CORRESPONDENCE

Commencement of medical internship during the COVID-19 pandemic: An honour with increased responsibility

To the Editor: Medical internship continues to be a significant challenge for newly qualified doctors in our country.^[1] Issues pertaining to placement allocations and uncertainty, a step up in workload and responsibility, and the impact of the ongoing COVID-19 pandemic on the healthcare system are particular causes for concern. Initially, the 2-year internship programme promised newly qualified doctors in South Africa (SA) an opportunity to gain experience so that they would be able to practise independently, competently and safely.^[2] Subsequent to this promise, in June 2020 the Health Professions Council of South Africa (HPCSA) acknowledged internship programme training concerns resulting from the COVID-19 pandemic in a document which highlights that the Council itself is aware of the compromised learning opportunities as pandemic protocols have reduced elective procedures and in-person consultations with patients.^[3]

The well-publicised corruption scandals and allegations during the COVID-19 pandemic have negatively impacted on an already fragile healthcare system.^[4] A major effect has been the shortage of personal protective equipment in some institutions, which has resulted in an increase in the number of healthcare worker infections, including infections of medical interns.^[4,5] Key medical intern clinical training rotations have been disrupted as a result of subsequent quarantine and isolation,^[3] and many interns serving in the frontline have fallen victim to COVID-19 due to this ongoing issue, thus losing valuable training time.^[3] Moreover, drastic consequences of the pandemic in some internship-accredited hospitals last year resulted in deplorable working conditions for all staff.^[6-8]

In addition to navigating their new clinical responsibilities in a rapidly changing healthcare system strained by COVID-19 and its collateral effects, some medical interns experienced a decline in their mental health. The ever-evolving consequences of the pandemic have included an increase in the incidence of depression, fatigue, emotional exhaustion and poor concentration among junior medical doctors.^[9] Such mental health issues not only affect medical interns personally, but also the patients and healthcare system they diligently strive to serve. Furthermore, it has been shown that suboptimal mental wellbeing exacerbates the risk of errors in clinical judgement, as well as breaches in infection prevention and control measures,^[9] in an arguably inexperienced cadre of the medical fraternity.

As prospective members of the 2022 medical intern cohort, we are aware of some apprehension among classmates navigating the internship application process. This apprehension pertains to the issues described above, but especially to the continuous uncertainty that lies within the course of the pandemic and its effects on our training, preparedness, and physical and psychological wellbeing. SA's healthcare system continues to face a severe shortage of medical doctors: it is estimated that we have only 0.9 medical doctors per 1 000 patients, which is well below the global average of 1.6 medical doctors per 1 000 patients.^[10] Since medical interns are an essential component of our healthcare system, there is an urgent need to institute accessible and sustainable support services to help them function better in a frantic time in our country's medical history. This support is crucial to preserve an irreplaceable component of our health workforce.

Acknowledgements. Dr A T Mnguni, HOD Internal Medicine, Khaye-litsha District Hospital; consultant, Division of Internal Medicine, Tygerberg Hospital and Stellenbosch University; and senior lecturer, Faculty of Medicine and Health Sciences, Stellenbosch University, and Dr Y Chothia, consultant, Division of Nephrology, Department of Medicine, Tygerberg Hospital and Stellenbosch University; and senior lecturer, Faculty of Medicine and Health Sciences, Stellenbosch University.

A A Nadkar, T D Malange

Final-year medical students, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa azhar.nadkar36@gmail.com

References

1. Erasmus N. Slaves of the state - medical internship and community service in South Africa. S Afr Med J 2012;102(8):655-658. https://doi.org/10.7196/SAMJ.5987        [ Links ]

2. Health Professions Council of South Africa. Handbook on internship training. Pretoria: HPCSA, 2021:2. https://www.hpcsa.co.za/Uploads/Registration_Forms/MDB%20FORM/2020%20Forms /2021_IN_HANDBOOK_PART_I.pdf (accessed 11 June 2021).         [ Links ]

3. Health Professions Council of South Africa. Draft discussion document addressing issues and concerns of medical internship during COVID-19 pandemic. Pretoria: HPCSA, June 2020. https://www.hpcsa.co.za/Uploads/MDB/Policy%20and%20Guidelines/MANAGEMENT_OF_ MEDICAL_INTERNSHIP_DURING_COVID-19_PANDEMIC.pdf (accessed 11 June 2021).         [ Links ]

4. Phagane T. 2020 Headlines: Corruption in procurement of PPE. SABC News, 31 December 2020. https://www.sabcnews.com/sabcnews/2020-headlines-corruption-in-procurement-of-ppe/ (accessed 11 June 2021).         [ Links ]

5. Malange T, Atia T. Blood shortage in COVID-19: A crisis within a crisis. S Afr Med J 2021;111(3):191. https://doi.org/10.7196/SAMJ.2021.v111i3.15525        [ Links ]

6. Chabalala J. Covid-19: PPE scandals that crippled South Africa's fight against Covid-19. News24, 5 March 2021. https://www.news24.com/news24/southafrica/news/covid-19-ppe-scandals-that-crippled-south-africas-fight-against-covid-19-20210305 (accessed 11 June 2021).         [ Links ]

7. Harding A. Coronavirus in South Africa: Inside Port Elizabeth's 'hospitals of horrors'. BBC News, 15 July 2020. https://www.bbc.com/news/world-africa-53396057 (accessed 11 June 2021).         [ Links ]

8. Lindeque M. Nurses, doctors warn Gauteng hospitals at capacity with COVID-19 3rd wave. Eyewitness News, 2021. https://ewn.co.za/2021/06/08/nurses-doctors-warn-that-gauteng-hospitals-at-capacity-with-covid-19-3rd-wave (accessed 11 June 2021).         [ Links ]

9. Robertson L, Maposa I, Somaroo H, Johnson O. Mental health of healthcare workers during the COVID-19 outbreak: A rapid scoping review to inform provincial guidelines in South Africa. S Afr Med J 2020;110(10):1010-1019. https://doi.org/10.7196/SAMJ.2020.v110i10.15022        [ Links ]

10. Govender K, George G, Beckett S, Quinlan T. Ten ways South Africa can step-up care for its healthcare workers. The Conversation, 22 July 2020. https://theconversation.com/ten-ways-south-africa-can-step-up-care-for-its-healthcare-workers-142836 (accessed 11 June 2021).         [ Links ]