Managing our expectations as we return to clinical school

As students return to medical school after the disruptions caused by covid-19, they should be keeping their expectations realistic, advise Laura Nunez-Mulder, Mahmoud Elbahnasawi, and Saakshi Bansal

This time last year we (three final year medical students in Cambridge, UK) were restarting clinical placements after a long break. One of us travelled to recover from a drop in mental health, another worked in medical journalism, and another worked while recovering from an acute illness. We were all nervous about coming back. Now, in the wake of covid-19, we have an unexpected opportunity to use and share the lessons we learnt about returning to medical school after time out.

Above all this academic year, as we return to medical school after lockdown, we will be keeping our expectations realistic. When I (Saakshi) resumed my clinical placement after a year away, I remember failing to differentiate between an antibiotic and an antihistamine, forgetting the guidelines for asthma and chronic obstructive pulmonary disorder, and feeling nervous when approaching patients—despite having comfortably passed my fourth year exams. We had all expected to restart placements at the same level that we’d left them, but we were far from it.

Covid-19’s disruption of clinical placements and structured learning will mean that a lot of medical students may find themselves in a similar position. Even if you studied throughout lockdown, you will likely find that you have become rusty in clinical reasoning and other core skills. I (Mahmoud) spent nine months in a radiology centre in Egypt last year, shadowing radiologists and reading the Oxford Handbook of Clinical Medicine. I thought I’d be well prepared for my first day back but when the consultant on the ward round asked me about the possible causes of a patient’s delirium, I froze. Clinical confidence and performance requires more than reading from books.

Practical skills are another area of significant deskilling. I (Laura) prepared judiciously after my year out last year, spending time in the clinical skills classroom and going through our clinical skills handbook. I’m glad I did—it reassured me that my muscle memory for cannulation and venepuncture was intact, and showed me that my weakness lay in logistics, such as gathering the correct equipment. This year—our second return to placement after a long break—we are preparing by reading through our handbooks to familiarise ourselves with the steps, while confident that the principles of movement we have practised before will see us through.

This time we return with realistic expectations, and knowing that while books and ward rounds teach at different paces, each carries value. At first, I (Mahmoud) found it frustrating to wait for opportunities when I was used to learning from books. It took time to recall how to make the most of clinical placements: clerking patients or reading notes while waiting for discussion or shadowing opportunities.

Returning to placements during the pandemic, we can likely expect longer waits for learning opportunities. Katie Collis, a final year medical student at the University of Oxford, has already been back in hospital placements for six weeks. So far, Katie says, students in Oxford have been advised to limit contact with patients outside of their routine care to minimise transmission risk. She shared her advice with us over the phone: prepare for cancellations, bring as small a bag as possible, enjoy wearing scrubs, and ask doctors to put their phone on speaker when running clinics.

Declan Murphy, a foundation year two doctor in Newcastle, is also familiar with the prospect of returning to clinical practice after a break. He is currently working in his second three month academic rotation; his first academic rotation was his first after graduating. Before that, he took a year out for intercalation before his final year of medical school at the University of East Anglia. “I was behind and felt frustrated at being worse at everything than I used to be,” says Declan. The habit that most helped him feel confident returning to placement was meeting up with another medical student who had also intercalated—“often on a Sunday afternoon, often with a glass of wine”—to practise examinations every week.

Declan says that having a friend in a similar position is helpful, but we shouldn’t assume that our classmates have had similar experiences of lockdown. If our three experiences of lockdown have differed, how much more will people’s stories vary across our clinical school? Naturally, some of our social ties have loosened due to distance, and we find ourselves working as hard to forge connections now as last year when we joined a new year group.

Some of us will have studied lots through lockdown, others little, but we should try not to measure how we’ve spent our time against other people’s experiences. I (Saakshi) felt behind my peers when I returned to clinical school last year. I remember fighting feelings of demotivation by reminding myself to move at my own pace or risk burning out. 

Clinical school is not a race. While we’re excited to return, unlike last year, we won’t be expecting to return at the same acumen as when our placements were interrupted. We will manage our expectations of ourselves, our placements, and of each other. However we compare with our peers right now, we trust that we will finish the year equally ready to be safe, patient centred, and healthy doctors.

Laura Nunez-Mulder, Mahmoud Elbahnasawi, and Saakshi Bansal are sixth year medical students at the University of Cambridge, UK. Laura is a former editorial scholar (2018-2019) at The BMJ. Twitter: @lnm_rugby

Competing interests: Laura is a student affiliate of BMJ OnExamination.