Balance Service and Learning: Insights from Volunteer Experiences of UK Medical Students During the COVID-19 Pandemic.

To the Editor: Harrison and colleagues investigated how U.S. medical education leaders responded to the COVID-19 pandemic, contrasting it with their response to the 1918 influenza pandemic.1 They concluded that responses to the COVID-19 pandemic were characterized by “an abundance of caution,” which contrasts with the approach taken in 1918 where students were given greater levels of autonomy in the clinical environment. Harrison and colleagues pose questions regarding the future place of medical students in pandemic responses, citing tensions between service and learning, where balance is needed between providing patient care and educational opportunities through continued clinical exposure. We add to the conversation our study exploring the experiences of 1,245 UK medical students providing clinical support during the COVID-19 pandemic from March to July 2020.2 Similar to the United States, UK medical schools suspended clinical placement for medical students in March 2020. However, many UK students provided clinical support across a range of roles. Final-year students were allowed to graduate early to act as interim-postgraduate-one doctors, and students from other years provided clinical support, such as doctor’s assistants, health care assistants, phlebotomists, ward receptionists, and vaccinators. In our study, we found UK students who provided clinical support experienced a greater educational benefit than those who did not. However, there was a wide heterogeneity in experiences among volunteers. We used the spectrum of service and learning as a conceptual framework, where roles have varied levels of service and learning components. We found that students valued being given greater autonomy, as it represented a more authentic experience, and the greatest benefit was derived from the interim-postgraduate-one doctor and the doctor’s assistant roles, as these roles aligned with future practice. Outside of these 2 roles, there were limited learning opportunities alongside the service requirement. It is likely that many U.S. medical students missed a broadly beneficial opportunity for learning during the COVID-19 pandemic. This would have impacted clinical teams since students represent an important asset for service provision during pandemics. However, to balance service and learning in future pandemics, the roles offered to students must align more closely with their practice as future doctors. Éabha LynnThird-year medical student, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom; ORCID: https://orcid.org/0000-0003-1185-9390Matthew Henry Vincent Byrne, MBBS, MRes, MRCSDPhil candidate and urology resident, University of Oxford, Oxford, United Kingdom; email: [email protected]; X (formerly Twitter): @mhvbyrne; ORCID: https://orcid.org/0000-0002-2414-352X