'Till crisis do us part: Are student healthcare workers ready to marry the frontlines?

When the pandemic first hit, the resounding public admiration for frontline health care workers had Ilyana Voth in awe.

As a second-year medical student, Voth was proud to be working toward being a part of this community. She knew it was going to be hard, but she took comfort in her future as a doctor, believing that she too, would one day make a difference.

But a year later, the initial excitement has faded.

“[I see] the expectations of the world on physicians as a result of this pandemic, and their limitations and the stress that they’re under scares me,” said Voth.

As UBC attempts to address the unique anxieties of future nurses, doctors and pharmacists, the question remains whether these changes will be enough to embolden students to one day marry the frontlines — or leave their pre-pandemic aspirations with cold feet.

In sickness and in health

COVID-19 is a big stressor for many frontline health care workers and the threat of getting sick weighs on students too.

“If I do get COVID, that would suck,” said nursing student Connie Ku, who split her first-semester clinicals between the Forensic Psychiatric Hospital and Richmond Public Health. “Not just for me, because I don’t have any chronic illnesses ... but I would feel very, very guilty if I was the person who passed it from clinical setting to clinical setting.”

Students with limited concern about being harmed by COVID-19 exhibit what Voth considers “an invincibility complex.” For many students, getting COVID-19 themselves isn’t scary — but the fear of what it can do to vulnerable people close to them and their patients is one of the many burdens for students to bear.

To have and to hold (a Zoom meeting)

To reduce the risk of exposure to the novel coronavirus, much of the learning for first- and second-year medical and pharmacy students has moved online in accordance with physical distancing restrictions.

“It’s a completely different kind of learning,” said first-year entry-to-practice PharmD student Erin Yang. “It’s really hard to stay motivated some days because … it’s more like you’re just working on this material on your own.”

This online transition has also reduced in-person clinical hours, further impacting motivation.

In the clinical setting, working with patients left Voth with a “wow” feeling that would inspire her to study for hours on end.

“I [felt] like I did something,” she said.“ And that makes me think, ‘Okay, well now I’m going to go home and study for another five hours because that was great. And next time when I walk in there I want to know more’ — but I don’t get that now.”

Dr. Leigh Hunsinger-Chang, acting dean of student affairs for the medical program, acknowledged that the pandemic has “created some specific challenges around isolation, fatigue [and] adaptation to online learning,” on top of the typical stressors students face.

For some medical students, the reduced in-person clinical experience breeds an additional fear: What if I end up being a bad doctor?

“There’s a really common thing that a lot of departments will say around this time and it’s that everyone’s in the same boat,” said first-year medical student Emily Gubski.

“To a degree it’s true: everybody in our year is in the same boat.”

There are students who have gone through the medical program without a pandemic and there will be students studying after it ends. Gubski felt that her group is at an inherent disadvantage due to “missing a lot of clinical experience.”

Despite clinical instruction being more pertinent in the later years of medical school, Voth explained that first- and second-year students typically still expect to gain clinical skills training and job shadowing experience.

To address the reduced in-person shadowing opportunities, Hunsinger-Chang explained that the faculty of medicine introduced the virtual cup of coffee program, a networking resource which helps medical students connect with physicians across the province and learn more about different specialties.

Ku echoed the stress of receiving less in-person clinical experience.

“Once I graduate, I go right into the workforce, and if I don’t know anything, I put myself and the patients in danger,” she said.

The School of Nursing looks closely at competency, according to assistant professor of teaching in nursing Dr. Elisabeth Bailey. She described training to become a nurse as often less about the amount of in-person clinical hours students receive and more about opportunities to “demonstrate those clinical competencies.”

The limited clinical opportunities that students do get, alongside online labs and simulations, are opportunities that the School uses to assess “how students are demonstrating the skills that they need to transition into practice successfully,” Bailey said.

Other faculties also rely on competencies demonstrated online to promote development of skills applicable to the workforce. The faculty of medicine implemented a virtual anatomy lab and the entry-to-practice PharmD program has moved labs online.

Despite UBC’s efforts, the virtual format has some students feeling left behind. “For someone who’s a very tactical or hands-on learner, it’s a lot more difficult to learn,” said first-year entry-to-practice PharmD student Heather Brodoway.

For better or for worse

Most students expressed gratitude toward their programs, acknowledging the professors who are open to extensions and compassionate towards students. The faculty of medicine has made the previous two semesters formative, ideally making it easier for students to pass.

The importance of health care provider mental health has been highlighted by the pandemic, making efforts to prepare students for future wellness challenges essential work. The School of Nursing, the PharmD program and the faculty of medicine have incorporated self-care discourses in their coursework.

The healer’s art program, one resource available to medical students, helps them create “a firm foundation for meeting the challenging demands of contemporary medical training and practice,” according to the website.

What makes this program special, according to fourth-year medical student Arielle Roberts, was its celebration of why she wanted to become a doctor in the first place.

“[We’re] the type-A overachievers,” she said. “We’re very vulnerable to that feeling, like, ‘Oh I made a mistake, therefore, I’m terrible.’”

It can be easy for medical students to get wrapped up in their desire to be the best possible doctor they can be, Roberts explained. This can make learning to treat oneself with grace after a mistake a hard but crucial task.

Roberts acknowledged that the culture of health care toward mental health needs work and the pandemic may facilitate needed changes.

“We spend so much more time talking about the mental health of health care workers and the consequences of burnout … That in and of itself is a hugely positive change,” said Roberts.

Though attitudes toward wellness are adapting, health care students have the added challenge of navigating well-being in the shadow of their frontline counterparts.

“You also feel guilty for complaining because you know that there’s people on the frontlines that are still there,” said Voth.

I now declare you to be med

When asked if they had retained a desire to commit to the health sector, most students were ready to one day take their vows.

But before students can take care of patients, the focus is on taking care of themselves.

“We have struggles. They are not the same as the doctors and they’re not the same as the nurses,” said Voth.

“But they are different — and they’re real.”