Published on 21st April 2020 by Premela

All prospective medical school applicants will have heard the phrase “lifelong learning” and it alludes to the requirement of all doctors to continuously update their knowledge throughout their careers.

This is made necessary by the array of new evidence, drugs, surgical techniques, and even diseases, such as COVID-19, which are emerging within the field. 

In this article, I wanted to outline how the medical community has learned in the wake of COVID-19 and end with a few take-home messages that are relevant for your applications.

#1 – Learning from past pandemics

Between 1900 and the present there have been several global pandemics and notable outbreaks:

  • 1918-20 – Influenza A H1N1, ~17,000,000 deaths
  • 1957-58 – Influenza A H2N2, ~2,000,000 deaths
  • 1968-69 – Influenza A H3M2, ~1,000,000 deaths
  • 1960-present – HIV ~32,000,000 deaths
  • 2002-4 – SARS, 774 deaths
  • 2013-16 – Ebola virus, ~11,300 deaths
  • 2015-16 – Zika virus, 53 deaths
  • 2019-present – SARS-CoV-2, ~ ~88,338 deaths (as of 08/04/20 – JHU website)

Note – this is not an exhaustive list but a sample.

Just from these examples, you can see that several viruses and their associated strains have the potential to cause outbreaks. However, each has a different profile with regards to variables such as:

  • Infectious period – the duration of illness where an individual can transmit the infection to another
  • Mode of transmission, e.g. respiratory droplet vs oro-faecal vs sexual contact
  • Disease severity, morbidity and mortality

Hence, the rate of outbreak progression, the peak of case volume, and the duration of the outbreak can vary drastically. However, there is one influential factor that is common to all outbreaks and unrelated to viruses – the volume and type of human interactions.

Epidemiologists have evaluated the effect of so-called “social distancing” measures in previous pandemics, either in observational studies or in simulated mathematical outbreak models and their findings indicate it can be a powerful tool. Examples of measures which may have significant effects include:

  • Reactive school closure – closing a school once there is a confirmed case of a given infection within the school
  • Pro-active school closure – closing a school before there is a confirmed case of a given infection
  • Workplace closure and working from home
  • Voluntary isolation of positive cases
  • Voluntary quarantine of individuals who have had close contacts with those who are positive for a given infection
  • Cancellation of mass gatherings

The UK government have implemented all of the above measures and if you are interested in diving into their evidence base, you can find all the relevant articles, summaries and consensus documents that their Scientific Advisory Group for Emergencies (SAGE) is utilising here.

#2 – Learning from other countries

Whilst the current outbreak of SARS-CoV-2 began in China, as of 08/04/20, cases have been reported in 184 out of 195 countries according to the Johns Hopkins University Coronavirus resource centre.

It has been interesting to observe the variation in approach between countries. Japan, South Korea, Taiwan, Singapore and Hong Kong have taken many plaudits for their swift implementation of widespread testing, contact tracing and social distancing measures.

Their actions appear to have been rewarded as their case and death curves are noticeably shallower than several European countries. Within Europe, we have seen Italy, Spain, France and the UK suffer quite significantly whilst Germany has, seemingly, been able to exert more control. In fact, our Chief Medical Officer Prof Chris Witty has publicly stated that his team were trying their best to evaluate what made the German strategy so effective.

There are of course differences in geography, politics and culture between countries which may significantly influence the shape of local outbreaks, but the rapidly progressive nature of an outbreak necessitates that we open our minds to the methods of other countries.

#3 – International Clinical Research Collaboration

Putting epidemiology to one side, for healthcare staff on the frontlines, understanding how COVID-19 presents, progresses and ultimately leads to one’s demise was impossible at first. It was in exactly zero of our textbooks and we had exactly zero virus-specific treatments. When faced with this problem, the first call of action is to collect data on the clinical characteristics of the condition and report findings in the form of a “case-series” and this is exactly what was published on the 21/12/19 on China’s CDC weekly website and journal.

Since then there have been numerous further reports, studies and trials from countries around the world and major journals including the Lancet, the British Medical Journal and the New England Journal of Medicine have dedicated and free-to-access COVID-19 hubs where clinicians can review the most recent evidence on the subject.

#4 – A National Effort for Evidence-Based Guidelines

We are very fortunate in the UK to have several national, independent bodies that are well funded to achieve their aim of producing evidence-based clinical guidelines.

The National Institute for Health and Care Excellence (NICE) have produced several summaries on managing COVID-19 in specific patient groups and the British Medical Journal have made their “Best Practice” COVID-19 overview free to access online. 

Moreover, at the hospital level, these summaries and guidelines are made even more concise and tweaked to account for local variations in resources and service structure. Most hospitals will go a step further and run dedicated teaching sessions for their staff members as well.

Overall, having organisations which produce guidelines can drastically reduce the amount of reading that individual doctors have to do, and it allows departments to work in sync across the country. In fact, having standardised diagnostic criteria and treatment algorithms also makes it easier to collect data and conduct further studies to answer questions as they arise.

#5 – Take home messages for prospective medicine applicants

COVID-19 is perhaps a once or twice in a century event, but it has forced doctors around the globe to showcase their ability to learn rapidly, conduct research, and adapt their practice.

These are a few of the key traits which medical schools assess for in their applicants and hence, it is crucial that you address them in your personal statement and interviews.

Firstly, it is important that you elaborate on your own evidence of learning beyond your school curriculum and don’t be afraid to discuss non-academic examples.

Sporting, musical or theatrical achievements all involve extended periods of practice, performance under pressure, and creative expression. Your ability to learn in those domains can be just as transferable to medical school as an Extended Project Qualification or long-form essay.

Secondly, discussing strategies for studying can show a level of maturity which will set you apart from other candidates. There is a wealth of information, accessible with the tip of your finger, and the most effective clinicians of the modern day are those who combine excellent retention of foundational concepts with an efficient strategy for accessing the most reliable information.

In medical school, it is easy to get lost in textbooks or be fatigued by PowerPoint presentations and learning how to select your resources, identify key topics and study consistently is crucial for striking a balance between achieving breadth and depth of understanding.

Finally, remember that you are applying not only for a place in medical school, but to the medical profession. As the COVID-19 pandemic highlights, your learning is not complete when you are granted the title of doctor, but rather, it has only just begun.

To cope with the ever-changing nature of the field, doctors must regularly admit ignorance, be willing to self-educate, and ask for help when needed. However, grappling with this can be an incredibly pleasurable and exciting endeavour, even if it does carry an element of struggle.

Words by: Prakhar Srivastava – check out his blog here.

Other content you may enjoy:

10 Ways to Look After Your Mental Health in Isolation

5 Things To Do From Home To Support Your Medicine Application

COVID-19 – The Best Work Experience Alternatives


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