The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is bringing the world to its knees with over one million cases by 8 April 2020.1 Several governments have responded by locking down entire countries with dramatic repercussions for all sectors of society. Since 21 February, the total number of cases in Italy has followed an exponential trend with 139 422 (including 13 522 healthcare workers) by April 8, which is four times higher than 3 weeks before (35 713 confirmed cases on March 18).1 Among the currently active cases (n=95 262), 28 485 (29.9 %) are hospitalised and 3693 (3.87 %) in intensive care units (ICUs).1 Italy has overtaken China with the most SARS-CoV-2 deaths, reporting 17 669 fatalities,1 a fatality rate of 12.6% (of confirmed cases, table 1).
Table 1.
Estimated increase in hospital doctor workforce in the COVID-19 outbreak in Italy shown per region
| Regions of italy |
Final year medical students (n=9640)1 |
Hospital medical doctors (n=92 950)5 | Estimated increase % in medical doctor workforce (10.3%) |
COVID-19 current positive cases (n=95 262)1 |
Hospitalised patients (n=28 485)1 29.9% |
Patients admitted to intensive care unit (n=3693)1 3.87% |
Deaths (n=17 669)1 |
Case fatality rate (12.6%)* |
|---|---|---|---|---|---|---|---|---|
| Lombardy | 795 | 16 114 | 4.9 | 28 545 | 11 719 | 1257 | 9722 | 18.2 |
| Emilia Romagna | 636 | 6844 | 9.3 | 1311 | 3769 | 361 | 2234 | 12.3 |
| Piedmont | 537 | 7530 | 7.1 | 10 989 | 3493 | 423 | 1378 | 9.9 |
| Veneto | 427 | 7347 | 5.8 | 10 171 | 1554 | 285 | 736 | 59.3 |
| Liguria | 112 | 3172 | 3.5 | 3245 | 1109 | 153 | 654 | 13.3 |
| Marche | 96 | 2412 | 4.0 | 3562 | 974 | 133 | 652 | 13.4 |
| Tuscany | 533 | 6921 | 7.7 | 5557 | 1066 | 260 | 392 | 6.1 |
| Trento | 0 | 915 | 0.0 | 194 | 354 | 77 | 255 | 9.8 |
| Lazio | 1403 | 8337 | 16.8 | 3448 | 1241 | 196 | 244 | 5.7 |
| Campania | 1789 | 6390 | 28.0 | 2859 | 608 | 97 | 221 | 6.8 |
| Apulia | 510 | 6094 | 8.4 | 2238 | 639 | 90 | 219 | 8.3 |
| Bolzano | 0 | 945 | 0.0 | 1281 | 268 | 65 | 183 | 10.0 |
| Abruzzo | 518 | 2044 | 25.3 | 1534 | 331 | 62 | 179 | 9.6 |
| Friuli V.G. | 87 | 2077 | 4.2 | 1415 | 162 | 41 | 169 | 7.6 |
| Sicily | 987 | 6786 | 14.5 | 1893 | 563 | 65 | 133 | 6.2 |
| Aosta Valley | 0 | 288 | 0.0 | 606 | 120 | 20 | 102 | 12.0 |
| Calabria | 144 | 2446 | 5.9 | 755 | 170 | 15 | 60 | 7.0 |
| Sardinia | 359 | 3318 | 10.8 | 840 | 112 | 31 | 59 | 6.1 |
| Umbria | 633 | 1632 | 38.8 | 823 | 155 | 41 | 50 | 3.9 |
| Basilicata | 0 | 913 | 0.0 | 270 | 48 | 17 | 14 | 4.7 |
| Molise | 74 | 425 | 17.4 | 181 | 30 | 4 | 13 | 5.8 |
Data are from the Italian Ministry of Health, Italian Ministry of Education University and Research.
*Based on the total count of 139 422 confirmed cases on 8 April 2020, 17h00 UTC+1.
The immediate and urgent demand for more doctors has led the Italian government to take unprecedented measures. On 17 March 2020, the Council of Ministers passed the Cura Italia decree which changed the rules of Italian medical board examinations.2 As a result, almost 10 000 Italian medical students from all medical schools will be fast-tracked into the healthcare system after graduation, without sitting the postgraduate examination which concludes the practical training.3 This change is permanent.
In the UK, the Medical Schools Council has suggested the possibility of releasing final-year medical students, even before the conclusion of their clinical examinations, to be provisionally registered by the General Medical Council in order to help the healthcare system to cope with the developing crisis.
Before Cura Italia, the Italian medical licence required postgraduate training and an exam. The new decree permanently makes the medical degree fully qualifying. Licence training will now take place in the years before graduation. Therefore, it is estimated that 9640 newly graduated medical doctors will be qualified earlier to join the healthcare system.4 This could see a rapid 10.3% increase in hospital doctors, supporting departments and ICU dedicated to COVID-19 treatment in all regions. For instance, Lombardy, with 9722 deaths,1 a 18.2% case fatality rate of confirmed cases, might benefit from a 4.9% increase in doctor numbers; Emilia Romagna, the second most affected region, could have an increase of 9.3% (table 1).5 Also, these graduates might cover roles in less front-line areas from which medical personnel have transferred to acute care. Italy is, therefore, the first country to respond formally to the COVID-19 emergency by permanently changing the medical board examinations and altering the curriculum.
On the one hand, the decree shortens the licensing process by about 9 months,3 a crucial time for the immediate movement of thousands of new doctors into the workforce for the COVID-19 emergency. On the other hand, a shift from medical school to clinical work without a transition period might put graduates at a greater risk of work-related stress. Furthermore, without a written examination, more emphasis would be on the assessment of the practical training during medical school.
The provisions adopted by the Italian government regarding the permanent change of the rules for the medical board examination and the consequent fast-tracking of doctors will affect medical education for future students and augment the healthcare workforce to improve care during the current crisis. Consequently, the new Italian model might be considered by other countries. However, transparency and clear guidelines for newly qualified doctors and precise human resource planning of the new healthcare workforce are essential to safeguard patient safety in one of the gravest challenges of our time.
Acknowledgements
We thank Dr. Regent Lee (University of Oxford) for providing guidance in manuscript submission.
Footnotes
Contributors: PL for study design, literature search, data analysis and interpretation, writing and table preparation and responsibility for overall content. AM for manuscript revision.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Patient consent for publication: Not required.
Provenance and peer review: Not commissioned; internally peer reviewed.
Contributor Information
Pierfrancesco Lapolla, Department of Surgery P. Valdoni, Policlinico Umberto I, Sapienza University of Rome, Roma, Italy.
Andrea Mingoli, Department of Surgery P. Valdoni, Policlinico Umberto I, Sapienza University of Rome, Roma, Italy.
References
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