THE Australian health system has responded to the coronavirus disease 2019 (COVID-19) pandemic with drastic measures. As part of this response, many final year medical students were sidelined from clinical training designed to prepare them for their upcoming roles as junior medical officers (JMOs).
Despite this, and the ongoing uncertainty about the future, there may be an unexpected silver lining. For me, this came in the form of the Assistant in Medicine (AiM) Program as I complete my final year of medical school during the pandemic.
Assistant in Medicine Program
Unprecedented in Australia, the NSW Minister for Health introduced the AiM Program in May as part of the surge workforce in response to the COVID-19 pandemic and, particularly, in preparation for a potential second wave.
Medical students in their final year of study who satisfied the essential AiM criteria could submit an expression of interest in this opt-in program. While the exact program structure varies across different medical schools and clinical sites, the Central Coast Clinical School (CCCS) of the University of Newcastle offered students a 6-month placement to work 32 hours per week in a clinical team.
Although this may seem daunting, it matches the existing 32 hours per week clinical placement at the CCCS that final year medical students were already expected to do. This proposed program would allow both AiM and non-AiM students to complete their course requirements through either work or clinical placements, respectively. There was no doubt in my mind that the AiM Program would be more challenging, yet after much deliberation, I, like many other students, submitted an expression of interest.
Given my experience so far, I am glad I did.
As an AiM, I have a well defined role with a clear scope of practice that I have been able to communicate to all members of my team. This was not systematically done in my previous rotations as a student, with my roles and expectations largely dependent on the individual team, a common experience among medical students. Consequently, some of my peers and I gained limited exposure and confidence in performing essential tasks expected of a competent junior doctor, including learning crucial “soft skills”, as they were anticipated to be picked up on the job. For instance, despite evidence showing that high quality discharge summaries enhance communication, improve patient outcomes and reduce readmission rates, many graduating medical students had limited skill and confidence in drafting discharge summaries. A similar lack of confidence has been documented for professional peer-to-peer communication skills including patient-care handovers and specialty inpatient consultation requests (here and here). Just like performing a physical examination during objective structured clinical examinations, targeted practice, feedback and persistence is required for continuous improvement in such logistical yet essential skills for optimal patient care.
Since starting as an AiM, I have specifically focused on taking this opportunity to hone my proficiency in performing these tasks. In addition to the desire for self-improvement, a formal employment created a deep and satisfying sense of responsibility that encouraged active engagement in ward work and patient care – a feeling shared by many of my peers in the program. While I gained experience in a range of jobs, including drafting discharge summaries and learning to prioritise competing demands during ward work, I have also gained significant confidence in communicating with peers, senior clinicians and, most importantly, patients.
Although developing an appreciation for the logistical reality of being a junior doctor has been important, the AiM role has been much more than that. In a relatively short period, I have gained invaluable experience across a range of clinical skills. Under appropriate supervision, I have consistently attended to pager calls, performed clinical reviews, escalated patients for further care, refined my targeted history taking and examination skills, presented patients for consults, and gained increased confidence in a range of procedures including venesection and peripheral intravenous cannulation — skills that will be crucial as a JMO. While I had already practised many of these tasks as a medical student on an ad hoc basis, the key difference in my role as an AiM was consistency. Importantly, the support provided to AiMs, and the recognition that we are, in fact, students, means a helping hand is always available. As a result, I have been learning and gaining significant clinical experience in an encouraging and stress-free team environment.
Important part of the team and patient care
I have integrated into my clinical team in a manner I found difficult to do as a medical student, developing a greater sense of comradeship, and experiencing satisfaction from being an important part of patient care. I point this out because a common contributor to medical student dissatisfaction during clinical placement is not feeling like we are part of the team or trying to “stay out of the way”. As medical students, we frequently move between wards after 1–4 weeks, which makes it difficult to meaningfully get to know the team and build rapport. As I have been allocated a much longer time in my AiM position, the team and I have invested time in getting to know each other well, which has certainly helped me feel more supported during each working day. I was able to communicate my strengths, areas of improvement and goals for my placement, which my team has actively helped me in working towards so far. This is particularly important across all levels of the health care system, as high quality workplace relationships have a significantly positive impact on reducing work-related stress, increased perception of social impact and greater commitment to patient care.
Shortcomings of the AiM Program
From the perspective of a medical student, the AiM Program at CCCS, like most things, is not perfect. The most obvious is the limited discipline-specific rotations across multiple departments, meaning that some of us may graduate without having a formal final year placement in the emergency department. While CCCS and the Central Coast Local Health District (CCLHD) have been working closely to organise practical teaching and simulation sessions for any of us who were disadvantaged, it is difficult to replicate the experience gained by being at the frontline of our hospitals. Also, the AiM Program is formal employment, which may prove stressful for students who are simultaneously completing formal course requirements of their final year of medical school. However, the communication and support from my faculty has been appreciated, with 8 protected hours of teaching each week and a further 2-week intensive teaching period for those who require any additional support to complete their graduation requirements.
Overall, my time so far as an AiM has been a period of both personal and professional growth. I am grateful to the CCCS faculty, the CCLHD and my team for designing a unique program where we could not only contribute to the ongoing pandemic response in Australia but also gain invaluable skills that will no doubt help in transitioning from being a medical student to a junior doctor in the coming months.
Riashad Monjur is a final-year medical student at the University of Newcastle and an Assistant in Medicine at Gosford Hospital, NSW. All views are the author’s.
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.