Medical students as resident assistants: a novel approach to tackling the medical workforce shortage conundrum

The shortage in medical workforce is a global health problem, and a focus of health system policy makers and organizations. Worldwide, one of the solutions for providing adequate healthcare services has been the establishment of advanced practice provider (APP) roles. Israel was a late adopter of these professions. Contrarily, a unique profession arose locally in the early 2000's, the medical student resident assistant (MSRA). Defined as a post for Israeli medical students during their clinical years, who assist physicians with their medical work during evening shifts, and under their supervision. Since, working as an MSRA has become commonplace among Israeli medical students. In an attempt to estimate MSRA workforce trends since their emergence, we screened the Sheba Medical Center's employee data from 2003 to 2023. A total of 1,423 separate employee contracts were identified, with an average employment length of 2.0 years. The majority of MSRAs worked in the adult medicine departments (849, 60%), followed by surgery (220, 15%), pediatrics (208, 15%), obstetrics and gynecology (126, 9%), and psychiatry (11, 1%). Overall, 46% of MSRAs became interns and 25% became residents at the SMC. From a total of 595 current residents in the SMC, 118 (20%) had previously worked as MSRAs. Between 2022 and 2023, 29% of students from affiliated universities who conducted clerkships in the SMC were recruited as MSRAs. MSRAs, de-facto another readily available APP role, have been an integral part of the Israeli health system workforce in the last 20 years. Paid medical student assistantship programs like MSRAs could be a true "win-win-win" situation, combining experience-based medical education (ExBL) and paid work while supporting the overstretched health workforce. The effect of this role on the patient, on the system, and on the MSRAs themselves has not been described or researched. We call for extensive research on the clinical, academic, educational, occupational, financial and workforce aspects of the MSRA entity in Israel and suggest implementation of similar roles worldwide.