Necessity is the mother of invention: how the COVID-19 pandemic could change medical student placements for the better

Abstract

COVID-19 led to the widespread withdrawal of face-to-face hospital-based clinical placements, with many medical schools switching to online learning. This precipitated concern about potential negative impact on clinical and interprofessional skill acquisition. To overcome this problem, we piloted a 12-week COVID-19 safe face-to-face clinical placement for 16 medical students at the Hospital for Tropical Diseases, London, during the first wave of the COVID-19 pandemic. COVID-19 infection control measures necessitated that students remained in ‘social bubbles’ for placement duration. This facilitated an apprenticeship-style teaching approach, integrating students into the clinical team for placement duration. Team-based learning was adopted to develop and deliver content. Teaching comprised weekly seminars, experiential ward-based attachments and participation in quality improvement and research projects. The taught content was evaluated through qualitative feedback, reflective practice, and pre-apprenticeship and post-apprenticeship confidence questionnaires across 17 domains. Students’ confidence improved in 14 of 17 domains (p<0.05). Reflective practice indicated that students valued the apprenticeship model, preferring the longer clinical attachment to existent shorter, fragmented clinical placements. Students described improved critical thinking, group cohesion, teamwork, self-confidence, self-worth and communication skills. This article describes a framework for the safe and effective delivery of a longer face-to-face apprenticeship-based clinical placement during an infectious disease pandemic. Longer apprenticeship-style attachments have hidden benefits to general professional training, which should be explored by medical schools both during the COVID-19 pandemic and, possibly, for any future clinical placements.

A scoping review on adaptations of clinical education for medical students during COVID-19

“…Whilst onsite modified clinical clerkships continued in parts of the world [ [57] , [58] , [59] , [60] , [61] ], in others it was combined with online teaching [ 28 , 62 , 63 ]. Thomas von Lengerke et al [ 64 ] described communication skills teaching for preclinical students using simulated patients in a classroom setting under social distancing and infection control guidelines.…”

“…Lee et al [ 60 ] reported a modified paediatric clerkship in response to reduced patient volume and parents' reluctancy to be seen by medical students. The University College London infectious diseases team [ 61 ] trialled an 8-week ‘COVID-19 apprenticeship’ for the graduating students to work as Doctors’ Assistants or Healthcare support worker assistants. The Doctors’ Assistant program was also positively reported by Lavender et al [ 59 ] and Cowley and White [ 57 ] who reported the assistantships to form part of the mandatory medical school as successfully piloted in the UK.…”

“…COVID-19 has been the spark that accelerated the implementation of already existing technology in medicine. Students being excluded from the clinical space led to many novel ideas from clinical teachers who used the available technology to facilitate real patient contact in the ward or outpatient setting [ 29 , 38 , 58 , [60] , [61] , [62] , 65 ]. Even without real patients, the passion of clinical teachers has led them to become simulated patient themselves [ 36 , 37 ] and taught using clinical case scenarios allowing access to real patient imaging and EMR [ 18 , 19 ].…”

Global Health Education during the COVID-19 Pandemic: Challenges, Adaptations, and Lessons Learned

“…As a result, the medical school, like many medical schools around the world, rapidly sought elective virtual curricula. [15][16][17][18][19][20][21][22][23] When the university asked for virtual electives, we as faculty in global medicine rapidly converted our online curriculum designed for continuing medical education to instruct more than 120 medical students on immigrants and refugee health, global health, and tropical medicine. In-person courses could never have been expanded in these ways.…”

Educational opportunities for postgraduate medical trainees during the COVID-19 pandemic: deriving value from old, new and emerging ways of learning

“…Indeed longer clinical placements have also been valued by undergraduate students participating in apprenticeship-based models of learning during the pandemic. 5 Those redeployed outside their usual specialties have been able to re-visit and reinforce skills in general medicine, which will be invaluable in helping them to provide holistic, safe care for future patients, regardless of trainees' long-term specialty aspirations. 6 Redeployment has thus resulted in improved cross-specialty collaboration and a reduction in working in silos.…”