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O’Byrne et. al raise the important issue of pandemic preparedness in medical students’ readiness to deal with the covid-19 pandemic. Healthcare professionals have a moral obligation to volunteer to help, however, there has been a lack of strict consideration for the preparedness and clinical competency of medical students in these circumstances. The article correctly highlights that medical students’ desire to help is insufficient alone, and there is a need for adequate medical education and training to better prepare students for any potential moral trauma and adverse risks to mental health. However, for those newly graduated students, we feel as though the need for a break from clinical activity is a concept that has been overlooked and may be imperative to true pandemic preparedness amongst this cohort.
The majority of medical students will complete an intensive 5-year curriculum before graduating and applying to the foundation programme to continue their training, 43% of whom will have had no break from education up to this point.(1) As highlighted in the article by O’Byrne et. al, many of these students face problems with their mental wellbeing during medical school and thereon after. These problems regarding mental and emotional wellbeing are heightened in situations where students feel anxious or unprepared, such as clinical placements and rotations.(2) The importance of breaks to aid mental wellbeing are well recognised throughout the curriculum, such as tim...
The majority of medical students will complete an intensive 5-year curriculum before graduating and applying to the foundation programme to continue their training, 43% of whom will have had no break from education up to this point.(1) As highlighted in the article by O’Byrne et. al, many of these students face problems with their mental wellbeing during medical school and thereon after. These problems regarding mental and emotional wellbeing are heightened in situations where students feel anxious or unprepared, such as clinical placements and rotations.(2) The importance of breaks to aid mental wellbeing are well recognised throughout the curriculum, such as time-outs and project periods to break-up clinical activity.(3) The concern is that those deployed early onto the frontline will not have had the adequate break required to replenish their wellbeing in preparation for their lifelong career ahead.
The obligation to patient care and dire need for volunteers will see most graduating medical students quickly enter clinical practice. However, stress, anxiety and burnout are well recognised issues amongst medical students, and may be exacerbated for this cohort.(4) The covid-19 pandemic is likely to cause heightened moral distress for newly graduated doctors, as they are required to make increasingly challenging decisions regarding patient care.(5) This highlights the need to build moral resilience to reduce the chance of moral injury or burnout.
It is well recognised that breaks during work are important to avoid burnout, particularly for healthcare professionals. A study conducted on doctors working in a stressful intensive care environment showed that taking breaks from the intensive care unit environment was one important strategy to rejuvenate from moral distress.(6) However, the concern is that those more junior faced with the existing anxiety of a new job role and responsibilities may have a lower tolerable threshold for morally distressing situations; as a result increasing likelihood of burnout. Additionally, many more doctors are taking time out from foundation training in recent years due to stress and exhaustion.(7)
Reflexivity is important in developing as a practitioner and may be crucial in the period between graduating and becoming a medical professional. Coates et. al(1) showed that this transitional period is an important time for life skill development, such as through increasing confidence, emotional stability and independence; important traits of a medical professional. The importance of a break is recognised throughout, with trainees now opting to take a break during medical training, of which the result has been an addition of valuable experience to the development of their future profession.(7)
Therefore, whilst providing newly graduated students with the invaluable learning opportunity of assisting during a global pandemic, it must also be remembered that students must receive an adequate break from clinical studies in order to develop moral resilience, boost mental wellbeing and reduce the chances of burnout during foundation training.
1. Coates WC, Spector TS, Uijtdehaage S. Transition to Life—A Sendoff to the Real World for Graduating Medical Students. Teaching and Learning in Medicine 2012;24(1):36-41. doi: 10.1080/10401334.2012.641485
2. Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Medical education online 2018;23(1):1530558-58. doi: 10.1080/10872981.2018.1530558
3. Tolhurst HM, Stewart SM. Balancing work, family and other lifestyle aspects: a qualitative study of Australian medical students’ attitudes. Medical Journal of Australia 2004;181(7):361-64. doi: 10.5694/j.1326-5377.2004.tb06326.x
4. Wang Q, Wang L, Shi M, et al. Empathy, burnout, life satisfaction, correlations and associated socio-demographic factors among Chinese undergraduate medical students: an exploratory cross-sectional study. BMC Medical Education 2019;19(1):341. doi: 10.1186/s12909-019-1788-3
5. Wald HS. Optimizing resilience and wellbeing for healthcare professions trainees and healthcare professionals during public health crises - Practical tips for an ‘integrative resilience’ approach. Medical Teacher 2020:1-12. doi: 10.1080/0142159X.2020.1768230
6. Henrich NJ, Dodek PM, Gladstone E, et al. Consequences of Moral Distress in the Intensive Care Unit: A Qualitative Study. American Journal of Critical Care 2017;26(4):e48-e57. doi: 10.4037/ajcc2017786
7. Rizan C, Montgomery J, Ramage C, et al. Why are UK junior doctors taking time out of training and what are their experiences? A qualitative study. Journal of the Royal Society of Medicine 2019;112(5):192-99. doi: 10.1177/0141076819831872
I read with great enthusiasm the article by O’Byrne. As a senior medical student, my feelings resonate with her discussion. I also believe that medical students are given a further ethical challenge. This challenge is dedicating time towards volunteering during the COVID-19 outbreak or continuing with studies remotely. As stated in the article, the ‘curriculum is not readily compatible with the removal of students from their clinical placements(1). However, the guidance from Medical Schools Council (MSC)(2) state that the student’s first responsibility is to continue education and not jeopardise this with taking on too many additional duties.
As the GMC has not suspended education(3), we attend online tutorials and prepare for exams. However, one could argue that the online tutorials and self-learning from textbooks is not adequate education for such a vocational profession. Furthermore, medical schools have created excellent programmes for students in all years to volunteer and help. This ranges from practical clinical work for senior students to first-year students taking on tasks like the general public. With such well-managed, organised volunteering schemes, it seems that the student body has a duty to help. With students coming forward to volunteer in such large numbers(4) it is suggestive that medical students, just like other medical professionals, feel they have a moral duty to help in healthcare.
Even though these well-organise...
Even though these well-organised volunteering roles exist, medical student duties to their study and difficult exams present a challenge in finding a healthy balance between study and volunteering. There is significant pressure to pass and perform well in exams that students may discover volunteering contradicts their academic output. Hence, I believe that the continuing remote education and examination (which pose their ethical considerations) retract students from being able to volunteer their full potential. Given that a large part of medical training is hands, future clinicians and tomorrow’s doctors need as much clinical experience as possible given the prediction of increasing epidemics(5).
Perhaps the best form of education is to adapt to our surroundings and to be able to engage our students in the present moment. Then we will feel fully educated and wholly resourceful.
1. O'Byrne L, Medical students and COVID-19: the need for pandemic preparedness, Journal of Medical Ethics Published Online First: 03 June 2020. doi:10.1136/medethics-2020-106353