We have to get the Covid response right for medical students

The management of flows of thousands of young people to university as we have seen has been, at best, shambolic and, at worst, dangerous.

Placing students, particularly first year undergraduates who have left home for the first time, in isolated cramped halls in a new city is not good for their mental health.

We already knew that British universities were experiencing a surge in student anxiety, poor wellbeing and depression – articulated, most vehemently, by the students themselves. Covid-19 exacerbates it. And students around the country feel their universities are failing them.

What we have now is a major student mental health crisis fuelled by a toxic combination of academic pressures, economic recession and the pandemic. Included in this are the thousands of students at medical schools, particularly final year medical students who have been uniquely affected by the changes imposed by the pandemic.

Safe practise

UK medical schools are responsible for ensuring that their graduates meet GMC outcomes to practise safely as a doctor. This means that they must pass their end of year exams, complete a student assistantship and often undertake a medical elective.

Student parents, those who live in multi-generational households while on placement, and those who were otherwise vulnerable need to be accounted for when creating policies that impact on their attendance and clinic exposure.

These are the very people on whom we will depend for healthcare in the future, yet the pressure of doing this during the pandemic is immense on both physical and mental health.

Advice and rules from government have been confused and chaotic. We cannot continue to have a government response that fails on the basics of transparency and communication – basics that we are taught in our public health lectures. The lack of clear and cogent planning has created panic at a time when brightest and best of a new generation should be embarking on a stage in their studies – albeit with restrictions – but confident that their physical and mental well-being are being looked after.

The front line of the front line

Medical students, many inspired by older medics who have been at the front line in the fight against Covid-19, are desperate to get back to their education. We saw the professionalism of final year medical students in the first waves of the pandemic stepped up early into medical posts, putting their shoulders to the wheel alongside countless other health care workers.

Students can see their own educators whose own psyche has been sapped by their first wave – and desire a public health response which builds solidarity, not finds scapegoats. These young trainee doctors must have guarantees that their medical schools are safe, not only physically but mentally and that their emotional needs, as much as their clinical placements, are properly risk assessed.

Students who are at great risk find themselves in a difficult position. Government has failed to provide concrete policy responses to BAME people’s increased risk of poor outcomes of Covid-19 – unconscionable in a sector in which just over 44 per cent of doctors are from BAME backgrounds.

For medical students and applicants with disabilities, there is concern about adequate protections and support for those who may interrupt their studies. Risk assessments and reasonable accommodations and mitigations must happen. This is a time for creativity in response to crisis – equality considerations shouldn’t be a second priority in a pandemic but are the real concerns of worried people.

Opportunities for change

The pandemic provides a key opportunity for medical schools to introduce alternative modes of medical education and assessment, allied with innovative support for medical students’ mental and spiritual well-being. Ironically, a field that advocates the promotion of health and wellness in patients, often falls behind in supporting the needs of its own.

Burnout and psychological distress are common amongst medical students and doctors and this has to be addressed. Many lessons have been, and will continue to be learnt, throughout the months of this pandemic but we need to be better placed to act promptly in future health crises or disruptions to medical education.

The welfare of student doctors is a priority for the BMA, and one that we will continue to highlight at this uncertain time. The mental health impacts of unprecedented workloads, exposure to pandemic death rates alongside increased isolation from friends and family is a potentially toxic combination.

While all university students are facing difficulties, medical students’ very individual circumstances need particular attention. We started lockdown talking about the mental health impacts of Covid-19 – as cases rise and regional lockdowns and circuit breakers are introduced, we now need to act on the mental health impacts of the virus.

Medical schools and health employers have to get this right, not just for this year’s cohort of students themselves, but because investing in them now secures the future health of the nation.

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