Impacts of the COVID‐19 pandemic on medical students in Australia

COVID‐19 has been formally declared a pandemic by World Health Organization on the 11th of March 2020. ¹ The effects of this on the health systems cannot be under‐rated. In this unprecedented situation, perhaps one of the more under‐estimated repercussions will be on medical students. There are several challenges common to all medical students such as the uncertainty in course requirements, the fear of exposure to COVID‐19, the lack of guidance and the loss of learning opportunities. Nonetheless, it has also affected medical students of different levels indistinctly.

Pre‐clinical medical students are accessing e‐learning solely while socially isolating themselves. E‐Learning certainly has its merits but lacks the engaging qualities of in‐person learning. The study of medicine is complex, requiring a multimodal approach with specialists providing clinical experience and guiding students out of the maze of endless archaic textbooks. Adjuncts to classroom teaching such as anatomy dissections, microbiology and histopathology labarotory work as well as the development of interpersonal skills in clinical interactions are paramount to these years. Furthermore, e‐learning may present new challenges including technical issues, adaptability‐struggle and computer literacy. It may be unaccessible by some, without access to on‐campus wifi. To overcome this, certain universities have provided USB modems to students to increase accessibility to internet facilities. ² Other universities have altered term outlines and exam dates. ³ These amendments in addition to technical issues that arise during exams may cause unneccesary added stress. There have also been concerns that students may be disadvantaged when exams are un‐invigilated, with co‐students cheating. During such times, we have little choice but to trust that students will maintain the highest standards of academic integrity.

Students in clinical years are experiencing different challenges. Disruption to normal teaching and examination has left many students feeling uncertain and disoriented. The structure and length of clinical placement blocks are modified, along with semester breaks. Traditional examinations en masse are not possible. Practical assessments such as Objective Structured Clinical Examinations require alteration given the transmission risk associated with close contact of simulated patients and examiners. Most students in this group have been removed from clinical placement, leaving them without any practical teaching to rely upon.

Final‐year medical students face a more diverse spectrum of outcomes, albeit from a much stronger vantage point to both comprehend pandemic management and contribute to it directly. Their core study comprises almost exclusively of clinical placement with practical teaching in preparation for internship. For these students, changes to staffing and services are challenging. In Victoria, where a merit‐based system is normally used for internship positions, the Postgraduate Medical Council of Victoria has now announced that references will no longer be considered due to the already significant workload on consultants. ⁴ Some final year students have been allowed to continue clinical placement but are left to determine what risk they are willing to accept in order to graduate. Most clinical specialties have reduced clinic attendance in favour of telehealth, resulting in less face‐to‐face time with patients. Attendence of students are often discouraged or limited, for example during ward rounds. The reduction in elective surgery has also affected learning opportunities. With the presence of students in hospital, consideration must be given to the increased risk of cross‐contamination among medical teams. Education on the correct use of personal protective equipement is also vital.

Several countries have accelerated final year medical students to the level of intern during the pandemic. ⁵ , ⁶ Whether this occurs in Australia remains to be seen. They may have the option to work in COVID‐19 or non‐COVID‐19 facing roles, be it voluntary or via formal employment. This needs to be very carefully assessed at all levels by the state government in consultation with medical schools, taking into account the students' competency and scope of practice, before being executed. There has been the suggestion that students can volunteer as clinical assistants, receiving telehealth calls, performing sample collection and packing test kits in fever clinics. ⁷ While this relieves workforce strain, it also places students in higher risk situations without compensation. Students are in general younger, have less comorbidities and at a lower risk of becoming critically ill than the senior clinicians. It may therefore be logical to place them on the frontlines. Whether students feel compelled to act in such a selfless manner for the public good is a personal decision that should be made voluntarily, with the provision of avenues for open disclosure of any safety concerns.

At a global perspective, there were 2870 international students enrolled in Australian medical schools in 2019. ⁸ COVID‐19 has far reaching effects on this cohort, who have invested significant financial and personal sacrifice to undertake their degree. Several are met with disappointment at the abridged version of schooling provided, despite ongoing full fee payment requirements. ⁹ Some rely on part‐time employment to fund their international living, which may also be affected with social distancing measures in place. ¹⁰ Some have their education interrupted by international travel restrictions. ⁹ Compounding these changes is the fear that if less students graduate in 2020, future years may enrol a larger cohort and as such, increase competition for desired internship positions, for which they are already ranked inferior to their domestic colleagues.

The COVID‐19 pandemic presents a dynamic situation, making it difficult for faculty, health services and the government to plan and deliver new strategies for education and support of medical students. Communication with students is now more vital than ever for well‐being and continuing learning. Additionally, the consideration and recognition that students often contribute to the health system without any direct compensation is important during these times of increased risk. Undoubtedly, there are more important issues for the public good than medical students in this time of crisis. However, medical students are also being significantly affected and many are willing to contribute to the effort against COVID‐19. Overall, the widespread ramifications of COVID‐19 are becoming more evident over time. The authors hope to highlight the effect on and potential contribution that the medical student cohort can offer in these unprecedented times.