Personal view or opinion piece
Open Access

Transitioning from fourth year medical students to final year medical students during a global pandemic.

Nazia Ali[1], Merwa Badar[1], Maryam Goralwalla[1], Tasnima Khanom[1], Asma Younes[1]

Institution: 1. King's College London
Corresponding Author: Miss Nazia Ali ([email protected])
Categories: Students/Trainees, Teaching and Learning, Undergraduate/Graduate
Published Date: 09/10/2020

Abstract

The COVID-19 pandemic has disrupted medical education internationally. Medical schools have seen widespread cancellation of clinical placements, with teaching shifted onto virtual platforms. This is a highly stressful time for medical students who are transitioning into their final year. This time would originally have been used to practice and perfect clinical skills and patient communication. However, in light of the pandemic, medical students have had to showcase adaptability and patience while medical schools deliver adapted curricula to ensure these students are meeting objectives set by the General Medical Council (GMC). This article will highlight the anxiety faced by these transitioning students while providing suggestions on how to manage mental health and studies productively.

Keywords: medical student; medical education; COVID-19; curriculum; final year medical students; clinical placements

Reflections

The COVID-19 pandemic has forced the world into a distorted version of reality where adaptability has never been more crucial. Strict social distancing rules alongside remote working has meant that the population have had to revise their normal daily schedules to incorporate working from home, home-schooling and isolating away from their loved ones. Amongst a struggling nation, a unique group of students have also had to make the transition from fourth year medical students to final year medical students.

With clinical placements abruptly being cancelled and not resuming until late August, King’s College London medical students, like ourselves, have been dealt a very challenging card. We had to sit our final fourth year exam, despite missing a vital clinical placement in either Emergency and Critical Care, Women’s Health, Child’s Health or Mental Health. Our medical school has been under immense pressure to restructure the final year curriculum, due to start promptly in June 2020. It has been decided that virtual teaching will cover the theoretical aspects of final year placements (Acute care, Long Term Conditions and General Practice) in addition to talks on the Situational Judgement Test (SJT), Objective Structured Clinical Examinations (OSCEs), the Prescribing Safety Assessment (PSA) and Foundation Programme Application System (FPAS). From August, clinical placements will resume, with greater focus on patient contact, application of theory and consolidation of missed placements.

In this everchanging environment, students have had to make difficult decisions. Many students have volunteered as health care assistants, while others have decided to stay home due to having vulnerable family members. Dreams of elective placements overseas have been put on hold due to the inability to predict the nature of future travel restrictions or whether hospitals in foreign countries will be in a position to take on students. Many students observed Ramadan without family members and friends whilst international students have had to fly back home with much uncertainty surrounding future months.

In these times, mental health must be prioritised, and it is the medical school’s responsibility to encourage students to seek appropriate support (GMC, 2013). Counselling services have been moved online and although some students are not familiar with these settings, it is vital they access the support they need either through university services or their GP. To do this, medical schools could incorporate mental health helpline links and support services into their weekly newsletters. Moreover, King’s College London have created virtual tutor groups with weekly sessions. This provides us with a virtual support system with a tutor and our peers where we can discuss our concerns about COVID-19 and our education. It is a simple system that could be implemented in all medical schools.

Suggestions

Amid reflections in these unique circumstances, outlined below are 10 suggestions highlighting various way to maintain productivity whilst also taking care of our mental health.

  1. Prioritise good sleep quality and wake up at a reasonable time (Milojevich and Lukowski, 2016).
  2. Regular exercise (Sharma, Madaan and Petty, 2006).
  3. Eat well during the day; incorporating foods from each food group and taking vitamin supplements if necessary.
  4. Make a written plan for the day.
  5. Utilise different platforms for effective study
    • Plan small group revision sessions.
    • Practice physical examinations on family members.
    • Use online resources such as Geeky Medics (Geeky Medics, 2020) and Passmedicine (Passmedicine, 2020).
    • Ask for advice and revision tips from older medical students.
  6. Utilise technology to stay close with friends and family (eg. organise quizzes and games).
  7. Spend time enjoying hobbies (eg. reading, watching movies, painting).
  8. Reach out to peers that are transitioning to F1 in this daunting time and ensure they are well supported.
  9. Educate ourselves about discrimination in healthcare - form a discussion circle to address difficult topics and come up with ideas on how we can help (reading recommendations: Black Man In A White Coat, Medical Bondage, Medical Apartheid).
  10. Research future projects you would like to be involved in (email doctors in placement hospitals and ask if there are any projects they are working on and how you could contribute).

Reminders

We must also remember not to place too much pressure on ourselves. Many of us may adopt a somewhat unhealthy mentality of ‘making the most of our time’, with people urgently flocking to learn new languages and skills. This could lead to others feeling incompetent or low as they are not currently able to apply their time in the same way. It is important to understand that it is acceptable to be struggling in this unanticipated time of stress and uncertainty. We must not be overtaken by the need to be productive at the expense of our health and wellbeing.

Now more than ever, we must showcase the skills we proudly promoted in our medical school interviews and have continued to develop throughout university. We are adaptable, resilient, and creative individuals who are on our way to becoming the next cohort of competent junior doctors.

Take Home Messages

  • Medical education has been severely disrupted by COVID19 and medical students transitioning from their fourth year to final year have had to adapt to major changes within their curriculum.
  • Changes in the curriculum have meant that medical education is delivered virtually with lectures and talks on theoretical content, SJT, OSCE, PSA and FPAS applications.
  • Mental health support has also moved online and it is the medical school’s responsibility that their students are well supported
  • We can be mindful of various ways to stay productive and prioritise mental health.

Notes On Contributors

Nazia Ali is a final year medical student at King’s College London. She has a BSc in Psychology awarded in 2019. She is the co-author of this article and contributed towards the conceptualisation, editing and reviewing of the manuscript, with specific input towards the 'Reflections' portion. She has an interest in Emergency Medicine, General Practice and Medical Education. 


Merwa Badar is a final year medical student at King’s College London. She is a co-author of this article and contributed towards the conceptualisation, editing and reviewing of the manuscript, with specific input towards the 'Reflections' portion. She has an interest in General Practice and Medical Education. 

 

Maryam Goralwalla is a final year medical student at King’s College London. She has a BSc in Psychology awarded in 2019. She is a co-author of this article and contributed towards the conceptualisation, editing and reviewing of the manuscript, with specific input towards the 'Suggestions' portion. She has an interest in Emergency Medicine, Paediatrics and Cardiology.

 

Tasnima Khanom is a final year medical student at King’s College London. She is a co-author of this article and contributed towards the conceptualisation, editing and reviewing of the manuscript, with specific input towards the 'Suggestions' portion. She has an interest in Paediatrics and General Practice.

 

Asma Younes is a final year medical student King’s College London. She is a co-author of this article and contributed towards the conceptualisation, editing and reviewing of the manuscript with specific input towards the 'Reminders' portion. She has an interest in Emergency Medicine, Women's Health and General Practice. 

Acknowledgements

The authors received no financial support for the research, authorship, and/or publication of this manuscript.

Bibliography/References

Geeky Medics. (2020) Available at https://geekymedics.com/ (Accessed: 10/06/2020).

General Medical Council (GMC). (2013) Supporting medical students with mental health conditions. (Accessed: 10/06/2020):

https://www.gmc-uk.org/-/media/documents/Supporting_students_with_mental_health_conditions_0816.pdf_53047904.pdf 

Milojevich, H. M. and Lukowski, A. F. (2016) ‘Sleep and Mental Health in Undergraduate Students with Generally Healthy Sleep Habits’, PLOS ONEhttps://doi.org/10.1371/journal.pone.0156372

Passmedicine. (2020) Available at https://www.passmedicine.com/ (Accessed: 10/06/2020).

Sharma, A., Madaan, V. and Petty, F. D. (2006) 'Exercise for mental health', Primary care companion to the Journal of Clinical Psychiatry8(2), 106. https://doi.org/10.4088/pcc.v08n0208a

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

Ethics approval was not required.

External Funding

This article has not had any External Funding

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