The initial joy of reaching our final year of medical school soon gave way to anxiety about the occupational health assessment and faculty meetings that were to follow this year.

Medical students with underlying conditions have always had to operate with some adjustments during their clinical training. However, the current covid-19 pandemic has hugely increased the scale and difficulty of this challenge. Medical schools have had to rapidly formulate new protocols to keep students as safe as possible, while still enabling them to continue their training to appropriate standards. The implementation of which is understandably difficult and tension about the ramifications of covid remains; a concern greatly amplified for those of us classified as “clinically vulnerable” to severe infection. 

Having a long-standing heart and kidney condition respectively, each of us is well accustomed to the experience of being a patient. However, discussing our medical history with the assessor from occupational health, in a setting where we had hitherto seen ourselves as “the healthcare professional,” represented a disconcerting role reversal. We were allocated into risk groups—where we were both categorised as “medium-to-high”—a label which carried no meaning to us at this point. We waited anxiously for the faculty’s decision about its practical implications, fearing that the pandemic would continue to wreak havoc on our ability to complete the course in the expected time frame. Our head of year allayed these fears by designating a list of actions to mitigate the risk of covid while on placement in the hospitals.

The guidance comprised of an extensive list of prohibitions: do not attend cardiac arrests, do not go to the acute medical unit, do not attend orthopaedic theatres, do not observe aerosol-generating procedures, and on no account see any patient exhibiting covid symptoms. These restrictions raised concerns about how we are to gain the necessary experience to be competent when we begin our first junior doctor positions in the NHS. Especially given that covid presents similarly to many common illnesses or indeed may be asymptomatic.

Since returning to clinical placements, the guidance has been exceedingly difficult to follow in practice. The medical team is often unable to social distance when treating patients, due to time and space constraints.

Further, some seem resigned to covid exposure as part of the job, which influences their perspective on the necessity to follow the protocols stringently. Given this is our primary learning environment, it can place those of us with covid-related vulnerabilities in a difficult position: forced to choose between integrating into the team, caring for patients and risking exposure, or removing ourselves from the situation, but to the detriment of our clinical experience. This dilemma predominantly affects students on placements as we need to have patient contact to achieve the clinical experience required to qualify.¹

After placements were suspended for months, there is limited time for us to gain this experience. This has increased the value of group teaching at the bedside, which is often with patients who have not been confirmed covid-negative or are held in small rooms with many people. In such situations, where a patient and doctor have generously volunteered their time, it feels uncomfortable to request to change the teaching format or to see a different patient.

We have both had experiences where we have been questioned as to whether the risk is worth excluding ourselves from these learning opportunities, which can feel stigmatising. This makes it hard to display our vulnerabilities to colleagues, through fear of not being seen as competent or living up to their expectations or that of the public eye. Further, such challenges create an environment in which we can feel at fault for having a medical condition and a need to hide the limitations imposed by our conditions, instead of being supported to manage it. This is an issue affecting other healthcare professionals more widely in the NHS.^2,3 Generally, more open discussion and quality research about the health and wellbeing needs of healthcare professionals including those of us with underlying medical conditions could help clinicians combat this environment.^4,5

We think further lessons could be learnt from these experiences, to both improve the learning opportunities for vulnerable students and to make it easier for those who are training them. Many medical schools have already initiated integrated online and clinical teaching and a digital platform to mimic the theatre experience is being piloted. Improved planning to coordinate smaller teaching groups in open spaces could prevent vulnerable students being forced to disclose personal information in front of many people. In addition, improving testing efficiency, to reach the rapid 4-hour test target, would allow us to increasingly interact with patients and make teaching more accessible. Finally, it is essential that our supervising clinicians have clear guidance as to how best to help vulnerable students work within their limitations.^6,7        

Helen Woodward BSc, Final Year, Imperial College London, School of Medicine, UK

Vincenza Scannella BSc, Final Year, Imperial College London, School of Medicine, UK

Competing interests: none declared. 

References:

1. General Medical Council Outcomes for Graduates (2020) Available at URL: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards- and-outcomes/outcomes-for-graduates/outcomes-for-graduates [Accessed 21/08/20]
2. Fox FE, Doran NJ, Rodham KJ, Taylor GJ, Harris MF, O’Connor M. Junior doctors’ experiences of personal illness: a qualitative study. Med Educ. 2011;45(12):1251- 1261. doi:10.1111/j.1365-2923.2011.04083.x [Accessed 20/08/20]
3. Carpenter L, The Guardian, Why Doctors hide their own illnesses Available at URL:https://www.theguardian.com/society/2014/may/16/why-doctors-hide-their- own-illnesses [Accessed 20/08/2020]
4. Margaret K, Mitchell G, Clavarino A, Doust J. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience, Br J Gen Pract, (2008) Jul 1; 58(552): 501–508
5. Morishita M, Iida J, Nighigori H, Doctors’ Experience of Becoming Patients and Its influence on their medical practice: A literature review. Explore (2020); 16(3): 145- 151
6. General Medical Council, How we work with Doctors with Health Conditions Available at URL: https://gmcuk.wordpress.com/2017/09/12/how-we-work-with- doctors-with-health-concerns/ [Accessed 21/08/20]
7. Stergiopoulos E, Fernando O, Martimiankis MA, ‘Being on Both Sides’: Canadian medical students’ experiences with disability, the hidden curriculum, and professional identity construction. Academic Medicine 2018; 93(10): 1550-1559