Going back to the ‘bad old days’?

Dan joined TASME as a regional rep for North West England before becoming joint Awards Lead in 2018. He is an ST5 trainee in Emergency Medicine, though currently out-of-programme doing a PhD at Lancaster Medical School looking at staff retention in Emergency Medicine. He is also the Emergency Medicine Trainees’ Association rep to the Royal College of Emergency Medicine’s Sustainable Working Practice Committee and the Academy of Medical Royal Colleges Trainees Doctors’ Group.

Dan Darbyshire

Dr Daniel Darbyshire
@dsdarbyshire

COVID-19 has been a tragedy on many levels, but it has succeeded in achieving the aim of the cancelled 2020 ASME ASM. Medical education has been, in every conceivable way, disrupted. After months and months of lockdown people are pining for a return to normality. I, for one, can't wait to go out for dinner with my family, watch some live music and enjoy a weekend away. For many, there is a real fear that things won't ever return to normal after the pandemic, whenever 'after the pandemic' is. Not for me. My main fear is that things will return to just how they were. And while I appreciate the need for vital services, cancer treatments for example, to return, I don't want things to just fall back to how they were. I mean this on two levels: both the day-to-day work of medicine and how medical education conducts itself.

Pre-COVID, my working environment as a specialty trainee in emergency medicine (old school A&E registrar) often consisted of packed waiting rooms, long waiting times, and even longer waits to get a bed. This took an obvious toll on patients, but also staff. Staff retention in the emergency department - the focus of my PhD research - was taking a beating. Whatever your preferred jargon—burnout, incivility, erosion of resilience—they were obvious to see in the emergency department and evident in the growing medical education literature. And while the issues of chronic excessive workloads were visible in the emergency department, they were being felt across the entirety of healthcare. COVID showed us what practice could be like with patient flow, manageable patient numbers, and dynamic and proactive support from the wider hospital. I don't want to go back to the bad old days, and it seems like I am not the only one. Strong statements have been flying around like the excellent example below from @RCEMpresident.

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We need to learn from the innovations in clinical practice that have resulted from COVID, and hold onto the improvements, many of which had been held up for years until the red tape was removed. Virtual consultations done right, community outreach properly resourced, advanced care planning for our most vulnerable patients–all these things and many more have been great examples of positives that I don't want to just disappear in the rush to 'return to normal'. This situation has been mirrored in health professions education.

The disruption of medical education has impacted all healthcare professionals, though some more than others: final year medical students working on the frontlines earlier than anticipated, postgraduate trainees having exit exams cancelled and their completion of training becoming uncertain. But, as in clinical practice there have been silver linings. In its ability to facilitate conferences, meetings, and even exams, online is not only better for the environment, it has highlighted previous norms rooted in intersectional discrimination—such as the assumption that learners could easily travel. Returning to ‘business as usual' would not just be a step back, it would be discriminatory. If we can do things better, it would be unacceptable to not continue to do so.

The pandemic has reiterated the need to look after our healthcare professionals and learners. 'You can't drink from an empty cup' is a hackneyed phrase, but that it seems overused is a testament to the fact that discussions about wellbeing are taking place, and concrete improvements have ensued as a result. Rest spaces, proper breaks and both formal and informal psychological support have helped people through the pandemic, but if these were to disappear then any good they achieved will quickly be lost.

We have seen the vital place of education in dealing with events such as the COVID-19 pandemic. The initial rush to cancel everything and concentrate on preparation was probably right in its ethos, but missed some of the subtleties that quickly emerged. Education is key and places that used any leeway to prepare in an education focused-manner seemed to do better. Simulation, remote updates, collation and dissemination of the epic volume of COVID research allowed practitioners to give the best possible care for patients affected by the virus, which is ultimately the thing that binds us together.

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