Years of medical school, graduate school and clinical hours are meant to make doctors ready for anything. But no number of disaster-scenario trial runs or years of on-the-ground experience could have prepared health care professionals for the early weeks of the COVID-19 pandemic.
“Nothing like what’s happened with COVID-19 prepared us for what was coming,” says Parveen Wasi, associate dean of postgraduate medical education at McMaster University.
Even in Toronto, with its handling of SARS1 in 2003 and H1N1 flu in 2009, the learning curve has been steep.
“The disease and the pattern [of the viruses] are different, but the principles were familiar, and we had some structures in place,” explains Glen Bandiera, associate dean of postgraduate medical education at the University of Toronto. “The magnitude of this response was bigger and the threat [the pandemic] posed to the system was greater because of the sheer numbers of [patients], the lack of personal protective equipment and the impact on the health work force.”
Medical schools were doubly hit: Not only were they responsible for the continuance of studies and keeping student residents safe, they also had to change the way medical education was being delivered, and quickly. Medical students were pulled from all clinical settings in March across Canada and didn’t start returning until August, which meant a large number of training hours had to be made up.
And while residents are still in training, they’re also hospital employees and, therefore, essential workers. “We had to start from ground zero in terms of how we protected our residents and then how we planned education around the pandemic,” Dr. Wasi says.
This meant identifying gaps in the system, such as issues around PPE. For example, health care professionals using N95 respirators are required to be fitted every two years. At some hospitals, many of the residents had never been fitted and there was no documentation to confirm who had. As PPE use is exacting, protocols must be followed to protect patients and health care workers; how it’s done changes, depending on the level of exposure to infectious agents.
“I mask-fitted two years ago, but when I actually had to use one, I wasn’t 100 per cent sure how to,” Dr. Wasi says. “Training for PPE – how to don and doff appropriately, how to put on an N95 mask – was hit and miss prior to this.”
The pandemic has also highlighted the need for more training in infection control for postgraduate students. “We just assumed it would also occur in the hospital setting,” Dr. Wasi adds. “So, lesson learned.”
Over all, the response by medical schools to the new world has been overwhelmingly swift and often innovative. While U of T’s medical school includes pandemic planning in its curriculum, a specific COVID-19 curriculum was constructed for third-year students returning to clinical environments in the summer. The new program includes PPE instruction, a mask-fit for N95 and an in-depth study of the virus itself.
Patricia Houston, vice-dean of medical education at U of T, says students learn about ethical concepts, palliative care and virtual delivery of health care. “We give them tips about how the hospital [is] different in these pandemic times. We also help them to deal with it personally and talk about being resilient.”
Within a week of COVID-19 being declared a pandemic, Dr. Houston says the school had moved lectures, small-group learning sessions and even clinical skills courses online. “Our pivoting is all strategic, and [the changes] will form the new normal, which have to be robust enough and responsive enough to future needs.”
Since mid-March Roger Wong, vice-dean of education at the faculty of medicine at the University of British Columbia, has been adapting the curriculum, beefing up sections on public health, social determinants of health and disease-specific treatment strategies, as well as developing COVID-19-specific sessions for final-year medical students.
UBC also moved to a blended mode of curriculum delivery, virtual and in-person when possible. It developed a free online learning module for medical and health professional students on how to use PPE appropriately. And over the summer, Dr. Wong and his team created a virtual anatomy lab, offering students three-dimensional scans of specimens to study at their leisure.
“It’s fair to say that everyone around the world is learning actively as the situation evolves,” he says. “[The pandemic] has catalyzed a large number of innovations in medical education that would have taken decades to happen otherwise. It would be almost unimaginable.”
Alim Pardhan, assistant professor of emergency medicine at McMaster, says flexibility for medical schools, doctors and hospitals is key, for example, changing the focus of the health care system from a single discreet event with lots of patients to a longer-term event that might last a year or two – “where you have higher volumes, fewer beds available and extra precautions with certain patients.”
All agree that COVID-19 will have an enduring impact on health care. Dr. Houston hopes the experience of the past six months will increase the support for, and understanding and appreciation of, public health.
“We’re always looking for the next cutting-edge medicine,” she says, “but we need to understand how we can better take care of not just individuals, but populations and communities. And that’s something public health teaches us to do.”