Qualified medical students should graduate quickly “as a matter of urgency”, the Medical Schools Council advised British universities.
The soon-to-be graduates were invited to complete their provisional registration as doctors and apply for an interim Foundation Year 1 post (Fi1). This new role will enable graduates to work in hospitals from 3 April 2020, according UK Foundation Programme documents seen by the New Statesman.
Ordinarily, final year medics would apply for a two-year foundation programme in April with a view to beginning in August, but due to the proliferation of Covid-19 nationwide, sources say that the NHS cannot wait four months to grow its workforce.
At present, roughly one in four doctors in the health service are self-isolating because they, or a family member, have contracted the virus, confirmed the Royal College of Physicians.
And in light of these staff shortages, the General Medical Council, which maintains an official register of UK medical practitioners, says:
“It will be essential to maximise the service contribution which can be made by final-year medical students [within the NHS].”
The new policy follows on the coattails of a pledge from Health Secretary Matt Hancock, who last week stated 5,500 final-year medical students would “move to the frontline” of the NHS within a matter of days.
The UK typically graduates up to 8,500 students in any given year. But what does this mean in practice?
“When the government made that announcement, I had not been given any news about when we would be starting,” says Caolán Duffy, a final year medical student at Newcastle University. He was aware that his peer group would be graduating early, but no firm plans had been put in place to provisionally register students by the end of the week.
In fact, Duffy credits his medical school for delivering “clear and concise updates” in relation to unfolding public health crises, especially since the cabinet’s timetable for fast-tracking graduations “wasn’t realistic”.
While there has been a lot of Churchillian language around how the NHS and its associate institutions have positioned themselves on a wartime footing with Covid-19, “whatever it takes” is not a licence to run roughshod over safety protocols.
Political will lags action, as medical institutions face a complex choreography: balancing the need for increased staffing capacity with the health and safety of doctors and patients.
“[We] will continue to ensure that medical students are offered contractual provisions to build in protections for their health and prevent burnout, as well as to ensuring they are acting within their competence,” say the Medical Students Committee co-chairs at the British Medical Association (BMA). “Medical students deserve the same rights as any other worker, and we will not accept the rolling back of these expectations.”
The UK Foundation Council advises that FiY1s are best deployed in supporting areas unrelated to Covid-19 activity, although these terms will be agreed on a local level with employers.
Generally speaking, however, the role of Fi1 doctors will mainly involve supporting senior healthcare professionals.
Graduates will be expected to perform a range of supervised tasks as part of a clinical team, including note-taking (for example, clerking patient histories), ordering investigations, carrying out blood work procedures, supervised prescribing, and filling out discharge documentation.
“We’ve been doing venepuncture and cannulation since our second day of clinical school,” explains Christian Holland, a student from Oxford University who will also graduate this week.
“We started off by learning and practising with each other, but graduated to real patients within a few days. Most students will have been doing these procedures for years by now.”
The idea here is that reassigning these tasks away from senior doctors will free up more of their time to treat severe cases of Covid-19, and other diseases.
At John Radcliffe Hospital in Oxford, final year medical students have also had the opportunity – while working in the emergency department – to stream patients into respiratory and non-respiratory treatments as they arrive, conduct receptionist work, and act as a healthcare assistant in performing electrocardiograms.
Under the General Medical Council proposals, there remains scope for final year students to make their own decisions about their readiness to take up an Fi1 post, which is “opt-in”.
Graduates can also reconsider their role at any time during the process.
“In cases where students are uncomfortable or struggling in their interim F1 posts, they can leave with no notice, as the arrangements will be voluntary, and the wellbeing of the students must remain a clear priority,” says the UK Foundation Programme.
At Oxford University, the approach to adapting to the Covid-19 outbreak has been agile but not rushed, says Holland.
For example, the university will graduate its final year students in two cohorts, several weeks apart, because half of the year group has yet to complete its three-week student assistantship. This is a requirement under the standards set by General Medical Council. During this module, students are supervised by a qualified junior doctor on a ward, and rehearse their practical and clinical skills, as well as their other eventual responsibilities as an F1 doctor.
Technology has proven useful, too. “We are communicating with our final year students by email, Zoom and by a dedicated app,” says Professor Ashley Blom, head of Bristol Medical School. “Even clinical courses such as medicine… can partially be taught using innovative online resources.”
At Newcastle University, clinical teaching fellows have helped prepare students for life as an Fi1 doctor through online teaching, where they set a task, students review it among their peer group, and then answer a virtual Q&A on Zoom.
Some wider concerns remain in relation to the availability of personal protective equipment (PPE), with organisations like the Doctors Association UK, which comprises over 6,000 frontline doctors, lambasting “unacceptable shortages”.
While Duffy harbours some anxiety over seeing images of nurses wearing surgical masks instead of the recommended FFP3 respiratory mask, he says that final year medics are eager to “prove themselves, and show that they deserve to have ‘doctor’ in front of their name”.
It has also been uplifting to see other medical students, many of whom are among the only remaining students on campus, deliver food to final year medics and even babysit for clinicians, says Holland.
He adds: “The other day the paediatrics team sent out an email asking for final-year medics to volunteer in the department and within 30 minutes it was oversubscribed… This isn’t how any of us imagined graduating and starting work, but having finished our training, we’re ready to go.”
Patrick Mulholland is a reporter for the Financial Times MandateWire