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The email came through whilst I was in my pyjamas at the kitchen table, teaching my 7-year-old brother about apostrophes. Six years of blood, sweat, and tears, for… an email? It was the most anti-climactic graduation one could imagine.
Like thousands of other final year student doctors across the country, I was propelled to the medical school finish line thanks to our invisible yet terribly disruptive enemy, COVID-19. Our hurried graduation was the first step in enabling us to join the medical workforce and help combat the virus. Thankfully I had sat my medical school finals in January, so I knew I had passed. Those who had not sat exams by the late-March lockdown faced uncertainty about how their finals would be carried out. Many had their exams postponed, or even cancelled, resulting in their grades being determined from previous academic and clinical performance. Others had their exams online. For example, Imperial College London assessed their 280 sixth-year medical students remotely via two open-book, online exams. Furthermore, medical students who have resits have been hit hard. Not only do they have to concentrate and revise amid a pandemic, but they have also been battling feelings of anxiety due to many unknowns including how exactly resits will take place, disappointment in not being able to graduate early alongside their friends, and frustration at ‘falling at the last hurdle’.
Not only were exams disrupted, electives were too. An elective is a four- to eight-week self-funded placement, often abroad in low resource settings, completed as part of a medical degree. Individuals can tailor electives to their preferences, to be able to experience first-hand healthcare in different settings. Whilst other students choose to remain in the UK. We looked forward to this part of our degree for a long time, some since before gaining admission to medical school. For many it was to be an opportunity to travel the world, a welcome break from 5-plus years of toil, whereas others earnestly wanted to experience medicine in a foreign land. For the majority, it provided a combination for both. Unfortunately the current situation thwarted these plans, with some students having to cut short their elective and return urgently to the UK, whilst others were unable to travel at all. When those in non-medical fields hear of the disrupted plans, their first reaction generally is to suggest “you can go again another time”, however, the reality is quite different. By the time Foundation Year 1 starts in August, it is unlikely international borders will be completely open for commercial use, with the FCO advising “British people against all non-essential travel worldwide” for an “indefinite” period. The countries we would want to go to will likely still be recovering or bracing themselves for their peak. Current data shows the UK is one of the worst affected countries in Europe – at the time of writing, the UK had the third-worst global fatality rate. Other countries will understandably and rightfully be apprehensive about allowing us to enter. We could be viral vectors, infecting their citizens thereby leading to overburdened healthcare systems – some of which are currently functioning precariously. Even so, in the unlikely event that ‘normality’ is restored in the coming months, finding time off to travel for extended periods as a doctor is tough. You do not have to search very far to find countless stories of doctors declined annual leave for important life events. There are other issues at hand too, such as anticipated difficulty in coordinating electives as we are no longer medical students, but now doctors.
Six years of blood, sweat, and tears, for… an email? It was the most anti-climactic graduation one could imagine.
My hunch is that the nationwide disruption will lead to a high proportion of ‘Class of Covid-19’ taking F3 years; F3 being an informal descriptor of a junior doctor who decides against entering into a formal training programme immediately after the two-year foundation programme. It would be an opportunity to take some time out before starting specialty training or be an exit route out of a medical career. The percentage of clinicians who go directly from foundation training to specialty training has declined in recent years. In 2010, 83.1% of doctors went straight into specialty training in the UK after finishing their foundation years. By 2018, this had dropped to 37.7%. Of those that do not enter specialty training immediately, the proportion of those leaving medicine completely has been slowly but notably increasing.
It should be noted that some final year medical students have been actively volunteering in paid roles with varying titles such as ‘senior medical student’, ‘doctor’s assistant’ or ‘clinical assistant’, to support the NHS during these unprecedented times before the foundation programme starts officially in August. Dr. Stephen Osei-Osafo has written about these experiences here. Others have taken up Interim Foundation Year 1 jobs (FiY1), which enables them to work as a doctor in the hospital trust they are starting in August, or in a trust near their medical school. In recent days it has been seen that some have been unable to start these positions due to – thankfully – no longer being needed, or they have been offered roles in other parts of the country for which there has been reduced uptake of the interim posts.
Despite being in the midst of difficult times, with lots of uncertainly, sadness and bad news, there is some good news.
Final year student doctors have been balancing these uncertainties with the pushes and pull of life, quarantining at home with family, in shared accommodation with friends or alone. Like everyone else, we too have been concerned for sick loved ones. We have been involved in homeschooling. We too are worried about the lack of PPE, the horrifying statistics around black, Asian, and other ethnic minorities dying at double the rate of our white counterparts.
Despite being in the midst of difficult times, with lots of uncertainly, sadness and bad news, there is some good news. We, the newly qualified doctors, have completed our medical training after numerous difficult years, and are deemed fit to be doctors. We have been preparing to help people and care for the sick – now, more than ever, is the time to put our training to good use.
Written by Dr Toluwani Majekodunmi, junior doctor in London