COVID-19's illness script: From its origins to the present day. A Tinguely-like kinetic sculpture

Illness scripts (IS) are mental representations of diseases formed through formal and experiential learning. Rich and mature IS are promptly activated in contextual information, expediting diagnosis and management. The COVID-19 IS developed atypically-experts had to build it without prior knowledge. This study examines its evolution from early pandemic stages to the present, assessing its richness, maturity, uncertainties, influencing factors, and its impact on clinical supervision.

A qualitative study was conducted at Geneva University Hospitals from December 2022 to May 2023. Volunteer physicians from various divisions participated in semi-structured interviews, which were recorded, transcribed, coded, and analyzed using deductive and inductive thematic approaches. The theoretical frameworks concerning IS development, richness, and maturity, as well as situated cognition theory, were used in the analysis.

Twenty physicians participated. The COVID-19 IS, developed from diverse sources, is now rich and mature. COVID-19 is primarily viewed as a respiratory infection, especially in vulnerable patients, with corticosteroids and supplemental oxygen as primary treatments. However, instability remains: atypical presentations still occur, viral variants raise treatment concerns, and long COVID introduces additional complexity. Political, institutional, and individual factors shape the IS. While the IS itself was shared across seniority levels, participants reported an erosion of the supervisor's epistemic authority: attending physicians saw a threat to trainees' formation, chief residents a shift toward collaborative reasoning, and residents a move from knowledge transmission to relational support. The pandemic harmed medical training, as COVID-19 overexposure led to poor IS development for common illnesses.

Despite atypical construction, the COVID-19 IS has become rich and mature, though some uncertainties persist. Moreover, it is operational and effective. It was shaped through dynamic interactions across multiple levels-from the immediacy of patient encounters to the broader institutional and sociopolitical contexts in which clinical practice unfolds.