Two years of medical education during COVID-19

THOUSANDS of Australian medical students have only experienced medical education and clinical placements in the context of a global pandemic. Many of these students have completed all of their preclinical years on Zoom, while others have never stepped foot into a hospital or clinic without wearing a mask. As the Omicron variant takes hold of our hospitals, the focus has, rightly so, been on the current medical workforce. However, it’s important we don’t lose sight of our future health care professionals and the impacts this ongoing pandemic is having on the training of medical students.

Early reflections on the impacts of COVID-19 on medical education were positive, highlighting the quick shift of many universities to more flexible online learning and innovative ways of teaching, such as using telehealth and live streaming ward rounds.

In late 2021, the Australian Medical Students’ Association (AMSA), surveyed over 500 medical students to examine the impacts of COVID-19 on their medical education (unpublished to date). When asked what changes that had occurred during the pandemic they would like to see stay, students mostly welcomed the shift to online learning, highlighting the increased flexibility of lectures and classes and increased accessibility of additional course content. Another benefit students found was the shift of many medical programs from previously graded subjects to pass/fail models.

In the same survey, AMSA asked medical students from around Australia about the key challenges they faced in their medical education during the COVID-19 pandemic. The responses to this question were more extensive but less cohesive. The impacts on students were incredibly varied and highly dependent on their location of study and the level of support provided by their universities and clinical schools. Students in states such as Western Australia and Queensland, up until the point of the survey, had unsurprisingly not experienced many negative impacts of COVID-19 on their medical education.

Most students elsewhere, however, reported a number of negative impacts, including reduced placement time and limited opportunities for clinical learning. Concerningly, 62.5% of students surveyed reported they felt less confident in their clinical ability and skills as a result of medical education during the COVID-19 pandemic. They experienced a decline in their exposure to patients, reduced exposure to physical examination skills, and felt that doctors, understandably, had less time to teach.

Medical school is incredibly difficult at the best of times. What has kept me going throughout my studies thus far are those experiences you have in the hospital where you truly feel like you are learning, where something you got taught in class really clicks, and when you are able to contribute to improving the wellbeing of a patient. There is no substitute for clinical placements and real-life patient experience. Although the innovations prompted by the pandemic have improved many aspects of medical education, our medical students are concerned about their clinical skills and their ability to be job-ready and competent in the future.

Alongside this, the COVID-19 pandemic has exacerbated the already poor mental health experienced by medical students. The commonly cited Beyond Blue survey of doctors and medical students in 2013 highlighted that medical students had higher rates of mental illness and suicidality than the general population. Contributors to poor mental health in medical students include, but are not limited to, balancing study and personal responsibilities, finances and debt, unpaid work hours, sleep deprivation, examination and study demands, racism, bullying, and social or geographical isolation. The COVID-19 pandemic has exacerbated many of these contributing factors, with many medical students becoming geographically isolated from family and friends interstate or overseas for a number of years. Anecdotally, students are reporting increased stress levels due to placements being cancelled and having to make up the missed time on weekends, nights, or summer holidays. Other students are finding themselves unable to complete required logbook tasks in the hospital due to a lack of available supervising doctors, or the inability to see patients due to the risk of COVID-19 exposure.

Many of students’ coping mechanisms for the stresses and difficulties faced in medical school have also been significantly affected by the pandemic. During my studies, I have found that study groups, coffee breaks with other students, and social events run by medical school groups or AMSA have been my way to keep myself sane throughout studies. Students have not only lost 2 years of clinical teaching and experience, they have also lost 2 years of everything else that goes along with medical school.

The complete impact of COVID-19 on medical education may not be seen for a number of years. However, the impact we are seeing currently, despite the initial increases in innovation, is that students have had significant disruptions to their education, and are lacking confidence in their clinical skills.

As students begin or return to clinical placements this month, AMSA has significant concerns about their ability to continue quality education and exposure in the context of the workforce shortage caused by the Omicron variant.

We want to help the workforce and the community, but for this to happen, it is imperative that we have exposure to clinical environments in order to acquire the skills and competencies required to be a prepared and complete workforce in the coming years.

If you are reading this as a doctor who has any exposure to medical students, we know you are tired, and we know the workforce is struggling right now. All we ask is that medical schools, hospitals and doctors include us where possible, provide us with the personal protective equipment to keep us and our families safe, and see us as a set of hands that can help and learn from you so that we can be prepared for our future work.

If you are a hospital or medical school leader reading this, we hope that you can continue to ensure we have access to clinical placements despite the difficulties you are facing due to the pandemic. Many of us are at a point where we cannot afford to miss any more placements, and the pressure that is being placed on many medical students to make up placements and missed time is contributing to already poor mental health in this group.

Medical students recognise that the pressure on our doctors, nurses and allied health workers during this pandemic has been immense. However, as we reflect on the impact of 2 years of medical education during the pandemic, and look to 2022 as another COVID-19-affected year, we must speak up to ensure our medical education is prioritised. As the future medical workforce of Australia, we need to be prepared for whatever comes next.

Jasmine Davis is the current President of the Australia Medical Students Association. She is an intercalated Doctor of Medicine and Master of Public health student at the University of Melbourne.

If this article has raised issues for you please reach out to any of the following resources:

DRS4DRS: 1300 374 377
NSW and ACT … 02 9437 6552
Victoria … 03 9280 8712
Tasmania … 1800 991 997
Queensland … 07 3833 4352
WA … 08 9321 3098
SA and NT … 08 8366 0250

If you or someone you know is having suicidal thoughts, there are people here to help. Please seek out help from one of the below contacts:

Lifeline| 13 11 14
    24-hour Australian crisis counselling service

Suicide Call Back Service| 1300 659 467
24-hour Australian counselling service

beyondblue| 1300 22 4636
24-hour phone support and online chat service and links to resources and apps

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.