Clinical Placement during the Covid-19 Pandemic

While most students have been attending the University of Youtube, a small minority of healthcare students have returned to in-person clinical teaching. Aela O’Flynn, in discussion with students across a number of healthcare courses, explores the challenges of clinical placement during a pandemic.

For tens of thousands of students across Ireland and beyond, the classrooms and lecture halls of the past year have been bedrooms, kitchens and attics. However, for a small minority of students, in-person classes have continued, with all the opportunities, experiences – and risks – that entails.

Medical, midwifery, nursing, radiography, and physiotherapy students are all currently in hospitals, doing their usual clinical placements, but even within those complementary disciplines, their experiences are very different. As a fourth-year medical student, about to take my first steps in scrubs, I really have no idea what to expect from clinical placement. The experiences in this piece come directly from personal interviews of current UCD nursing, physio, and medical students who have done their clinical placement during the pandemic.

“For a small minority, however, in-person classes are continuing, with all the opportunities, experiences – and risks – that entails”

Medical and physio students were predominantly kept off the wards during the first wave of the pandemic. Ongoing placements were paused, planned placements were cancelled, and, much like the rest of the university, their learning resumed online. However, nursing and midwifery students had a very different experience, with back to back 12-hour shifts and little-to-no autonomy over the hours or location of their placement. This was not new though, and has been commonplace since long before Covid. However, when this is coupled with constant direct contact with Covid patients since the first wave, this has meant that many student nurses and midwives have become frontline workers. The provision of compensation for these responsibilities is therefore, and has been, a topic of worthwhile and necessary discussion. 

A lot has changed over the past 12 months, and most students have now made a full return to clinical teaching. And I ask, how has placement changed since March 2020? Students generally agree that the level of practical teaching on clinical sites has been maintained as much as could be expected. Though it is relevant to note that many students currently on clinical placement have not experienced the pre-Covid alternative, and are without comparison, to some extent, it appears that the usual lottery applies. If the healthcare team you are assigned to is extremely busy, or simply less equipped to deal with students, you probably won't benefit a huge amount from your time in hospital. If the team is highly interactive, there are plenty of patients to see, and you are an enthusiastic participant on the team, there is much more to gain.

“Many students now on clinical placement have not experienced the pre-Covid alternative, and have nothing to compare to the current situation”

The number of patients available to interact with is an interesting consideration and important for placement. This can vary widely between types of placements and the number of Covid cases at any given time in any given hospital. For students being kept away from Covid patients, the wards are often much quieter, with far fewer patients to see. Teams busy with Covid patients, such as Emergency Departments, however, have often had to refuse students due to the sheer number of patients and the risk of infection. Medical students describe doctors who were assigned to teach them being redeployed to Covid wards at short notice, or being switched from one team to another at the last minute due to crowding in their original ward or department. While most students are given the option not to see a patient who has a confirmed or suspected Covid diagnosis, a smaller number of students have been deployed onto Covid-specific wards to learn. Prior to vaccinations, these students were extremely vulnerable, and cases of Covid were reported amongst this cohort. As vaccines are administered and the risk decreases, more students are now being assigned to Covid wards, but they are grateful to have the protection of a vaccine.

Vaccination was a key concern for students in every healthcare course. The HSE has now informed the School of Medicine that students must have begun the vaccination process prior to entering clinical sites. While everyone I spoke to had received at least one dose of the vaccine, the rollout for students has been highly erratic. While some medical students received leftover Pfizer vaccines months ago, many only received their first dose in March despite already being on placement. A similar situation was seen for final year nurses. Some student nurses were only placed on Covid wards after they were vaccinated, while others were face-to-face with Covid patients in the very first wave, when there was no sign of a vaccine. For a student who spends all day in a hospital, the risk of being exposed to Covid-19 is a constant source of concern. Particularly for students living with family or roommates in a non-healthcare course, their worst nightmare is to bring the virus home with them and infect their household. Every student I spoke with expressed disappointment that students had not been formally included in the vaccine rollout at an earlier stage.

The pandemic has put enormous stress on the healthcare system, hospital teams, university administration, and students, by extension. For students learning on clinical sites, the constant threat of infection is a huge strain. Vaccination has helped significantly, but this is a very recent development for most students, and many are yet to receive a second dose. The burden of PPE, while absolutely necessary during the pandemic, demands caution, concentration, time, and constant consideration. It is also uncomfortable, barricades normal communication, and can cause severe skin irritation. But more than anything else, uncertainty takes its toll. Uncertainty of vaccines, uncertainty of opportunities to learn, uncertainty of the patients you'll see, the risk that awaits you, or how you will be examined at the end of the year. Some level of stress is unavoidable in student life, but the strain on the healthcare system transfers directly to the shoulders of the students learning within it.

“Some level of stress is unavoidable in student life, but the strain on the healthcare system transfers directly to the shoulders of the students learning within it”

To observe and assist in the care of real patients, and to be taught skills by healthcare professionals in a clinical setting, is a privilege that healthcare students do not take lightly. We feel lucky to learn in person while other students remain exclusively online. But the pandemic has complicated clinical learning, in more ways than one, and for some more than others. Learning should not risk our physical or mental health, or that of our parents, siblings, grandparents, flatmates or partners. Is that really so much to ask?