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Education Article

Learning to practice medicine during COVID-19 and mucormycosis epidemics: an intern perspective from India

Bansal, Varun V. MBBSa,; Ozair, Ahmad MBBSb

Author Information
doi: 10.1097/SR9.0000000000000027
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Abstract

The COVID-19 pandemic had a significant impact on undergraduate and postgraduate clinical training worldwide, including in India1,2. Clinical rotations for students were stopped throughout 2020 across most Indian medical schools while most affiliated hospitals were converted to dedicated COVID care institutions3.

Medical school in India includes 4 and a half years of didactic education followed by a compulsory clinical internship year. With COVID cases overwhelming hospitals in India, students in their third and fourth years had to obtain their clinical training without having the privilege to examine, present, and manage patients. Many medical schools transitioned to remote and virtual education, with multiple downstream effects4. Such was the case in our medical schools where we spent our entire fourth year discussing virtual cases and attending lectures through video-conferencing applications.

While things began easing in early 2021, a new COVID-19 wave struck the entire breadth of the country, but this time carrying with it the advent of the rhino-orbito-cerebral mucormycosis (ROCM) epidemic5. Having passed our medical school examinations in the summer of 2021, we began our internship training amidst these dual pandemics. Over the last 2 months, we have worked in dedicated COVID and non-COVID wards, spanning various medical, surgical, and nonclinical departments, along with working in wards dedicated solely to ROCM cases.

We experienced a steep learning curve, being in the frontline from the very beginning of our training. We had to acquire basic skills and clinical knowledge in an environment that challenged us physically, mentally, and emotionally. While working in the COVID ICU, we performed phlebotomies and arterial punctures in patients with feeble pulses and a poor volume status because of sepsis and systemic inflammatory response syndrome, which are common complications of severe COVID infection. In addition, we wore double gloves with our standard personal protective equipment kits, making it more difficult to palpate veins. We faced similar difficulties while learning other procedures, including bladder catheterization, inserting nasogastric tubes, and securing IV lines.

While working in the ICU, we yearned to connect with our patients, having missed out on a year of in-hospital training during the lockdown period. However, we could not communicate with most of them as they were either ventilated via nonrebreather masks that are attached snugly to the face or were intubated. Eventually, we encountered death for the first time during our internship. As our institutions are referral centers for neighboring cities, we cared for many critically ill patients and observed very high mortality rates amongst severe COVID patients. We informed our supervisors when oxygen saturations dropped and monitors beeped incessantly, only to realize that we cannot revive our patients. We experienced this series of events within a matter of days on the frontline.

When working in non-COVID facilities, we noticed several shortcomings in our hospital systems. As a large share of resources and personnel were diverted to COVID facilities, we often worked for longer hours in non-COVID areas. Stocks of syringes, medications, and equipment were exhausted, and critical investigations were delayed. We even faced significant shortages of Amphotericin B in our ROCM wards6. Within a few weeks, we became an integral component of a fragile and overburdened system. To add to our perils, we observed that patients often presented with their ailments in complicated and advanced stages during the pandemic7. The delay in their presentation may be related to a difficulty in commuting because of lockdowns and fears of contracting the virus in a hospital catering to COVID-positive patients parallelly.

As interns, we are studying for licensing and competitive examinations to apply for residency positions alongside our medical duties. We have resorted primarily to remote learning tools, such as recorded lecture videos and live webinars via online platforms. Furthermore, the technological surge during the lockdown period enabled us to participate in many conferences and present research papers and posters virtually over the past year.

We belong to a generation of future physicians who began their training in unforeseen times. We have worked for extended hours in challenging conditions while trying to strive academically. Hopefully, by the end of our intern year, we will be resilient and diverse in our approach to our medical and surgical practice with the knowledge of pandemic preparedness. Our experience will be of great importance as we prepare for the third wave of COVID cases in India. We have grown tremendously and connected with people all over the world over the last year and will continue to do so in our journey towards becoming academic surgeons.

Ethical approval

None.

Sources of funding

None.

Author contribution

V.V.B.: performed a literature review and prepared the manuscript. A.O.: conceptualized, prepared, and revised the manuscript.

Conflicts of interest disclosure

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Research registration unique identifying number (UIN)

None.

Guarantor

None.

References

1. Syal A, Arya Y, Gupta M. Impact of COVID-19 on medical undergraduate students’ academics and its ramifications. IJMS 2021;73:26–29.
2. Upadhyaya GK, Jain VK, Iyengar KP, et al. Impact of COVID-19 on post-graduate orthopaedic training in Delhi-NCR. J Clin Orthop Trauma 2020;11(suppl 5):S687–S695.
3. Pandey N, Kaushal V, Puri GD, et al. Transforming a general hospital to an infectious disease hospital for COVID-19 over 2 weeks. Front Public Health 2020;8:382.
4. Singal A, Bansal A, Chaudhary P, et al. Anatomy education of medical and dental students during COVID-19 pandemic: a reality check. Surg Radiol Anat 2021;43:515–521.
5. Ravani SA, Agrawal GA, Leuva PA, et al. Rise of the phoenix: mucormycosis in COVID-19 times. Indian J Ophthalmol 2021;69:1563–8.
6. Explained: Why there is shortage of black fungus drug in India. The Indian Express. June 2, 2021. Available at: https://indianexpress.com/article/explained/shortage-of-black-fungus-drug-cases-india-7330327/. Accessed June 21, 2021.
7. Scheijmans JCG, Borgstein ABJ, Puylaert CAJ, et al. Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020. BMC Emerg Med 2021;21:61.
Keywords:

Medical education; Internship; COVID-19; Mucormycosis

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of IJS Publishing Group Ltd.