The Covid-19 pandemic has been a case of all hands on deck for qualified clinical staff – but hands off for those still in training, as university campuses and teaching hospitals alike became off limits to them.
In the UK, this sudden curtailment of the normal models of healthcare education resulted in a rapid and fundamental review of the essential and not so essential elements of the curriculum. The custom and practice of programmes, normally so constrained by legislation and regulation, was refocused on the essentials of educational practice.
Now, with many healthcare students back on campus, the question is whether that moment of liberation has passed – or whether it can be built on to improve clinical education and, ultimately, patient care.
Some new ways of working remain in place, but many of us hope the pandemic will allow us to tackle more radical questions around what we do and how we do it. Central to those questions is how to balance the competing priorities of universities and healthcare systems.
For many decades, joining a healthcare profession, such as medicine, dentistry or nursing, involved on-the-job training that led to both knowledge acquisition and socialisation into that profession. But in the 1980s training become embedded in universities as many new healthcare professions emerged alongside increased accountability and standardisation within healthcare training; entry to most of these professions is now highly structured and regulated.
This arguably created an unresolved challenge of competing agendas. Universities are concerned with instilling abstract academic values, such as a passion for pursuing understanding and synthesising complex phenomena. However, healthcare organisations are primarily concerned with equipping individuals for current practice, often characterised by standardised procedures and meeting defined competence measures.
Defensibility, validity and reliability are priorities within universities’ assessment frameworks, but the unit of success is often a series of small reductionist activities that may be devoid of context, authenticity and real-world complexity. In real clinical contexts, by contrast, standardisation is challenged by patient individuality and variability.
The pandemic has only heightened this tension as the move online has significantly reduced opportunities to gain clinical experience and seen what placements remain significantly altered in line with providers’ rapidly changing operational conditions.
Regulatory bodies are anxious to understand the impact of reduced or altered clinical training experience, but they appear less concerned about the impact of the online shift on other elements of educational delivery. Universities, by contrast, may not fully appreciate the impact of reduced clinical placements and be more concerned with programme quality assurance, academic standards and student engagement, attainment, well-being and satisfaction.
This is not to say that universities do not care for the clinical experience that students gain, but they understand it less and, as a result, may value it less. Likewise, the regulators undoubtedly value the scholarship of a university education but perhaps less so than the clinical experience – which they regard as irreplaceable.
This a good moment to go back to first principles and ask what all stakeholders hope to achieve, individually and together, in the development of the “professional”. But the first step towards managing the competing agendas and ensuring that they don’t stymie ongoing curricular innovation must surely be to acknowledge that they exist.
With that said, our academic perspective is that the pandemic has clearly demonstrated the attributes of a university education, over and above the training of a practitioner. Without the ability to question, understand and synthesise information, healthcare professionals and educators are unlikely to have been able to so quickly devise and adopt new ways of working.
Future-proofing our healthcare workforce in this way is absolutely essential. So however much clinical experience they have lost in the last 12 months, it is vital that their education and training should remain in universities.
Heidi Bateman is an honorary clinical senior lecturer at Newcastle University’s School of Dental Sciences, where Giles McCracken is professor of restorative dentistry and Janice Ellis is professor of dental education. Jane Stewart is senior lecturer in Newcastle University’s School of Medical Education.
