Risky Business: lessons from covid-19BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2221 (Published 05 June 2020) Cite this as: BMJ 2020;369:m2221
All rapid responses
We read with interest your feature on the lessons learnt from COVID-19. The impact of medical education is often overlooked in such discussions, although this field has similarly experienced drastic and innovative changes, with varying degrees of success. Towards the end of February, many medical schools took the decision to close due to the developing pandemic. Neither the institutions nor students were prepared for what was to come. The modern medical school curriculum is often carefully constructed and diverse, making use of small-group teaching, dissection, clinical skill sessions and lectures. This adaptive approach helps to strengthen students’ knowledge through a variety of teaching methods.
Clinical placements offer students a valuable first-hand experience of medicine, with opportunities to develop history-taking and examination skills under the supervision of senior clinicians. It also offers students the ability to consolidate and apply their scientific knowledge beyond the classroom. Students may also have been disproportionately affected due to the increasing reliance on clinical exposure as they approach completion of their degree. This sudden interruption can have severe implications on both their academic performance and their mental health. One recent study even suggested that there are increased rates of anxiety and depression among vulnerable students due to the lockdown and the deprivation of their education .
One popular method which has emerged is the use of streaming technology to deliver online lectures or tutorials. Education has changed dramatically in the internet age, with an increasing range of online resources and accessible content beyond the traditional textbooks. Although this may initially be meet with great enthusiasm, students may play a more passive role whilst simple technical difficulties can hinder participation. Embracing emerging technology such as virtual reality for simulation or role-play purposes may be an alternative which can help to offer more immersive practical or patient-focused experiences.
The pandemic also had implications for students approaching graduation as well as junior doctors. The creation of interim FY1 posts  introduced final year medical students into clinical environments earlier than was previously planned. Meanwhile, planned rotation changes for junior doctors were cancelled and trainees were redistributed to acute medical specialties. Many mandatory local teaching sessions for juniors were also cancelled, with an increasing reliance on online content, which is likely to remain with the persistence of social distancing restrictions. Although this can improve accessibility in the short-term, this can be problematic in terms of maintaining protected teaching time, which may risk further exhaustion or alienation.
The legacy of the COVID-19 pandemic on medical education remains unclear at present. The unique complexities of the healthcare system in the NHS means that there is a delicate balance between service provision and education for many trainees and students. Although dramatic changes were undoubtedly necessary at the height of the pandemic, these measures may have significant implications on individuals’ future careers. For a generation of doctors, the COVID pandemic will be a defining period in their personal and professional lives. Now, more than ever, we must be attentive to the educational needs and wellbeing of our students.
1. Morgan C, Rose N. Multidisciplinary research priorities for the COVID-19 pandemic. The Lancet Psychiatry. 2020;7(7):e33.
2. UK Foundation Programme. Impact of Impact of COVID-19 on the UK Foundation Programme 2020 [Internet]. Birmingham: UKFPO. Available at: https://foundationprogramme.nhs.uk/covid-19/
Competing interests: No competing interests
The danger of litigation is surely exponential, with a pandemic involving an unknown disease for which the NHS was never prepared - in terms of testing and PPE and much else. Have we forgotten scandals such as Mid-Staffs, etc?
Just look at the daily news conferences at five on the TV. They have the air of smug propaganda to mask the 'risky business' of COVID-19. A large 'posh' room and experts with graphs and diagrams seem to give the impression of a NHS in control. The reality is a people in panic and a NHS that has proved underfunded and far from effective.
The 'experts' have referred to the sensitivity and specificity of diagnostic tests without explaining to the uninitiated what sensitivity and specificity are. Then there are the diagrams that contain the complicated statistical idea of the confidence interval. Again, the experts, trying to be as baffling and cryptic as possible, do not actually explain what a confidence interval is. I did unfortunately notice that the confidence intervals involved were very, very large. The implication would be that the sampling was too small, and the numbers given are inaccurate.
Alas, the news conferences give the impression of all show, and no substance. There is something almost Machiavellian about them.
Competing interests: No competing interests