Megan Roby is a medical student at the University of Exeter and the first student to complete Critical Care International’s e-internship. Dr Marcus Stevens is a GP based in Bath and CCI’s Head of Operations. In this article they share their experience of the first year of CCI’s pioneering medical student e-internship and their reflections on the model’s potential to enrich medical education.
The formation of a medical student’s professional identity extends beyond the acquisition of medical theory. Experience in a variety of diverse settings is needed to develop the communication skills essential for patient-centred care and to enhance a student’s ability to adapt to challenging circumstances. However, despite their importance it is often difficult to identify opportunities outside of university curricula that encourage a more holistic approach to healthcare. In the lockdown environment we saw a temporary shift in traditional medical education from hands-on learning to online delivery, highlighting opportunities to experience healthcare in places otherwise inaccessible. This article will explore the relatively novel concept of medical ‘e-internships’, exploring how they can advance medical education and improve the quality of learning students receive before entering the workforce.
Critical Care International (CCI) is a UK-based company specialising in medical consultancy, training and in-situ medical provision in resource-poor locations across the globe. Since its inception the CCI team has been remote, with doctors deployed around the world receiving operational and clinical support remotely on a weekly basis. Dr Marcus Stevens, currently Head of Operations at CCI, realised the weekly call structure could be extended to medical students, offering an opportunity for real-life learning and personal growth within the supportive, professional, but virtual environment of an ‘e-internship’. CCI understood that despite some inclusion of global health topics in medical school curricula, students are often naïve to issues faced by health systems outside of the UK, and to career opportunities available globally. Furthermore, topics such as healthcare economics, the operational delivery of healthcare and business management are not widely covered. The internship programme has been designed to run alongside a medical student’s degree and provide direct insight into how comprehensive medical care is delivered in resource-poor environments, including recruiting and managing deployed staff, advertising and pitching to new clients, and structures of medical and financial governance. Having seen the value of the experience, we believe such programs could be extended to a range of organisations and either organised alongside day-to-day study or in shorter, more condensed periods, which could be thought of as ‘e-electives.’
Megan Roby started as CCI’s first e-intern last year and has found it a steep but extremely rewarding and varied journey. Initially attending weekly governance calls she met the team and gained insight into the company structure. Having her own company email address meant Megan could independently take the lead on projects as well as seek clarification on topics when needed. As she became more familiar with CCI, Megan was able to take on greater responsibility and actively engage in team meetings. This has allowed her to experience many aspects of medicine that would normally be difficult to gain exposure to during medical school. She has also gained invaluable mentorship and advice, including on the huge range of professional opportunities available outside of a traditional medical career. For instance, she hadn’t considered a career in general practice as she wasn’t aware of the notion of a portfolio career, such as pursuing research or setting up clinics abroad alongside a traditional NHS role. By talking to CCI doctors from a range of countries and backgrounds, she’s been able to network and learn about specific steps others have taken in their careers, which will serve as a rich source of inspiration as she considers her own options. CCI’s Medical Director shared with Megan his reflections on what led him to pair an NHS career with working for CCI. “It’s vital to excel in the scientific elements of your degree but pursuing other passions alongside this activity will both enhance your performance as a doctor and your enjoyment of your career”, he explained. Indeed, the insights gained through the internship facilitate exploration of one’s own capabilities, interests and knowledge.
The primary aim of the internship program is educational. CCI is committed to supporting e-interns in pursuing the areas which are of interest to them and as such, there are no business functions which rely on interns for completion. Despite this, there is ample opportunity to have significant, long-lasting and varied impacts on the way the business operates. Megan’s biggest contribution has been leading CCI’s first national student essay competition. During weekly meetings she understood the company wanted to expand medical student engagement and she realised an essay competition would both raise awareness of CCI and their aims, whilst furthering discussion around topics of global significance. She was afforded independence to design the essay competition and following extensive research and collaboration with all members of the team she delivered a project to be proud of. Moreover, this was a fantastic opportunity to expand her knowledge on topics ranging from global health and climate change to medical technology as she evaluated the submissions. The winning essay is available here. She subsequently built on the success of the essay competition to organise and host a virtual panel event, inviting a select number of students to discuss their essay topics in front of a wider audience. She learned how to organise an online conference and reflected on the factors that make large events successful, such as having pre-set discussion points, encouraging audience interaction and incorporating visual aids. Such skills become vital as one progresses through medical training and are required to demonstrate involvement and proficiency in non-clinical areas such as teaching, research and service development.
The internship also offers exposure, remotely, to clinical situations one would rarely see in the UK. Discussions about managing snakebites, malaria, and other tropical diseases within a culture where patients often also seek help from traditional healers has been incredibly thought-provoking. Furthermore, helping to write clinical protocols and discussing cases presented in clinical governance meetings has provided exposure to the flexible approach and relevant considerations required when working in remote environments. For example, if a woman goes into preterm labour in a small remote clinic, how can she be managed in an ambulance on bumpy roads en route to a distant hospital? Being challenged to apply one’s medical knowledge and logistical imagination to such scenarios is a unique and invaluable opportunity that can be provided by e-internships.
At times both CCI and Megan have had to be flexible. When the stresses of medical school resulted in more time being set aside for study, Megan was supported within the team and learned to manage her time whilst also remaining transparent about her capabilities. CCI have constructed the programme so that the current intern is responsible for interviewing and selecting the next intern. In doing so, the current intern can adapt and improve the internship based on their experiences and any challenges they may have faced. The focus of Megan’s internship has been operational rather than clinical, however, future programmes could be developed to include stronger clinical components where students are involved with on-site doctors directly to learn about patient cases and their outcomes. We have found the internship model to be stimulating, supportive and flexible, allowing both CCI and Megan to benefit immensely.
We are hopeful our experiences will encourage others to establish similar programs; however, it is important for organisations to consider what opportunities they can offer and how much responsibility they are willing to delegate to interns. It is crucial that both the host organisation and the intern’s expectations are matched. For example, will the internship be focused on shadowing members of the team or will the intern be able to directly contribute to meetings and projects, ultimately increasing their self-confidence in the workplace and developing a broader set of skills? Will the focus be on understanding the structure and logistics of a company, or will it take on a more clinical focus? From our experience, we believe mentorship should be a foundational component of an e-internship, to ensure the intern is adequately supported to get the most possible value from the experience and to address challenges and boundaries to engagement as they arise. Exploring these questions and themes early in the process has allowed the CCI internship to develop into a role that encourages growth and learning, as well as the possibility for later employment in CCI or a similar organisation.
Despite their potential, medical e-internships are not currently widely available. Having seen their power to expose medical students to novel environments and cultivate skills beyond those developed within a traditional medical school curriculum, we are excited by the role they could play within medical education. The model can be applied at home and abroad, in both commercial and charitable settings. There are myriad organisations in which they could be offered, covering a range of geographical, clinical and political landscapes. Looking ahead, we envisage medical schools offering internships that run in parallel to the curriculum, allowing students to pursue individual interests, however distant or diverse. Although further research should be conducted into the opportunities and challenges e-internships present, in a world where the challenges facing medical students are rapidly changing, innovative methods should be explored. Medical student e-internships offer the chance to bridge the gap between theoretical learning and first-hand experience. They can support students to become ‘work ready’ through exposure to the non-clinical aspects of medical service provision, as well as expanding their vision of what is possible within a medical career. Given the potential thematic scope of e-internships and their adaptability to fit alongside the traditional medical curriculum, we believe they could prove to be an invaluable addition to the medical school experience and contribute to preparing cohorts of junior healthcare professionals who are better able to meet the evolving demands of their careers.
To learn more about CCI’s work, please visit their website here.