Edmonton

Some new doctors who trained during the pandemic worry about gaps in their knowledge

Many students entered medical school to help and provide care to others, but COVID-19 restrictions and public health measures have impacted how and what they are learning, which impacts patient care.

COVID-19 initially limited clinical training, forced classes online, delayed exams

Dr. Charlotte McEwen in the operating room with teachers Dr. Saurabh Gupta and Dr. Richard Whitlock in 2021 at the Hamilton General Hospital. McEwan says she missed out on valuable clinic time when she was in medical school. (Submitted by Charlotte McEwen)

The pandemic has disrupted life in many ways for Canadians, but it has also interrupted learning for a group dedicated to the country's health-care system: medical students and residents.

Some residents who finished medical school during the pandemic say COVID-19 restrictions and public health measures have impacted how and what they are learning. And this could ultimately impact patient care.

Dr. Charlotte McEwen of Thunder Bay, Ont., was a registered nurse for two years before she enrolled in medical school. She said she felt a calling to be a surgeon. Half of her three-year medical program at McMaster University took place during COVID-19.

She and her peers were pulled from their hospital training for several weeks when the pandemic first broke out in March 2020. During that time, McEwen attended virtual lectures meant to help students keep up with their clinical learning, but said she missed out on valuable clinical time, which would typically provide more learning opportunities.

"We spent a lot of time away from the clinical environment and had to — over time — recover those opportunities," McEwen said.

Dr. Charlotte McEwen, a cardiac surgery resident at Hamilton General Hospital, describes her transition to residency as 'a cold shock of water.' (Submitted by Charlotte McEwen)

Not considered essential medical personnel

The pandemic and ensuing COVID-19 restrictions disrupted typical medical school education — forcing classes and lectures online, delaying exams, preventing travel so graduating students could not meet with different hospital programs across the country and initially limiting clinical training for students, which meant fewer opportunities to practice skills.

An August 2020 commentary in the Canadian Medical Association Journal acknowledges that residents have been limited to working at one site in some parts of the country, have had reduced exposure to elective procedures and surgeries, and may have received fewer learning opportunities than in the past.

"The days of crowded bedside rounds are over; infection control protocols for physical distancing must be followed and the consumption of valuable PPE reduced," the commentary reads.

"Training place assessments and patient care will remain the essence of medical education; however, creativity and innovation will be required to deliver these foundations."

It notes that residents should be aware of their skills gaps so they can be corrected during future learning.

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Medical students were removed from clinical duties at the onset of the pandemic because they are not considered essential medical personnel, said the president and CEO of the Association of Faculties of Medicine of Canada, Dr. Geneviève Moineau, in a statement to CBC News.

But students returned to clinical rotations as soon as their university was able to do so, she added.

The pandemic highlighted the need for educators to provide virtual clinical medical education in different and innovative ways, Moineau said.

"There is no backlog in learning. We are adapting to the new way of practicing medicine. Newly graduated physicians are learning how to practice in this new environment. The opportunities are different, but they reflect the care that is provided now," Moineau said.

A steep learning curve

McEwen graduated in the summer of 2021 and is currently a cardiac surgery resident at Hamilton General Hospital. She describes her transition to residency as "a cold shock of water."

"The learning curve of being a brand new doctor is very steep, even in normal circumstances. Certainly, the learning environment with a pandemic as well is a huge challenge," McEwen said.

"When I talk to my colleagues, we are concerned generally about the impacts that this has on our medical education."

McEwen said, while the pandemic has been a learning opportunity, it has also created some obstacles since many hospitals are doing fewer procedures to accommodate for COVID-19 patients. In January, the government of Ontario told hospitals to stop all non-urgent surgeries and procedures to preserve critical-care capacity. 

"It's a challenge for cardiac surgery residents and for surgery residents across Canada frankly right now, to have less training right now than normally we would," McEwen said.

"I want the public to know that we are working very hard in other ways to simulate work and to catch up on what we're missing out on. But certainly, I mean, it's challenging." 

Learning disruption

Dr. Conley Kriegler was a third-year medical student at the University of Saskatchewan when the pandemic hit. He was also pulled from the hospital for approximately five weeks, which he said "obviously disrupted our learning." He said he and his peers had fewer opportunities to learn how to intubate patients and limited exposure to work in ICUs because of restrictions.

When he did return to clinical training, there were limitations as a result of COVID precautions — Kriegler said he saw fewer patients and many appointments were done virtually or over the phone.

Dr. Conley Kriegler is seen doing procedural skills training during medical school. He says he's become very comfortable with uncertainty. (Submitted by Conley Kriegler)

He is now a first-year radiation oncology resident in Edmonton, but is adapting to residency in a pandemic.

For example, he said one type of radiation treatment called brachytherapy is not being used as much during the pandemic in favour of other types of radiation treatment, but he hopes to be exposed to it later in his residency.

"Going through medical school through the pandemic, I became very, very comfortable with uncertainty," he said.

Despite the challenges, Kriegler expects to make up on missed time before his five-year residency is over by continuing to learn, train and become proficient in his skills as a physician.

"I hope that as things settle or as we become a bit more adapted to how to be able to live in this, maybe, new normal that I'll be able to make up for some of those learning challenges," he said. 

Though the pandemic has upended a normal medical learning experience, one thing is clear: Kriegler will never forget starting his career during COVID-19.

"I think absolutely it's going to define who I become as a future physician."

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