Construction of the Illness Script of COVID 19: What an Unsettled Learning Curve!

Abstract

Introduction: Initially regarded as a type of influenza, COVID-19 was later identified as a severe acute respiratory syndrome. However, it soon became evident that COVID-19 was more than just a lung infection and that it was a disease with an increasing number of non-respiratory consequences, such as neurological and vascular issues, as well as clinical manifestations. Clinicians were abruptly faced with a difficult, hazardous, and unusual disease for which they lacked a well-defined and organized clinical script. We aimed to deepen and understand how the COVID-19 illness script was being constructed during the early stage of the pandemic. Methods: The study population consisted of residents, chief residents, and attending physicians from different departments. Two focus groups and a one-to-one semi-structured encounter were conducted. The researchers closely analysed the data to identify common themes—topics, ideas and patterns of meaning that come up repeatedly. The transcripts were then thematically analysed using both deductive and inductive methods. Results: Two major themes emerged from the qualitative analysis: 1) unsettled conditions of learning, and 2) successive steps and content of script building. Our findings demonstrate the challenging situation that doctors faced in an extremely uncertain environment without any prior knowledge to fall back on. Conclusion and Discussion: Clinicians have had to undergo awful levels of pressure as a result of the COVID-19 pandemic, and they have had to rewrite their illness scripts to account for this atypical context. We uncovered several main factors that were essential in script construction: clinical reasoning and decision making in an emotional context and stressful conditions, unsettled learning processes, and perturbed supervision. In this perspective, the COVID-19 pandemic offers a unique opportunity to examine how an unprecedented constellation of contextual factors may impact the processes and performance of clinical reasoning. Crises are characterized as situations that put institutions in jeopardy of failing, exposing their flaws and strengths and occasionally resulting in institutional change. Therefore, this pandemic gives the opportunity to review how to supervise and teach uncertainty, as well as to emphasize the value of patient communication in the process of the construction of illness scripts.