Jane Fagan: Clinical exposure is essential to medical students’ training

We can’t learn standing outside closed doors, says Jane Fagan

Similar to hundreds of medical students across my medical school, thousands across Europe and millions around the world, when I first heard about SARS CoV2, one of my first thoughts was “how will this affect my degree?”  Hospitals are at the epicentre of the pandemic, but also the epicentre of our clinical training. As non-essential people and visitors were banned from visiting hospitals, important questions were asked: Are medical students essential staff? Do the benefits of them being in hospital outweigh the risk of infection? 

I have been out of hospitals since March, when a nationwide lockdown was introduced in Ireland. Medical and surgical rotations were abruptly stopped and clinical face to face examinations changed to online multiple choice questions. Uncertainty was at an all-time high, among medical students and staff alike; would online learning become the new normal? I became more grateful for the previous learning opportunities available to us. I began to appreciate the value of talking to patients, hearing their stories and learning from them. I realised that I had definitely taken the privilege of patient contact for granted.

Examinations over, we drifted into the summer. The annual migration of medical students to hospitals, near and far, for mandatory clinical electives were halted. While our friends one year ahead were working on the wards after their early graduation, we were still trying to work out our roles. We wanted to go back to clinical electives, but every query was met with “We would like to, but we cannot guarantee…” We started to think laterally, with many of us applying for electives in research or education. It was during this time that I heard of an opportunity to complete an online medical education elective in one of our university hospitals. Interested in learning more about the principles which underpin medical education, and even more so about how coronavirus has and will impact these, I signed up. As hospitals were still closed for students and non-essential visitors, our elective was to be held online. I was slightly apprehensive for this aspect of the elective; it was new and my colleagues and I were exhausted, with significant virtual fatigue having completed ten weeks of online learning from April to June.

Nine medical students showed up on Monday morning for an introductory zoom call. Possible projects were discussed, and three were picked: to design and create an online MCQ bank, to develop a way to capture informal clinical teaching, and to write and create an obstetrics podcast for medical students

I was excited to embark on these three separate projects which will hold tangible value to students and educators alike. However, it felt strange to be sitting on the other side of the table as we had been the ones sitting the MCQs a few short weeks ago. This initial feeling of inadequacy soon dissipated as I listened to and worked with my colleagues. While completing these projects, we were receiving daily lectures learning about the principles of medical education and how to apply these to our projects. It was only after completing the three weeks, and finishing the projects, that I could appreciate the value that medical students can offer to medical education. We were able to draw upon our personal learning experiences and hone in on the most salient learning objectives for each topic. Furthermore, it proved to be a valuable revision tool for my colleagues and myself.

As well as the three projects, we slowly began to return to clinical work. This allowed us to experience the hospital setting once again and to see the changes which had been implemented in our absence. It was a strange experience, entering hospital for the first time in months; wearing face masks in clinics, keeping social distancing, and not being allowed in to see certain procedures if there was a query of covid-19. It was the latter that I found the most difficult; to sit with a woman in labour, only for her temperature to escalate and necessitate covid testing as part of the septic work up. Results pending, I wasn’t allowed to watch her birth for fear of contamination. This is a woman who I had spent hours with; comforting her throughout her labour, talking to her and her partner and letting her squeeze my gloved hand during her contractions. I may not have been acting in a typical medical student role but I felt that my role was an important one. 

Having spent the past three weeks learning about medical education and being slowly introduced back into clinical placement, I have learnt that clinical exposure is essential to our training. Whether hospitals will see us as essential remains to be seen, but one thing is for sure, we can’t learn standing outside closed doors. 

See also: The return of medical students to clinical practice is filled with uncertainty

Jane Fagan is a final year medical student in University College Dublin.

Competing interests: None declared.

Twitter: @FaganJane1