IMPACT OF THE CORONAVIRUS PANDEMIC: A FOUNDATION DOCTOR’S PERSPECTIVE

At the time of writing, there have been 4 258 666 cases of coronavirus globally since the first case was reported on the 31st December 2019 (1). This has had far reaching impacts in all aspects of life, resulting in lockdown of a third of the world’s population (2) at its peak and significant alteration in normal daily life, in attempts to control the virus. Governments have had to rapidly implement social an health policy, which have had profound impacts on individual doctors; these will be discussed in the following text.
During the outbreak in the United Kingdom, many adjustments have had to have been made to the operating structure of the NHS. Amongst theses are changes to the usually clockwork rotation pattern of junior doctors. Whilst it has been necessary to make changes, there has inevitably been costs associated, sometimes more than others. As a result of the coronavirus pandemic, Health Education England issued guidance that all rotations should be suspended, unless local arrangements allowed otherwise (3). Mid Essex Hospital Trust (MEHT) followed this advice and rotations were suspended. In addition to this, a number of foundation trainees at MEHT were redeployed to various areas during the course of the outbreak.
There have, as anticipated, been negative consequences to the rearrangements, and whilst they have certainly been necessary, they have caused significant uncertainty amongst those affected, and such uncertainty in the workplace has been shown to place a significant burden of stress on those involved. (4) Medicine is already a demanding profession, with high risk of burnout, and this additional stress could increase this risk in a time where there is already high levels of staff sickness and shortages, and so is something that should be seriously considered. Additionally, the suspension of rotations will cause a reduction in the breadth of training received, with some trainees missing out on important rotations.
However, there have been many opportunities to gain valuable experience that would not usually have presented. I, along with a number of other foundation trainees at MEHT, was redeployed to the intensive care unit at the beginning of April. During this time, we were encouraged to learn various practical skills, including arterial line and central line insertion, which will serve us in other fields due to transferable skills, including use of ultrasound and sterile technique. We were also exposed to a setting that we otherwise might not have been in foundation training, affording us the opportunity to learn about various treatment methods used in an intensive care setting. This allowed us to gain valuable experience, which will in future help us to appreciate how certain decisions are made, such as who will and will not receive intensive care.
Further to the clinical experience gained, I have witnessed a hospital being rapidly rearranged, with wards being reassigned and staff being redeployed, sometimes on a daily basis. These changes have all been affected with the aim of improving patient flow, increasing capacity of in demand areas and protecting patients from coronavirus infection. We have seen areas, such as recovery, repurposed as intensive care units and policy being regularly updated as situations evolve and evidence develops. Many of these changes would usually take months or years to happen outside of a time of crisis, and seeing them now has provided insight into what is possible. Intensive care capacity was increased rapidly from 13 to over 50 and nurses were given courses in how to operate ventilators, so that they would be ready, should they be needed to staff these areas.
The coronavirus pandemic has enabled myself and other junior doctors to grow in a way that would not have been possible otherwise. We have learnt to be flexible, having been redeployed, and have gained resilience in facing situations that change daily and unpredictably. I have also gained clinical experience that I will be able to take with me throughout my career. This period of time will have huge implications on the long term of the NHS; trainees will be affected by suspended exams and interviews, but used maturely, there will much to learn and reflect on, to enable us all to grow and develop as clinicians.
Authors
Dr Samuel G. Towell FY1
Mr Janso P. Joseph, Specialist Registrar

Department of Surgery, Broomfield Hospital, Chelmsford, UK
Court Rd, Broomfield, Chelmsford CM1 7ET

No conflicting interests
Acknowledgements
We acknowledge all the members of staff at MEHT who were responsible for planning, implementing and delivering these changes.
References
1. World Health Organisation. Coronavirus disease (COVID-19) pandemic. World Health Organisation. [Online] 19 May 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
2. Business Insider. More people are lockdown now than were alive during World War II. Business Insider. [Online] 25 March 2020. https://www.businessinsider.com/more-people-under-lockdown-than-alive-during-world-war-ii-2020-3?r=US&IR=T.
3. NHS Health Education England. Coronavirus (Covid-19) Information for trainees. NHS Health Education England. [Online] 19 May 2019. https://www.hee.nhs.uk/coronavirus-information-trainees.
4. Changes in mental well-being, blood pressure and total cholesterol levels during workplace reorganization: The impact of uncertainty. Pollard, Tessa M. 1, 2001, Work and Stress, Vol. 15, pp. 14-28.

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