Torn between two countries: On being an International Medical Fellow during a global pandemic (by Dr Revathy Krishnamurthy MD and Dr Archya Dasgupta MD))

The global healthcare system is currently facing an unprecedented challenge in the form of the COVID-19 pandemic, propelling medical workers into the frontlines. The personal lives and professional careers of medical students, residents, fellows, and staff have been altered in many ways and to different degrees, each gearing to assume elevated roles and responsibilities. 

The International Medical Fellows (IMF) are doctors in the final phase of their specialized training in a designated country, having received prior medical education in a different country. More than 70% of over 1500 clinical fellows in the University of Toronto (UofT) are international specialists originating from over 70 countries, making it one of the most renowned and colourful fellowship programs.1,2 Considering ourselves fortunate to be a part of the IMF community at UofT as oncology fellows, we wish to address the unique predicaments and uncertainties confronting us in the face of an ongoing global pandemic.

Answering questions and alleviating anxiety:

We anticipate from patients and their caregivers, general questions regarding COVID-19 as well as those pertinent to its impact on their ongoing medical care. It is very important to interpret correctly the barrage of information in the media and social media while educating ourselves and others.3 Having focussed our clinical practice and research on a specialised branch in the recent past, this could be challenging as the COVID-19 research spans over diverse domains (microbiology, epidemiology, critical care medicine) and is rapidly evolving.

Adapting to new roles:

As junior doctors on the verge of independent clinical practice, the IMFs should consider the current situation as an opportunity to volunteer for roles as necessary. Practices such as telehealth, restricting patient visits to the hospital, screening for COVID-19 at the hospital entrance and delaying or deferring therapy as suitable are being adopted globally to ensure continuity of clinical care. 

Depending on the situation and availability of resources, IMFs need to have the flexibility for a possible redeployment into medical services such as hospital emergency rooms, intensive care units, and triage facilities, which may need extra staffing. This should be preceded by appropriate and stringent training to ensure comfort and quality of care. There is also the cultural impact to consider in the redeployment of IMFs, given previous medical training received in a non-similar social setting. It is also vital for the IMFs to get oriented to the public healthcare and health governance policies of their host country.

Continuing education and research:

This is an ideal time for medical trainees to tap into all the available educational resources such as webinars, virtual libraries, and distance learning programs to continue education in their chosen speciality. It is crucial to keep existing essential research protocols running and considering a redesigning of protocols as necessary.4

Self-preservation: professional

The majority of IMFs are settled temporarily in a new place, most with plans of returning to their respective home countries after completion of fellowship training. In the setting of a pandemic, several countries have gone into lockdown with borders closed for an uncertain period. Also, given that many of the fellowship programs start/ end during spring and summer, the means of travel are limited due airlines cancelling many flights.

IMFs are generally on a short-term work permit with a fixed tenure of employment. This could cause some foreboding related to the possibility of temporary unemployment and financial problems resulting from travel restrictions. They could also find themselves torn between returning to their home countries to provide medical service and continuing to abide by the commitment undertaken with their host countries.

Self-preservation: personal

Care of IMFs beyond professional liabilities is often neglected and less discussed in the setting of a global emergency. IMFs are expected to have significant concerns regarding the safety of family and friends back home, particularly with the situation being turbulent and rapidly changing in many countries. They might find themselves isolated without a support network in view of the ongoing social distancing norms. Burn-out, anxiety and psychological distress arising due to the dilemmas mentioned above are very likely to affect IMFs, which can be a significant barrier to health care delivery. Setting up psychosocial support centres and online peer-support groups should be encouraged, as professional help is necessary.5

Emerging stronger:

We appreciate the prompt efforts initiated by UofT to support the international trainees and expect them to continue serving as role models for several other institutions globally. We acknowledge especially, the consideration shown with respect to the flexibility of employment tenures by allowing IMFs to return early or extend terms as needed.

To conclude, we need to continue learning while responding to the demands of the situation. Constant change is emerging as the new normal. Remaining prepared to assume any roles that may be needed of us, we can only emerge from this situation as better doctors, leaders, and humans.

dr.revathy.k@gmail.com

 

References

  1. University of Toronto. Raising the Bar: Recommended Standards for the Management of Clinical Fellowships.  https://pg.postmd.utoronto.ca/wpcontent/uploads/2016/06/FellowshipWorkingGroupReportSept2009.pdf. (accessed April 23, 2020)
  2. Post-graduate Medical Education, University of Toronto. Annual report 2018-19. https://annualreport.postmd.ca/#re-imagining-education-post-md-education-annual-report(accessed April 23, 2020)
  3. Stoye E. China coronavirus: how many papers have been published? Nature 2020: published online Jan 30. DOI:10.1038/ d41586-020-00253-8.
  4. Safely conducting essential research in the face of COVID-19. Nature 580, 549-550 (2020) doi: 10.1038/d41586-020-01027-y
  5. Mahmood T. Dealing with trainees in difficulty. Facts Views Vis Obgyn, 2012; 4(1):18-23. PMID: 24753884; PMCID: PMC3991443.

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