COVID-19 pandemic personal development plan: A model for maximising higher specialty training

Challenges to delivering higher specialty training during the COVID-19 pandemic

During the COVID-19 pandemic, trainees across all specialties and levels of seniority will be experiencing different challenges. Some of these will occur within their speciality; for others, new challenges beyond the scope of their usual competencies and skills will be experienced. While there may be a tendency to perceive these challenges negatively in terms of their impact on training, this unprecedented situation does present a unique opportunity for trainees currently in GM higher speciality training (HST).

The GM curriculum differs from other medical specialties in that there are no procedural competencies and outpatient-based sub-specialty curriculum elements are often supplemented by inpatient exposure (with continence, movement disorders and psychiatry of old age, for example). However, a commonality across all specialties is the presence of emergency rotas, service pressures and associated difficulties in obtaining SLEs and workplace-based assessments (WPBAs). Our early experiences caring for COVID-19-positive patients has highlighted numerous important learning experiences that trainees could use to further their personal development. These align with curriculum competencies and arguably offer opportunities to obtain greater evidence of achievement.

Pandemic personal development plan

Across the UK, GM departments are providing core support in acute hospitals during this COVID-19 pandemic. Trainers and trainees are at the heart of this. By being innovative, forward thinking and positive, training opportunities can be maximised. The GM-specific training plan shown in Table 1, devised by a GM trainer and trainee team with wider input from local trainers and trainees, provides a unique example of how all specialities can optimise training through encouragement of experiential learning linked to a pandemic personal development plan (PDP). Prior literature has demonstrated that formal development programs in circumstances involving a changing training landscape permit greater flexibility and responsiveness to challenges.⁷ COVID-19 patients have clinical presentations closely linking to many of the GM competencies, providing clear opportunities for training benefit; equally, some GM presentations are less obviously related and therefore clinical exposure will be less easily gained during the pandemic period. Through careful documentation of COVID-19 phenotypes encountered in the ward setting, described during cross-specialty meetings and outlined in the medical literature, the opportunity to link COVID-19 care to existing GM curriculum elements was deemed necessary.

Despite a paucity of literature currently existing to support approaches to caring for older people with COVID-19, we have explored current understanding to help support the themes raised in this training plan. We know screening and streaming of frail older people to COVID-specific facilities can be challenging.⁵ In a French study of older people, fever was the most common symptom.⁸ However, cough, delirium, dyspnoea and fatigue were also common. Additionally, lymphopenia, renal and hepatic impairment were common. Atypical signs of COVID-19 infection such as confusion, fall or diarrhoea were hypothesised to be associated with greater likelihood of severe infection.⁷ Furthermore, severity assessed using rapid scoring systems is more sensitive and specific in those <65 years of age than >65 years of age.⁹ From a sub-specialty perspective, the long-term consequences of this pandemic on Parkinson's disease (PD) is highly uncertain, and timely education and reassurance of patients may help ease the burden.¹⁰ Beyond the disease itself, several challenges have been identified during the pandemic which are likely to affect older people, including reductions in physical activity and corresponding increases in sedentary behaviours, increase in stress levels, nutritional challenges, and limited access to routine health care and/or home care visits.¹¹ The aforementioned clinical presentations and complications of COVID-19 infection highlight the breadth of training opportunities for all medical specialties and in particular for those dual training in general internal medicine (GIM).

Interestingly, in the USA, there has been some negativity around the potential effects on training in GM, with a trainer stating:¹²

I worry about permanent effects of this pandemic on doctoring in general and geriatrics in particular, both because our bedside care has changed and because we hear public pronouncements denigrating the value of elderly lives.

While this may hold true in other countries, our experience is that attempting to deliver care as we always do, while paying particular attention to COVID-19-specific elements, ensures training opportunities are maintained and potentially strengthened. As a Trust that recently adopted the ‘Recommended Summary Plan for Emergency Care and Treatment’ (ReSPECT) form process, enhanced learning and greater exposure to careful advanced care planning has been possible. This process is crucial as it ensures the patient's ‘personal preference sits alongside the expectations and limits decided by their clinician’.¹³ Additionally, interaction and bidirectional learning between infectious diseases and GM teams has helped reinforce current approaches to caring for patients with COVID-19. Specifically, early during the pandemic, cross-specialty debriefs gave junior and senior colleagues an opportunity to share good practice and discuss evolving issues. In the event of a ‘second wave’ of the pandemic in the UK, a trainer and trainee meeting in the first week to develop a pandemic PDP could be encouraged, together with the establishment of weekly cross-specialty debriefs. This approach is of potential value to all specialties, with a pandemic PDP giving an opportunity for trainees to enter into a dialogue with trainers about the implications of COVID-19 clinical presentations on their specialty-specific JRCPTB curriculum competencies and to acknowledge how clinical exposure is likely to be affected (such as an expected reduction in specific non-emergency procedures in gastroenterology or cardiology). Future work in this area could involve assessing the relative performance of trainees who did/did not use this tool.

Conflicts of interest

Jatinder S Minhas is supported by the National Institute for Health Research (NIHR clinical lectureship in older people and complex health needs). Manish Pareek is supported by the National Institute for Health Research (NIHR post-doctoral fellowship). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.