Even a couple of months without face-to-face clinical contact has a significant impact.
The past 12 to 18 months have been challenging for all. It has been particularly disruptive for trainees, especially with regards to examinations and meeting other training requirements.
For rheumatology trainees, this has meant reduced face-to-face training and clinical contact – a necessity in a specialty that relies so heavily on physical examination to diagnose patients and guide treatment. In most states and territories, rheumatology trainees typically complete two years of core training, so even a couple of months without face-to-face clinical contact has a significant impact on the quality of training.
Further, as a result of increased telehealth, there have been significantly fewer opportunities for trainees to learn and practice essential procedural skills, such as joint aspirations and injections.
The silver lining has been that many trainees have developed new skills practising tele- and video-conferencing medicine, something that is not usually a common experience in training environments.
There has also been a large loss in formal education programs due to the cancellation of conferences, regular teaching sessions and other educational programs over the past 12 months.
In response, most have now moved to online or virtual platforms. This has provided significant benefit in allowing trainees better access to conferences such as EULAR, ACR and ARA by reducing the cost and travel burden which can often be prohibitive for those trainees who are more regionally based and for those with children and other carer responsibilities.
These are the sorts of innovation in training that I hope will continue post covid-19, allowing both hybrid virtual and face-to-face options that will increase access and flexibility for trainees and fellows who are bound by other commitments.
However, the shift to predominantly online teaching, conferences, meetings and other educational events means that trainees have had less social interaction with their peers, which can be isolating at times. Furthermore, the convenience of online teaching must be balanced by the potential for reduced effectiveness of teaching sessions which often occurs when performed online as opposed to in person.
The other affected field for rheumatology trainees has been access to research opportunities and support for research. The pandemic has refocused resources away from general research, and efforts have naturally been on covid-19 research.
Watching this research being rapidly developed has been enlightening, but has come at the cost of other research work streams. Research studies have also been impacted by the limitations of recruiting patients due to safety concerns. The Royal Australasian College of Physicians (RACP) has recognised this and has introduced flexibility with research projects for advanced trainees.
Further, given the international border closures and domestic border lockdowns, there has been a valid reluctance to access fellowships and other research position opportunities that may be available interstate or internationally. This again puts pressure on trainees seeking non-core training positions, both within and outside of Australia.
Delays to examination processes led to the interim development of “Provisional Advanced Trainees (pATs)” – that is, trainees with a provisional AT position dependent on passing the RACP clinical examination. This has proved challenging for these trainees as they had to balance advanced training requirements and studying for examinations. It has also been challenging for rheumatology departments to support pATs studying for exams, and pATs failing the clinical examination has further impacted the workforce.
It is clear that covid has created a lot of disruption to training, and this article has focused particularly on the impact of the virus on education and training. However, it should also be mentioned that all the above factors, in addition to the usual pressures of training and service delivery, have truly impacted the wellbeing of trainees. This, combined with the lack of social events and connectedness with other trainees and the rheumatology community, has been difficult for everyone.
As things continue to be relatively uncertain at least for the next several months, it is clear we have a lot to do to compensate for the significant negative impacts of the pandemic on all medical training. We must continue to support each other as trainees and fellows, and also embrace the innovative changes that have occurred as a result of the pandemic and aim to carry these on into the future.
The ARA Early Career Group (ECG) would like to highlight our Online Learning Resources List collated during COVID-19 to help supplement teaching and education.
And please feel free to get in touch if you would like to add any other resources: ecg@rheumatology.org.au
Dr Hashim Abdeen is a rheumatology trainee at Gold Coast Hospital & Health Service and a member of the ARA ECG Steering Committee.
