Dr Lynelle Govender MBChB, PG Dip (HPE), MPhil (HPE) Senior Lecturer, University of Cape Town discusses dealing with the disruption of COVID-19 on medical training and highlights real-life feedback from students.
“In the early days of the pandemic we were taken out of our usual rotations and spent full days testing hundreds of patients. At night, we would again be removed from the first-year rotations (internal/obs/surgery/peads) in order to do shifts in the newly established COVID-ICU. These hours were certainly the most gruelling I’ve ever experienced as a doctor. I have many desperate memories from that ICU”
- anonymous doctor, community service (2022), internship (2020/2021)
As a senior lecturer who works closely with medical students, I have had a first-hand view of the impact that this pandemic has had on medical education. Conversations, like the one above, with my past students gives a chilling idea of what COVID-19 meant to junior doctors whose early career experience has been coloured by this pandemic.
Globally, face-to-face medical training had been suspended or migrated online in response to the need for physical-distancing. Similarly, in South Africa, the majority of medical schools reduced clinical rotations and shifted pre-clinical teaching to an online environment. This has not been without challenges.
Challenges
Both interns and students faced the similar challenge of having access limitations. For interns this meant reduced clinical exposure where rotations were changed/adjusted to divert resources towards COVID-19. For students, access limitations meant reduced clinical exposure and closed on-campus study spaces. These physical limitations were over and above the inequitable access that students already have to online learning resources; with some students having more reliable connectivity than others, and a home environment that may or may not support learning.
All these challenges speak to the impact COVID-19 had on medical training, and particularly the ability for medical students and interns to acquire clinical competencies that are best learnt in the clinical environment. Additionally, medical students and interns, like so many others faced a number of personal stressors associated with COVID-19. Such as isolation, illness, burnout, financial instability or the loss of loved ones.
“Sweating profusely through the layers of PPE during resuscitations. Rushing patients, waiting for high-flow, from the wards to the ICU to take up the last remaining high-flow (only available because another patient had passed away). Countless calls of breaking bad news with family and faces I’ll never know. I remember feeling incredibly alone on some of those calls… wondering if anyone knew what I was going through.”
- anonymous doctor, community service (2022), internship (2020/2021)
Solutions and strategies
COVID-19 is not the first time a crisis has interrupted medical education. The SARS virus in Hong Kong and Canada, and Hurricane Katrina in Louisiana are just a few historical examples of other natural events which disrupted medical training. The thinking is, if it happened before, and it happened with COVID-19, theoretically it could happen again. So, what lessons can we learn from COVID-19. How do we meet the challenges of medical training disrupted?
Support. Support. Support. Mental health, physical health. Both these things are important. Medical students and interns alike, need support to meet the individual challenges that they face. As senior colleagues, we should be inviting open dialogue, to do what we can to help meet their needs. As medical students and interns, try to speak up. Tell people that you are for example: “not feeling confident to suture a patient, because you never had a chance to learn this under supervision during COVID.” Your registrar does not know what you don’t know. It is your responsibility to point out areas where you think you are struggling, and take action to address these gaps.
South Africa is known for its busy hospitals, and while this is a challenge, it is also an incredible opportunity to experience medicine, build confidence and establish your own professional identity. Maximize the available opportunities to learn clinical skills, by making yourself a part of the team and setting goals for yourself. Embracing this kind of attitude can help you to not only survive the pandemic, but thrive and create incredible opportunities for growth.
“We were certainly able to develop practical skills in COVID-ICU. We were able to do many CVPs, A-lines and intubations. We definitely became well versed in the ‘difficult airway’. We learnt how to deal with change - every day there seemed to be a new protocol or shift change or way of doing something.”
- anonymous doctor, community service (2022), internship (2020/2021)
Silver linings
Among the inordinate stress and chaos of the COVID-19 pandemic, there have been several examples of positive opportunities that arose from this environment. Medical students have risen to the challenges for example by volunteering to play their part in Covid-19 call centres and vaccination roll-out programs. Interns have in the majority of cases, accepted the changes to their usual rotational program and made a meaningful contribution to South African healthcare, while acquiring skills in critical care.
Online teaching has opened up the opportunity to attend teaching sessions and global conferences from the convenience of your home. This allows medical students and interns the freedom and flexibility to partake in medical education in a way that has not yet been seen. Finally, with the increased attention directed at COVID-19, there has been an increasing interest in public health related degree programs. Perhaps many years from now, the imminent specialists in the field will be those medical students and junior doctors who faced COVID-19 in the recent years past.
“My social interaction was very limited, and I thrive both academically and socially when I'm surrounded by people with similar mind-sets. I missed my friends and colleagues, even seeing my lecturers in person. Although I experienced some teething difficulties at the start, I felt quite empowered by the time and freedom in the opportunity to have a more open schedule - allowing me to study, be with my family and see to my mental health needs at the same time. My advice would be to establish a flexible routine. Flexible, because life happens, and even more so when you're taken out of your own controlled environment.”
- Miss Ghéte Klaasen, fifth year medical student, University of Cape Town
References
Prashar J, Ranasinghe C, Rao CB. Twelve tips for medical students to enhance clinical skills learning during disrupted placements. Med Teach. 2021:e1-5. doi: 10.1080/0142159X.2021.1910644.
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