Carlo Ross: Covid-19 and medical students—the impact of doing nothing 

Over the past few months, it’s been hard for final year medical students to decide what to do during a situation in constant flux, says Carlo Ross

For medical students around the UK, springtime is usually associated with sitting or preparing for exams. But that’s not been the case in 2020. Ever since my cohort received an email on 17 March informing us that all further placements and examinations were cancelled due to the covid-19 pandemic, our medical lives completely altered. The contrast couldn’t be sharper; as healthcare practitioners across the UK braced themselves for exponential strain on the health service, medical students experienced a sudden withdrawal from their most intense work to date, to none at all. 

Over the past few months, medical students have shared the same stressors of living through a pandemic as the general population, while further struggling to ascertain where we fit in. For final year students, feelings of redundancy initially arose, knowing we had passed final examinations and that normally, we would be expecting to be in our first jobs as doctors within months. Despite hearsay regarding deployment to the “frontline” imminently, the vast majority were in limbo, waiting on details of what we could do to help. 

Those throughout medical education have sat listless, a foreign feeling with no revision or examinations to prepare for. With it being well documented that people undergoing medical training are more likely than the general population to experience anxiety and depression, this raised an important question: how has this sharp transition—from a structured routine (which often provides a locus of control) to having nothing to do—impacted upon medical students?

On 24 March, Matt Hancock, the secretary of state for health and social care, outlined the recruitment of 5500 final year medical students to the “frontlines,” which generated a great deal of uncertainty. This seemingly kneejerk response to the baiting press saw medical students being used as unwitting pawns. To hear this from the health secretary on a national broadcast before any concordant information from the General Medical Council (GMC), Medical Schools Council (MSC), or British Medical Association (BMA) suggested a paucity of dialogue. 

However, anxiety is rarely one thread of thought, and woven through these mixed emotions was excitement. After all, the last international example of medical students being called upon to provide this scale of assistance was during the 1952 polio epidemic in Copenhagen when medical students provided round the clock manual ventilation to patients. This undoubtedly unique opportunity to help the NHS and the public, in a way no other medical students have had the opportunity to do in decades, excited many medical students and was acknowledged, in itself, as a tremendous privilege. But, like every other decision taken in medicine, we’ve had to ask ourselves—is this better than doing nothing?

Just days before Matt Hancock’s announcement, the GMC had outlined that final year medical students should not be expected to carry out the duties of a doctor. The MSC said there was “little to be gained” from fast tracking registration, and there were warnings from the BMA against so called “pre-foundation year 1” or “FY0” roles. In a later statement, the BMA (along with the GMC) outlined their surprise at Matt Hancock’s address, but also their acceptance of provisional registration being brought forward, warning of the necessity for the same “induction, education, and supervision” as the normal foundation programme. 

The discordance between statements from the government and other authoritative bodies reflected the evolving situation, and the reactive nature of institutional strategies, but provided little reassurance to those in medical training hoping for clear boundaries and expectations on our role, as well as adequate support and supervision.

As myself and many in my cohort have now completed our first months in pre-foundation year 1 roles, it is clear how far the situation has evolved since March. For many final year students, it’s been hard to decide what to do during a situation in constant flux. Medical students are taught to make judicious use of current best evidence when managing patients and undoubtedly find comfort in clear guidance—something that has clearly been absent, and which has had to be adjusted to for those in pre-foundation roles. Final year students haven’t had the tools they need to weigh up if “doing nothing” is a better option for them in these circumstances.

Yet while it may be a foreign concept to many medical students, “doing nothing” over these past few months and in the upcoming weeks may ultimately prove to have been the best thing we could do. After all, the past few months under lockdown need not have equated to complete isolation. It is perhaps this generation of students who are most comfortable with the concept of virtual connectedness who can continue to adapt to social and educational life via FaceTime, Skype, or Zoom. 

Furthermore, there have also still been plenty of opportunities to volunteer remotely, such as in the NHS volunteer taskforce. Working with communities and within any social restrictions is an incredibly productive way for students to contribute to efforts to manage covid-19. 

What once seemed like the beginning of the end—with the sudden cessation of medical training, incongruent messages from medical schools and government bodies, and with only an opaque way forward—can now be seen as the end of the beginning. The nation is moving out of lockdown and final year students will soon all take up their foundation training and work in a new era of healthcare where covid-19 is intrinsically mixed. 

As we ask ourselves what we have and still can contribute, it is pertinent to think of the chancellor of the exchequer’s words, “When this is over—and it will be over—we want to look back on this moment and remember small acts of kindness done by us and to us. We want to remember how we thought first of others and act with decency . . . it’s on all of us.” For medical students, our small act of kindness may be volunteering for the NHS or taking up roles as a pre-foundation doctor or healthcare assistant. It may be reaching out to help those most vulnerable in society, or it may have been following the clearest guidance from government and educational bodies alike—doing nothing and staying at home.

Carlo Ross is a pre-foundation year 1 doctor at Manchester University Foundation Trust. He studied medicine preclinically at the University of St. Andrews and then clinically in Manchester. Carlo has accepted an academic foundation post commencing in August. 

Competing interests: None declared.

Acknowledgements: Thank you to Dr Christian Warner for editorial guidance and help with this article.