Changing practice COVID-19 Medical Training On the Wards

Covid… What Covid?

Richard Whitaker is a Director of Clinical Training at Cairns Hospital. This article is his opinion and not necessarily that of the Cairns & Hinterland Hospital and Health Service.

A pandemic is an event that can be thought of as a great ‘disruptor’. Over the past few months life as we knew it has changed dramatically, perhaps for ever. Home life has changed, social life has changed, and for health-care workers there have been many significant changes in the way we work.

Junior doctors may be asking why there was so much preparation, so much disruption, so many changes, when the expected tsunami failed to eventuate? We have seen and heard and read stories from overseas, countries that we relate to such as the UK, the USA, the European countries. Yet we have seen little of this terrible illness here in Australia.

For many reasons Australia has been lucky so far, and avoided its hospital system being over-run by patients with Covid-19. Hospitals haven’t really contributed much to this success, so why then have junior doctors suffered so much disruption? Rosters have been changed without consultation, teaching has been sporadic, senior doctors are tense and anxious, AHPRA has made some alarming statements that suggest that junior doctors can be used as covid-fodder, and training pathways have stalled.

Covid-19 has not gone away. It is still active in Australia, and as restrictions are eased it is expected to continue to spread, but in a hopefully controlled way that we can cope with. We will see patients with Covid-19, and some of them will be very unwell and some of them will die. So what have we learned from the past few months? What does this mean to junior doctors?

If Australia had suffered from covid-19 in the worst case scenario we would all be in a different mind-set right now. We would never have had enough PPE, enough hospital beds, enough ICU beds, we would have seen some of our colleagues succumb to the disease, we may have lost family members, we would be tired and exhausted and left wondering what the future held for us.

Instead we have been given time to learn and prepare. For junior medical officers this means:

  1. Senior staff have had time to plan and anticipate. There is more certainty about how we will cope with covid-19 patients.
  2. There has been time to accumulate PPE (although more is still needed).
  3. Some clinical practices have been revised – use of nebulises, NIV, for example.
  4. We have had time to practise some important processes, such as radiology and transport of potentially contagious patients.
  5. Very importantly, we have had opportunity to see the effects of some significant rostering changes. Many of these changes have been made at short notice and have not been popular with junior doctors. As the workplace returns to a ‘new’ normal over the next few weeks, there is opportunity for junior doctors and their supervisors to revisit how rosters may look if a change is ever required again.
  6. Finally, the Prevocational Medical Education Units have had time to absorb the possible permutations of AHPRA’s internship statements, and are now prepared to ensure that junior doctor training will continue as near normal as possible.

So with this reprieve it is a good time for senior and junior doctors to work together to plan for the likely next wave of infection. Hopefully it will be containable and not stretch our health system too far. Whatever unfolds, we have the opportunity now to plan so that we can achieve the best possible patient outcomes and continue to maintain high standards of training and supervision for junior doctors.

Junior doctor responses to this article are encouraged.

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