of those changes. Any delayed rotations will need to be made up at a later date. No rearrangements of clinical scheduling can be made within Phase 2 schedules for this year, as has been the case since June. The alternative options could include: 

  1. Take a vacation period instead of the rotation. This will require using vacation time and will reduce vacation availability later in  Phase 2 or Phase 3. The delayed rotation would need to be made up at a later date based on availability of clerkship slots in the next academic year, after the incoming Phase 2 student schedules are set. Herefore, available times and campus/facility locations may be limited and those rotations may not be completed in time to be included in the Medical Student Performance Evaluation that is included with your residency application. While we will do our best to help you with your schedule, taking a vacation instead of currently scheduled clerkship rotations has the potential to result in extension of the medical training period and could have an impact on financial aid issues depending on enrollment status.
  2. Consider a formal program of study (MBA or MPH) with return to clinical training at a later date (typically 1 or 2 year programs).
  3. Request a formal Leave of Absence (LOA) from school. Specific LOA will be discussed on an individual basis but will involve having to move required clerkships to Phase 3 (with no guarantee that rotations can be rescheduled early in the Phase 3 experience) and would likely result in extension of the medical training period and could have impact on financial aid issues depending on enrollment status.
  4. MSE will work with students to consider possible non-clinical elective options that could be taken during these times, in lieu of the currently scheduled rotations when feasible.
Will all students, even those with known high risk factors, be seeing COVID-19 patients as part of rotations?

IU School of Medicine, like our clinical partners, follow the CDC’s guidance on high-risk conditions that qualify a team member to be excluded from caring for COVID-19 patients who are in isolation and considered infectious. The list includes people who:

  • Are age 65 or older
  • Have chronic lung disease or moderate to severe asthma 
  • Have a serious heart condition 
  • Are immunocompromised (This can be caused by cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, or prolonged use of corticosteroids and other immune-weakening medications).
  • Are severely obese (BMI of 40 or higher) 
  • Have diabetes 
  • Have chronic kidney disease, or are undergoing dialysis 
  • Have liver disease 
  • Are pregnant
How do I request being excluded from direct care of COVID-19 patients (in isolation and considered infectious)?

Only students who have one of the above health conditions are eligible for this exclusion. To do so, they must complete and submit the COVID Care Exclusion Form (being constructed) to start the consideration process. Exclusion from care of patients with COVID-19 does not mean opting out of care for patients altogether, and students who are excluded will be assigned to caring for non-COVID-19 patients. As discussed above, the prevalence of patients with COVID-19 in the hospital may result in those students with this exclusion status needing to change rotation locations to meet the required clinical exposures of a rotation. If that is not possible, the student will need to make up that time at a later date to satisfy graduation requirements.​

How does getting the COVID vaccine impact my ability to work with patients who are infected with COVID-19?

We are very excited that the COVID vaccine is now available and will be rolled out to frontline healthcare workers, including IU School of Medicine Phase 2 and 3 students, over the next days to weeks statewide.  Although we highly recommend our clinical facing students get the vaccine when available, it is a voluntary decision.  Studies have shown the vaccine is highly protective after the two-dose series is complete.  Just as we have done over the last several months, clinical care of SARS-Co-V2 infected patients continues under the standard precautions whether healthcare team members are vaccinated or not.  This includes students.  Vaccination for COVID is not a requirement to work with patients with COVID-19. IU has an extensive FAQ list around the vaccine.

What precautions will be taken for seeing COVID-19 positive patients?

Involvement of IU School of Medicine students with COVID-19 patients will only occur when the standard Centers for Disease Control and Prevention (CDC) precautions can be met, including adequate personal protective equipment (PPE) for the conditions. Standard surgical masks are still the primary protective mechanism used in all routine interactions with patients with known or suspected COVID. N-95 fit testing or alternatively fit checking will be done to ensure adequate protection when N-95 masks are needed (aerosol-generating procedures).

What if I am at high-risk for severe infection from COVID-19?

As has been the case since April, IU School of Medicine students can discuss existing or new medical conditions with Medical Student Education to consider applying for formal accommodations and the possibility for a medical leave of absence from training.

Flexibility will be offered to students to the greatest extent possible, but rotations that are delayed will need to be made up in the future and these changes could lead to delay in completing graduation requirements.

As has been the case since the clinical rotation restart on June 26, no schedule changes/rearrangements can be made through the end of Phase 2.

What will the process be for fit testing/checking of N95 masks?

IU School of Medicine Student Health has been partnering with Medical Student Education to accomodate students in or near Indianapolis for fit testing. The first round of scheduling for fit testing of N95’s masks began the week of December 14. It is our goal to have the majority of Phase 2 and Phase 3 students complete fit testing from December 14 to December 18. Students were excused from required activities to complete fit testing. Regional Campus options can be found by checking with the Regional Campus teams or will be placed on our COVID-19 website as information is provided.

What if the facility I’m rotating at doesn’t have adequate PPE?

Students, and all healthcare providers, should only see COVID patients with appropriate use of PPE. Medical Student Education is working with our statewide clerkship sites to ensure that they are able to meet the needs of our students.

How do I report issues with use of or access to PPE in a hospital or clinic setting?

For IU School of Medicine learners in clinical settings, we have developed a reporting form for potential concerns or incidents related to COVID-19 safety concerns that vary from the CDC COVID-19 related guidelines. This form will address the learning environment for student training. Any patient safety or issues covered by HIPAA should be reported within the healthcare system’s local incident reporting procedures. Your clerkship directors and coordinators are also available to help with any questions during your rotations.

When do I need an N95, and when do I need a surgical mask?

You should always follow local healthcare facility infection control procedures. Healthcare systems have developed detailed local guidelines based on state, federal, and other specialty-specific guidance as well as local prevalence data. Standard surgical masks remain the method of protection for routine care of COVID patients. An N95 respirator or higher respiratory protection is required for any aerosol-generating procedure such as positive pressure ventilation, intubation, invasive procedures, or CPR. Updated recommendations are available from the IDSA and CDC and nicely explained by our own Dr. Cole Beeler in this video.

Is it safe to re-use N95 masks?

Extended use or “re-use” of N95 masks was a common practice during the early COVID-19 pandemic in order to maintain respirator supplies and has been well-studied during this time. Healthcare providers and systems should follow CDC guidance on the safe and effective extended use of PPE and N95 respirators. Hospital protocols vary based on specific equipment and processing procedures to ensure safe extended use. Healthcare providers practicing extended use of a respirator should perform a respirator seal check per current CDC guidance.

Can I bring in my own face shield or other PPE?

In general, healthcare providers should use hospital-issued PPE to ensure that all protective equipment meets current requirements for functionality and use. Some hospital systems have specific exceptions (for example, some hospitals allow providers to use their own face shields or eye protection). 

How will students make up missed rotation time due to COVID-19? When will students make up time if they don’t have remaining vacation days?

The April 2021 block in the Phase 2 curriculum is scheduled as an opportunity for students to make up time missed due to COVID-related quarantine, illness, or events. There will be several weeks during that period to make up clinical responsibilities from incomplete clerkships. Additional time required for make-up would possibly need to carry over into the Phase 3 academic year depending on circumstances.

What is the rationale for the virtual testing hubs not providing mitigation testing after high-risk exposures?

The IU Health Virtual Testing Hub was created for statewide healthcare workers to get expedited testing in the event that they developed any symptoms suggestive of COVID-19. IU School of Medicine students are included in this priority access process. 

As testing options have become more prevalent and accessible, mitigation testing after high-risk exposures, for people at high risk of severe disease, or those concerned about transmitting infection to others have arisen. The IUH Virtual Testing Hub is not one of these sites and does not intend to be in the foreseeable future in order to maintain capacity and turn-around times that serve the needs of HCWs who are experiencing symptoms and need to be tested quickly for COVID-19 to avoid lengthy, unnecessary quarantine.

IU provided mitigation testing pre-travel around Thanksgiving and is doing so again. There are a limited amount of tests available on-demand for individuals on the IUPUI and Bloomington campuses.

Students who have concerns about high-risk exposures to SARS-Co-V2 or desire testing for other reasons, are encouraged to do so through local testing sites in their vicinity such as Optum or CVS sites. The turn-around time on these tests has been improving and these tests should be free or covered by your insurance.

Why do our COVID-19 policies restrict taking NBME exams in person but allow taking care of COVID-19 patients?

The primary rationale here is to minimize interactions when there is the potential for alternative methods (i.e. lectures, exams, didatics). If there are alternatives to meeting in groups, like taking exams remotely versus in-person, curricular directors are doing their best to utilize those alternatives. However, when it comes to learning how to take care of patients and preparing students to become an intern physician in 18 months or less, there are no educationally sound alternatives that can replace clinical rotations.

What are the AAMC guidelines for students seeing COVID-19 patients?

“The AAMC recommends that medical schools ensure: (1) reasonable safeguards are in place to minimize medical students’ risk of contracting COVID-19, and (2) medical student participation in the required clinical experiences and assessments aligns with the school’s educational program objectives. Medical schools should also implement medical student direct patient contact activities in alignment with the school curriculum committee’s identification of those clinical experiences and assessments that can only be met through direct patient contact.” The full context of the AAMC guidance was considered by IUSM leadership and you can view the entire updated Guidance on Medical Students’ Participation in Direct In-person Patient Contact Activities. This guidance, released on August 14, 2020, replaced prior AAMC restrictions that prevented medical students from direct care of patients with COVID-19.