Having recently graduated early from medical school, we offer our own reflections on the obstacles and opportunities associated with working in an uncharted clinical environment. We know that we will be joining the workforce at a challenging time. Beyond the direct threat that COVID-19 may pose to our own health, we are concerned that staff sickness and self-isolation may have substantial effects on our supervision (Hope, 2020). Clinicians will be in a state of rapid flux and turnover, and at a time where we would already be adapting to new environments and new people which may become disorienting. The importance of adequate supervision and rapport building with our mentors remains constant but adapting to these challenges requires flexibility within the clinical team. How we respond to the pandemic may set a precedent for how we manage the medical student to junior doctor transition in the future.
Reassuringly, The Medical Schools Council of the UK has stated that medical students working pre-qualification should not be allowed to work beyond their competencies and that shadowing and induction must continue as normal (Medical Schools Council, 2020). We recognise that challenging clinical situations – such as exposure to difficult decision making and end of life scenarios – may approach earlier in our careers than previously anticipated. We hope that we can seek senior support when faced with challenging situations that stretch or fall outside of our skillset. Needless to say, proper supervision will reduce medical errors, but if mistakes do occur, we need senior support for reflection and to derive learning benefits which could benefit the whole team (Kroll et al., 2008).
In a time where all doctors are adapting to a new way of working, it should not be assumed that we are aware of pre-existing protocols. Nowhere is this more apparent than in the case of personal protective equipment (PPE). We are fortunate to have had recent online training how to don and doff PPE correctly, though local hospital inductions should ensure that all staff are performing this important procedure to a high standard.
The pandemic reflects an opportunity for immersion of senior medical students in a clinical team. The communities of practice theory of medical education highlights learning-by-participation rather than learning-by-acquisition, where the currency of learning is authentic work (Morris, 2018). Never has the opportunity been greater for senior medical students to learn by becoming a core part of the professional community. We hope that our learning won’t only be semantic: it should include management, personal skills and the fostering of an appreciation for the importance of the wider multidisciplinary clinical team, including allied health professionals, in our response to the pandemic. Furthermore, the disruption to the ‘social hierarchy’ of the clinical team caused by this novel challenge may benefit learning, as power dynamics are known to inhibit full engagement with the clinical team (Pemberton, Mavin and Stalker, 2007).
The pandemic should not be a time of educational stasis, it is a chance to harness the power of technology and novel educational tools. Digital inductions and virtual webinars with educational supervisors are one possibility, and medical schools are adopting this widely to deliver final sets of lectures and even high-stakes exams. These steps are necessary now but could also be used to supplement invaluable face-to-face contact in the future.
Whilst many medical students may feel compelled to work, we think it is important to be mindful of the risk of burnout inherent in entering a stressful job following premature termination of medical school with minimal interleaving holiday. Some steps can be put in place now to minimise risk. For example, it is important that starting work early is voluntary; we are pleased that this is the case for us in the UK. For some students, the time between ending medical school and starting work will be needed as a valuable break.
Lastly, the support networks normally available to junior doctors must still be present for senior medical students as they transition, albeit in a different format given social distancing. Again, technology can be leveraged: for example, with regular video calls using a ‘Schwartz Round’ format, or instant messaging groups. In the coming months, an open culture of talking about concerns, mental wellbeing and experiences on the wards must be fostered, recognising that being mindful, open and honest about your concerns is a crucial part of doctors’ development. As final year students, we hope that these opportunities will be available to us, so we can take the lessons learnt with us in our future career.