Dr. Brenda Merritt. Photo submitted.

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For graduating health sciences students, the blossoms of spring usually coincide with the end of their mandatory 10-12 weeks of “hands-on” experience under the eye of supervisors in hospitals and clinics.

Once these clinical placements are completed, aspiring nurses, physiotherapists, X-ray and ultrasound technologists, respiratory therapists, and audiologists must then write exams to earn the credentials their licensing bodies require before starting their professional careers.

But this year has been like no other because of the coronavirus pandemic. Not having convocation ceremonies this spring and fall are mere minor disappointments. The real issue — which is requiring creativity and flexibility on the part of  teachers, students, and regulators — is how to ensure students poised to enter the health professions have the necessary skills and competence despite missing nearly two months of hands-on training.

As of mid-March, all clinical placements were postponed for graduating students in Dalhousie’s Faculty of Health — an umbrella that includes 3,000 students spread among more than 30 diverse health professions. Placements were also cancelled for medical, nursing, and dental students in their respective schools.

Dr. Brenda Merritt, Dean of the Faculty of Health at Dal, says these cancellations due to COVID-19 have forced professors and students to suddenly shift gears and re-arrange their programs. Merritt explains that, “Our occupational therapy, physiotherapy, speech language and audiology students would typically be out in the field in the spring, and then they would finish their term with on-site courses. So we have taken those on-site courses and put them online. We have pushed those forward so we can free up space for whenever things open up again — whether it’s summer or early fall — so they’re ready to go and they can finish.”

Online Exams — Using Mirrors

Fourth year Pharmacy students did their placements during the winter and will graduate this May. Alana Currie, president of the Faculty of Health’s Student Association, is preparing to graduate as a sonographer, or ultrasound technician. The full-time job she expected to begin this summer is now in limbo; the licensing exam she was supposed to write in May has been postponed until June 25. She will be writing the exam from home, online, like many other students these days.

“The testing centres are closed until July 1,” says Currie. “So I’ve heard I’ll need a webcam and mirrors set up behind me so the proctors can see there is nothing in front of me that I could be reading — to make sure I’m not cheating.”

Alana says she is “one of the lucky ones” because her 12-week clinical placement began during the winter, so the disruption from COVID-19 left her just 2.5 weeks short of the experience she required. Sonography Canada (the licensing body) has bent a few rules to allow Alana and her classmates to use “previous” cases to complete the course work in order to write the national Clinical Skills exam.

“I know many students with a lot more worries,” she said. “But not having to pay back our student loans until September is a big help.”

Physiotherapists Affected

“For the graduating class, we’ve been given more time to complete our placements, with the hope of still graduating on time (Fall of 2020). But that could be delayed depending on the ever-changing circumstances of the pandemic,” explains Holly Nason, president of the Physiotherapy Student Association at Dalhousie.

“The School of Physiotherapy is doing everything in its power to complete our placements and ensure we receive the best education and experience possible,” continued Nason in an email. “The class would normally do the written part of the national Physiotherapy Competency Exam in July and then the clinical portion of the Competency Exam in November. However, the July exam has been postponed, thus potentially delaying when we can write our practical. In order to work under a supervisor in Nova Scotia, we must have graduated from the program and completed the written portion of the Exam. So, we could potentially be delayed as to when we can enter the workforce as a result of COVID-19.”

“We really want to get our senior level students through their clinical placements so they can enter the workforce,” echoed Merritt, “that would also include respiratory therapists who need to finish their placements. It’s a priority.”

Supply and Demand

Many of these health professionals are in short supply in Atlantic Canada. Questions remain regarding how long COVID-19 could delay their entry into the workforce. Speech language pathologists and audiologists who normally would have done weeks of practical training in the schools are also disrupted.

If accreditation standards are relaxed because of COVID-19 challenges related to hands-on practice, another uncomfortable thought is how much confidence the public should have in freshly-minted health professionals.

Merritt says it’s more probable entry into the workforce will be delayed. “In some programs, students still need 10 weeks,’ she says. “To graduate them now, they wouldn’t have the skill set they need to be in practice.”

What Will Fall 2020 Look Like?

This problem will continue for Dalhousie University’s health professions and research community well into the autumn months. How will they deliver lab instruction and hands-on training in the time of COVID-19? One option is making more use of video conferencing and conducting virtual patient consultations, said Merritt, as some professions are already doing.

Dalhousie President Deep Saini’s message last week to the university’s community underlines the uncertainty surrounding the fall term:

Continued social efforts to “flatten the curve” over these next several weeks will help us to be able to return to on-campus operations, but there may still be significant restrictions required. There are many potential scenarios that are possible depending on how the public health situation evolves.

We can assure you that degrees, courses and instruction will continue, whether online, in person, or some combination of both….we will continue to explore and invest in our online learning platforms to enhance the learning experience. We will heed the lessons learned from this winter term and apply them in support of our students and their academic experience whether our students are on-campus, learning remotely or involved in a blended approach.

[emphasis in original]

An oral presentation to the Dalhousie Senate from Provost Dr. Teri Balser outlined three possible scenarios under consideration. Merritt described them as:

  1. “Status quo,” where all professors and students teach and learn remotely.
  2. A “blended or partial lockdown,” where most courses are delivered online and person-to-person teaching is reserved for skills labs and hands-on procedures.
  3. A more “open lecture” model with restrictions on class size and international students.

The Balance Sheet

If borders remain closed to try to limit a second wave of the coronavirus, this will also affect Atlantic universities financially. International students now account for 20% of the total number of students enrolled at the region’s universities, and most significantly for university revenues — they pay double the tuition fees.

On the other side of the ledger, the closure of facilities such as libraries, gyms, pools, buildings, and cafeterias has saved universities millions of dollars over the past two months.

The best-case scenario for students hoping to graduate from many health professions this fall would be for the Nova Scotia government to ease restrictions around which services can be provided by hospitals and clinics. The pandemic model developed in Nova Scotia projected the need for 35 hospital beds in a best-case scenario — a projection that so far remains three times higher than the actual number of people who had to be hospitalized because of COVID-19. Meanwhile, people newly-diagnosed with cancer and those needing hip and knee replacements continue to wait while hospitals run at 70% capacity.

When the doors do re-open, Merritt hopes health-care professionals will be eager to assist Dal students.

“We are going to need good collaboration with our health partners because some medical services have been minimized or postponed, such as elective surgeries and private practices,” she said. “Those are at bare bones, and they don’t have enough case-load to take on a student. We really need to work with the province once they start ramping up services again so we can get our students in there.”

And since the colourful autumn leaves usually coincide with thousands of students swarming back to campuses, Merritt highlights the knock-on effect of COVID-19. “From a university perspective,” she points out, “if we aren’t able to finish the clinical placements for these graduating students, we have another whole group coming behind them, which could create a backlog.”

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Jennifer Henderson is a freelance journalist and retired CBC News reporter.

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