Thrown in at the Deep End: A Conversation with the Class of COVID

“We were soldiers being sent over the trenches into the firing line”

On the 23rd

March 2020, PM Boris Johnson announced a nationwide lockdown in response to the Covid-19 crisis. Less than 2 weeks later, on the 3rd April 200 final year Bristol medical students graduated early to work in the UK’s hospitals. “We were soldiers being sent over the trenches into the firing line”, one told me, fresh from 3 months of work as an interim foundation doctor. Bristol was one of the first medical schools in the country to fast-track the qualification of its ready-made and raring-to-go final year students, who signed up in great numbers. Interim foundation doctors could choose to work in their university town, home town or the trust they’d be joining as junior doctors, and one told me it was heartening that so many Bristol graduates chose to stay in the South West area and work with their medical school mates. As final year students returned to their last placements in Bristol in January 2020, having sat their finals the previous November, the emergence of CoVid-19 in China was nothing more than a distant news story; at best, an interesting point of research, at worst, the butt of a joke. Over the next few months, the wave that crested in Wuhan would rush towards the shores of Europe and break catastrophically across the world. For these early graduators, it was when certain students were recommended to change elective plans that the severity of the virus hit home. At first it was “some of the far-off places… Philippines, China [but] over the week, more countries [were] added to the list of where the uni [was] banning us from going”. Longawaited and anticipated elective plans were “dropping like flies”. Finally, on the 5th March an email was sent out: all electives were cancelled. “Pretty soon after that…[there were] rumours of us graduating early”. The last two weeks of placement were cancelled, and final year medical students, along with most of the student body, found themselves back in their family homes. The overwhelming feeling, I was told, was a keenness to get out and help. “It felt…pointless just sitting at home doing nothing when we could start work as an interim foundation doctor”. But it took some time to get to that stage – portfolios needed to be completed and pulled together, exam passes checked, support forms filled out for health and wellbeing. The ex-students I spoke to praised the tireless work of Andrew Blythe, head of year, who “carried all of us… got us all “doctorready””. “You didn’t really know what the timescale was going to be…[you were] always waiting for that email: you have to be back now, you’re starting working”. Almost a month later, provisional GMC registration received and Zoom graduation ceremony completed, they were ready to go. Leo, one foundation doctor I spoke to, although excited to start working, admitted to the apprehension associated with entering the medical profession during a pandemic. He described “an overwhelming sense of danger: we didn’t know how dangerous COVID was or wasn’t going to be, we didn’t know how bad things were going to get, we didn’t know what the PPE situation was”.

Phoebe found herself placed on a 30 bed COVID ward in Gloucester, which was to become the peak of the South West. The consultants on the ward were originally geriatricians, but soon many other specialities were redeployed to help. Orthopaedic surgeons, rheumatologists, ophthalmologists and dermatologists all spent time on the ward - “everyone was just trying to work it out”. It was a unique experience seeing doctors with diverse medical backgrounds working together and bringing whatever knowledge they could to fight the virus, which Phoebe described as “amazing for both patient care and teaching purposes”. This included a refreshing of traditional hospital hierarchy, with certain seniors accepting that medical juniors of other specialities were best placed in general medical knowledge to lead a ward round. The consultants on the ward rotated every 3 days, whereas the interim F1s were there Monday to Friday, providing continuity. The turnover of staff from different specialities was fascinating and meant that Phoebe got “random bits of teaching”, but it also meant that the new consultants wouldn’t always know that she was the interim, so “they just assumed I was fully functioning”. Did she feel out of her depth? “I was overwhelmed…Most of the time, I was the only F1”, but everyone on the ward was supportive, “checked in a lot” and became, cheesy as it sounds, “a really big family”. Importantly, because the situation was new to everyone, it was OK not to know everything. Or anything, even. “There were geriatric consultants looking after 35-year-olds. Because everyone didn’t know, it didn’t matter if sometimes I didn’t know either. Everyone helped each other out”. Harry worked at Southmead where staffing and levels of support were comparatively higher. He described watching substantial technological advancements take hold within the space of a few weeks – new apps being developed (“Facebook for hospital patient flow”) and a “Registrar on-call” system where the registrars shielding at home could give advice down the phone or chase blood results. “[It was] a really interesting time – because of the need, they needed to work out better ways of doing everything. The staff had to be very adaptable”. Over their three months as interim F1s, they learnt more about hospital life than any hours of medical school placement could give them. Things like knowing the names of the nurses on the ward, discharging patients and planning social care, everything in fact that happens after 5pm on a weekday. And on a serious note, they came face to face with a virus unlike any found in Kumar & Clark’s Clinical Medicine, a disease that struck unexpectedly and uncontrollably and has changed the face of medicine forever. The interim jobs finished in July, and on the 5th August, the new doctors started their F1 rotations. Having worked during the greatest medical crisis in a generation, the F1s I spoke to felt that, unsurprisingly, settling into their new jobs was a walk in the park. “I was totally relaxed”, said one. Overall, it was a steep learning curve, but one that these graduates are proud to have scaled. Inevitably, they will be forever defined as The COVID Cohort, bringing experiences with them into their new careers that no graduates before them could ever have imagined. As Phoebe put it, “We’ll always be that generation that pulled their socks up and had to help”.

Written by Eve Miller