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Viva Voce and the Virus: Interviews with the Very New
2020 was a year like no other in living memory. Next to a pandemic, only war brings such a wholesale dislocation and reorganisation of our social and economic life—and so it was with the COVID-19 assault on the human population. Indeed, the impact of the current global health crisis has been psychologically more profound than any military battle because the enemy moves invisibly and tirelessly among us with no regard for the accepted rules of engagement in a deadly conflict.
The College membership as a whole has played a valuable role in coping with the crisis and helping to maintain the healthcare system under less-than-ideal field conditions. Yet, as with war, it is unsurprising to note that, in the defence of a nation's (or nations') health from a novel threat, the disruption to normality tends to fall heavily on those who arrive at the front just as the first wave hits. So it was for our trainees and recent graduates last year and today.
This uncomfortable thought led Inside News to ask six of the newly-arrived cohort at the start or in the early phase of their careers to tell us of their recent experiences.
As could be expected, the responses were mostly the stuff of bad dreams or, if not truly nightmarish, unsettling enough to induce a serious loss of sleep. Yet, despite the pain, the persistent sentiment among the interviewees was positive or at least self-deprecating—about the impact of the crisis on self and family, their workplaces, and on their future careers.
As one was adamant to remind us, “my experiences with COVID are minor compared to the death of a loved one due to the infection.”
Nonetheless, disruptions to both training and work were widespread. Sally Ayesa, a clinical radiologist in Gosford, completed her second year of nuclear medicine advanced training in 2020. “I had planned to pick up some casual radiology work in 2020 but the plans fell through.” With the pandemic, patients were getting fewer scans and, with a downturn in demand, a private practice appointment and two locum positions she had been offered at public hospitals failed to result in any work. “It was a frustrating and uncertain time in my career,” she recalled. However, one of the hospitals kept in touch with “open and honest communication” and eventually got her on board. “I ultimately decided to settle long-term at the hospital that had offered me the best support through the times of uncertainty,” she said.
Cara Odenthal completed a hybrid fellowship in abdominal and pelvic imaging in Brisbane last year and now works for a large private radiology clinic and two breast clinics in the public and not-for profit sectors. During her fellowship, she experienced a significant drop-off in caseload and ability to attend multidisciplinary team meetings, conferences and courses, as the pandemic took hold. But the setback had its compensations, she recalls.
Shivraj Saini, a trainee who began a preparatory course at Westmead Hospital in 2020 for the Part I applied imaging technology (physics) examination, found it hard to adjust to the online delivery of lectures, partly due to technology issues in video conferencing. He was also enrolled in an anatomy course at UNSW, but the course switched to self-directed learning after only a couple of lectures, which increased the challenges facing him.
“To learn this much anatomy in such detail requires help from someone who is senior and able to help with tips and tricks for memorising [the detail],” he said. Dr Saini's work at two Sydney hospitals was also disrupted. “It was almost impossible due to COVID restrictions to introduce myself in person to the radiology departments”. And, as a nuclear medicine registrar, the holding of all meetings online limited his interaction with consultants. Yet, despite these experiences, he still sees considerable benefit in online meetings and conferences that allow him to “tune in remotely during a lunch break”.
In New Zealand, Sarah Benson-Cooper, a clinical radiologist in Auckland, lost, due to the lockdowns, much of the value of an MRI fellowship and the ability to travel overseas for an interventional course to complement her body imaging fellowship, which she is completing at present.
Prior to the pandemic, she had planned to take a year off from study, work flexible hours in Queenstown for a teleradiology company and spend more time with her family. “However, after the pandemic hit, there was job uncertainty, especially for full-time work, and with travel options limited, it was better to secure a position straightaway” in Auckland. Uprooting her three young children during a pandemic to pursue a fellowship overseas no longer seemed wise.
From her discussions with other trainees it seems that often they too chose to stay close to home during the pandemic. This has increased competition for highly-sought-after NZ and Australian fellowships and complicated their efforts to secure post-training jobs and experience.
Dr Benson-Cooper is aware that trainees sitting their examinations in 2021 have been adversely affected by a loss of “traditional exam preparation time”. This is due to the delayed 2020 examinations for the previous trainee cohort. The delay has meant that the bulk of teaching and viva practice was understandably focused on the pre-exam trainees over a longer period, not on upcoming trainees who, as a consequence, have received less supported preparation time. However, despite continuing uncertainty and disruption, she feels trainees have coped remarkably well with the added stress. “They have shown incredible determination and commitment to training,” she said.
Calvary Mater Hospital Newcastle
Dr Sally Ayesa
Sam Dickson, a radiation oncologist in Newcastle, had planned to apply for a fellowship in Adelaide at the end of his examinations in early 2020.
When the viva component was delayed until December due to COVID restrictions, the interstate opportunity was lost, but that wasn't the worst of it. The loss of certainty around the training program and the exam timetable worsened the “huge amount of guilt” he had felt for the previous 18 months. “When I was studying, I felt guilty I wasn't spending time with my family; and when I spent time with my family, I felt guilty I wasn't studying enough.” These challenges are normally manageable because the trainee knows when it will end. In 2020, that knowledge and the comfort it gives were absent. “When the certainty around the timeline was removed, it became a lot harder for all involved,” he said.
But then he got lucky—a one-year contract covering for a radiation oncologist on maternity leave became available at Calvary Mater Newcastle as he was completing his examinations. “So I have managed to transition to being an RO at the centre where I did the majority of my training.”
However, he continues to feel the impact of the pandemic, with staggered start times and longer treatment hours to help maintain social distancing, and a workplace that has been scattered over different hospital floors to make room for a COVID testing clinic. Practices have changed as well, with online meetings, visitor limits, postponements for non-urgent radiotherapy, and the use of hypofractionation whenever safely possible.
Michael Chan finished his clinical radiology examinations in 2019 and obtained a fellowship in 2020 working across three hospital campuses in Toronto, Canada. He encountered a highly supportive working environment in Toronto, but, with three extended lockdowns to date, personnel and resources have been stretched.
Dr Chan will return to Australia at the end of his fellowship but in the meantime he has keenly felt the absence of his wife and family and friends, especially on his wedding anniversary and for Christmas and birthday celebrations. “Multimedia communication is far better today than it was a decade ago, but it cannot fully replace the social interactions we took for granted pre-pandemic,” he said.
All the interviewees saw some positive outcomes arising from their experiences of the pandemic. Of these, the most endorsed sentiment was that the scramble to move communication and teaching online has created lasting benefit for the profession.
Sally Ayesa, who was involved in radiology registrar teaching and exam preparation, was suddenly forced “to become familiar with Zoom very quickly,” develop electronic teaching materials to replace film-based tutorials and record lectures for virtual conferences.
Today she is again using film in face-toface tutorials but also keeping with the electronic materials she developed in 2020. “I was able to run a practice viva with a candidate in New Zealand while sitting at my desk in Sydney—it was incredible to be able to connect and learn in that way,” she said.
“Looking back over the last year or so, it is evident that COVID-19 dealt a body blow to the healthcare systems of Australia and New Zealand, and the impact of that blow was felt strongly throughout the medical colleges as they sought to maintain their education and training programs.”
Sarah Benson-Cooper sees a clear benefit today in continuing to allow some consultant radiologists to report from home, so as to maintain a healthy work-life balance, reduce travel commitments or continue to work despite having mild coryzal symptoms or children home sick. “This is something that could be utilised more in our profession, although it needs to be balanced with staffing, supervision and teaching requirements,” she concluded.
Dr Cara Odenthal
Dr Samuel Dickson
We acknowledge that, while examination dates in 2020 and arrangements for 2021 were determined and communicated as quickly as possible, the complexity and fluidity of circumstances created by the pandemic brought unprecedented pressure on our processes and ability to manage the flow of information uniformly.
At one point it seemed as if the entire exam timetable for 2020 might be cancelled—that this did not happen was a win for us as an organisation. However, it is now clear there remains room for improvement in the timeliness of critical communications with trainees, and the methods used for these, and we undertake to do better in future.
As Cara Odenthal concluded in her comments, “any additional transparency regarding College exam decisions would go a long way to abating the stress levels of exam candidates.”
Sam Dickson's experience in receiving exam-related information from the College is a reminder even small decisions may have big impacts. He recalls receiving an email from the College about the postponement of his viva about 10 days before the examination. The email was sent and received about midday on a Saturday. “They could have easily waited until the next business day, Monday, to send that email. But once I got it, I immediately put the books down and spent a wonderful day and a half with my family without any feeling of guilt about not studying—something I hadn't done for 18 months. It made a massive difference to me.”
