Anna Harvey: Covid-19—Medical students face disruption and uncertainty

Medical students are facing disruption, uncertainty, and a lack of information as a result of the covid-19 outbreak

I am a final year medical student who has interrupted my studies for a year to work at The BMJ. I have watched my medical school cohort reach milestones—passing final exams, sitting the Situational Judgement Test, securing their first jobs—with a mixture of wistfulness and jubilation. I still have all this to come. Now, I watch grimly as medical students across the country find their studies disrupted as the extra burden of medical education becomes too much for a system preparing for a pandemic. I find myself in a position where I can only advocate, not just for my friends, but all medical students, by collecting their worries and experiences in a piece of writing. I spoke to medical students from different medical schools and year groups to find out how covid-19 is affecting them.

Final year students, many of whom have already sat and passed their final exams, and who are just five months away from qualification, have been hit hard by cancellations of exams and clinical placements. Many have been banned from attending their overseas electives, and there is little chance they will be able to recoup many of the costs associated with these placements. At one London medical school, all international students have been told that returning to their home countries risks them missing exams and assignments, and may result in them being required to defer the year.

Others have had final exams cancelled—a dream scenario, you might think—but one such student, from the University of Cambridge, described himself and his peers as feeling “numb”—denied the opportunity to prove their knowledge and hard work of several years of study. Initial worries about the impact of losing these modules and exams on students’ completion of their degrees has been mitigated somewhat by a letter written by the Medical Schools Council (MSC) stating that universities must prioritise ensuring final year students have completed their training and are ready to join the workforce in August, even if that means changing assessments radically. No practical information has been given about how this will be done as yet.

Another worry for senior students is that they may be “called up” to work on the wards early—particularly on the back of the announcement that 18,000 final year student nurses may be given their registration early in order to boost numbers. The General Medical Council (GMC) has said that students, even those who have sat and passed their final exams, should not be expected to take on the duties of a doctor. Similarly, the MSC has stated that “there is little to be gained from the early graduation of students,” but that medical students might in the near future have the opportunity to volunteer in areas other than seeing critically unwell patients, for instance as an NHS 111 call handler, or manning a minor injuries clinic. Despite this, rumours on Twitter say that students from Liverpool Medical School received an email on Friday stating final year students would be working, this week, as FY1s. These are just rumours on social media, but show the level of uncertainty facing medical students at present.

Even if the GMC and MSC were to agree that final year students who have passed their exams could work as FY1 level doctors, there are a number of processes that newly qualified doctors must go through in order to safely work—a shadowing period, a number of inductions, being set up on hospital systems such as electronic recording and prescribing. The MSC maintains that it is the responsibility of the receiving trust to arrange this kind of admin. In a service under such immense pressure, who will supervise these processes if students join the medical workforce early, while cases are peaking? Without clear guidance, patient safety will undoubtedly be compromised. These questions have not been answered, and perhaps will not need to be. But the uncertainty for senior students as to how and when they will be expected to help out remains.

And students do want to help. As well as senior students preparing themselves for some form of work within the healthcare system, social media has seen an influx of first and second year students offering their skills and time, as babysitters, dog walkers, meal preppers for those who are working, unwell or vulnerable. Undoubtedly medical students, be they first or final year, are able to meaningfully help with efforts to combat the virus, if deployed in the right way.

Among all this, the main plea is simply for more information. While many, if not most, medical schools have pulled their students from clinical placements, at least for the time being, there is yet to be a centralised decision about whether students should be on the wards at all. MSC advice that states if they are, they should be given access to full personal protective equipment if needed—which, in some places, isn’t even available to those treating suspected cases in primary care or triage. A student from Cardiff, who was on the wards all of last week before receiving an email cancelling clinical placements late on Friday night, worried about the impact of medical students moving around, from primary care to inpatient settings, and the potential for students to become vectors. Communications have been patchy and rumour driven, with some universities more successful at keeping their students updated than others.

Planning for medical students may not be a priority during the first wave of the covid-19 outbreak. What’s clear is that students are willing and able to help, however they can. But without transparency and clear communication, there is a risk that the educational experience of students could be disrupted significantly, interrupting the pipeline of new clinicians that, even before covid-19 hit, the health service so desperately needed.

Acknowledgements: Thank you to the medical students who shared their experiences, feelings and internal communications with me during the writing of this piece.

Anna Harvey is a final year medical student at King’s College London and 2019-20 Editorial Scholar at The BMJ. Twitter: @a_c_harvey

Competing interests: Anna is an unpaid member of the editorial boards of the GKT Gazette and JSAMR and an unpaid Medics.Academy Fellow. She has worked on widening participation projects since she started medical school, including, until recently, running a magazine for aspiring medics from widening participation backgrounds.