AS the anticipated COVID-19 peak in Australia is fast approaching, the entire health care sector and its workforce are feeling immense pressure already. While drastic measures have been slowly implemented to try and reduce future caseload, it is inevitable that we need to go to extraordinary efforts to safeguard and fortify our medical workforce as we prepare for an accelerated uptick in COVID-19 cases.
Beyond our current medical workforce, COVID-19 has also shaken the foundations of our future medical workforce. For the Australian medical education system, COVID-19 is a shock to what is a traditional evidence-based system and a well oiled machine of a medical professional pipeline. The impact on medical education is too broad to cover in one single article, with elements from content delivery to assessment requirements and future curriculum development all being impacted in some way or other by COVID-19. Instead, I want to focus on how COVID-19 affects the medical workforce and the intersection with medical education and medical students.
Student clinical placements and the future medical workforce
For many students across Australia, the most disruptive aspect of COVID-19 is the inability for students to successfully complete clinical placements in a safe and effective manner, for themselves and for patients.
COVID-19 represents a risk to all medical student safety and further represents a disproportionate risk to students who may have underlying conditions that predispose them for becoming extremely ill. Examples include students who may be immunocompromised or those with respiratory conditions. The lack of personal protective equipment (PPE) in certain clinical environments, such as GP clinics, also places students at higher risk of contracting COVID-19. From the perspective of patient safety, medical students, who are often in their 20s, are potential vectors for transmission. Rotations in places such as aged care residencies also represent a disproportionate risk to our vulnerable and elderly populations.
From the perspective of clinicians, over the past few weeks, there have been increasing accounts of students being told to go home by their supervising consultant or medical teams as they simply do not have time to supervise or teach students should they accompany them on ward rounds and consultations. Embedding medical education into their clinical routine is not a priority for many clinicians.
For these reasons and many more, it has meant that a proportion of medical students have had all clinical placements paused by their medical school to ensure that students are safe and that there is a concrete plan to combat what will likely be a drawn-out COVID-19 pandemic. In part, this decision ensures consistency across medical student cohorts in regard to clinical exposure, while also giving clinicians and medical schools time to come up with a curriculum that could see students be safely reintegrated into the clinical environment.
The flow-on effect of COVID-19 is that it represents a tremendous barrier towards the continuity of education for many medical students, especially those who are in their clinical years. While pre-clinical students may not be adversely affected, as the majority of their learning is completed in lecture or tutorial style, which can be directly transposed onto online learning platforms, clinical placements are by far more difficult to replicate in any online format. This inability for students to fulfil educational requirements and competency standards to complete their degree has deep and long-reaching implications for our future medical workforce.
Each year, around 3500 to 3700 final-year medical students graduate across Australia, ready to become an intern. Interns play an important operational role in patient care and the functioning of the hospital. Should any proportion of these students fail to graduate their final year, this would have marked implications for the effective operation of hospitals across Australia in 2021, especially those hospitals which often find it difficult to attract and retain interns. Simultaneously, should there be a failure to graduate students in 2020, we will have a reciprocal flow on effect in 2022, where there would be an oversupply of graduating students flooding the workforce resulting in students missing out on internships, especially international students who have trained and lived in Australia for the entirety of their degree.
Ultimately, this is unacceptable as an outcome. The longer term and broader implications of a weakened workforce in the immediate future is significant.
Potential workforce involvement of medical students
During these times of crisis, medical students around the world have been touted as a potential solution to some workforce shortage issues. This is primarily to provide more capacity in the surge workforce in the coming months, especially in anticipation of those on the frontline becoming overburdened or becoming sick with COVID-19 and needing to self-isolate.
In some countries where COVID-19 has already rocked the foundations of health care systems, we have seen medical schools fast-track medical students to graduation so that they can enter the workforce and join the fight. Medical students in Italy, the UK and the US are some examples. While Australia is very unlikely to see such drastic action implemented due to various systematic differences in education systems, involvement of medical students is still a possibility.
However, the involvement of any medical students in the COVID-19 pandemic response needs to be very carefully assessed and executed. There should be state government coordination, ideally from the state Departments of Health, with extensive consultations with medical schools and students of each jurisdiction. Throughout these consultations, key issues such as medical student competency, potential scope of practice of students and a detailed implementation plan for medical student involvement should all be drawn out.
For medical students, there is a spectrum of roles that students can play in combating COVID-19. Some examples include receiving telehealth phone calls, triaging patients, contract tracing, sample collection in fever clinics and packing sterile COVID-19 test kits. But beyond directly engaging with patients that are affected with COVID-19, there are also non-COVID-19 roles that students can play to relieve the stress on our medical workforce. These include students, particularly final-year students, operating in a newly created junior medical role where they step up in clinical teams and partake more actively in their home medical team under the provision of extra support or supervision. Contributions could include writing notes on ward rounds, helping with discharge summaries and taking histories, which can free up the time of other more senior doctors who can be repositioned or rested to increase our surge capacity against COVID-19.
Among the potential roles of medical students being involved, there is, however, a broad range of considerations that government and stakeholders should keep in mind. A number of them are listed below:
- Students should not be coerced, whether directly or indirectly, into the workforce against COVID-19. The opportunity for students to participate should be provided to students, but it must be up to students to choose to engage.
- Students should have safeguards and entitlements afforded to them, just as any other employee working as part of the broader COVID-19. This includes fair remuneration and working hours, indemnity protection, adequate PPE, adequate clinical supervision and sufficient clinical support or escalation pathways for support.
- Students should have an educational framework placed around more advanced workforce roles they undertake to allow for their clinical experience in the workforce to be able to contribute towards their medical education.
- Students should have alternative learning pathways to ensure that students who don’t undertake any workforce roles are not unduly disadvantaged and that they can still fulfil their clinical placement or education requirements.
- Students should be primarily approached by their medical school regarding these opportunities, as medical schools are best placed to communicate and assess which cohort of students are suited to fulfil certain workforce shortages.
Ultimately, discussions around providing certain medical students the opportunity to step up in response to COVID-19 is a testament to the fantastic work that medical deans and schools all around Australia have done to educate our future doctors. However, to fully harness any potential medical student workforce, there needs to be rigorous thought and attention paid to all aspects of any system and framework for students, with the points above all taken into due consideration.
In and among the challenges and difficulties everyone is facing during what are unprecedented and stressful times, I’m hopeful that medical education and our future medical workforce will evolve in the future to become more resilient when combating such incidents in the future.
Daniel Zou is the President of the Australian Medical Students’ Association and a 3rd-year medical student at the University of Melbourne.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.