Covid-19: medical students to be employed by NHS
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1156 (Published 20 March 2020) Cite this as: BMJ 2020;368:m1156Read our latest coverage of the coronavirus outbreak
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Dear Editor
The necessity for involvement of medical students in responding to the calls of the COVID 19 pandemic seems eminent not only for UK but for other countries such as India. With the risings tolls on human lives daily and the escalating figures of COVID 19 affected persons and lack of trained health doctors the role of the medical students will also see a change over time. Currently, in India the medical colleges are not conducting any face to face classes and there is a shift to load the lectures in online mode or through webinars. The scheduled tests are postponed till further orders. However, in the event of their need, they can be called anytime and their prime responsibility would be to create awareness, help in the screening process with questionnaires for suspected cases and provide information and counselling needs if required. Their active role in patient care is not expected. They can maintain a list of the suspect cases, monitor their health status through telephone, mobile or videos and also check for the isolation or quarantine status of the affected individuals at home or in the hospital depending upon the nature of acute shortage of medical manpower. The question, remains regarding the provision of personal protective equipments such as the masks, gloves, and sanitizers at the minimum. National governments are not able to provide the required essential items for protection and this needs to be addressed so that local manufacturing could be done.
Competing interests: No competing interests
Dear Editor,
Medical students across the UK have experienced a large change in the structure of our medical training due to the suspension of clinical rotations. This has resulted in thousands of medical students across the country, at a loose end, with a moral obligation to help but insufficient clinical experience to be exposed to the wards.
This article focusses primarily on final year medical students who have been fast-tracked into the workforce to relieve pressure within the NHS (1).
Whilst final year students may have found a role within this pandemic, there is a distinct lack of guidance and coordination of medical students in early clinical years, in determining what our role could be during this crisis.
It has been widely reported that there is anxiety throughout the NHS regarding the potential lack of availability of Personal Protective Equipment (PPE) as the number of Covid-19 cases increases (2). It is therefore of upmost importance that PPE should only be used by essential personnel and whilst junior medical students feel they would like to help on the wards, at this stage it is not a sensible use of this scarce resource.
However, what this article doesn’t cover, is how medical students can be utilised within the safety of their own home and local community (1).
General Practitioners (GPs) are now shifting to remote consultations via telephone or video as a new way of interacting with Covid-19 patients (3). Covid-19 consultations are likely to occupy the majority of a GP’s time, accompanied by an increase in GP absenteeism, there is little time left for those vulnerable patients within the community who have chronic diseases.
Therefore, we propose a country-wide coordination of GP surgeries, to utilise medical students in clinical years (3rd-5th year) to perform telephone consultations from their own home. Whether this involves chronic illness check-ups or contacting vulnerable patients within the community. For example, patients with asthma require frequent GP check-ups and it is absolutely critical during this Covid-19 crisis that their condition is even more closely monitored than usual. Surely this is an ideal opportunity for medical students, following well-established algorithms of care, to alleviate some of the burdens that our general practitioners are facing.
Medical students will not be facing the same time constraints as a busy practitioner, so in addition to monitoring chronic conditions, medical students can also play an important role in providing a point of contact for isolated, vulnerable and lonely members of the community.
This potential opportunity to work safely in the healthcare setting will enable medical students to enhance their learning and fulfil their desire to have an important clinical role in helping the NHS deal with this unprecedented world-wide pandemic.
References:
1. Mahase E. Covid-19: medical students to be employed by NHS as part of epidemic response. BMJ [Internet]. 2020 Mar 20;368:m1156. Available from: http://www.bmj.com/content/368/bmj.m1156
2. Mahase E. Covid-19: hoarding and misuse of protective gear is jeopardising the response, WHO warns BMJ [Internet] 2020 Mar; 368 :m869. Available from: https://www.bmj.com/content/368/bmj.m1156
3. Greenhalgh Trisha, Koh Gerald Choon Huat, Car Josip. Covid-19: a remote assessment in primary care. BMJ [Internet] 2020 Mar; 368 :m1182. Available from https://www.bmj.com/content/368/bmj.m1182
Competing interests: No competing interests
Dear Editor,
As a final year medical student, this article highlights three key areas of concern, which need to be addressed sooner rather than later.
1. What exactly will our role be?
2. How will we be supported in our new roles and how will competency be assessed?
3. How will our psychological well-being be supported during and after the pandemic?
Clear, coordinated and uniform plans across the country are needed to ensure the best use of final year medical students throughout this pandemic.
Firstly, this article raises the question that is on the mind of many final year medical students: What exactly will our role be?
Rumours and differences between the approaches of medical schools has led to the generation of anxiety and confusion amongst medical students. The main concern is that we don’t know exactly what role we will be called to. Will medical students act as physicians’ assistants or healthcare assistants? Or will we be acting as FY0s in a role similar to current foundation year doctors? Will we be used to ensure the smooth running of services for non COVID-19 patients? Or will we be acting on the ‘frontline’ in A&E, ITU, and on COVID-19 wards in an attempt to increase numbers of doctors working in these areas.
Secondly, the article importantly raises the point that ‘students need to be appropriately supervised and looked after to maintain their own safety and the safety of others’. The next key question therefore is: How will we be supported in our new roles and how will competency be assessed?
Kindly, current foundation year doctors have been posting helpful documents such as ‘the ultimate guide to being a confident FY1 out of hours’ in medical student Facebook groups in a bid to better prepare us for the wards if we are indeed granted early GMC registration. However, a more formal online induction process led by medical schools or hospital trusts themselves is needed to ensure we are better prepared and to ensure patient safety.
An additional thought in response to this article is that it would be better for medical students to join NHS trusts before and not during the ‘crisis point’. The first Wednesday in August, when new junior doctors start work, is known as ‘Black Wednesday’ due to the first week in August having a 6-8% higher mortality rate compared with the last week of July. [1] This occurs even though the new doctors have successfully completed 6 years of training and a full week of induction training, which often includes shadowing a doctor who is currently working in your prospective role.
Seemingly, a better approach would be the inclusion of medical students in NHS services before the peak of cases is reached and before staff shortages reach a critical level. This will enable students to join in an environment with reduced pressure and allow time for them to adapt to their new roles so that we feel more confident and better equipped to be helpful.
Finally, the article mentions that the ‘safety of … students must be a top priority’. Thus, the question: How will our psychological well-being be supported during and after the pandemic? Needs to be addressed.
Under usual circumstances, starting Foundation year is known to be a stressful and mentally challenging time in any doctor’s career. [2] Starting this role amid a global pandemic could be the perfect storm for the development of mental health issues further down the line. Already in the UK doctors are witnessing colleagues and young patients with COVID-19 requiring intensive treatment and ventilation, this is bound to influence the well-being of doctors. In Bergamo, Italy, doctors working with COVID-19 patients have access to a telephone counselling service during the pandemic and efforts will be made to provide ongoing support after the numbers of cases have reduced. Will there be the same provisions to protect the mental health of healthcare workers and incoming medical students during the UK Coronavirus outbreak?
1. Early In-Hospital Mortality following Trainee Doctors' First Day at Work, Min Hua Jen et al PLoS One. 2009; 4(9): e7103. doi: 10.1371/journal.pone.0007103
2. Italian doctor on how virus ‘exploded’, having coronavirus & how to fight it. (2020, March, 23) Retrieved from https://www.youtube.com/watch?v=dkozG3IcXUU
Competing interests: No competing interests
I welcome the news that trusts and schools are exploring routes medicals students can assist during the current crisis. Across the UK medical schools have suspended their face to face teaching or are transitioning to remote learning. Whilst medical students in pre-clinical years are able to engage in remote learning, clinical students are unable to learn on placement across hospitals and primary care. During the SARS outbreak in 2003, students in Toronto expressed their frustration at the suspension of their studies and I imagine many students feel the same way today. (1)
Many medical students want to help and can provide useful, valuable skills, however it is vital certain issues are considered and addressed before they start to help.(2)
The impact of the Covid-19 epidemic on the mental health of UK health care workers could have no comparison during the time since World War II. Health care workers involved with care during this crisis will be at risk of developing mental health symptoms, burnout and psychological distress. Many students and staff will feel a duty to work, putting others’ wellbeing ahead of their own mental and physical health.(3) Couple this with multiple stress factors such as conditions of work, witnessing colleagues become unwell, the fear of infection and finite PPE, it seems inevitable a lasting impression will be left across the workforce. A recent study of healthcare workers responding to Covid-19 in Hubei province reported high rates of depression, anxiety and distress amongst them, with previous studies examining the SARS outbreak of 2003 also reporting adverse psychological reactions.(4) We already know that medical students need better mental support at their institutions, so it is essential that throughout this upcoming period all students volunteering or working in the NHS have access to adequate psychological support or interventions. (5)
Without this support in place, we could see more junior doctors leaving the profession, but most importantly a group of people who could be suffering from work related stress or burnout after experiencing one of the worst health crises we will ever face at the very start of their career.
1. Clark J. Fear of SARS thwarts medical education in Toronto. BMJ [Internet]. 2003 Apr 12;326(7393):784. Available from: http://www.bmj.com/content/326/7393/784.4.abstract
2. Mahase E. Covid-19: medical students to be employed by NHS as part of epidemic response. BMJ [Internet]. 2020 Mar 20;368:m1156. Available from: http://www.bmj.com/content/368/bmj.m1156.abstract
3. Simonds AK, Sokol DK. Lives on the line? Ethics and practicalities of duty of care in pandemics and disasters. Eur Respir J [Internet]. 2009 Aug 1;34(2):303 LP – 309. Available from: http://erj.ersjournals.com/content/34/2/303.abstract
4. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open [Internet]. 2020 Mar 23;3(3):e203976–e203976. Available from: https://doi.org/10.1001/jamanetworkopen.2020.3976
5. Coombes R. Medical students need better mental health support from universities, says BMA. BMJ [Internet]. 2018 Jun 27;361:k2828. Available from: http://www.bmj.com/content/361/bmj.k2828.abstract
Competing interests: No competing interests
Re: Covid-19: medical students to be employed by NHS as part of epidemic response
Dear Editor,
thanks for this oportunity
the medical student is a diamond that needs to be polished.
would polish well allowing you to assist in remote counseling or a telemedicine service in the morning or afternoon and to avoid contact with patients
God save the world
Thanks
Competing interests: No competing interests