Covid-19: Learning experiences of a medical student working in intensive care

Five months ago I signed up as a volunteer in one of the hospitals linked to my university. During the induction, I learnt that I was to start the next week on a covid positive intensive care unit alongside a group of my peers from medical school. I was anxious. I had spent the previous two weeks since the cancellation of our university placements compulsively following media reports on lack of personal protective equipment, scarcity of resources, and understaffing in UK hospitals. Although little has changed on this front, my anxiety has given way to confidence and my learning experience has been rich. I hope that my account of this experience will give other medical students the motivation to volunteer if there is a second wave of infection.

Being a member of the multidisciplinary team 

The landmark change for me has been the shift in role from that of the “medical student”, permanently observing from a distance, to a working member of the multidisciplinary team. For the first time during medical school, I have felt useful to those working around me. This was one of my primary concerns before starting as a volunteer in the hospital, “what can I, a medical student, actually do to help?” The answer proved to be rather a lot. For most of the time, my job has been an extra pair of hands for anywhere it is needed. This has meant the involvement in a variety of roles, ranging from being on the “proning team” (helping turn patients onto their front to aid oxygenation), being a “runner” (gathering anything needed from “clean” areas of ITU to give to the “Covid” areas) and assisting the nurses in moving and caring for patients. Through doing this, I have acquired a new knowledge of intensive care, learning the rationale behind the commonly used drugs and equipment as well as acquiring new skills such as filling in the ITU observations chart. 

As part of the MDT, I have learnt first-hand the importance and interconnectedness of each of the various healthcare professionals, who work together to achieve the slow and difficult recovery facing covid-19 patients. I have been inspired by the unremitting kindness of the ITU staff; the humanity shown in their efforts to help patients retain dignity in death have been extraordinary. I have had an amazing lesson in what it truly means to be a good healthcare professional.

Having an active role in patient care

Over the past few months I have followed patients’ journeys starting on arrival in intensive care, through multiple hospital transfers and complications, to the completion of their ventilatory weaning and transfer to the wards. This has taught me how complicated and devastating covid-19 can be. It has also given me a chance to witness continuity of care over time to an extent I have not seen before as a medical student. I have had the unforgettable privilege of seeing some (although sadly not all) patients improve, and taking a shared pride in their recovery as they are applauded upon leaving the ITU. 

Through shifts being paired with ITU nurses,  I have been taught how to use ventilators and how to care for patients with a tracheostomy, as well as learning a huge number of other new practical skills. As my confidence in my practical abilities and interaction with patients and staff has improved, the anxiety associated with beginning my professional life as a doctor has lessened. 

Improving communication skills 

One of the new roles I have taken on is in the “communications team”, a team led by redeployed non-ITU consultants whose prime role is to update patients’ families each day about the progress of their loved ones. My role in this was to update the relatives of the patients with the fewest complications and the best prognoses. At the start, I was worried that relatives would be angry to receive updates from an unqualified medical student. I found the first week of phone calls nerve-wracking. However, I soon found that relatives were overwhelmingly thankful to be receiving updates whoever they were from, and with each phone call my confidence and communication skills improved. Another part of the job was to facilitate video calls between patients and relatives on iPads that had been donated to the hospital; a role well suited for medical students as we have had the time and the technological expertise required to ensure these calls are successful. I have found that patients and their relatives have been extremely grateful for being connected in this way, given no visit policies, and as a consequence this element of the job has been particularly fulfilling. 

Although I have emphasised much that is positive here, my experience has also been difficult. I have seen death in volumes I could not have anticipated, I have seen extreme rationing of resources that I would not have expected, and I have sometimes felt underqualified and out of my depth. Reflecting my overall experience, however I feel I have learnt valuable lessons and have achieved something that I can be proud of. I hope that medical schools do not have to cancel further clinical placements in this academic year, and recognise and try to incorporate ways in which medical students can be useful by drawing on our experience of hands-on care in the pandemic response. My recommendation for students who are still unsure whether to get involved is—do it. It might be hard, but it is worth it. 

Lydia Warren, 4th year medical student, Barts and the London School of Medicine and Dentistry.
Competing interests: None declared.