Tom Bradley is a 3rd Year Medical Student Scholar studying at the University of Leicester. This is an open debate about an important question that many healthcare professionals are grappling with at this point in time. Tom has posed the debate question to stimulate your thinking, so have a read of his example below and then join the debate by trying to answer the question. Tom will be keeping an eye on the comments section and challenging your thoughts. Ultimately, this could become a very common interview question and in the process, it will help you to learn about ethics and view a problem in the way that doctors would go about ethically problem-solving. Good luck and enjoy the debate!
The sun is out and I’m back home, back with the dog constantly demanding entertainment, back with a plethora of organisation to accomplish, back with the better wine than a student can afford, back with my Lego, back with my family. Isolation is seen to be the ultimate holiday, negligible responsibilities and more time to spare than ever before. I find myself both revelling in this retreat from the daily grind, yet also ill at ease.
As a third-year medical student you find yourself reflecting (as all good medic’s should), should it be me out there? Should I be on the frontline assisting our colleagues to be? Or should I stay home, carry on studying, learning and relaxing in safety and let this crisis pass me by.
Probability dictates that as a fit and well 20-year-old, I will come out of the other side of this virus relatively unscathed, therefore should it not be my duty to volunteer in place of the returning NHS staff who’ve hung up their stethoscopes at far more risk than I am?
At this point in my training, I have spent 6 months in GP practices and hospitals, I ‘m deemed competent in taking blood, managing a cardiac arrest and taking a reasonable history from most patients, skills that have the potential to ease the load of any overworked junior doctor. A time like this may also be the perfect time for me to hone those skills, which I have been trained for.
Despite this, I know that I’m still brand new to the craft and have more to learn than I can possibly imagine. I make mistakes often and rely on the F1’s to both recognise and rectify these. On placement this is part of the learning process and so it is accommodated for, however in a time of such national emergency, it does not seem fair to increase the burden of the junior doctors I’m assigned to. I am also a quantifiable risk factor for infection spread, both in the hospital and to my family back home.
Should I stay or should I go? The former could leave me better equipped to assist the next time the health service faces a challenge such as this, when the skills and knowledge I will have are needed far more than those which I now possess. The latter could put myself and my family in harm’s way, but make a true difference to the lives of both the patients I serve and the colleagues I serve with.
So, should I stay or should I go?
Post your thoughts below! It does not matter if you are right or wrong; by participating in the learning process, you will have a greater chance of understanding how ethical principles can be applied,
This is so well written and shows that internal struggle of what I think a lot of medical students (including myself) are feeling right now!
Just to kick off this debate here, a lot of healthcare trusts have been advertising for medical student only posts that should be within the realms of what we can already do. It doesn’t change the fact that it puts us at risk, but could definitely ease the burden on the NHS staff. Would students be more willing to go in situations like that?
That’s a very good point Keertana, the MSC (medical schools council) has issued guidance for students wishing to volunteer stating that they should be placed in positions with the least exposure possible to COVID-19 and to only act within their competency’s. I think it depends a lot on the position offered for medical students as well. Hospitals are offering for students to fill the roles of HCA’s (Health Care Assistants) which would obviously involve a lot of close contact with patients in the duties of feeding and washing them for example. Can we guarantee that students won’t be required to fill places on high risk wards to make up staffing levels if lots are taken off work?
Hi Tom and Keertana! Just to mention that the group at my medical school who were coordinating placing medical students in jobs in the surrounding trusts have in the last few days said they are stopping placing medical students because the hospitals no longer need them.
Additionally, students who are already placed in jobs are being told that they are no longer needed. Of course, I’m sure we are going to be welcome to volunteer and work in other roles as HCAs etc.
Also, this is the internal debate I’ve been having for the past month. I began to volunteer in a clinical environment however living with a large family who would unlikely fare well if they had the disease, I made the hard decision to stop helping clinically. Whilst I know that my skills could be of use I then felt so guilty about stopping and hence looked for other ways I can help – namely research (which I’m now pursuing).
Whilst it’s very easy to say all medical students should be on the wards helping because that is our duty, there are legitimate reasons why many are unable to. For example, logistically I am unable to return to my university city to work in the trusts they are permitting us to. Additionally, my local trusts are not accepting medical students from different universities. There are ways to demonstrate empathy and teamwork etc in other, non-clinica roles. Also, I am unable to move out of my family home to live alone (and if I lived alone I would help clinically in a heart beat).
This is a really interesting ethical debate, I can definitely see this coming up in interviews. In my very unprofessional opinion, as a secondary school student who is interested in medicine, I would say that medical students should try to do as much as they can to help during this pandemic. They could take on very low responsibility roles within the hospitals as to not further increase the burden on the junior doctors, or they could even help the NHS by campaigning to raise money to support their future colleagues on the frontline. There is still a lot to do, whether it is from the comfort of your home or on the frontline.
Hi Yasmin, this is definitely something that can be asked about in an ethics station at interviews. Something that could be thought about is that medical students do have a level of clinical knowledge greater than members of the public, would it not be more appropriate to find use for that knowledge somehow and let that fundraising be done by members of the public such as Capt Tom?
Hey Tom. Excellent hypothetical scenario. here is my take:
The ultimate holiday is not the current lock down scenario, it is post retirement; you have the rest of your life to focus on hobbies. in fact not all people are lucky enough to call this event a holiday, including essential workers, the homeless, those who have lost jobs or those who do not have a suitable and safe home environment, all of which, are at risk of death.
retired doctors who had worked hard for their whole lives and have supported the country’s overall well-being for decades were still called upon by the government to continue saving lives. They did not need to sign up, and they are at a greater risk of death than a young med student. You will most likely live and save many lives at it. 80% of all people develop mild to moderate conditions.
as being one of the few people skilled enough to work in a clinical environment, it would be of great usefulness and importance to go save lives and think about the position of others; your hobbies can wait, their lives possibly cannot. Key traits of a doctor are empathy and teamwork. You need to support your colleagues to ensure there is less weight on their backs too. And on top of this, this will be an excellent lesson. A once in a lifetime medical crisis which will definitely develop your character for the better.
Retired doctors have given up part of their life-long holidays, risking their lives much more than the average healthy 20 year old doctor-in-training. As a doctor one needs to remember that they are one of the few skilled people available to help other medical workers and patients. this will reduce the strain on the public sector. and that this is part of the reality of being a doctor.
Hi there Haytham, thanks for your participation. You make some good points, the returning retired NHS staff are putting more on the line than some medical students would be. I would argue that a medical student, particularly those still at the beginning of their clinical training are in no way on the same skill level or have the capability as the junior doctors.
The returning staff are (all be it a little rusty for some of them) all trained in many more skills and much more experience in undertaking these skills, therefore one returning doctor will be able to do so much more than a volunteering medical student.
In a time when you want as few people on the wards as possible so that the risk of infection transmission is low, yet enough to keep the ward functioning, who is more valuable to be on that team?
During your clinical placements you are constantly chaperoned and supported by the doctors, only in the final years are you likely to be allowed to undertake these tasks unsupervised. A question you could ask is, is this an appropriate environment for medical students to be learning and practicing their skills in? Or should it be left to the doctors who know what they’re doing?
Hey Tom. Made me think for a while to respond to your message. You brought up the question ” Should I be on the front line assisting our colleagues? ” Although being less skilled than doctors, your skills are still incredibly useful to put the weight off any junior doctor, as you have mentioned yourself. This will definitely reduce the stress of other medical workers, reducing the toll on the mental well-being of the overworked.
With notice to your next point, about increasing the chances of transmission, this is inevitable so long as we have essential workers. Your skills will certainly reduce the death rate despite increasing the number of cases.
There are few (in comparison to the total UK population) people that have a certain level of skill to be able to help in a hospital setting. Most are not qualified and have not been taught how to take bloods or take a patient’s medical history. There are however, enough able people to help the local community by delivering food parcels or collecting prescriptions. These tasks do not require medical school training. The level of skill you have acquired is small, but big in terms of helping in this crisis. Although you are susceptible to making mistakes, your help could free up a doctor who can help on a Covid-19 ward. If you are not a vulnerable member of society and not shielding anyone at home, I believe you should help in any way you can.
I think that this is a very interesting debate and it is clearly hard to reach a conclusion due to key arguments favouring both sides. However, I believe that due to empathy being an important part of medicine, I believe that if a student can they should take up a role to help in the NHS. This could be given according to what the student has experience with and clinical exposure. I also think that this should be taken according to an individual student’s risks and circumstances I.e. if they are living alone/ with people who are vulnerable to Covid-19.
These students could also volunteer in non-clinical places such as delivery, pharmacies etc. which would not put themselves or patients at risk.
Although, the argument is valid that if one waits to gain further knowledge after studying medicine for a longer period of time- they will be better equipped to face future challenges; the country is facing a national emergency, of such a great scale- that any help will be significant as lives can be saved. And a medical student does have more experience than someone who is not medical trained, therefore, arguably this extra pair of hands will be more valuable.
A key pillar of medical ethics is beneficence and I believe that more help that the NHS receives the better, clinical or non-clinical. To prevent the NHS from being put under excessive strain and pressure, people are needed to alleviate the burden and all help, despite the form, can be beneficial. Therefore, in this particular time of a national crisis- I believe that if at all possible, according to one’s circumstances, medical students should help by volunteering for the NHS.
Hi there Lizzie, a very well balanced argument. I like the way how you’ve taken account of the fact that some medical students will not be in the position to help. Like the rest of the population some have health conditions, or live with people who have them so it wouldn’t be safe or responsible for them to go and join in, and likely do more harm to their families. Health professionals, especially at this difficult time, are sometimes portrayed as almost superhuman with their work ethic and willingness to keep on going, however we have to remember that they are fallible and need looking after too. We have been told by the MSC that our top priority is the continuation of our studies, could volunteering in this crisis put that at jeopardy?
That’s an interesting point, however, I think that part-time volunteering can be arranged. So if it were to be non-clinical such as volunteering as a delivery-driver, maybe one could do this in just the mornings? Usually a medical student would probably not be studying continuously while at university- they may have societies and other social activities, hence, I don’t think it would be opposing the MSC’s advice by volunteering for these hours.
Furthermore, Rebecca mentioned that medical students could work/volunteer as a nurse or HCA. This could in fact further a student’s education by working with healthcare professionals and improving doctor-patient communication and rapport in the future. Therefore, volunteering in a clinical setting could be very beneficial to a medical student.
Hi there Grace, thank you for joining in. I would like to point you to the comment I made to Haytham about the disparity in skill levels that doctors and medical students have. The addition of a third-year medical student would not be able free up a doctor to the point where they could move wards, but it could potentially ease the doctor’s burden and allow them to do more specific things such as discharge letters and prescriptions that a medical student could not do. Doctor’s aren’t the only members of the care team who are overstretched at this moment in time, should a medical student instead take over the role of a nurse or an health care associate, as our skills are more on a par with theirs?
Very interesting question Tom! Here’s my thoughts.
I think something we should all aim to do is to try and help in some way. Medical students are in many ways more experienced and will undoubtedly provide support to clinic staff who are stretched too thin. But arguably the danger to family is too high and it’s better just to leave the professionals to it. I think helping the community can be just as beneficial, for example offering to buy shopping or keeping people connected by organising online events.
What do you think?
Hi there Daksh, thank you for joining in. A very reasonable argument, and you are right, I think that helping the community could well be just as beneficial and fulfilling. I think that this is interestingly different to Grace’s point about there being enough other less clinically minded people to fill these roles, what would you say to this. Is there anything more specific that medical students, using that clinical knowledge they have gained, could do to help out with the community as a whole aside to the usual delivering shopping?
This is a very interesting debate – here are my thoughts:
I think, where possible, as medical students have a greater medical knowledge than the general public, they should try to help in some way during this pandemic. This could involve taking on roles of a low responsibility level (depending on their stage in medical training) to relieve pressure on doctors, or filling the roles of HCA’s.
They could offer community support, by buying shopping for the elderly for example. Whilst this would not directly help NHS staff on the frontline, protecting the vulnerable is also important, so in doing this they could help lessen strain on the NHS, by reducing the spread of COVID-19.
Of course, it is important to consider whether medical students would be putting family members in danger by volunteering to help. For those who are living with family members who are ‘at-risk’, for example, the risk would seem too high, however for medical students who live alone, and are fit and healthy, their support would surely make a difference, to relieve pressure on doctors, or fill some gaps due to NHS staff who are self isolating.
Overall, in a time of crisis such as this, I believe medical students who are not vulnerable, and not living with family who are vulnerable, should volunteer to help the NHS.
Hi there Will, thanks for joining in. Another well balanced response. I wonder if, for those you mentioned who are either vulnerable themselves or shielding others, you can think of roles that these medical students could undertake? For example, Public Health England have advertised positions involving data collection around COVID-19 in hospitals, this could be done remotely if the hospital trust has online notes. Would such a thing like this, or is there anything else that may be appropriate for these students?
There are so many different situations and opinions that make this such a hard call to make. A medical student assisting a doctor would, in my opinion, be more of a burden (due to the need for constant supervision) than a help and would just add an extra body that could transmit the virus. Yet they have more skills and knowledge than a member of the public and are happy to work in a hospital setting.
Therefore I believe that the role of a nurse or HCA would be most appropriate for a medical student to undertake and this would also allow them to practise some of their skills, gain more experience with patient interaction and allow them to learn how to be part of a team dealing with a crisis.
However they should only do this if they are not at risk themselves or shielding a family member. In consideration of the MSC saying that medical students’ top priority is to continue with studies, perhaps a part time role as a nurse or HCA would be best, however I don’t know if this is possible particularly if staff shortages become an issue and you are in high demand.
Hi there Rebecca, thank you for joining in. You have taken a very different stance here than Haytham has. The experience that you gain as an HCA would be invaluable in the ways you’re mentioning. It would also give you a much greater understanding of how essential the role of the HCA is in the hospital. One thing which is often asked at interview is what this role is, and how valuable it is. Sometimes doctors and medical students alike are known to look down on the nurses and HCA’s however it is vital to appreciate the amount of experience and wealth of knowledge that they have, especially at the time of a crisis. I think it would be difficult to say no to agreeing to more hours if you are in high demand at the hospital if working part time. What way would you effectively communicate the fact that your studies need to take priority to your position in the NHS to someone who is asking you to prioritise the opposite?
Hello Tom,
Thank you very much for providing us with an insight into your internal conflict as to whether you should or shouldn’t step forward. I have also really enjoyed reading through the comments that others have left.
I think that individual medical schools should have greater input in assessing whether they feel their students are prepared. At its core, medicine is a relatively standardised course but the universities do vary on the amount of time their students spend in clinical settings at different stages of the course. If they and their students feel comfortable with the idea of working within the hospital in positions of lower responsibility, then they should be granted this option. Many students will want to help in a clinical environment and it would be unjust to stop them from doing so if they also comply with the standards.
I do fear that, by having medical school students out working, it would hinder their progress in an already very academically intense course, with such vast content. Long-term repercussions might be felt, such as restricted knowledge on certain modules or the need to extend the length of term.
My personal opinion is that medical school students shouldn’t be working as they need to concentrate on their studies, as highlighted by the MSC. The fact that some trusts are not accepting students implies to me that they do not need the extra numbers of staff or they are not willing to take the risk as these students do require close monitoring – I think that someone mentioned the latter point above.
I believe that this is a decision everyone should make for themselves. If you are confident that you can remain calm and perform the skills which you have gained under a huge amount of pressure then helping out is the better option. If you will be worried about messing up or unable to focus due to fear of spreading the virus to your family members then perhaps you are not ready to handle a huge crisis such as this. I believe it is down to everyone to judge if their confidence of their own capability is at a level where they will perform to the best of their ability. Ultimately it is down to each medical student to make that choice.
Hi Tom, as a sixth form student applying to medicine, I believe medical students can take advantage of this unprecedented opportunity and practice on their skills that they need improvement on. Even though one could suggest this will create a burden on both the doctors and patient in terms of not being a professional at the skill, you could be assigned to volunteer on a ward or a particular job you feel most comfortable with. This will allow you to grasp on other skills you never thought you needed, as skills you already have can always be improved.
Also, the idea that many medical students may not have the advantage to volunteer due to certain circumstances is reasonable, but doesn’t mean they can’t help from their own homes. Helping with volunteering campaigns, awareness on social media and other ways that could benefit the health care system and those suffering from the virus. This could even mean supporting those in care homes via FaceTime. In this way, as a medical student it’s your duty to support the health care system within the UK.
Even though you want to relax and take this time as an advantage, your commitment to this role (becoming a doctor) is lifelong, you’ll always be a doctor and that’s a huge sacrifice you have to take before deciding to even going into medical school.
In my opinion, I think medical students should go out of their way to help the NHS in anyway possible, it will only benefit you, both with the satisfaction of using your prior medical knowledge and putting it into practice and patient care.