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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:m1156

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Rapid Response:

Covid-19: Are final year medical students really ready?

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

23 March 2020
Fiona Kehinde
Medical Student
Cambridge University
University of Cambridge School of Clinical Medicine Box 111 Cambridge Biomedical Campus Cambridge CB2 0SP. UK