Clinical support during COVID-19: An opportunity for service and learning? A cross-sectional survey of UK medical students

Figures & data

Figure 1. The spectrum of service and learning, adapted from Furco Furco (1996).

Figure 2. (A) Duration of clinical support in weeks; (B) Hours spent providing clinical support per week; Clinical support role performed for (C) all year groups and (D) divided by year group.

Figure 3. Opinions on the benefit of the first lockdown period on medical education and preparedness for FY1 across all students who provided clinical support, students who did not, final-year students who provided clinical support and first-year who provided clinical support for (A) perceived benefit for medical education career, and (B) perceived preparedness for FY1.

Table 1. Multiple regression analysis of predictors of benefit for students’ medical education or career; preparedness for FY1; and aggregate clinical skills performed.

	Perceived preparedness for FY1		Perceived benefit for education or career		Skills performed
Predictors	Estimates	p	Estimates	p	Estimates	p
Year of study	0.04	0.599	−0.04	0.598	4.06	<0.001
Age	−0.06	0.014	−0.05	0.04	−0.25	0.503
Role – Allied healthcare professional/technician	−0.29	0.516	−0.46	0.326	−2.87	0.705
Role – Carer/care assistant (in hospital or care home)	−0.12	0.737	−0.22	0.547	1.47	0.8
Role – Interim foundation year one (or equivalent)	1.12	0.002	0.8	0.035	53.35	<0.001
Role – Doctor’s assistant	0.81	0.033	−0.58	0.141	13.74	0.029
Role – Healthcare assistant	0.18	0.536	0.11	0.712	4.09	0.413
Role – Other	0.02	0.951	−0.05	0.893	−1.07	0.852
Role – Vaccinator	−0.4	0.35	0.1	0.832	−6.34	0.375
Gender – Male	0.06	0.707	−0.16	0.306	0.58	0.809
Gender – Non-binary/third gender	−0.33	0.6	−0.73	0.265	9.14	0.373
Gender – Prefer not to say	−0.33	0.706	−0.56	0.54	29.28	0.041
Number of hours spent volunteering per week	0.02	0.001	0.01	0.383	0.42	<0.001
Existing role held previously (Yes)	−0.35	0.107	−0.27	0.233	1.63	0.65
Duration of volunteering in weeks	0.03	<0.001	0.03	<0.001	0.58	<0.001
Graduate entry medicine student	0.2	0.321	−0.19	0.365	8.05	0.014
Allocated a named supervisor	0.31	0.042	0.34	0.032	5.7	0.021
Ethnicity: white vs. non-white	−0.02	0.914	0.14	0.43	0.59	0.833
Observations	372		374		367
R^2/R^2 adjusted	0.303/0.267		0.175/0.133		0.674/0.656

Bold values denote p <0.05 = significant.

Figure 4. Number of times clinical skills were performed during the first lockdown for: (A) students who provided clinical support (all year groups); (B) students who did not (all year groups); (C) Final year who provided clinical support; D) First year who provided clinical support. Data is presented as the percentage of students who performed each skill on a scale of: None, Observed, Assisted, Performed one to five times (independently), Performed six to ten times (independently), Performed 10+ times (independently).

Table 2. Themes identified from qualitative analysis relating to how clinical support influenced learning.

Complementing the medical school curriculum
Knowledge and skills	‘It gave me a lot of hands on experience, allowing me to practice clinical skills which I'd learnt’ (nr 34) ‘[I] have developed communication skills, in particular information giving and answering tricky questions’ (nr 308) ‘Increased my exposure and experience with lots of different unwell patients which was really useful experience’ (nr 950)
Changing approach to patients	‘I’m more aware of peoples [sic] needs beyond the pure ‘medical” things and am more willing to actively try to help with these in non-volunteer settings’ (nr 528) ‘It’s given me a lot more confidence and compassion because I've really felt how the patients have been feeling during this pandemic. They really spoke to me about how they were feeling, what they were thinking, what and who they were missing.’ (nr 644)
Developing personal attributes	‘It has made me quite hard in the sense that very little shocks me and I can now manage intense situations better’ (nr 652) ‘It has given me a huge amount of confidence to be able to handle any type of emotional state…’ (nr 78)
Depends on support for development	‘Much less time spent on learning the material needed for exams, still expected to keep up with this during volunteering, had very little teaching time from drs, working shifts as a HCA isn’t a substitute for organised teaching from Drs. Working night shifts difficult to balance with studying as sleeping schedule is disturbed’ (nr 759) ‘Occasionally there have been weeks I have signed up for too many shifts and have missed out on teaching opportunities as feel unable to let teams down by dropping out. Potential revision time reduced.’ (nr 173) ‘Did not have the drive or energy for academic study (additional learning) especially as we did not have any recorded or live streamed lectures.’ (nr 825)
Impact of role on preparation for practice
Alignment of role with practice	‘Volunteering helped me transition from being a medical student into a FY1. Through clinical exposure I was able to take on responsibility for patients, complete ward based tasks and procedure’s in a supported environment.’ (nr 911) ‘when you are reviewing a patient on your own, deriving your own management plan and discussing the plan over with a senior… it is far better when one is actively involved with a patient’s care’ (nr 877) ‘I learned more about what the F1 does when on call and doing ward cover, I learned how they prioritise jobs and how they handover.’ (NR 556) ‘Improved situational awareness on ward and working relationship with nursing team’ (nr 578)
	‘Wasn’t always relevant, tasks like stocking cupboards and turning patients didn’t further my learning’ (nr 770)
Nature of role	‘…more realistic than an apprenticeship could ever have provided’ (nr 535) ‘…being given the responsibility to do activities as a volunteer aided my learning a lot more than just being a passive observer with no responsibility as is typical for a medical student’ (nr 217)
	‘Ill-defined role, no formal rota, unclear reporting lines … mixed messages from the medical school as to whether I could accept this role or not, and for how long, and what responsibilities I could take on.’ (nr 820) ‘It is definitely emotionally and physically exhausting and I'm glad we’re only allowed to do one shift per week’ (nr 1135) ‘I contracted covid and that has had long-lasting effects on my health’ (nr 985)
Understanding how health systems work
Practical experience of health systems	‘Much better understanding of the “workings” of the hospital and structure – i.e. clerking, referrals etc.’ (nr 286)
	‘Showed me how underfunded the NHS is, how much money is wasted, and how hard people work. Especially how people go above and beyond what they should to provide care and how under supported and appreciated they are.’ (nr 51)
Awareness of roles within health systems	‘Massive appreciation and respect for the nursing team who are on the ward with patients 12 h a day. Also health care support workers who are the ones that get to know patients the best- so I will know as I doctor if I want to know how a patient has changed then these are the perfect people to ask as they actually look after the patients all day.’ (632)
	‘Fairly dramatically changed my view of the hierachy [sic] and how poorly connected the medical and nursing aspects [of] a hospital are… it made me realise what a hard, grinding task it is being a HCA and how they are undervalued and belittled.’ (nr 29)

FY and F1 are commonly used abbreviations for FY1.

FurcoA. 1996. Service-learning: a balanced approach to experiential education the service-learning struggle. In: TaylorB, editor. Expanding boundaries: serving and learning. Washington (DC): Cooperative Education Association. p. 2–6.

 Google Scholar

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.