key: cord-0869080-kqdji4es
authors: Reddy, Rohin K; Palmer, Emilia G
title: Response to: Medical students’ preference for returning to the clinical setting during the COVID‐19 pandemic
date: 2020-06-21
journal: Med Educ
DOI: 10.1111/medu.14283
sha: b99e456faaa18e764a7a4298e7f3a8c92d461aa5
doc_id: 869080
cord_uid: kqdji4es

As fourth‐year medical students in the UK who have had to adapt to working from home amidst nationwide cancellation of clinical placements, we read with interest Compton et al.’s survey assessing the prevalence of medical students’ preference for re‐entering clinical environments during the COVID‐19 pandemic(1).

This article is protected by copyright. All rights reserved Editor, As fourth-year medical students in the UK who have had to adapt to working from home amidst nationwide cancellation of clinical placements, we read with interest Compton et al.'s survey assessing the prevalence of medical students' preference for re-entering clinical environments during the COVID-19 pandemic 1 .

The finding that approximately two-thirds of surveyed students preferred to 'Return' to clinical placements resonates with us 1 . Following cancellation of undergraduate clinical learning activities, our institution provided a series of online problem-based learning seminars to ensure we met our learning objectives. Many other laudable innovations have since been reported 2 . Despite novel approaches, we believe nothing can replace the integration of history-taking, physical examination and clinical reasoning with decision-making, empathy and professionalism in the authentic context that clinical placements provide 3 . We therefore agree with the majority of surveyed students in hoping for a timely return to placements 1 .

An important finding was that students preferring to 'Return' were significantly more likely to agree with the statements "It is part of my professional responsibility", "I am part of the team…", "It is part of my moral obligation" 1 . Furthermore, 'Return' students were more likely to be autonomously motivated. This reflects Dornan et al.'s 'experience-based learning' model,

This article is protected by copyright. All rights reserved whereby through participation, students achieve practical competence and positive mind states including confidence, motivation and sense of professional identity 4 . Greater competence reinforces positive mind states and vice versa, resulting in a virtuous cycle where learning begets further learning via integration within the clinical team.

Conversely, reluctance or perceived inability to participate can result in a vicious cycle where progress is impeded. At times, we have felt like spare parts, swallowed up by the complex machinery of clinical environments, particularly in early stages of training. These feelings are surely magnified during a healthcare crisis and may explain why students were least likely to prefer to return if they were in their first clinical clerkship year. This feeling of non-belonging is echoed by the increased agreement in the 'Not return' group with the statements "I don't want to be a drain on clinician's time" and "…I am not properly trained" 1 . The authors' logistic regression model encompassing these elements was highly predictive of preference to 'Not return' and highlights the need to provide extra support to these students and address root causes of lower confidence and motivation to participate within clinical settings, thus ensuring future cohorts of doctors are not disadvantaged by the COVID-19 pandemic.

Medical Students' Preference for Returning to the Clinical Setting During the COVID-19 Pandemic

Learning and teaching in the clinical environment

Experience-based Learning: A Model Linking the Processes and Outcomes of Medical Students' Workplace Learning. Medical Education