COVID-19: Medical Students Await Emergency Arrangements

Rachel Pugh

March 24, 2020

Final year medical students are waiting to hear what emergency arrangements have been made between the regulatory bodies to allow them to be accelerated onto the NHS front line as hospitals battle to handle the surge of patients as a result of the COVID-19 pandemic.

Talks are going on involving the General Medical Council, the Medical Schools Council (MSC), the individual medical schools, the BMA's UK Medical Student Committee, and the NHS to work out the best way to fast-track the medical students, who would normally be starting work as junior doctors on August 1st. An announcement is expected in the next few days.

The MSC has advised medical schools to adjust their final assessment in response to the pandemic. A spokesperson said: "Legally, it's for the relevant university to decide whether, or not, a student is able to graduate. Throughout this period, we'll continue to work with medical schools to ensure that final year students can graduate and receive provisional registration, in time to start work in August."

Cambridge University students will not sit the two Final MB Part III clinical examinations (SCEE and OSCE) they would have taken in April due to the worsening Covid-19 situation, in consultation with the GMC. A spokesperson said: "The exams would have involved students interacting with large numbers of NHS patients and they require over 200 examiners, all hospital doctors or GPs, over a 2 week period. The students have already completed their final written examinations and been assessed on clinical competence in previous examinations and on placements in a range of clinical environments."

Sheffield sent out a note last week to all its final year students announcing the cancellation of all its placements, and indicating that most final year students will be considered to have fulfilled the requirements to have graduated. Students will be required to return to university to be offered positions working in the NHS in May.

Bristol announced that in the 'unprecedented situation' it was preparing plans to bring forward the date of qualification from the MBChB programme for most students. A statement to students said: "This means that you will be available for work as doctors as and when the NHS needs you after April 1st 2020."

Criteria

Legally it is up to the relevant university to decide whether individual students have satisfied the GMC requirements and to graduate them.

Professor Malcolm Reed, co-chair of the Medical Schools Council, pointed out that many medical students are continually assessed and a single 'finals exam' is not the sole predictor of readiness to practise. Some medical schools have waived certain elements of their final assessments in order to avoid risk to students and staff or to avoid diverting essential NHS resources at this time of crisis.

He said: "The Medical Schools Council wishes to make clear that where this has happened schools have sufficient pre-existing and alternative sources of information to be certain that graduating students are safe and competent to join the NHS workforce and to help deal with the current crisis. No medical student will be permitted to graduate until the university has evidence to confirm that the person has met the GMC's required standards and outcomes."

The crux of high-level discussions is to establish the status of the final year students when they take up emergency positions in hospitals straining to cope with the pandemic.

Working Pre-Qualification

A document sent out to medical students by the BMA Medical Students Committee stressed to individuals that the decision to work pre-qualification should be voluntary. It also emphasised the need for students to be given work within their competencies and to receive proper support in doing so.

The BMA Medical Students Committee will be releasing a list of appropriate duties for students to undertake and said any necessary arrangements for these will need to be agreed in advance of them taking up the role.

The BMA's document expressed concerns that some medical schools and trusts have asked their final year students to 'step up' and work in the local hospitals in a currently non-existent role (nicknamed 'Foundation Year Zero' or 'FY0') to bridge the gap between graduation and the Foundation Year (FY1). The BMA does not support this being locally negotiated.

A spokesperson said: "We have significant concerns that these contracts are inappropriate and offer little clarity on the competency expected of medical students and the remuneration offered. This may have the inadvertent consequence of students working unsafely or not taking on these roles with adequate information being provided."

However, some medical students have expressed enthusiasm at the prospect of working in some kind of junior doctor role in the emergency, rather than as a healthcare assistant as the GMC had suggested might be appropriate.

A final year student at Manchester Medical School (where finals took place in January) said the school had emailed students to ask them for their views about working in some kind of FY0 role. Normally her cohort would have been undertaking assistantships between now and the start of their FY1 on August 1st.

 "A lot of us are quite happy about volunteering." she said. "We are going to be paid. It's an opportunity to start in a real position and we are glad to give it a go in an area we know and with the support of doctors we already know. We've seen the impact of the pandemic on the hospitals where we've been training. We are doctors and we can be helpful."

Similar moves are being worked on in nursing. Student nurses will be able to choose to carry out the final 6 months of their course as a paid clinical placement to help fight COVID-19.

Case Study

So what was it like sitting finals in unusual circumstances?

Deputy Chair & Welfare Lead, BMA Medical Student Committee, Stephen Naulls, told us: "My finals were originally meant to be held in an exam hall at my main campus in South Kensington [London] as a closed-book assessment. Instead, my written papers were delivered as online remote assessments and became open-book. We had access to any resource we needed during the course of the exam. However, our questions were completely randomised in order to prevent students being able to sit the exam together.

"In total we had 300 questions spread across two 3-hour exams, giving us an average of 72 seconds to answer each question. I would say the standard of the examination still felt very high: despite it being open-book, I felt like I sat a difficult exam on the level of medical school finals.

"This is because the questions themselves were often multi-step and required application of knowledge, not just factual recall. There were the odd questions here and there where you could quickly google the answer, but mostly the questions required clinical reasoning which meant applying facts to a vignette and using your judgement to determine the correct diagnosis and/or management. It represented the accumulation of knowledge and judgement over a 6-year degree, rather than just regurgitation of facts. To me, it demonstrated that we really have been on a journey throughout medical school worthy of gaining the title of 'Dr'.

"The way that my medical school were able to turn this around so quickly is a real credit to them.

"I’m very grateful to all of the Faculty and administrative staff for the hard work they put into this."

Has he been told he's graduated? "I have not. I have to wait for my results in early April to know."

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