COMMENTARY

COVID-19: What's the Impact on Junior Doctors?

Prof Mamas Mamas

Disclosures

April 11, 2020

This transcript has been edited for clarity.

Hi. Welcome to Medscape UK. My name is Mamas Mamas. I am professor of cardiology based at Keele University. Today's programme is going to focus on the impact of the COVID-19 pandemic on our junior doctors. Junior doctors represent the largest proportion of clinical doctors within the NHS, and therefore, the current pandemic will impact on their training greatest.

Traditionally, training to junior doctors has been delivered through outpatients clinics, through elective admissions for investigations, for procedures. However, by necessity, we have had to restructure how we deliver care within the NHS. Much of our elective activity has ceased, therefore removing opportunities for training for fellows and cardiology SpRs and so forth.

By necessity, we have had to restructure our services to allow us to gain capacity and to be able to deal with the pandemic of COVID-19, but second of all to protect our patients.

Many of the patients using elective services are the highest risk elderly comorbid patients that are at greatest risk from COVID.

Our trainees have moved from being trained to delivering services.

Many of the trainees have been redeployed in areas that they may be unfamiliar with, or even in areas that are not their main specialities. Therefore, placing these trainees at increased risk.

Over the next couple of minutes we will study how COVID has impacted on our medical training workforce.

And my first guest is Dr Sarah Hudson. Dr Hudson is a cardiology SpR based in Bristol, and is one of the country's first NHS Topol Fellows. Dr Hudson will discuss the impact of the COVID pandemic on cardiology training.

Dr Sarah Hudson

As hospitals restructure in response to COVID-19, cardiology trainees have temporarily suspended their speciality training to help.

Usually trainees spend around 40% of their time doing general internal medicine as part of the acute medical take, and in many trusts all their cardiology commitments are currently being removed to allow them to do general medicine 100% of the time.

In tertiary centres, where trainees often don't have any general internal medicine commitments, some have been redeployed to help, whilst others have stayed in cardiology to maintain core cardiac services and backfill roles left by more junior doctors being redeployed.

Even trainees who are currently out of programme doing research have generally returned to 100% clinical work to help their colleagues.

Overall, it is clear that cardiology training experience is not going to progress at the expected rate.

Cardiology training programme directors have been very supportive and explain that no one should be disadvantaged by what is occurring, and that progression is competency rather than time based.

However, many trainees feel that they won't get the required number of procedures to become competent, and anticipate their training time being extended.

Overall, this is a minor inconvenience compared to what some other people are going through at the moment. And although we may not be increasing our cardiology training, we are privileged to have other skills that allow us to help at this time.

Managing Risk

One of the major issues faced by our trainees in this COVID-19 pandemic is one of risk.

Only yesterday it was announced that over 100 doctors have died during the COVID pandemic in Italy. And we know from data from Spain that 20% of those infected with COVID are individuals that work in the health services over there.

We also have seen many reports in China, in the United States of America, and within the NHS, of healthcare professionals passing away because of infection with COVID.

The newspapers are full of reports of PPE shortages within the NHS, and certainly this has been mine and many others’ experiences all across the country.

But risk is not just about the risk of infection and shortage of PPE, but also risks that we place our medical trainees under by virtue of the fact that they're being redeployed in areas that they may not be familiar with.

My next guest, Dr Rohin Francis, a cardiology SpR from the Essex Heart [Cardiothoracic] Centre, will discuss this further.

Dr Rohin Francis

Hi, my name is Rohin Francis. I'm a final year interventional trainee working at the Essex Cardiothoracic Centre and I'm going to talk a little bit about the importance of protection for trainees during this unusual time in our careers.

Cardiologists by nature are people that head towards action and are comfortable caring for sick patients. But during the coronavirus pandemic, it's imperative that we do not endanger ourselves unnecessarily. Within our teams, we also have junior trainees, including for the first time brand new graduates who find themselves new doctors at a time of crisis, all of whom require adequate protection, and specialist trainees should aim to be role models for our junior colleagues.

It's about more than just PPE. We might have to undertake roles we're not familiar with, and now more than ever speaking up when you're in need of help and supporting each other is vital.

While you might feel less experienced within cardiology than your consultants, we are all learning about this disease and the implications for us as we go along. So don't be afraid to voice your concerns.

While we cannot eliminate risk entirely we can minimise it.

Attempt to rationalise staffing and tasks within your team, such that exposure is minimised. This might mean only one person seeing a patient on a ward round, avoiding unnecessary people in the cath lab, only performing echos that are going to alter management. Develop good habits like disinfecting your phone, pen, stethoscope, leaving unnecessary things at home, changing clothes and washing at the end of the day. If you feel unwell, please jettison ideas about inconveniencing your colleagues and stay home.

PPE is of course on everybody's minds these days. I hope you're able to access the requisite protection in your centre.

In the UK minimum guidance - at the time of recording this video - is that unstable admissions, or those direct to the cath lab such as a primary PCI, level 2 PPE should be worn, which is full fluid resistant gowns, a filtering respirator mask, and eye and face protection. Level 1 PPE, which is surgical mask, plastic apron, and gloves, reserved for other settings, although your own departments might have more intense policies.

The equipment that you have is irrelevant if you don't know how to use it properly. So it's imperative you familiarise yourselves with not only donning and doffing procedures, even if you're in a lower risk environment, but practise what you need to do in an emergency. It can feel completely alien to not immediately tend to an unstable patient, especially when in cardiac arrest. But while you might be able to offer help to one patient like that, you can't save any patients if you're sick.

The best way we're going to get through this is to look after each other and share the literal and emotional workload. Good luck.

Unknowns

During this time of uncertainty, there are many unknowns.

We don't know how long this pandemic is going to last for, and how it will penultimately impact on the training of our junior doctors. And furthermore, how it will impact on our future workforce planning.

Our trainees are losing many opportunities, opportunities to travel and do fellowships abroad.

It's only by removing the hierarchies within medicine that have traditionally existed between the consultant and the trainee will we get through this together.

Unfortunately, I don't think this is going to be the only time that this will happen. I think that we're likely to face this situation down the road. And I think we're going to have to rethink about how we can deliver training to our medical workforce, but also how we restructure services.

I think going forwards, telehealth is going to be much more important. And I think we're going to have to think about how to protect patients with the greatest number of comorbidities in delivering our healthcare, perhaps through using digital solutions.

That's it for today. I'd like to thank both Dr Sarah Hudson and Dr Rohin Francis for joining me. And I'd like to hear what you think. Thank you for joining me and stay safe.

Dr Hudson and Dr Francis have no relevant disclosures.

You can follow Mamas Mamas on  Twitter

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