New Delhi: The pause in education of medical students, especially hands-on learning, due to Covid-19 may result in long-term “negative” consequences for society as a whole, according to a handbook released by the country’s largest doctor’s lobby, the Indian Medical Association (IMA).

Titled Surviving Covid-19 as a medical student, the handbook was launched Sunday by the IMA for medical students, under its initiative Doctors 4 Doctors (D4D).

The aim of the D4D initiative is to tackle the burnout and ease the mental health challenges medical students, residents and clinicians were likely facing during the pandemic.

“A medical student may miss out on the opportunity to deliver a newborn on their obstetrics rotation or to participate in a code called in the emergency department,” the book said as it highlighted the ramifications of the Covid-19 pandemic on the medical profession, apart from listing several suggestions.

“COVID-19 has had an unprecedented impact on medical education worldwide, leading to the cancellation of lectures, exams, clinical rotations, and ultimately the temporary closure of medical schools,” said the 103-page handbook which is divided into several chapters, written by 22 doctors across India.

While, currently, the definition of essential workers during the Covid-19 crisis has excluded medical students, it said “the profound consequences of this crisis on medical education and its future repercussions in the training of physicians must be acknowledged”.

It further added that “this break in education or at least the limitations to hands-on learning, might result in negative long-term consequences for our students and our society as a whole”.

The handbook further shared the instances and importance of real learning against reel learning.

“Learning anatomy dissection virtually is unrealistic as the tactile element and real-world complexities of the body cannot yet be simulated satisfactorily. Medical education and indeed medicine as a profession was never designed to be fully online. We do not know the impact of large gaps away from direct, in-person clinical rotations.”

The editors of the book are Dr Suhas Chandran, assistant professor and psychiatrist at St. John’s National Academy of Health Sciences, Bengaluru, and Dr Sandip Deshpande, consultant psychiatrist, Bengaluru.

Early graduation of medical trainees

In the later sections, the book mentioned the consideration of “early graduation” to help the frontline workers.

“The issue of whether to graduate medical trainees early is controversial,” it stated, adding that “such action, however, has historical precedent such as during the Spanish flu in 1918. In the ongoing pandemic, several medical schools in some of the hardest-hit nations such as Italy and the US have been graduating the trainees early on the pre-condition that they agree to serve as frontline health care workers.”

Student volunteers can also be recruited to assist with telemedicine consultations and remote care of patients diagnosed with Covid-19, it suggested.

“Such opportunities to help will reinfuse a sense of purpose and altruism among doctors in training,” it said, adding, “this type of positivity will be necessary to balance against possible disillusionment and hopelessness that could arise in the wake of large numbers of deaths and perceived inability of science to find a cure for Covid-19”.

Keep up to date by studying on Zoom, Skype, Google meets

Until the risk of infection ceases and medical colleges reopen, e-learning is likely to continue, the handbook suggested.

“Overall, strategic planning during this COVID-19 pandemic, that includes triaging of critical activities is a must. There needs to be a priority-driven decision on what actions should be continued, which should be postponed, adapted, as well as dropped, or added in academics,” it said.

“Students who are taught respiratory diseases only theoretically cannot be assessed for their skills in clinically examining such a case.”

Now, didactic lecture-based teaching has been transitioned to online platforms such as Google Meets, Zoom, Skype, Microsoft Teams, MedWhiz and Cisco WebEx.

The book advises students to update themselves on the system requirements for online learning.

“An online repository of live/pre-recorded patient-interview sessions can be requested, if not already available. Use this content to develop interview skills, observe and learn to identify non-verbal cues of the patient as well as of the interviewer. These are better possible in online platforms rather than real-life scenarios, as you could be an unobtrusive observer,” it suggested.

Pandemic could give rise to crop of doctors high on empathy

According to the handbook, due to the lack of definitive treatments for Covid-19, doctors are re-discovering their co-scholastic skills of empathy and compassion, both of which are neither formally taught nor assessed at medical schools.

“Perhaps, the pandemic will also bring in a positive change in the medical curriculum by giving these issues their deserving place. This crisis could help in creating a new generation of doctors who not only treat but also soothe and reassure their patients.”

Moreover, it suggested a possible creation of new specialities post Covid.

“Such events (such as pandemics and disasters) may legitimise and pave the way for the genesis of new specialities such as post-doctoral fellowships (PDF) in telemedicine, Doctor of Medicine (M.D.) or courses in disaster management or pandemic diseases.”

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