Uncertainty in Medical Training is Worse than Ever with Covid-19

Uncertainty in Medical Training is Worse than Ever with Covid-19

Sep 22, 2020

Written by Dr. Thomas Kelly

Dr Kelly is a surgical doctor in training at a Melbourne hospital.

I’ll save you some reading. Covid-19 has made the medical training bottleneck worse. There has been a steadily worsening training bottleneck since the influx of new medical graduates in the early 2010s from new medical schools, which thrust students into a system that was designed for scarcity, rather than surplus. In this setting, Covid-19 has swept in and caused further strains, but it’s also highlighted the areas needing reform. 

Let's look at the training bottleneck and how Covid-19 has impacted it.

Watch Tom and Noa's Conversation on “Present Your Findings”

Covid-19 Impact for Unaccredited Registrars and PHOs

Unaccredited registrars are doctors acting in specialty trainee roles without being “officially accredited” on their desired speciality training program. Many were stopped from applying to their specialty this year. These applications have the highest stakes. Years of research, study, awards and references all culminating in one application to finally secure a position as an accredited registrar in your chosen specialty. We’ve written about the length of time people plan for these applications and the amount of money that goes into applying. In some cases, the applications even have an expiry for their CV criteria, ie: everything has to have happened within the last 5 years. All of this effort can be switched off in an instant, if unforeseen challenges emerge, this is the fear of many doctors in this phase, there is absolutely no certainty.

Despite the gravity of the process, most colleges failed to even acknowledge that applications had been delayed until multiple days after due dates had passed. One of the registrars in my team was left panicking while we rounded, compulsively refreshing his email and the college website to see if he’d missed the deadline. Although slow by modern standards the response was pretty impressive when it happened, here’s all the latest information from RACS, RACP & RACGP.

Some of the hurdle assessments impacted include: the emergency final exam was delayed, changes to GP OSCE, the GSSE was delayed, BPT exams were delayed, surgical applications postponed and trainee rotations extended by 12 months. All of these effects lead to a stall. Stalling in the medical conveyor belt that takes freshly minted interns and finishes with specialists stepping off the line. 

This adds to the uncertainty in all the ‘in-between’ roles that doctors like myself are expecting to enter into in 2021. A doctor that would have moved forward into a training program is now stuck in their role, with all of us on one or two year contracts.

Where are all the doctors going to go?

Halting The Rotations Of Junior Doctors

In addition to training changes, Covid-19 had the effect of halting the rotation of doctors within hospitals. This was based on a very real infection control hypothesis, that doctors in new roles are at higher risk of infection and the rotation of doctors would be creating an internal game of musical chairs that would increase the rate of transmission from infected individuals to others in different specialties. But the halt in rotations had another effect too.

Covid-19 Impact for Interns

Interns, doctors in their first year, are mandated to rotate through at least one rotation of medicine, surgery and emergency in their first year. At my hospital, interns that were on their surgery rotation were halted from starting their only opportunity for emergency or medical rotations, possibly placing their accreditation at risk. In this case, the Medical Board of Australia acted fairly swiftly to ensure that interns would graduate from internship with an accreditation, updating their intern training guidelines as follows - interns need to work “at least 40 weeks full-time equivalent service … the clinical experience can take place in accredited and non-accredited positions.” Releasing the interns from their stress. 

By making the above announcement, the medical community has collectively agreed that the rotations we do in internship are not necessary to hold a full registration. Innovation does happen in times of crisis. It makes me wonder what these stakeholders would do if they took a blank canvas approach to medical training and built an optimal system from the ground up. What are the necessary components of medical training as a junior? If they’re not necessary in a time of Covid-19 are they necessary ever? It’s an interesting thought experiment.

Covid-19 Impact for Residents

Residents or Hospital Medical Officers (HMOs) — that includes me — are doctors that are post-graduate year (PGY) 2 or greater and not in pre-vocational training. We were similarly affected in that our rotations ceased and in some cases we were moved to working from home on the hospital’s electronic medical records. Not to mention other important announcements including our various courses and certificates being put on hold. Although this has no direct effect on our registration, it can have significant impacts on the jobs that we are positioned to receive in 2021.

I can use my experience here as an example. I had been scheduled to rotate into Cardiothoracic Surgery (CTS) in my second rotation, which happens to be my specialty of choice. However, this was cancelled and I remained in my role in the trauma team, which I loved. 

Does it change my career trajectory meaningfully?

Yes and no.

It pushes back my opportunity to gain experience in CTS by at least 1 year. Typically, the jobs that surgical doctors look at from PGY3+, are unaccredited registrar positions in your desired specialty. To get that type of role you need experience in that specialty as a resident or at a “PGY2 level”. So, inadvertently, this pushes back when I could work as an unaccredited CTS registrar to 2022.

Unpredictable Career Consequences

These changes have introduced some unpredictable consequences. A few of my colleagues have been fortunate to receive additional experience in highly coveted specialties, such as ICU. These rotations are valuable for most applications. These few residents, through no input of their own, other than good fortune, now find themselves ahead in the rat race towards specialty applications. 

This unpredictability is replicated across the medical vertical with students relying on their 2020 GPA for medical entry left displaced and trainees heterogeneously affected. For me, the CTS vocational pathway evaluates the number of PGY2 rotations that a doctor has done in different specialties. Some doctors have continued to rotate and have received all the expected CV points from their PGY2, whereas people like myself and others have again fallen a little behind.

Final Thoughts

In any career, luck and timing create success. Medical people look at their careers differently. It is so academically rigorous with many objective standards throughout our premedical and medical journeys that the idea of meritocracy and an even playing field is ingrained. Any injustice, from something in medical school, to Covid-19 pausing rotations, to missed research opportunities, have to be addressed within its complicated context. Unfortunately, life is unfair, sometimes things fall out of our control and in the context of suffering and human loss by Covid-19, the fact that I have one less CV point going into next year is the farthest from my mind.

The Coronavirus pandemic has had an unpredictable impact on an already strained training bottleneck. Some specialties are forging forwards unphased, with others delayed for an unspecified period. My opinion isn’t the only one and we want to hear yours, email us at at editor@medicguild.com

From my perspective we have a long way to go, to improve the equity of medical training to give agency back to junior doctors. Too often I am finding in my conversations with colleagues that the jobs and rotations we get are both completely out of our control and utterly vital to our career progression. I hope to see reforms that remove this uncertainty.  

Stay connected as at MedicGuild we will continue to publish updates on the changes in the medical training space as well as proposed reforms to ameliorate the medical education training crisis. 

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