Unprecedented. This was the word used time and time again, in public speeches and email communications; in conversations with colleagues and planning meetings.
As our personal lives became dramatically affected, so did our professional ones, with never-ending lists of questions – what do we do about face-to-face contact with patients? How do we manage suspected cases? Who should be shielding? How will my job change now?
Years of experience in general practice were suddenly not enough to prepare for the chaos and challenges that ensued. So what happened to those of us who do not yet have years of experience and who have yet to find their feet as GPs? The COVID-19 pandemic has been a test for all of us, but I want to draw attention to the profound effect it has had on GP trainees.
When I started training
On Wednesday 7 August 2019, I woke up with a huge grin on my face – I was finally a GPST1! Over the weeks that followed, I attended various inductions and events hosted by our local training scheme and couldn’t believe the amount of brilliant opportunities available to me over the next three years.
At the first meeting of the Severn Deanery GP Trainees Committee, on which I sit, the discussions over upcoming projects for the region were exciting, as were the aims and priorities of the ever-inspiring RCGP associates in training community. I’d entered into the world of general practice with enthusiasm, and it was a joy to be greeted with so much of it in return.
And then along came COVID-19. Suddenly, everything was put on hold – and then stopped entirely.
Study days and conferences that trainees had passionately worked towards and looked forward to were cancelled, and weekly regional teaching – which ensures that we are given access to the wide range of knowledge expected of well-rounded GPs – would no longer take place. Reassurance was not possible, because nobody knew what was happening.
Trainees working in hospital placements were relocated to other departments, some suddenly finding themselves on ITU ward rounds instead of the clinical area they had chosen on applying to the training scheme.
Those of us working in general practices were faced with a dramatic switch to remote consulting – a skill which many trainers and supervisors admit to finding challenging, let alone an ST1 at the start of their career. I personally found telephone triage daunting and stressful, as it called on an entirely different skill set that I hadn’t yet developed.
Some trainees, like myself, also fell into the shielding category, therefore facing even greater changes to their professional lives. Having spent only seven weeks at my ST1 practice, to then be working remotely from home for the next four months was at times very difficult, challenging and lonely.
However, I was one of the lucky ones when it came to assessments. Frustrating as it was to be unable to complete workplace-based assessments, I know I will have the chance to do these later on in my training. But for those trainees due to complete their CSA – so close to the end goal of CCT – the effects of COVID-19 were heart-breaking.
The RCGP did eventually replace the CSA this with the new recorded consultation assessment (RCA), but we should acknowledge the stress, anxiety and disappointment felt by a cohort whose plans were scuppered at the last minute. To have your exam which you have prepared tirelessly for, and which is the gateway to finally qualifying as a GP, cancelled at the last minute is very distressing.
Training in any specialty is tough. More attention has been focused on protecting the wellbeing of junior doctors in recent years and trying to prevent exhaustion and burnout. Unsurprisingly, there have been concerns over heightened stress for all doctors during the pandemic, as workload, pressure and general anxiety have increased.
Personal worries (will my family be OK?) accompanied by more general ones (how will my hospital cope?) are then added to by concerns and questions that are impossible to ignore as a trainee. How will this affect my training in the long run? What if I deskill due to working from home? Will the AKT be going ahead? Should I start revising for it now? Will my other hospital rotations take place as planned? What does COVID-19 mean for the future of general practice? What will my career look like now?
Unprecedented. The word certainly captures a lot of the emotion and trials encountered by all of us in 2020. And one thing is for certain – when I woke up on that August Wednesday last year, this was not how I expected my first year of training in general practice to be.
- Dr Zoe Brown is a GP trainee in Gloucestershire