Firstly, on behalf of the College, we would like to extend our deepest sympathy to the families and friends of all colleagues who have died from COVID-19 in service of their patients. This editorial is dedicated to their memory.
In a few short months the world of clinical medicine, training, examinations and education has changed. In most countries doctors and healthcare workers have had to transform the way they work in order to accommodate the response to the COVID-19 pandemic. We are all facing complex clinical and ethical decisions which continue to evolve from day to day.
The College’s part – as at all other times – is the support of best patient care through medical education, advice to government and the maintenance of professional wellbeing through collegiality, fellowship and support. We have endeavoured to provide a wide variety of online education on COVID-19 to keep doctors informed; we have lobbied governments on behalf of our Fellows and Members on issues such as personal protective equipment (PPE), ethics and testing, and we have developed a COVID-19 Hub on our website with advice, guidance, news and wellbeing resources.
International perspectives
It is only by sharing our experiences that we can learn from, and improve, our own. As such, we have been pleased to receive reports and analysis from a number of our Overseas Regional Advisers as to how they are managing the COVID-19 pandemic locally. We have accounts from a diverse range of countries which we have featured in a new interactive map1 on our website. Contributions from Advisers include Professor Marius Rademaker examining the proactive stance taken in New Zealand2 and the escalation of their national alert system, and Dr Muhammed Aasim Yusuf, who provides a different perspective as he examines cancer care in Pakistan3 and how this has been impacted by COVID-19.
Protecting the healthcare workforce
The College welcomed the UK Government’s revised national UK guidance on PPE,4 which provides advice that fits more closely with evolving clinical experience and evidence from other countries. However, we share the concern of other Colleges about PPE reuse guidelines5 and have reiterated our position that procurement and provision of adequate new supplies is clearly preferred to reusing of PPE items only intended for single use. The College has called for transparency regarding the stocks of PPE available in England and Wales, as well as an action plan indicating what PPE can be expected by primary, secondary and community care – and when healthcare workers in these sectors can expect to receive PPE. We have supported an individualised response to the use of PPE in cardiopulmonary resuscitation, defending and protecting our colleagues’ need to exercise their clinical judgement in the pursuit of patient safety.
Ethics and end-of-life care
Ethical issues have remained important as the pandemic has developed and we have also had to adapt our response in this important area. The College has formed a COVID-19 Ethics group. The group has discussed a range of issues, including anticipatory care planning, visiting restrictions for families, capacity management, care escalation policies and strategies for managing COVID vs non-COVID disease. Each of these have ethical aspects relating, for example, to the balance of good and harm, justice, and autonomy. The College will ensure that our UK governments frame their policies around these principles. The College, the Scottish Academy of Medical Royal Colleges, the Marie Curie charity and Scottish Care came together to publish new guiding principles6 regarding visiting at the end of life.
Education
Our weekly online COVID-19 webinars have been broadcast on Thursdays and are available afterwards on the RCPE Education Portal.7 At each webinar we aim to include an international perspective and have recently featured the views from Italy, Singapore, India and the USA. These have been extremely popular with thousands of colleagues around the world joining us live each week. The need for continuing professional education has not diminished and the College will continue to fulfil our key role in this, despite the difficult circumstances. We have also offered complimentary membership to doctors returning to the NHS to help with COVID-19, including access to online resources.
The College has collaborated with the University of Edinburgh to launch a FutureLearn course on COVID-19 Critical Care: Understanding and Application.8 This free learning resource has been designed for frontline clinical staff who are caring for critically ill patients and will support those refreshing critical care knowledge and skills, newly qualified doctors, those who are upskilling and those returning to acute clinical services during the COVID-19 pandemic. Within a few weeks the course had attracted over 30,000 registrants from 175 countries; there is also a free accompanying handbook.9
Online resources and information
We have also developed a series of COVID-19 Conversations: podcasts, talks and interviews on a variety of COVID-19 related topics. Our Trainees and Members’ Committee have interviewed colleagues in a new podcast series10 about their perspectives on the pandemic. We also have a variety of interesting talks11 from colleagues on topics ranging from health and wellbeing to the risk to asylum seekers and undocumented migrants. I am grateful to colleagues from across the world for taking time to share their local experiences and expertise relating to COVID-19.
Our website is transformed – we have aimed to collate relevant information in as accessible and helpful way as we can. Our COVID-19 Hub12 contains updates, a daily news summary, links to the latest guidance, research and advice as well as wellbeing resources to help during challenging times. We welcome additional suggestions from our Fellows and Members to enhance this further.
The College recognises that the COVID-19 pandemic will have lasting implications of interest to future medical professionals as well as to society as a whole. Our Heritage Team are recording COVID-19 diaries: in essence, asking practitioners to document their experiences of COVID-19. If you would like to contribute, more information on this project is available on our website.13
The coronavirus has turned a spotlight on many areas of human activity. The value, relevance and importance of much that we do and much that we take for granted has been cast in sharp contrast. In facing a new disease, we have learned again of the importance of easily accessible, accurate and up–to-date medical education, of the balance between evidence, compassion and judgement in the provision of best patient care, and of the strength that comes from approaching difficulty together. Our College has sought to meet these needs in support of our Fellows and Members and the patients for whom they care, and in doing so plays its own part in the fight against COVID-19.
Acknowledgements
Dr Graham Nimmo is Co-Director of our MSc Critical Care with the University of Edinburgh, and lead for the FutureLearn resource.
References
1 RCPE. International Perspectives on COVID-19. https://www.rcpe.ac.uk/college/international-perspectives-covid-19
2 RCPE. Marius Rademaker, New Zealand OSRA. COVID Perspective. https://www.rcpe.ac.uk/college/overseas-regional-adviser/new-zealand
3 RCPE. Muhammed Aasim Yusuf, Pakistan Punjab OSRA. COVID Perspective https://www.rcpe.ac.uk/college/overseas-regional-adviser/pakistan-punjab
4 Gov.UK. COVID-19: infection prevention and control (IPC), Public Health England (Updated 27 April 2020) https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infec...
5 Gov.UK. Considerations for acute personal protective equipment (PPE) shortages (Updated 27 April 2020) https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infec...
6 RCPE. COVID-19: allow families equal access to visit dying relatives (15 April 2020). https://www.rcpe.ac.uk/college/covid-19-allow-families-equal-access-visi...
7 RCPE Education Portal, COVID-19 Coronavirus Resource https://learning.rcpe.ac.uk/course/index.php?categoryid=114
8 The University of Edinburgh, RCPE. FutureLearn: COVID-19 Critical Care: Understanding and Application https://www.futurelearn.com/courses/covid-19-critical-care-education-res...
9 The University of Edinburgh, RCPE. COVID-19 CRITICAL CARE: Understanding and Application, Edinburgh Critical Care Online Handbook https://www.rcpe.ac.uk/sites/default/files/covid-19_critical_care_handbo...
10 RCPE Portal. COVID-19 Conversations https://www.rcpe.ac.uk/college/covid-19-conversations-0
11 RCPE Portal. COVID-19 Conversations https://learning.rcpe.ac.uk/course/view.php?id=707
12 RCPE. COVID-19 Hub https://www.rcpe.ac.uk/covid-19-hub
13 RCPE Heritage. RCPE recording COVID-19 / coronavirus https://www.rcpe.ac.uk/heritage/rcpe-recording-covid-19-coronavirus
