For Mehak Singh, the first year of pursuing an MBBS degree at University College Of Medical Sciences (UCMS) in 2019 was fairly smooth-sailing. Then, the pan-India lockdown was imposed in March 2020 and her classes were shifted online.
When the situation improved, physical classes resumed but again discontinued in the second wave. Attending online seminars and classes were doable, but what majorly impacted her was missing out on practicals.
"There are two requirements in the medical stream. First, you read, secure good marks and top the exams. And second, you become a good doctor. I don’t doubt myself about getting good marks, but my confidence is low as I do not have as much (on-ground) experience, such as going to different departments, talking to people and understanding the complexities… as my seniors have. I feel less prepared," said Singh, now a second-year MBBS student.
Main worry: No practical experience
Singh voices the lament of medical students and their tribulations in the past year-and-a-half in tackling the pandemic. Along with healthcare workers, even MBBS final-year students and PG students were roped in when hospitals were overwhelmed with sudden surge in COVID cases.
Overnight, the focus shifted towards tackling the COVID situation, and in the process, academics has taken a hit.
Dr Vishakha Arya, a third-year PG student, Pathology, Lady Hardinge Medical College, says the theoretical bit can be studied. "But for pathology, we need slides and microscopes. This gap can still be remedied to an extent. So if earlier interns gave their 100 per cent, now they will have to put in 200 per cent. A lot depends now on the individual and his/her ability to take up challenges. For instance, in my time, OTs were not functional and surgeries were not being performed. So, we did not receive many specimens. But I experienced these in my first and second years. However, those who joined last year hardly got that opportunity," observed Arya.
Dr Setu Gupta, who is pursuing a super-speciality course at AIIMS in Endocrinology, chose this "premier institute" because the facility deals with rare diseases, which widens the scope of learning for medical students.
"Getting a chance to deal with rare cases is the biggest advantage at AIIMS. I didn't get to witness and discuss these cases, and this has undoubtedly affected my course. However, I can catch up as my field involves knowledge-based studies, but those who were mostly affected are the ones who undertook surgery," said Gupta.
"Thesis work at PG level was affected as there were hardly any cases. OPDs - where we see thousands of patients - were shut down. Some have their thesis on emergency and follow-ups which didn't take place. The gastro department remained shut for many days, and all manpower was all diverted for COVID duty. To go on field, you must have good (on-duty) experience, but that was largely missing. In fact, many medical students developed suicidal thoughts and faced severe burn-outs owing to stress," commented Dr Dinesh Gora, Senior Resident, Trauma Surgery and Critical Care, AIIMS.
Professors trying to offer a helping hand
Meanwhile, professors and senior doctors are rising to the challenge to bridge the gap in academics. Last year, when COVID cases began dipping, the Resident Doctors' Association of Maulana Azad Medical College demanded restarting academic courses and non COVID-19 services in a phased manner.
Last month, resident doctors of AIIMS appealed to the management to reopen the trauma centre for non-Covid patients as most of the beds were lying vacant.
Dr Sandeep Mishra, Professor of Cardiology at AIIMS, explained that medical education is largely categorised in three parts — first is theoretical, second is practical and third is skill-based education. He observes that MBBS students were comparatively least affected as they mostly have theoretical learning and a bit of practical cases.
"But for MD/MS, the learning is case-based or transformative where the theoretical is less. Even for super-speciality students, the learning is mostly skilled-based but there were no cases coming in. For instance, students need to learn echocardiography skills but if there are no cases coming in, how will they learn about it?" said Dr Mishra.
About overcoming the gap, he added that AIIMS is trying to allocate posts for those pursuing specialised courses so that they can stay back and learn skill-based education. "We are not coming in their way of getting the degree. But what we are offering is if after a degree anyone wants to stay back for another year, we are trying to see if they are paid a good salary and pick up the required skill. The time is already lost but at least we have sufficient time to pick up the lost phase. Now that we are getting cases back, many of the specialised classes are happening," he noted.
Debate on online learning continues
At UCMS, affiliated to Delhi University, a research paper was published on the need to shift laboratory teaching to online mode. A Demonstrate-Engage-Assess framework for online practical teaching of preclinical subjects (DEAPP) was developed and implemented.
Feedback was obtained from 103 first-year students and six teachers from preclinical subjects. Around 62-80 per cent students were satisfied with online practical teaching or agreed with the benefits of various online tools used in the teaching sessions.
"Teachers found the framework more planned and resource-efficient, while students found it to be more engaging, enjoyable and motivated for learning. No face-to-face interaction, non-experiential learning, and adaptation to newer technology were the main barriers perceived in online practical laboratory teaching. The DEAPP framework was found to be feasible for rapid online transition of practical lab teaching and reported by the students and teachers as engaging, enjoyable and motivated learning," the study noted.
Dr Neelam Vaney, Director Professor and Head, Department of Physiology, UCMS, and GTB hospital, who is also researcher of the study, noted that earlier it was difficult in the medical profession
without undertaking practicals.
"But gradually this has settled down. We would send YouTube videos or record videos and send it to students. We are trying to make things interesting virtually, but making students understand everything is not easy. Virtual teaching can never match what is taught in classroom," said Dr Vaney.
Dr Satendra Singh, MD & Professor of Physiology, UCMS, pointed out that the academic career was also hampered due to cancellation of exams and allotting medical students in COVID duties.
"The government's move to postpone PG was not good. It was a difficult time for many postgraduate students when NEET PG was postponed as they had to do extra duty in COVID wards which proved mentally exhausting. The students were already worried about their own exams. Then, despite coming in from different specialities, all of them were designated to COVID wards. Though some universities issued certain relaxations such as submission of thesis after five-six months, for MBBS students, it was a watershed moment as they had so many new elements in their curriculum," he noted.
Decisions for med students
Since 2020, the Delhi government has been engaging MBBS and PG students, and BDS doctors in various Covid duties, while resident doctors’ association feels the students need more skills and are at a higher risk of contracting infection
In November 2020, the Delhi Government allowed its COVID-19 designated hospitals and medical facilities to engage fourth and fifth-year MBBS and PG students, interns as well as BDS doctors to assist the duty doctors for effective COVID management.
It was stated that MBBS students and BDS doctors have to be paid an honorarium of Rs 1,000 for an eight-hour shift and Rs 2,000 for a 12-hour shift per day. Interns engaged by the COVID hospitals will receive an honorarium over and above their stipend. Federation of Resident Doctors Association (FORDA), in a letter to Delhi Health Minister Satyendar Jain Sunday, objected to this order, saying undergraduate medical students are "not skilled enough yet to be posted for Covid duties". It said: "They are still under training to acquire necessary clinical skills and are at higher risk of contracting the infection."
In April this year, the state government again ordered that 4th and 5th-year MBBS students, interns and BDS doctors be engaged to assist in the treatment of COVID patients to meet the increased demand for manpower in all Delhi government hospitals.
In May this year, PMO approved postponing the NEET-PG by at least four months to make a large number of qualified doctors and medical interns available for pandemic duty. It stated that all such professionals who complete 100 days of duty will be given priority in forthcoming government recruitments and honoured with the Prime Minister's Distinguished COVID National Service Samman.
Final-year MBBS students were utilised for providing services like teleconsultation and monitoring of mild COVID cases after due orientation under the faculty’s supervision. Medical interns worked under the supervision of their faculty. BSc or GNM qualified nurses were utilised in full-time COVID nursing duties under supervision of senior doctors and nurses.
Major medical examinations rescheduled
In 2020, the National Eligibility cum Entrance Test (NEET) for medicine was postponed twice and finally took place in September
In 2021, the NEET UG and PG exams were rescheduled twice in view of COVID-19 - from January 10 it was rescheduled to April 18. These finally took place on September 12 and 11
Over 16 lakh students took NEET UG. Nearly 1.6 lakh candidates appeared for NEET PG