We analysed a dataset of 155 reflective entries. The pandemic appeared to impact medical students’ PIF primarily in five areas:
a) Awareness of social role of the doctor
b) Awareness of global role of the doctor in addressing health inequities
c) Becoming a member of the wider healthcare community
e) Appreciation of person-centred care
f) Awareness of personal needs and self-care
Awareness of social role of the doctor
Students reflected on their social responsibility to educate their communities about Covid-19, such as raising awareness regarding symptoms and how spreading the infection could be prevented. The students also expressed their desire to contribute to other local efforts through charity fundraising, volunteering in healthcare settings, or through more simple methods such as role modelling mask wearing. Such activities provided them with a sense of purpose and a feeling of being useful. For many students the pandemic also highlighted the limited access to medical provision for their local communities. This motivated students to advocate for vulnerable patients and to appreciate the value of being a socially accountable doctor.
“I started volunteering at a care home […] I was horrified at the discrimination that individuals faced when trying to access healthcare, refused care or resources such as chemotherapy and surgery. It was in this care home that I met Chris – a man diagnosed with Down syndrome and dementia. Chris contracted COVID and was refused treatment at most public hospitals – he passed away. This piece [the creative response submitted] focuses on the hopelessness I felt as a medical student trying to save someone who society had sentenced to death. Chris will inspire me to continue to be the best doctor I can possibly be.” – 3rd year, Pretoria, South Africa
Awareness of global role of the doctor in addressing health inequities
Students referred to the pandemic highlighting significant inequality both in their own countries and across the world. They commented on socioeconomic and health disparities, unemployment, and homelessness, with some highlighting struggles in their own countries on issues such as government corruption and poor infrastructure. The experience and recognition of these injustices and inequities served as a point of inspiration to the students in their future role as a doctor, and that addressing some of these challenges, such as advocating against racism and discrimination, would form the kind of doctor they would like to become.
“This pandemic has further exacerbated wealth, racial and health inequalities. As long as we refuse to actively address racism in medicine and medical education, we cannot be good doctors. We must recognise our biases and call others out on theirs. Silence is complicity. As a Black woman, I want to work in a system that would advocate for me; as a doctor and a patient” – 3rd year, Queensland, Australia
“I chose this painting because my mind has really been buzzing thinking about marginalized communities in my country, wondering how they’re coping. I would like to find ways of having much more accessible health care to people in rural areas, where the standards of care will be better, affordable and around the clock” – 3rd year, Nairobi, Kenya (Fig. 2)
Becoming a member of the wider healthcare community
Students reflected upon the importance of working collectively in multi-disciplinary teams, including healthcare professionals, charities, and governmental organisations.
“My illustration reflects the heroic efforts of healthcare workers in bringing patients back from the brinks of death. This is reflected as a person drowning to the ocean depths while chained to a prison ball, while healthcare workers try to pull him out of the water. There is emphasis on teamwork and multi-disciplinary teams, which is paramount in our future practice in medicine.” – 1st year, Sydney, Australia (Fig. 3)
Medical students expressed a sense of pride at being part of a healthcare community that makes a great impact on people’s lives, even in the circumstances where students had to deprioritise their own needs for the benefits of others:
“These students, who a month back were partying, studying and having a great time, were suddenly required to get into PPE suits and in literal sense " save the world". This makes me proud of the medical fraternity and fortunate to be a part of it” – 3rd year, Jhansi, India
Some students also suggested that the pandemic was a call for greater unity beyond the local or national level, and an opportunity for a truly global medicine:
“Although medical students around the world are separated by thousands of kilometres of land, we are all connected by the same energy, the same goal of being part of the medical community and helping as many people we can” – 6th year, San Luis Potosi, Mexico
Appreciation of person-centred care
Students expressed that the experiences of the pandemic allowed them to recognise more than ever the importance of person-centred approaches, such as active listening, empathy, and understanding of the patients’ needs. They expressed their motivation to teach and adopt person-centred care in their role as future doctors. As students mentioned:
“I’d like to advocate for mental health and teaching people the empathetic dialogue of identifying when someone is not O.K. As a future doctor I aim to make the necessary changes personally and systematically so that patients feel cared” – 1st year, Queensland, Australia
“It has made me realise that when I qualify, I hope that I am able to show my patients that I really care about helping them to the best of my ability and to ensure that they feel supported and treated as individuals. I hope to care for my patients in the future in the way that I would like to be treated if I was a patient” – 4th year, Buckingham, UK
Awareness of personal needs and self-care
The pandemic inevitably had a strong impact on medical students’ mental health and wellbeing. Students expressed feelings of loneliness, helplessness, frustration, anxiety and depression. Some students also witnessed doctors making personal sacrifices to serve their communities, such as putting themselves in danger, being overworked and stressed, and prioritising the wellbeing of others ahead of themselves. For some students, not unexpectedly, these observations caused distress, for example:
“I think to myself that one day, I will get to help people like my senior colleagues and my heart swells with joy. But when I see how overworked doctors are, how stressed they look, and not to mention how exhausting medical school is, I can’t help but feel a little discouraged.” – 4th year, Lagos, Nigeria
Such observations triggered students to develop self-awareness, understand and prioritise their own health needs. For example, some students became increasingly aware that success, recognition, and validation might not bring life satisfaction. As a result, these markers of external validation became less important, for example:
For the first time, I saw my life and pursuits clearly - chasing after success, recognition, validation, and all that I thought would satisfy but never did.” – 1st year, Manchester, UK
“"_missed calls" aims to capture this pressure and the feeling of only having myself for company. My isolation accentuated my other symptoms and propelled me into a depressive state. Recovery began with prioritising my health before work and visiting my GP. My experience during these past months has made me examine my behaviour before lockdown and acknowledge my toxic productivity. I contemplated whether my deterioration was inevitable due to my inability to relax and how this could affect me in the future” – 3rd year, London, UK (Fig. 4)
Some students also mentioned that they discovered new coping mechanisms, such as mindful walking, engaging with the arts, and appreciation of life and nature.
“I took this photo during week 8 of lockdown. I was bored and lacked motivation. I decided to pick up my camera and photograph random things that I would often overlook. I decided to look up at the clouds and how they were still moving despite the chaos on the ground. This allowed me to truly appreciate the small things and the beauty of everyday life.” – 2nd year, Johannesburg, South Africa
“In an attempt to salvage my life, I decided to fix my sleep and wake up before dawn […] Surprisingly, in those silent and peaceful hours I realized how blessed I was to be able to see the beauty of this earth. Watching the sunrise and witnessing nature come to life helped me unravel the chaos inside me and gave me hope.” – 5th year, Riyadh, Saudi Arabia