How does a medical school provide new doctors during the COVID-19 pandemic? We explore how the University of Cambridge Clinical School made quick decisions to ensure the students in each year of medical training would still receive the best education and for those in the final year, ensure they were fit to practice.
As COVID-19 started to develop into a pandemic, the University of Cambridge Clinical School had to react quickly. Within three days, major decisions had to be made about how medical students could continue to learn, while students in their final year of training could complete their studies early so that they could practice medicine at a time they were needed the most.
Below is a timeline of major decisions taken across three days between 13-15 March 2020:
- Friday 13 March: Medical Schools Council met, which included: six Clinical Deans, Health Education England and the General Medical Council (GMC). The decision was made to cancel clinical placements and the National Health Service (NHS) asked for the final year students to graduate early to support the NHS.
- By Sunday 15 March, the University of Cambridge Clinical School decided to
- Move all teaching online, with less than 24 hours to get the technology, staff and students ready for the switch. Regardless of the mammoth task, everyone worked together to make it happen.
- Suspend clinical placements in medical settings including the incoming and outgoing elective programmes (a programme that medical students travel nationally and internationally to work and learn from different medical settings)
- Graduate final year medical students using previous assessments, exam scores and previous performance on assessments as a guide to graduating medics.
Graduating Final Year Medical Students:
The decision to graduate medical students early needed to be made with confidence that the students would be fit to practice. The students were due to complete their studies in August 2020, however, due to the pandemic, there was a push for the final year medics to graduate in April 2020.
To prepare students for working in the clinical setting in the midst of a pandemic, the University of Cambridge faculty and teaching doctors put together a two week programme covering medical situations the students may come across right away. Some of the items covered were: common infections, professional practice, COVID-19 awareness, haematological blood test problems, IV fluids and biochemistry. These sessions were taught through self-directed learning resources and online teaching with questions and answers from professionals working in the environment the junior doctors would be joining.
To be certain of the decision to graduate the final year medical students; the educators went through each students file to review their exams, placements, submitted work and fitness to practice. The students had already completed their final written examinations and were continually assessed for clinical competence on each of the clinical placements. The review of each file was completed to be certain that students accomplished everything necessary and if there was something missing there was an opportunity to review and update appropriately.
This resulted in 265 medical students graduating in April 2020. They were able to seek early registration with the GMC and enter the NHS workforce four months earlier than expected.
From 1 May 2020, students were granted provisional registration and started working in medical roles. The Clinical School made sure that the students continued to receive support as well as access to the Welfare Team. The support provided by the clinical school was particularly important given the circumstances.
Delivering First Class Medical Education as a Pandemic Emerges:
In addition to graduating the final year medics, focus had to be placed on the medical students in the fourth and fifth years of medical education. At short notice all students were removed from the clinical environment, this necessitated a need to restructure the way teaching was delivered.
All theoretical teaching would be moved online, delivered via Zoom or Teams. Staff worked tirelessly to reschedule each student’s timetable to pull forward the theoretical classroom teaching into intensive year specific blocks. It was essential to get the classroom based teaching brought together so that when students were able to go back into clinical placements in the medical settings they could do so without interruption for classroom based learning.
A decision was made to use the ‘flipped classroom’ method of teaching. This method requires the students to complete self-directed activities to explore core content before the teaching session and during the live teaching session students would be able to clarify and reinforce the information they studied before. After the teaching session students would reflect on the activities completed in order to support the learning. This required teaching staff to add additional resources to the platform that students use and create the content and support needed to teach in this more interactive way. All the above needed to be complete with very short notice.
The faculty were able to use shared Council resources, a platform in which medical schools shared information and teaching resources in order to aid online learning. In addition, the faculty wanted to continue with the learning that Cambridge is known for with weekly, small group discussions between students and faculty.
Individuals working behind the scenes were very responsive. Everyone quickly set up home working and ensured that schedules could be changed, information was disseminated quickly, assistance was given when needed and virtual learning support was provided.
When the online learning was underway, there was a need to figure out when and where the students’ placements would be once they were able to go back into the clinical environment. Several scenarios were drawn up so that students would be able to complete all the clinical training necessary to become doctors.
In addition, there was a need to start thinking about how medical education would be delivered face to face. It was clear that COVID-19 would be an issue for some time with social distancing and small group work being the only means of in person teaching. Once again, the faculty and staff worked together to figure out a number of scenarios and ways of working in the future.
What lessons were learned about this process?
- The faculty and support staff were amenable to the changes required, responded quickly and effectively to continue to deliver excellent medical education.
- Both students and faculty had to experiment with new technology and were supportive and accommodating with one another as everyone ventured into the uncertainty and need for change at such a rapid pace.
- Everyone is pleased with what was accomplished in a short space of time, lessons for online learning will be integrated across the board and help shape future courses.
- Our students were amazing at stepping up to the tasks amongst such uncertain times and we feel the resilience of everyone involved will continue to create excellent doctors of the future.
It was clear that working with an agile team that were willing to ensure the success of our students meant changes could happen quickly and effectively when so much uncertainty was surrounding the future. We continue to be grateful for the excellent faculty, staff and students working together in the clinical school.