Medical Students Can Be Deployed as 'Respiratory Therapist Extenders' During COVID-19 Surge

By Marilynn Larkin

May 20, 2020

NEW YORK (Reuters Health) - Medical students and other healthcare professionals can be quickly trained and deployed in a new "respiratory therapist extender" (RTE) role as a surge strategy during the pandemic, University of Michigan, Ann Arbor, researchers report.

Thomas Hester, a third-year medical student, told Reuters Health by email, "RTEs work under the supervision of respiratory therapists to provide routine care to stable patients requiring non-invasive oxygen support. This enables hospitals to reserve RTs to care for critically ill and ventilated patients."

"Although we do not anticipate continuing this role during a non-pandemic situation, this experience has demonstrated that, when healthcare needs arise, health systems can be more adaptable than previously imagined," he said. "We hope that the rapid creation and implementation of a successful RTE role can inspire future creation of other roles to fill any unanticipated needs that may arise."

As reported in ATS Scholar, a three-part training program was developed, with both online and in-person components, and delivered to 25 University of Michigan medical students, who were trained in basic respiratory care, documentation, and equipment preparation and processing for clinically stable patients.

The online portion of the training was created by medical students, and included a review of respiratory physiology, pathophysiology, and ventilator mechanics. Information was presented in a series of seven PowerPoint lectures followed by short comprehension assessments

The first cohort of trained RTEs was deployed to provide patient care within one week of volunteer recruitment. The RTEs operate in a tiered staffing model in which they report to a single RT, thereby extending that therapist's initial capacity.

The authors state, "We are sharing the RTE concept and training openly to help address RT shortages as the pandemic evolves."

The PowerPoint training lectures are freely available at

Hester said, "Moving forward, we plan to study the effectiveness of our training curriculum in order to improve upon it for future iterations. We also hope to better define the role through qualitative analysis of RTE utilization, experience, and the RT perspective on supervision."

"For other hospital systems considering this model, we recommend viewing the RTE as a dynamic role," he added. "The RTE tasks and responsibilities should reflect the specific needs of the institution."

Dr. Vikram Padmanabhan, attending physician at UW Medicine - Northwest Pulmonary and Critical Care Medicine in Seattle, commented in an email to Reuters Health, "In the setting of a surge, demand for hospital resources may not be met by their supply. We have heard a lot in the news about ventilators, oxygen, and medication, but not so much about the boots on the ground."

"For our most critically ill patients, this is a team approach in the ICU - traditionally an attending physician with a respiratory therapist, critical care nurse, and a critical care pharmacist," he said. "The concept of a respiratory therapist extender - a senior medical student who has been trained to 'extend the reach' of the respiratory therapist...allows one respiratory therapist to safely double their patient load."

SOURCE: ATS Scholar, online April 23, 2020.


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