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Forged on the frontlines: reflecting on a unique cohort graduating into health

Introduction by Croakey: Few aspiring healthcare workers could have foreseen, when they embarked on their training just a few short years ago, that they would soon find themselves on the frontlines of an unprecedented global health emergency.

Many found their education derailed, delayed or delivered in new and unorthodox ways by the COVID-19 pandemic, examining patients over Zoom and sitting their final examinations online, after months not setting foot inside a healthcare facility. Others were thrust into the coalface, whether on the wards, public health and contact tracing units or in the mass vaccination rollout.

In this piece for Croakey, Professor Robyn Ward, who is Pro Vice-Chancellor Medicine and Health at the University of Sydney, reflects on the experiences of a unique cohort joining the ranks of our healthcare professions.


Robyn Ward writes:

Each year thousands of newly graduated health professionals take their place in our hospitals and community settings. They are absorbed into a system which is always under strain, yet continually strives to deliver high standards of care day in day out.

By this metric, January 2022 was not like any other cohort: two of their four years of postgraduate health training had occurred during a pandemic. Online education simply cannot impart the skills required to graduate as a doctor, dentist, nurse, physiotherapist, occupational or speech therapist, amongst others.

Training to be a health professional requires patient contact and the incremental acquisition of both manual and professional skills. As a medical student (a long time ago) I still remember the patience and care of physicians and surgeons who guided our training. I also remember the patients – from all walks of life – who graphically imparted what it was really like to live with a chronic health problem, to have emergency surgery, to break a bone, or get a diagnosis of cancer.

Professor Robyn Ward. Image credit: Supplied

As students we were afforded the privilege of observing our own profession apply their skills, sometimes in the most challenging of situations. Our training was thus a product of deep immersion in the practice of healthcare, where we learnt to treat each patient as if they were a member of our own family, and to understand our place within the multidisciplinary team.

Ultimately, my teachers became my colleagues, and only then did I really understand the importance of this virtuous cycle of intergenerational experiential training. For health professionals it’s a form of paying it forward.

Forged on the frontline

At this point you might wonder whether an encounter with a young doctor, nurse, dentist or pharmacist in 2022 will be in some way inferior to your experience in previous years?

Training and assessment has — by necessity — been adapted in the face of the pandemic, yet all graduating students have achieved the accredited learning outcomes set by our professional bodies. Despite any imperfections in our educational system, adherence to standards gives us confidence that the capabilities of the 2022 graduates will be comparable to those of previous cohorts. The ultimate adjudication will require further research, building on studies that have already taken place in Australia and internationally.

Sydney University volunteers packing PPE for student placements. Image credit: Supplied

Over the past two years, students have learnt to work in full personal protective equipment (PPE), to engage with patients despite masks, gloves and gowns, and to constantly adapt to the priorities and environment of a health system under unprecedented strain. The pandemic has had a profound impact on every aspect of the operating environment of a health facility, from resourcing health workers and keeping them safe to basic logistics such as cleaning and accessing enough PPE.

The health system was called upon to switch from face to face to telehealth consultations, to establish vaccination hubs with capacity to administer 30,000 injections per week, and to run quarantine hotels. These extraordinary changes impacted on the training of health professionals in dramatic and unpredictable ways.

We estimate that at least 50 percent of health students undertook paid or volunteer work as part of the pandemic response. They pitched in to do everything from taking nasopharyngeal swabs to supporting telehealth and contact tracing efforts. As demand for COVID-19 vaccinations ramped up across the state, more health professionals outside of medicine and nursing were allowed to administer vaccines.

PPE placement packs for students (top); Sydney University students at a COVID-19 vaccination training session (below). Image credit: Supplied

Despite the risks, medical, pharmacy and other students redirected their efforts to the pandemic frontline, working alongside hospital pharmacists at immunisation hubs to draw up and administer vaccines. I was proud to have supported University of Sydney staff developing train-the-trainer and student immunisation programs to ramp up an emergency workforce with best-practice vaccination techniques.

A level playing field

In these ways, the pandemic has broken down some of the traditional barriers between health professionals and students: there has been no time to stand on ceremony with so much to do. In a sense we came together on a level playing field, with both student and clinician equally ill-prepared for what the pandemic offered up. How could we have imagined this?

Although the new skills and experiences were very valuable for the students and provided relief for a much-depleted health workforce, supporting the pandemic response is not a proxy for a health professional qualification.

Over the last two years, many adaptations have been made so that health students could continue their training and acquire the dexterity, professionalism, and knowledge they needed to graduate. One example is the increased use of simulation, which has provided a safe place for skills to be assessed and developed prior or concurrent with clinical experience.

Sydney University students at a COVID-19 vaccination training session. Image credit: Supplied

Like others in our community, students have also faced the imperative of vaccination, and a small percentage have chosen to remain unvaccinated at least in the short term, and have thus potentially forgone a career in healthcare.

A constant among all the changes thrown up by the pandemic was the commitment of practicing clinicians, hospital administrators and university educators wherever I have seen them, to ensuring health students graduated with the skills they needed to enter the workforce.

Maybe this commitment is motivated in part seemingly by self-interest, given we all will need to call on a health professional one day, but I know I speak for others when I say we are proud to have played a role in training the next generation, despite the pandemic. We could not have done this without our hospital partners, who found ways to continue the requisite student rotations during the coronavirus emergency.

Universities and hospitals are crucial partners ensuring a sustainable healthcare workforce, whether it is a crisis or business as usual. We must not take this healthcare ecosystem for granted.

Professor Robyn Ward is Pro Vice-Chancellor Medicine and Health at the University of Sydney


See here for previous COVID coverage via Croakey’s regular COVID Wrap

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