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“Retired physicians continue to experience the same sense of duty and ethical commitment. Many of them have decided to return to work to combat COVID-19.”
In less than 20 years, we have experienced three pandemics: Severe Acute Respiratory Syndrome (SARS), H1N1 influenza, and, recently, the COVID-19 coronavirus (Lebrija, 2020). Globalization and hyper-connectivity have boosted the intercontinental mobilization of the population, products, services, and capital to a global scale. However, this interconnectivity has also allowed diseases to circulate the world by air, sea, and land, through unwashed hands, bats, or mosquitoes (Angier, 2001). Infectious disease such as COVID-19 means a radical change in normalcy.
We have seen that health systems in different countries have collapsed because they do not have sufficient resources nor medical staff to care for so many critically ill COVID-19 patients. In this emergency, everyone is doing the best they can with the limited resources available. This has triggered processes of adaptation and restructuring in the hospitals, the training of staff with new protocols, and measures to recruit more staff with the skills required to care for patients with this disease.
“Through the invaluable workforce of health professionals, we obtain as a society a unique service that little depends on an employment relationship or economic remuneration for their work.”
Some of these measures have included the early graduation of medical students who leave school to enter a disrupted reality. Many become volunteers in the hospital because of their high sense of duty. However, when the students were enrolled in the medical program, they did not imagine that their professional career would begin amid a pandemic (Abrams and Ducharme, 2020). During their training, the students participate in clinical activities regularly and practice complicated procedures in simulation laboratories but never for a scenario of this magnitude. However, as the coronavirus progresses, and the number of patients with complicated infections increases, their role in the medical force is essential (Goldberg, 2020).
Algunas de estas medidas han incluido la graduación temprana de estudiantes de medicina quienes egresan a una realidad trastocada. Muchos se convierten en voluntarios en el hospital, por su alto sentido del deber. Sin embargo, cuando los estudiantes se inscribieron al programa de medicina, no imaginaban que su carrera profesional daría inicio en medio de una pandemia (Abrams y Ducharme, 2020). Durante su formación los estudiantes participan en actividades clínicas de manera regular y practican procedimientos complicados en laboratorios de simulación, pero nunca para un escenario de esta magnitud. No obstante, en la medida que el coronavirus avanza y la cantidad de infectados en estado complicado aumenta, su rol en la fuerza médica es esencial (Goldberg, 2020).
Lessons learned about the professional vocations of healthcare providers
The health professionals, doctors, nurses, psychologists, all of them, spend their careers studying and updating to provide the best care to patients and their families. However, the pandemic is making them understand that there is no longer any certainty, putting to the test their professional identities while they try to adapt emotionally and psychologically to the enormous challenge that the pandemic brought with it, causing more than 160,000 deaths (WHO, 2020).
Professional identity is comprised of vocation, attitude, social recognition, and integration into a community of practice (Lopez, Olivares, and Heredia, 2020). Especially for health professionals, the process of building their identity is carried out repetitively through contact with patients, other colleagues, and mentors. The state of health emergency caused by COVID-19 raises many questions about how this professional identity emerges in health personnel in extreme situations like that we are living now.
Below are the lessons learned about the professional vocations of healthcare providers on the front line dealing with the Covid19 pandemic:
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The years of experience do not determine professional identity. Although it has been believed that professional identity depends on time, that it emerges after years participating in a practice recent graduates are demonstrating the vocation of service and attitude that ensures the well-being of patients and the community.
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It arises in a shared space of the individual and his professional and sociocultural environment. While professional identity is indeed personal, consolidated from elements inherent in the individual such as his or her personality, extraordinary factors such as a pandemic force a thoughtful process, which triggers decision-making and the dedication to a professional commitment.
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It lasts even after the professional activity has ended. A physician retired from clinical practice continues to experience the same sense of duty and ethical commitment that he or she declared as part of the Hippocratic oath.
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It conflicts with the identity as a member of other social groups. Health professionals have been faced with the conflict of deciding which interests should guide their decision-making. They have confronted the questioning of what they are first: Are they doctors (professional identity)? Are they part of a family (personal identity)? Are they part of a community (social identity)? Daily, all these aspects of their identity share space and time. However, the emergency has suspiciously demanded its time.
After the pandemic, health training institutions must integrate learning into their curriculum design. The participation of students on the health team should include greater autonomy with accompaniment by certified care professionals. The clinical cycles where students engage with the patients should not be limited to the handling of everyday cases. The students must consider adherence to the different protocols of safety and quality of care. The training process should include in situ drills of extreme situations so that they experience the emotions and tensions that may arise in emergencies such as those unleashed by the new coronavirus.
The care and emotional well-being of healthcare professionals
Although the medical professionals demonstrate their professional identities through their vocation and their attitudes towards their roles in the front lines of care-giving, they are worried about carrying the coronavirus to their loved ones. At the end of the day, we all think about our families, their well-being, and giving them the best. One complaint from doctors and nurses who attend patients with COVID-19 is that the social and economic recognition for their work is scarce or null (González, 2020). They face the decision between their interests and those of the community, which has turned them into outcasts even in their neighborhoods. Some have also rec
eived assaults on public roads instead of recognizing, applauding, or respecting the medical staff, paramedics, and the cleaning and security personnel (UN Mexico / Aubin, 2020).
Surprisingly, the practice community, the one in which new professionals are attended and trained, maintains a transcendental role. They have offered Hotlines and programs to ensure the well-being of the health professionals on the response teams. This community involves even those already retired, who have shown high levels of commitment. These doctors, already retired, have decided to return to work to combat the disease. They view it as a responsibility to their profession, to their country, to their community, and to their family (Einhorn, 2020).
Some instances in other countries, such as Spain and Italy, face a fierce battle, where there are not enough professionals to care for the sick. So, they have called upon medical students to volunteer in the first line of response. In Mexico, the case involving medical students is still under discussion because of the limited personal protective equipment (PPE). Because of this lack of safety equipment, the students could become burdens on the health systems instead of benefactors. The Mexican Association of Faculties of Schools of Medicine (AMFEM) has pronounced itself in favor of ensuring the health of all personnel in training and temporarily suspending participation in clinical rotations and social service work (AMFEM, 2020). The organization anticipates that the students could return once more is known about the protocols for care, the level of contagion decreases, and there is sufficient equipment available to ensure their safety.
One element of increasing interest is the care and well-being of healthcare professionals. The significant increase in the number of inpatients, the scarcity of intensive care beds, and the lack of a vaccine to protect patients in vulnerable conditions are causing an unprecedented level of anxiety. For the doctors and nursing personnel involved in the fight, a contagion curve that does not flatten has caused nightmares at the end of their shifts; they have dreams about being surrounded by patients with coughs (Weiss, 2020). Seeing their colleagues one-by-one getting sick, they wonder how long it will be before the inevitable happens, that they get sick themselves (Associated Press, 2020).
Through the invaluable work of doctors, nurses, firefighters, police officers, and soldiers, as a society, we are receiving a unique service that has little to do with their employment relationship or the economic remuneration they receive for their work. It is happening due to a call they decided to attend, something that continues being hard to understand, which increases the importance of studying their process of building professional identity.
About the author
Dr. Mildred Vanessa López Cabrera (mildredlopez@tec.mx) is Director of Innovation and Educational Research at the School of Medicine and Health Sciences. She holds a Ph.D. in Educational Innovation and is a Fellow of the FAIMER Institute (Foundation for Advancement of International Medical Education and Research) and the Pontifical Catholic University of Chile.
References
Abrams, A., and Ducharme, J. (2020). Meet the Medical Students Becoming Doctors in the Middle of a Pandemic. TIME. Retrieved from: https://time.com/5820046/medical-students-covid-19/
AMFEM. (2020). Comunicado importante: ante el avance de la pandemia por COVID19. Retrieved from: https://www.amfem.edu.mx/
Angier, N. (2001). Case study: globalization, location: everywhere; together, in sickness and in health. The New York Times Magazine. Retrieved from: https://www.nytimes.com/2001/05/06/magazine/1-case-study-globalization-location-everywhere-together-sickness-health.html
Associated Press. (2020). Yonkers ER doctor describes the nightmare of the coronavirus front line. New York Post. Retrieved from: https://nypost.com/2020/04/22/yonkers-er-doctor-describes-nightmare-of-coronavirus-frontline/
Eirnhorn, C. (2020). Out of Retirement, into the Coronavirus Fight. The New York Times. Retrieved from: https://www.nytimes.com/2020/03/31/climate/coronavirus-doctors-retire.html
Goldberg, E. (2020). A Medical Class ‘Minted by the Pandemic.’ The New York TImes. Retrieved from: https://www.nytimes.com/2020/03/24/health/medical-school-coronavirus-students.html
González, M. (2020). Coronavirus: el preocupante aumento de agresiones en México contra personal médico que combate el covid-19. BBC News. Retrieved from: https://www.bbc.com/mundo/noticias-america-latina-52319044
Lebrija, M. (2020). Las pandemias más letales que han azotado a la humanidad en los últimos siglos. El Universal. Retrieved from: https://www.eluniversal.com.mx/ciencia-y-salud/coronavirus-las-pandemias-mas-letales-que-han-azotado-la-humanidad
López Cabrera, M.V., Olivares Olivares, S.L., Heredia Escorza, Y. (2020). Professional Culture in Medical Schools: A Medical Educator Interpretation. Medical Science Educator. https://doi.org/10.1007/s40670-019-00896-x
ONU México, Aubin A. (2020). La ONU en México condena las agresiones contra los profesionales de la salud que lucha contra el coronavirus. OMS México. Retrieved from: https://news.un.org/es/story/2020/04/1473372
Organización Mundial de la Salud [OMS] (2020). Alocución de apertura del Director General de la OMS en la rueda de prensa sobre la COVID-19 celebrada el 22 de abril de 2020. Retrieved from: https://www.who.int/es/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19–22-april-2020
Weiss, K. Doctors Fear Bringing Coronavirus Home (2020). The New York Times. Retrieved from: https://www.nytimes.com/2020/03/16/us/coronavirus-doctors-nurses.html
Editing by Rubí Román (rubi.roman@tec.mx) – Observatory of Educational Innovation.
Translation by Daniel Wetta.
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This article from Observatory of the Institute for the Future of Education may be shared under the terms of the license CC BY-NC-SA 4.0 
