Medical Education and Covid-19

By Dr Kevin McConville | Academic General Practitioner

As the 2020-21 academic year kicks off with 4th years and transition block the new GP Soc committee kindly asked for some comments on the GP teams’ thoughts about issues that might emerge this year, educationally, especially given COVID.

My immediate thoughts have sprung from the great flexibility that GPs have in approaching problems, especially being able to manage and deal with uncertainty. However, even then, I have to admit COVID is stretching it for us on this occasion. In such times I often fall back on a favored quote, who’s source is attributed to various persons, but I’ll go with Nietzsche,

‘...in order not to have the rug pulled from under you, one must learn to dance on a shifting carpet....’

So what will this actually mean for you in terms of clinical practice / experiences this year? For the early years I’m afraid this will probably mean less time in the community or GP settings due to a combination of social distancing, changes in clinical encounters with patients and overall capacity of GP surgeries during these unusual times. However, your small group and case bases group tutors are in the process of developing novel online teaching sessions aligned with new comm skills opportunities, patient contact online and a whole set of videoed consultations of GPs with patients taken from a national database!

Clinical placements remain a priority for the senior medical students and so normal negotiations with practices taking into account COVID adaptations are being finalised. The medical school staff work very hard on this, the is no downtime for uni staff over the summer. As the Yr 4 students completed their teaching (lockdown resulted in a new online environment being created which will remain available into 2020-21) by 4.7.2020...the next cohort of 4th years started 27.7.2020. So just a few weeks to regroup and adapt in between.

Below are the types of things we have suggested to GP tutors and students alike as we grapple with clinical interaction changes generated by COVID (list adapted from Professor Hugh Alberti in Newcastle University):

Telephone and Video consulting in practice

• Listen and observe first

• Discuss strategies for building rapport

• Move on to joint participation: Consider 3-way remote consultations, speakerphone, phone splitters.

• Then semi-independent surgeries by telephone/video

• Keys: Discussing when to switch from telephone to video, when to request photos, etc.

Clinical reasoning and the virtual consultation

• New ways of thinking

• Discuss loss of non-verbal information

• What examination can be conducted remotely?

• Delegating examination to patients – how and when?

• Thinking aloud with students and patients

• Use of econsults – potential wealth of clinical reasoning vignettes

• When to – arrange face-to-face (F2F); go straight to investigations; safety net.

F2f consulting

• What is the current practice policy?

• Encourage some f2f interactions if at all possible.

• Consider more involvement in teaching of non-GP clinicians who may be seeing more patients f2f (e.g. Nurse practitioners)

• Discuss whether students should or should not see patients with covid-19 symptoms; with reference to students’ own health risk assessment.

• Home visiting issues (good experience but PPE, social distancing? Nearby visits only?)

So lots to think about and lots of different dance steps to try out during these shifting times of change! Good luck!

#COVID19 #GP