Scarlett Brandley describes her placement working on the CardMedic tool

Covid-19 has changed many people’s plans, goals, and lives. From a personal perspective as a medical student, one such modified plan for me was my elective placement. I had initially planned to travel to Barbados for my elective, but covid-19 meant that I (like many other students) had the task of finding a new elective in the UK that was appropriate to do in the middle of a pandemic. 

Having worked as a healthcare assistant in paediatric theatres before medical school and during covid-19, I was fortunate to have a network of healthcare professionals that could help me with this task. One such contact was Dr Rachael Grimaldi, an anaesthetic registrar, who had developed a novel disaster innovation response to covid-19. The idea came to her after reading about a patient who described feeling frightened in the intensive care unit when he was unable to understand what healthcare staff were saying to him through their personal protective equipment (PPE). The project, CardMedic, became my new elective placement. 

CardMedic is a digital communication tool (a website and an app), with an A-Z list of flashcards related to patient care and management. You can search for the topic you’d like to talk to your patient about and use the digital flashcard to aid this communication. You can use the introductory “Hello My Name Is” flashcard, and then, as an example, you may want the flashcard that asks about their pain, or you may want to explain a blood test. 

CardMedic has an ever growing list of topics, and evidence from a pilot evaluation study undertaken during the first wave of covid-19, as well as user feedback, has already shown it to be of benefit as an aid to improving patient communication and care. It’s available in multiple languages, with a read aloud option available for patients who are partially sighted or blind. There is also a free text option for direct communication and British Sign Language videos are soon to be uploaded. A team of speech and language therapists (SLT) and learning disability (LD) nurses are currently developing accessible versions of the flashcards for patients with underlying communication difficulties, which will feature simple English phrases, images, and symbols. 

One of my main roles at CardMedic has been with the SLT and LD nurses, where I’ve been helping to create accessible flashcards for patients with differing communication needs. I’ve learnt so much from this group and even been able, with their supervision, to write my own accessible flashcards. I’ve seen how by working and collaborating with different professionals, you start to share knowledge and experience that can alter how you yourself practice. When I’m on placement now, I will be much more attuned to considering if a patient has any different communication needs and, if so, how I can best adapt my practice to help. 

One of the key learning points I have taken from this experience is how challenges to communication can widen health inequalities. As medical students, we’re given regular teaching on communication to help us to improve our skillset across different scenarios, whether that be breaking bad news or explaining an endoscopy to a patient. However, we were never prepared for PPE to become an everyday barrier that we have to contend with in our communication with patients. 

PPE, as many of us know, often covers the nose, mouth, and most of the face. When worn, it can create more quiet, muffled voices, takes away the option to lip read, as well as reducing the chance to see facial expressions. All of these cues for communication and context can be critical in a patient’s understanding of their health and the care they’re receiving. Patients with underlying communication needs, such as a reliance on lip reading, a hearing or cognitive impairment, and those for whom English is not their first language, already face barriers. This pandemic has, unfortunately, only widened the communication gulf for these patients. We have a duty as future doctors to understand the importance of adapting our skills and resources to accommodate the patient. To do this, we must be adept at assessing people’s communication needs and be aware of the different resources and varied multidisciplinary teams who are available to assist the patient. 

In the future, I hope CardMedic will be used in medical education. I think the platform could be a useful learning tool for teaching students about communicating with patients using non-medical jargon, as well as interacting with individuals where simple spoken English and symbols complement the consultation. I’m excited to be a part of CardMedic expanding in the future, and I’m looking forward to using it more during my final year of medical school. 

Due to the uncertainties that covid-19 poses to planning for the future, I’m sure that many medical students are considering their options for their electives in 2021. I always thought that going abroad was how I would get the most out of the unique experience, however, it’s worth remembering that there are a number of diverse opportunities available in the UK. I’m extremely fortunate to have found an elective that has provided me with the chance to network, the chance to develop my skills, and the chance to further my understanding of the health inequalities covid-19 has intensified. 

Scarlett Brandley is a fifth year medical student at the University of Leeds. Twitter @ScarlettxB

Competing interests: None.