Concerned that medical school had not adequately prepared her to deal with potential moral injury, Saskia Locke describes how she’s started taking steps to protect her wellbeing

Like many fourth year medical students, I applied to work as a healthcare assistant during the covid-19 pandemic. While waiting for my application to be approved, I had plenty of time to consider whether I have been adequately trained to deal with the potential moral injury that I may experience on the frontline as a “key worker.” The truth is, I don’t think I have been, so I have been reflecting on how best to prepare myself for the challenges ahead.

I have always been aware of the importance of developing resilience to be a doctor, and this requires teaching and techniques. However, coronavirus has sparked a sense of urgency in me to research methods for maintaining good mental health, specific to a healthcare setting, while still having a year to act on them before becoming a foundation year doctor. 

Before applying to medical school, I was warned about the shocking and upsetting things I might see, as well as the long hours of work that medicine entails. To protect our wellbeing, we are told at medical school to maintain a good work-life balance, with time to switch off when we need it. We’re told to maintain a portfolio of reflective pieces under prescribed categories, which is given a “pass” or “fail” at the end of the year. While I can see the benefit in burning off steam and keeping a diary, I still cannot shake off the feeling that I am not mentally prepared for what I might face as a fully qualified doctor, rather than a somewhat protected medical student.

Support networks and tools are not a “one size fits all,” and people need different forms of support after a long day or seeing an upsetting case. This is why, after four years of medical school, I would have hoped to have trialled several different forms of formal training in this area, beyond maintaining a portfolio. However, this is not within the curriculum at my medical school, and group reflection or wellbeing schemes are not routine in the hospital in which I attend placement. A particular form of support that has caught my eye is Schwartz rounds. These include discussing emotional cases, or cases in which difficult decisions were made, in a multidisciplinary setting. They have been shown to be effective in reducing poor psychological wellbeing and creating a greater sense of team working. However, uptake by hospitals and medical schools is still limited.

The covid-19 pandemic has acutely drawn my attention to the additional skills that are key to being a foundation year doctor. Most crucially, an effective approach to protecting one’s emotional wellbeing. This will be pertinent when exposed to potential moral injury and stresses, but also when adapting to taking on a new role. Medical students are keen to bolster the workforce during the pandemic, and as new recruits, our mental wellbeing will be tested. If, as students, we had been exposed more to a variety of effective resilience techniques, we could be applying them now to our daily lives on a small and frequent scale, ranging from reflective and mindful thinking, to remote Schwartz rounds over video chat with peers or colleagues. Though my role during the pandemic is not one of a doctor, it has already exposed me to new situations that I must prepare for in more ways than just passing my medical school exams.

We are very aware of the importance of good mental health today, and support is available for those medical students who are in need. However we should be trailblazers in protecting our wellbeing before any intervention is needed—creating a stronger and more compassionate workforce in this crisis and beyond. 

I hope that we are not too late in providing practical solutions to protect our mental health during the pandemic, and will of course take every step to ensure this. What I can be certain about is that I can take strategies to help protect my wellbeing and improve my resilience into my own hands, and in doing this I will be more prepared—both as a covid-19 healthcare assistant, and then as a foundation year doctor.

Saskia Locke is a fourth year medical student at the University of Manchester and healthcare assistant. Twitter @SaskiaLocke

Competing interests: None declared.