The COVID-19 pandemic has greatly affected medical education and training experiences for interns and resident doctors. As medical schools shifted their teaching curriculum to virtual platforms, most senior medical students lacked sufficient clinical exposure as they missed out on in-hospital rotations before beginning their intern year. In this article, we share our experience in transitioning from medical school to our intern year while working in COVID and non-COVID facilities. We discuss our challenges while learning basic skills in a resource-limited setting during a period of high patient mortality because of COVID-19 and Mucormycosis.

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10/28/2021
Learning to practice medicine during COVID-19 and
mucormycosis epidemics: an intern perspective
from India
Varun V. Bansal, MBBSa,
*, Ahmad Ozair, MBBSb
Abstract
The COVID-19 pandemic has greatly affected medical education and training experiences for interns and resident doctors. As
medical schools shifted their teaching curriculum to virtual platforms, most senior medical students lacked sufficient clinical exposure
as they missed out on in-hospital rotations before beginning their intern year. In this article, we share our experience in transitioning
from medical school to our intern year while working in COVID and non-COVID facilities. We discuss our challenges while learning
basic skills in a resource-limited setting during a period of high patient mortality because of COVID-19 and Mucormycosis.
Keywords: Medical education, Internship, COVID-19, Mucormycosis
The COVID-19 pandemic had a significant impact on under-
graduate and postgraduate clinical training worldwide, including in
India[1,2]
. Clinical rotations for students were stopped throughout
2020 across most Indian medical schools while most affiliated
hospitals were converted to dedicated COVID care institutions[3]
.
Medical school in India includes 4 and a half years of didactic
education followed by a compulsory clinical internship year. With
COVID cases overwhelming hospitals in India, students in their third
and fourth years had to obtain their clinical training without having
the privilege to examine, present, and manage patients. Many medical
schools transitioned to remote and virtual education, with multiple
downstream effects[4]
. Such was the case in our medical schools where
we spent our entire fourth year discussing virtual cases and attending
lectures through video-conferencing applications.
While things began easing in early 2021, a new COVID-19
wave struck the entire breadth of the country, but this time car-
rying with it the advent of the rhino-orbito-cerebral mucormy-
cosis (ROCM) epidemic[5]
. Having passed our medical school
examinations in the summer of 2021, we began our internship
training amidst these dual pandemics. Over the last 2 months, we
have worked in dedicated COVID and non-COVID wards,
spanning various medical, surgical, and nonclinical departments,
along with working in wards dedicated solely to ROCM cases.
We experienced a steep learning curve, being in the frontline from
the very beginning of our training. We had to acquire basic skills and
clinical knowledge in an environment that challenged us physically,
mentally, and emotionally. While working in the COVID ICU, we
performed phlebotomies and arterial punctures in patients with feeble
pulses and a poor volume status because of sepsis and systemic
inflammatory response syndrome, which are common complications
of severe COVID infection. In addition, we wore double gloves with
our standard personal protective equipment kits, making it more dif-
ficult to palpate veins. We faced similar difficulties while learning other
procedures, including bladder catheterization, inserting nasogastric
tubes, and securing IV lines.
While working in the ICU, we yearned to connect with our
patients, having missed out on a year of in-hospital training during the
lockdown period. However, we could not communicate with most of
them as they were either ventilated via nonrebreather masks that are
attached snugly to the face or were intubated. Eventually, we
encountered death for the first time during our internship. As our
institutions are referral centers for neighboring cities, we cared for
many critically ill patients and observed very high mortality rates
amongst severe COVID patients. We informed our supervisors when
oxygen saturations dropped and monitors beeped incessantly, only to
realize that we cannot revive our patients. We experienced this series
of events within a matter of days on the frontline.
When working in non-COVID facilities, we noticed several
shortcomings in our hospital systems. As a large share of
resources and personnel were diverted to COVID facilities, we
often worked for longer hours in non-COVID areas. Stocks of
syringes, medications, and equipment were exhausted, and cri-
tical investigations were delayed. We even faced significant
shortages of Amphotericin B in our ROCM wards[6]
. Within a
few weeks, we became an integral component of a fragile and
overburdened system. To add to our perils, we observed that
patients often presented with their ailments in complicated and
advanced stages during the pandemic[7]
. The delay in their pre-
sentation may be related to a difficulty in commuting because of
a
Faculty of Medicine, Seth G.S.M.C and K.E.M Hospital, Mumbai, Maharashtra and
b
Faculty of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
This manuscript has been peer reviewed.
Sponsorships or competing interests that may be relevant to content are disclosed at
the end of this article.
Published online 28 October 2021
*Corresponding author. Address: UG Office, Ground Floor, Seth G.S.M.C and K.E.M
Hospital, Parel, Mumbai 400012, Maharashtra, India. Tel: +91-7984097195;
fax: N/A. E-mail address: varunvbansal@outlook.com (V.V. Bansal).
Received 24 June 2021; Accepted 25 June 2021
Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of
IJS Publishing Group Ltd. This is an open-access article distributed under the terms
of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC),
where it is permissible to download, share, remix, transform, and buildup the work
provided it is properly cited. The work cannot be used commercially without
permission from the journal.
International Journal of Surgery Short Reports (2021) 6:e27
http://dx.doi.org/10.1097/SR9.0000000000000027
’Education Article
1

2. lockdowns and fears of contracting the virus in a hospital catering
to COVID-positive patients parallelly.
As interns, we are studying for licensing and competitive examina-
tions to apply for residency positions alongside our medical duties. We
have resorted primarily to remote learning tools, such as recorded
lecture videos and live webinars via online platforms. Furthermore, the
technological surge during the lockdown period enabled us to parti-
cipate in many conferences and present research papers and posters
virtually over the past year.
We belong to a generation of future physicians who began their
training in unforeseen times. We have worked for extended hours
in challenging conditions while trying to strive academically.
Hopefully, by the end of our intern year, we will be resilient and
diverse in our approach to our medical and surgical practice with
the knowledge of pandemic preparedness. Our experience will be
of great importance as we prepare for the third wave of COVID
cases in India. We have grown tremendously and connected with
people all over the world over the last year and will continue to do
so in our journey towards becoming academic surgeons.
Ethical approval
None.
Sources of funding
None.
Author contribution
V.V.B.: performed a literature review and prepared the manu-
script. A.O.: conceptualized, prepared, and revised the manuscript.
Conflicts of interest disclosure
The authors declare that they have no financial conflict of interest
with regard to the content of this report.
Research registration unique identifying number (UIN)
None.
Guarantor
None.
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