COVID-19 pandemic and implications for graduate medical training.

Abstract

Sir, The COVID-19 pandemic has forced sweeping, and probably durable, changes in personal habits, lifestyles, and patterns of social interaction. The education system, too, has seen many changes with the need for social distancing forcing the suspension of traditional classroom teaching and a rise in adoption of remote learning approaches such as virtual classrooms, e-learning, and m-learning. The current times, though indeed distressing, also offer a unique opportunity to revamp medical education so as to equip budding doctors with the necessary skills to respond to changing demands of the society with confidence and enthusiasm. Below, we outline a few key areas in medical training that need to be revisited: Bedside clinics in medicine, an integral part of medical training, may need to be modified so as to ensure social distancing and minimize face to face contact. In a recent guideline statement,[1] the Association of American Medical Colleges, suggested that medical schools temporarily suspend clinical rotations for trainees. This will free up some additional time which may be utilized to finish the didactic components of training till the situation normalizes. To implement this, administrators will have to consolidate and restructure the academic calendar appropriately. A less disruptive strategy would be to have virtual clinics with real or simulated patients which can even be recorded to facilitate asynchronous “anytime-anywhere” learning. Clearly, the challenge for medical educators is to design clinical immersion experiences while adhering to the requirements of the “new normal” environment, where quarantines and social distancing will be needed. There is virtually no focus on organized epidemic or disaster training and public health preparedness in the ongoing medical curriculum. This may make many doctors feel inadequate about responding to the care needs of disaster victims. An Indian study of undergraduate medical trainees[2] showed that 95% of respondents never got any training or demonstration in disaster medicine and only 16% felt confident of tackling public health emergencies. There is wide variability in disaster training methods adopted by different medical schools. One medical school described a comprehensive 8-h course comprising lectures, simulation exercises, and full-scale hospital disaster drills in which the students participate as the victims.[3] Introducing disaster medicine training early in the curriculum, having brief but mandatory rotations with the National Disaster Management Authority, and exposure to hospital administration and management to inculcate planning and leadership skills have also been mooted.[2] Inter-professional training of health-care workers and collaboration, essential for high-quality patient care, is not emphasized enough in the current medical curriculum. The current pandemic has brought this lacuna to the fore, and this has contributed to the lack of organized response to the COVID-19 pandemic. Pilot studies involving medical and nursing students have described the use of experiential learning techniques to teach necessary inter-professional skills in areas such as shared decision making and problem-solving, inter-disciplinary communication skills, conflict resolution, identification, and development of individual learning needs and professional roles.[4] Administrators must value and encourage the implementation of inter-disciplinary education and practice. Since the turn of the century, this is the third pandemic that the world has seen. History will judge us by the way we utilized this opportunity to reflect, learn, and make changes to be better prepared for future. These recommendations will assist doctors in adjusting their workplaces to meet the changing demands of the society while simultaneously maintaining the quality of medical training and patient care. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.