The class of COVID-19: a reflection on working as a new doctor in the midst of a global pandemic

Abstract

On January 30th, 2020, the day that COVID-19 was highlighted as a Public Health Emergency of International Concern, the majority of present day Foundation Year 1 (FY1) doctors in the United Kingdom were in the process of sitting their final medical school examinations1. Watching as the largest global pandemic in a century unfurled, it became increasingly apparent that COVID-19 would dominate our early medical careers. What followed was a whirlwind of early graduations and deployment into hospitals, mass public hysteria and clinical environments where our experience in managing this disease would be uniquely equivalent to our seniors. One year and 2 waves later, we share our reflection on our experiences. The most striking departure from the traditional introduction to hospital wards was the stark rise in acutely unwell patients and hospital deaths. With in-hospital mortality rates for COVID patients ranging between 11% and 12%, the cumulative psychological burden of such high exposure to death and its subsequent normalization cannot be understated2. Shifts would be met with seas of patients starving for oxygen—management plans consisting of turning dials on walls. Treatment escalation plans were signed on the doorstep of the hospital, and death certification a certainty during every on-call. Medical Emergency Calls became regularities while intensive care beds were gold dust. At the lowest rung of medical training, we regularly managed patients requiring noninvasive ventilation on general medical wards—previously only used in dire intensive care settings. The impact on our perception of “normal” practice in the apprenticeship model of medical training has been severely skewed. The implementation of redeployment was another novel experience. Many junior doctors were redeployed from respective surgical and community specialties to “COVID wards.” This vital step allowed the National Health Service to cope with the rapid influx of acutely unwell patients, however, also presented its own challenges. With many colleagues contracting COVID-19, the level of responsibility we held as FY1’s was amplified. We became more comfortable managing acutely unwell patients when asked to “step-up,” under the guidance of our seniors. Despite the disappointment of missed experiences in specialties, theaters, and clinics; we find ourselves more confident and resilient medical professionals as a result. While the pandemic was a learning experience in itself, the diversion of focus to service provision has had a profound impact on postgraduate medical education. With the sheer prevalence of COVID-19 on the wards and the necessitated redeployment, the reduced exposure to different specialties not only affects future career choice but also limits our understanding of the greater framework of the NHS. Furthermore, the increased burden of work has, on occasion, made it exceptionally difficult to find time for training, such as supervised learning experiences, case discussions and even protected mandatory teaching. Understandably, due to COVID-19 risk, several courses and conferences have been cancelled. While the response and innovation in online delivery of such training is commendable, these approaches are still no true substitute for the classical teaching formats that have bred generations of doctors. Before starting medical school, the mere idea of a global pandemic of this scale was unfathomable. Now, having been placed on the frontlines in the infancy of our medical careers—the experience is one that will remain for life. The first and second waves of COVID-19 were bleak, with heart wrenching patients and devastating mortality rates. However, it has truly been our privilege to provide care for patients in these circumstances—and a reminder of why we wanted to become doctors. It has been an arduous beginning to our careers but one that has equipped us with experiences that will stand us in good stead for the future. Ethical approval None. Sources of funding None. Authors contribution Z.A., K.S., H.R. all contributed equally to the conception, planning, writing and revision of this article. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Zaid Alsafi.