Clinical support during COVID-19: An opportunity for service and learning? A cross-sectional survey of UK medical students

Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements. We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 ‘lockdown’ period in the UK (March–July 2020). Analysis was informed by the conceptual framework of service and learning. 1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (<i>p</i> &lt; 0.0001). However, not every individual’s experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop. The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.<b>Practice points</b>There was a benefit for most students who provided clinical support compared to those who did not during Covid-19.Most students found clinical support roles more beneficial than clinical placements and most final years wanted their final year clinical placements replaced by a formal role within a clinical team.Not every student’s experience of clinical support was equal. The conceptual framework of service and learning can help explain this heterogeneity.The most beneficial roles for students complemented the curriculum and provided opportunities for clinical skill development, reflective practice, and meaningful contribution to the health service.There is an added benefit of combining service and learning if done correctly, and we can use this to inform the structure of clinical placements going forwards. However, there are risks, and we discuss principles of good practice and provide our own considerations. <b>Practice points</b> There was a benefit for most students who provided clinical support compared to those who did not during Covid-19. Most students found clinical support roles more beneficial than clinical placements and most final years wanted their final year clinical placements replaced by a formal role within a clinical team. Not every student’s experience of clinical support was equal. The conceptual framework of service and learning can help explain this heterogeneity. The most beneficial roles for students complemented the curriculum and provided opportunities for clinical skill development, reflective practice, and meaningful contribution to the health service. There is an added benefit of combining service and learning if done correctly, and we can use this to inform the structure of clinical placements going forwards. However, there are risks, and we discuss principles of good practice and provide our own considerations.

新冠疫情（COVID-19）期间，医学生支援临床团队的举措，本可成为兼具服务实践与学习成长双重价值的契机。本研究旨在探明为何既往报道的教育效果参差不齐，以期为未来的临床实习安排提供参考。研究于英国首轮新冠疫情封控（lockdown）期（2020年3月至7月）内，针对英国医学院校的医学生开展了横断面调查（cross-sectional survey）。本次分析以“服务与学习”概念框架为指导，共计37所英国医学院校的1245名医学生参与了本次调查。57%的受访者以多种岗位形式参与了临床支援，与未参与支援的学生相比，他们普遍反映自身获益更多，其中包括对住院医师基础第一年（Foundation Year 1）工作的准备度显著提升（p < 0.0001）。但并非所有学生的支援体验均一致：部分学生的支援岗位与课程体系形成互补，为其提供了临床技能锻炼、反思实践以及为医疗服务做出实质贡献的契机；另有部分学生的支援岗位与自身学业的关联性较弱，此类岗位通常仅侧重服务供给，几乎未提供能力成长空间。“服务与学习”概念框架可有效解释医学生支援体验存在异质性的原因。本研究阐释了该概念框架如何用于指导未来的临床实习安排，尤其聚焦于其中的风险、获益与架构设计。
实践要点：
新冠疫情期间，多数参与临床支援的学生较未参与者获得了更多获益。多数学生认为临床支援岗位比常规临床实习更具获益性，且多数毕业班医学生希望将其毕业临床实习替换为临床团队中的正式支援岗位。并非所有学生的临床支援体验均一致。“服务与学习”概念框架可有效解释这种体验异质性。对学生而言获益最大的支援岗位，可与课程体系形成互补，并为其提供临床技能锻炼、反思实践以及为医疗服务做出实质贡献的契机。若实施得当，“服务与学习”相结合的模式可带来额外获益，我们可借此指导未来临床实习的架构设计。但此类模式亦存在风险，本研究将探讨优质实践的原则，并给出自身的思考建议。
实践要点：
新冠疫情期间，多数参与临床支援的学生较未参与者获得了更多获益。多数学生认为临床支援岗位比常规临床实习更具获益性，且多数毕业班医学生希望将其毕业临床实习替换为临床团队中的正式支援岗位。并非所有学生的临床支援体验均一致。“服务与学习”概念框架可有效解释这种体验异质性。对学生而言获益最大的支援岗位，可与课程体系形成互补，并为其提供临床技能锻炼、反思实践以及为医疗服务做出实质贡献的契机。若实施得当，“服务与学习”相结合的模式可带来额外获益，我们可借此指导未来临床实习的架构设计。但此类模式亦存在风险，本研究将探讨优质实践的原则，并给出自身的思考建议。