COVID-19 and its impact on Medical Education of Pakistan

COVID-19 and its impact on Medical Education of Pakistan

COVID-19; an overview

COVID-19 has badly affected every community of the world especially the medical community. The condition of Pakistan in this situation is no different with 43,966 confirmed coronavirus cases and 939 deaths to date. The health crisis originated in the city of Wuhan, China,. Most of the world was not prepared to tackle a health crisis like this. Despite constant warning messages, the response of policymakers and the global health community was slow. This led to a huge increase in the number of coronavirus affected persons. World Health Organization declared the outbreak a Public Health Emergency of International Concern on 30th January 2020. World Health Organization announced a name for the new coronavirus disease, COVID-19 in February 2020. Coronaviruses are a group of related RNA enveloped viruses that cause respiratory, hepatic, and neurologic dysfunction. It has an incubation period of 2-14 days with a wide range of severity from asymptomatic to mild disease to a life-threatening ailment among different individuals. The mode of transmission is still ambiguous and unclear. However, it is believed that the spread is through respiratory aerosol by coughing or sneezing or through close personal contact with the infected person. Touching objects contaminated with the virus can also be a source of transmission. Infection preventive and control measures (IPC) include avoiding contact with infected persons, regular handwashing with soap or disinfection with hand sanitizer, use of face masks, covering coughs and sneezes with a flexed elbow, maintaining a distance of 1.5 to 2 meters from each other and refraining from touching eyes, nose and mouth with hands. Individuals consuming a well-balanced diet have better immune systems and appear to be relatively safer. There is a lower incidence of chronic diseases and infections in a person with a better immune system.

The Situation in Pakistan

Pakistan is facing major health and economic crisis these days. To control the spread of the virus, the government has improvised ways. The government has implemented first complete lockdown and then partial lockdown with complete closure of non-essential services like shops, restaurants, industries, and travel. There is a ban on public transport with check posts at specific points to control the traffic. All the academic institutions are closed and there is a ban on big gatherings. The government has issued orders for the closure of outpatient departments and elective surgical services in all the Tertiary Care Hospitals, District Headquarter Hospitals, and private clinics. Specific hospitals are designated with the screening of COVID-19 and the management of the cases. Quarantine centers are also established across the state. Furthermore, constant messages are raising public awareness about COVID-19. Despite all these efforts, the number of people testing positive to COVID-19 continues to rise because an across the board enforcement of such restrictions and lockdowns is beyond the capacity of the state. As LHC Chief Justice said, “The whole world has been affected by the spread of the pandemic. Even developed countries are facing difficulties in procuring and providing for the personal protective equipment of health workers.”

Online classes in Medical Institutions

In Pakistan,all the educational institutions are closed including medical and dental colleges and universities. Recently, the Higher Education Commission (HEC), Pakistan issued guidelines to start delivering online classes so that academic loss could be minimized. Across the country, many medical institutions are suspending courses or moving to online classes. First and second-year MBBS students can afford cancellation of classes as they mainly learn in the classrooms and there is no such practical work demanded by them. But clinical students, those in their third and fourth years of medical school, work in the hospitals. That means they face new concerns about their education. Pulling medical students out of the hospitals can have long term consequences. There is no online substitute for learning by direct patient care; refraining students from hospital work and sending them home would surely halt their education. It could even delay graduating an entire batch of new physicians as medical students work on strict schedules to fulfill all the requirements necessary to become a doctor. Administration of the medical institutes and teachers are making continuous efforts to devise ways to utilize the available technology. So that process of education may be continued and the gap between the teachers and the students may be minimized that is going to result as a consequence of these critical circumstances. Students are kept engaged by delivering online lectures, giving them assignments, and evaluating their learning skills. Medical and Dental colleges’ administrators and teachers are taking appropriate measures to conduct effective e-lectures, e-tutorials, and e-case based learning. Feedback forms are submitted for online attendance in many medical colleges. These steps taken by the administration create a link between the students and their teachers so that medical students may not indulge in other useless activities.In Pakistan, there is a recent advent of this new teaching methodology. Thus, students and even teachers are not well acquainted with the new system. They are adapting the new teaching methodologies to continue the unhindered education process. Shafqat Mehmood in his tweet on March 26, 2020 told about the poor online education system.

Demerits of e-learning

Despite all the advantages of e-learning, it has certain limitations such as lack of student-teacher interaction, social isolation, and of course connectivity problems are also there. Despite the worldwide adoption of e-learning and its development, it was never considered a formal system of education by the majority of institutions in Pakistan until the spread of coronavirus recently. Also, the cancellation of classes presents a challenge of how to re-engage students within the community spirit of medical school after this pandemic is over.     
As the education minister Murad Raas tweeted on May 11, 2020;

Every medical student has his own story of how this quarantine has affected his education. For a variety of reasons clinical rotations have been canceled. One probable reason is the lack of protective equipment in the hospital.

There is a major shortage of PPE kits in public and private hospitals.”

Dr Mukhtiar Zaman, Head of Pulmonology, Rehman Medical College, Peshawar

Another reason is to decrease the risk of exposure for medical students, which is an understandable concern. Finally, to flatten the curve of rising COVID-19 positive cases, it is necessary to minimize close personal contact.
Many medical schools have also canceled clinical presentations which play an integral part in the personality development of the students. Students learn many things through these presentations; therefore, these lost opportunities have the potential to be a serious detriment in medical students’ career.
Another way in which COVID-19 has affected medical students is the cancellation of medical conferences. These conferences play an important role in shaping the clinical acumen of the medical student. Cancellation of medical conferences thus will have long term consequences in the life of a medical student. 
Opportunities for doing research work are also limited during this quarantine period. As the research work helps the medical student to think beyond the books, lack of this opportunity will also prove detrimental to the future career of the student.

Problems Faced by Dental Students

Dental students are facings the same problems as MBBS students. There is a complete shutdown of practical work due to this pandemic. Students in their final year of course are mostly involved in professional work which is a part of their learning. Cancellation of these practices has a solid reason to avoid close contact with the patients. Any patient might be a corona patient and contact of dental students with his saliva or mucosal secretions can endanger the life of the dental student. Furthermore, the mental health of dental students is also of concern.

Effect on mental health

Medical students are also experiencing a serious impact of this quarantine on their physical, mental, and social well-being. The probable reason for this detrimental effect is social isolation; a feeling of having departed from friends and fellows, losing the ability to move freely due to restrictions and experiencing threats about the severity and spread of this disease. Many students are constantly in doubt of when this quarantine will over and they would be free to move around and meet their beloved ones. These doubts and fears have a detrimental effect on students’ health.

Strategies for medical students

It is high time to support each other especially our professional family of medical students. Students must exhibit healthy habits; they should practice healthy eating and drinking habits with a minimum of 6-8 hours’ sleep and communication with family and friends. They should engage their selves in some sort of physical activity like exercise or some recreational activities like art and designing. They should try to study the e-lectures given by their teachers to compensate for the educational loss due to the cancellation of classes. These ways may certainly help in preserving the physical and mental well-being of medical students.

“Take charge of your health; stay at home and keep your children at home!”

Dr Shobha Luxmi, Dow University, Karachi.
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Post By: Qasim Mehmood 

Student, 3rd year MBBS, King Edward Medical University, Lahore.

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