To the Editor:
As an international medical graduate who finished medical school in September 2019, I found resuming my training in Nigeria in January 2020 in a compulsory one-year internship in the middle of the COVID-19 pandemic to be quite challenging. My classmates and I recited the Hippocratic Oath with joy and celebrated with our parents over the successful completion of medical school only to find ourselves being recruited into a battle against an enemy about which the entire world is still learning. It was tough working with a limited supply of personal protective equipment. Several front-liners at my hospital got infected and were admitted immediately into an isolation center. This decreased the number of medical workers available to take care of an already overwhelming number of patients.
There is a shortage of doctors in Nigeria,1 and COVID-19 has caused a further decrease in the number of health workers by stalling medical education in my country. Clinical activities for medical students have been suspended due to government-mandated social-distancing guidelines and are expected to resume when the pandemic ends. There is uncertainty as to when medical students will begin to attend clinics and observe surgical procedures again. The lack of electronic medical records (EMRs) makes it difficult to create platforms to conduct virtual ward rounds.2 In the meantime, students have been encouraged to embrace remote learning. They can join live video lecture sessions via Zoom and access study materials using Telegram and WhatsApp. Participation in remote learning, however, has created additional costs for data and Internet services. Further, my country’s unstable electric power supply has made students miss tests being administered virtually.
Despite these challenges, remote learning has benefits and can contribute to improving medical education. Remote learning has been shown to be convenient and effective,3 and it will help medical schools meet their commitment to produce high-quality doctors during—and despite—the pandemic. Adoption of a hybrid model, where small in-person group discussions are allowed and lectures are held online, should be encouraged. Technology companies should offer discounted Internet services to students and facilitate the implementation of EMR systems. This would help students participate in virtual ward rounds. Students should also be provided opportunities to be involved in research and attend virtual conferences.
During this period, it is important that we embrace remote learning and find new ways to integrate it into medical education and health care delivery. We must also keep our hope alive: Just like a small but frightfully painful kidney stone, this difficult period will surely pass.
1. Ebuehi OM, Campbell PC. Attraction and retention of qualified health workers to rural areas in Nigeria: A case study of four LGAs in Ogun State, Nigeria. Rural Remote Health. 2011;11:1515.
2. Odekunle FF, Odekunle RO, Shankar S. Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region. Int J Health Sci (Qassim). 2017;11:59–64.
3. Autti T, Autti H, Vehmas T, Laitalainen V, Kivisaari L. E-learning is a well-accepted tool in supplementary training among medical doctors: An experience of obligatory radiation protection training in healthcare. Acta Radiol. 2007;48:508–513.