Medical and Surgical Education Challenges and Innovations in the COVID-19 Era: A Systematic Review

Bringing the "Joy of Healthy Eating" to Advanced Medical Students: Utilizing a Remote Learning Platform to Teach Culinary Medicine: Findings from the First Online Course Based on the ACLM's Whole-Food Plant-Based Culinary Medicine Curriculum

Over 80% of chronic disease is caused by lifestyle practices, including an unhealthy diet. Despite this, most medical students in the United States graduate having received minimal nutrition education, guidance towards improving their nutrition, or skills needed to coach patients to adopt a healthier diet. This study aimed to educate fourth-year medical students in evidence-based knowledge regarding a delicious, whole-food plant-based diet while introducing practical culinary skills and patient coaching skills. We adapted an open-source culinary medicine curriculum designed for in-person teaching of pre-clinical medical students to provide a novel 1-month online elective to fourth-year medical students. We used a 26-item pre/post questionnaire to assess change in evidence-based knowledge regarding nutrition, culinary skills, patient coaching skills, and attitudes toward a whole-food plant-based diet. In addition, we reviewed narrative comments by the student participants, course directors, and medical-school administrators. Scores in all 4 domains were tested, and for all individual questions, they showed statistically significant improvement following the course. Most narrative responses were positive, and areas for improvement were also identified. We successfully adapted an open-source whole-food plant-based culinary medicine curriculum for advanced medical students into a 1-month elective taught on a virtual platform. This course filled a need for training in nutrition and counseling for these students as they start their professional careers.

Maternal and Child Health Nursing education before and during COVID-19: An exploratory descriptive study

Background

Major disruptions to higher education during COVID-19 resulted in a rapid shift to online learning and associated adaptations to teaching and assessment practices, including for postgraduate programs requiring practical skill development such as nursing and midwifery. Educator perspectives of this transition have not been widely studied.

Purpose

This qualitative descriptive study aimed to describe Australian postgraduate Maternal, Child and Family Health nurse educators' perceptions of COVID-19 impacts on student knowledge of theory and practice, and lessons learned through their responses.

Method

Semi-structured interviews were reflexively thematically analyzed.

Results

All participants recognized struggles, opportunities and innovations within three key themes: “We've learned how to be flexible”: Grappling with COVID-safe teaching and assessment; “Chat rooms and Zoomland”: Learning in a virtual community; and “We've had a few struggles”: Clinical placement tensions. Educators described a sense of uncertainty, increased flexibility, opportunities for change and new ways of connecting. They adapted by developing new online resources and broadening clinical practicum and assessment requirements to address new practice approaches including telehealth.

Conclusions

Rapidly changing practice requirements and concerns about risk of disease transfer between workplace and placement venues restricted placement opportunities. Educators learned and incorporated new skills and strategies into their teaching, while aiming to meet professional expectations and maintain quality of education. Some strategies are likely to be maintained for future education programs.

A single-center, cross-sectional study of cross-professional faculties' perception to virtual class under different scenarios: A stepwise approach

BACKGROUND

Virtual teaching in medical education is rising with the increased need caused by the recent pandemic. However, evaluations of the perception of clinical teachers across professions for setting a virtual class in different teaching scenarios are limited. This study aims to identify cross-professional clinical teachers' perception of virtual classes and the acceptability of the virtual class-specific checklist for setting a virtual class.

METHODS

We conducted a cross-sectional study to investigate clinical teachers' need to set and teach a virtual class and then designed a virtual class-specific checklist with five essential steps and a related training program in July 2021. After the training, 186 participants were randomly enrolled in October 2021 to evaluate their perceptions about setting virtual classes and the acceptability of the virtual class-specific checklist using an online assessment questionnaire.

RESULTS

In our institution, the number of faculty-led virtual classes has recently been on the increase. Our study revealed that most teachers agreed that virtual classes could break space and time limitations, but that the Internet environment could affect the fluency of the virtual class. They further agreed that the essential five steps in the checklist should vary depending on the type of teaching scenario. Most clinical teachers, with the exception of those who teach in the operating room, considered the operating room as the most difficult scenario for setting virtual classes.

CONCLUSION

Faculty training for setting virtual classes is essential, and the essential virtual class-specific five steps are suitable for different teachers and teaching scenarios. However, the virtual class-specific checklist should be further adjusted according to the limitations caused by emerging innovative virtual teaching technology.

Learning in the COVID-19 pandemic and beyond: development and rapid uptake of an online learning platform for vascular surgery

INTRODUCTION

With the onset of the COVID-19 pandemic, alternative methods of delivering medical education were rapidly required. An online learning platform was developed with the aim of providing high-quality, accessible learning to vascular specialty trainees. We describe the design, delivery and analysis of the first 15 months of the platform. Although originally a regional initiative, we discuss how popularity and feedback led to a rapid expansion of the training programme internationally.

METHODS

A fully online educational platform for vascular surgery specialist trainees was developed. The primary aims and ethos of the programme were that it should be easily accessible from any location, convenient, flexible, cooperative and collaborative, social and free financially to access. All learning resources were researched carefully and based on the UK vascular surgery curriculum and 20 seminal papers targeted in the Vascular Specialist Fellow of the Royal College of Surgeons (FRCSVasc) examination.

RESULTS

The project demonstrated that it is feasible to design, build and deliver a postgraduate clinical teaching platform with minimal time requirement, resources and cost while creating and maintaining high-quality content. Rapid national and international uptake has proven there is demand - in addition to overwhelmingly positive feedback from educators and learners, this demonstrates that previously perceived barriers to online education can be overcome. At present, 53 educational sessions have been delivered and are available in the online library, and in the past year (8 December 2020 to 8 December 2021) the website has been accessed 3,877 times.

CONCLUSIONS

Although the programme has grown and evolved, a strong focus is being kept on its original ethos and aims - easily accessible, collaborative, free learning resources for all vascular professionals, based on the UK vascular surgery curriculum. Making learning convenient is key. The COVID-19 pandemic may be a watershed moment for a new era of learning. It is an opportunity for people from different backgrounds to share experiences and to develop cohesion within a hospital and network, nationally and worldwide.

Virtual Compared to In-Person Obstetric Anesthesiology Trainee Education During the COVID-19 Pandemic: A Short Report

Background: The COVID-19 pandemic brought many changes to medical training, including in-person education platforms being disbanded and replaced with virtual education. At our institution, dedicated obstetric anesthesiology teaching for residents and fellows occurs daily and is highly valued and rated. In March 2020 due to the COVID-19 pandemic, we changed the teaching platform from in-person to virtual teaching (via video communication). We subsequently surveyed residents, fellows, and attendings to determine the impact of virtual compared with in-person teaching.

Methods: To assess the impact of this change, an electronic survey was sent to 10 anesthesiology residents on their 2nd obstetric anesthesiology rotation, and 10 residents on their 1st rotation, respectively. The electronic survey was also sent to three fellows and eight obstetric anesthesiology attendings. Answers were based on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).

Results: The results for 1st rotation residents were higher in all domains compared with 2nd rotation residents and fellows, where “quality” achieved statistical significance (p=0.009) between 1st and 2nd rotation residents. “Engagement” was overall the most impacted domain for trainees. Attendings did not feel that virtual teaching impacted their ability to provide adequate education, however, learner engagement was again the lowest rated domain, and teachers strongly favored resuming in-person teaching.

Conclusions:Virtual teaching is an appropriate alternative when in-person teaching is not possible. Future initiatives are needed to improve engagement and better facilitate virtual teaching.

COVID-19 and its effect on Instagram adoption by #OBGYN residency programs

OBJECTIVES

Instagram (IG) is becoming one of the larger resource tools within medicine. Since the onset of the COVID-19 pandemic, it is becoming important for programs to improve virtual presence and outreach. We evaluated the adoption of IG by OB/GYN residency programs in the United States and aimed to see if highly ranked programs had higher utilization rates.

METHODS

IG presence and engagement metrics were extracted for all ACGME accredited OB/GYN programs. Doximity residency navigator tool was used to obtain nationwide program rankings, and statistical analysis was performed to prove any significant correlation. Mann-Whitney U test, Cochran-Armitage test and Analysis of variance were used for analysis. IRB exemption was obtained.

RESULTS

Seventy percent of programs (202/287) have IG presence, with the majority creating presence after the COVID pandemic began (115/202; 57%). Seventy-two percent (83/115) of these programs created their IG account once virtual interviews were announced. The top 25% of programs, as ranked on Doximity, have a higher number of posts, followers and likes when compared to the rest of the programs.

CONCLUSIONS

The COVID-19 pandemic has led to increased adoption of IG by residency programs. Highly ranked and reputed programs have higher rates of activity, popularity, and engagement on IG.

Can Customized YouTube Videos Improve ABSITE Performance?

INTRODUCTION

The COVID-19 pandemic decreased in-person didactic sessions in our general surgery residency. We piloted a program to develop online tutorials posted to a YouTube channel designed to prepare our residents for the ABSITE examination.

METHODS

Study participants were General Surgery residents in our five-year ACGME accredited general surgery residency program who took the ABSITE in-service exam between 2019 and 2021. We compared raw scores and overall programmatic percentile scores for three academic years (2018-2019, 2019-2020, and 2020-2021).

RESULTS

From academic year 2018-2019 to 2019-2020, before introducing the YouTube teaching platform, average raw scores and percentile scores among our general surgery residents remained unchanged (raw scores 64 - 65% (p = ns), percentile scores 39 to 37% (p = ns)). However, raw ABSITE scores increased significantly after introducing the YouTube teaching platform. A one-way ANOVA showed a statistically significant difference in raw ABSITE scores for AY 2020-2021 compared to the two prior years (F(2, 30) = [1.193], P < 0.01). Mean percentile ranking scores (program-wide) increased 15% from AY 2018-2019 to AY 2020-2021 (Figure1).

CONCLUSION

Teaching via an online platform such as YouTube allows residents to review material at their own pace and schedule. It is other our hypothesis is that the online YouTube material presented in the Ventura Surgery School channel contributed, in part, to this relative improvement compared to resident peers in other institutions. Teaching via an online platform could be a valuable tool to educate surgical learners in our ever-changing teaching environment.

The Impact of the COVID-19 Pandemic on Research and Volunteering Activities among Medical Students: A Cross-Sectional Study among Romanian and International Students from One Medical Faculty from Romania

Introduction: This study focuses on the influence of the COVID-19 pandemic on medical students in their last year of study at the Faculty of Medicine of the University of Medicine and Pharmacy in Cluj-Napoca, Romania. It analyzes the impact of social distance limits on the conduct of research activities required for the development of the graduation thesis, as well as assesses sixth-year students’ attitudes and behaviors toward volunteer activities during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted in June–July 2021 among sixth-year students. It used an anonymous online questionnaire and was sent to all students from the Faculty of Medicine studying in the Romanian, English, or French sections (n = 606). The response rate was 38.28%, resulting in a final sample of 232 students from both Romanian and international sections. Results: The findings demonstrate that two-thirds of the students in the survey agreed that the COVID-19 pandemic had a substantial impact on their research. Some of the students had to choose another subject for their graduation thesis, while about a quarter of the students gave up collecting personal data, 25% of respondents stated that it was difficult to contact research participants, one-third of them linked the difficulty of doing activities at the hospital to the present outbreak, and almost 30% of the students had difficulty communicating with the coordinator. The disturbance of the research activity seems to be higher among international students in comparison with the Romanian students, while there are limited gender differences. One out of five medical students has been involved in volunteer activities during the pandemic. Most have opted to volunteer at hospitals (especially international students) and contribute to health education activities (especially women). Conclusions: This is the first study from Romania and one of the few from Europe that presents data regarding the influence of the COVID-19 pandemic on research and volunteering activities among medical students.

One academic year under COVID-19 conditions: two multicenter cross-sectional evaluation studies among medical students in Bavarian medical schools, Germany students' needs, difficulties, and concerns about digital teaching and learning

BACKGROUND

Since March 2020, COVID-19 has created a need for adaptation in many areas of life. This study explores medical students' perspectives on digital teaching under conditions of the COVID-19 pandemic. It focuses on expectations and concerns about digital teaching, the evaluation of specific aspects of teaching, and requests for future teaching.

METHODS

Six German faculties have joined forces within the Bavarian network for medical education to develop and deploy a common core questionnaire. Cross-sectional surveys were conducted at the end of the summer semester 2020 and winter semester 2020/21. Medical students from different semesters participated in the online survey. Data was analyzed descriptively and/or inferentially. Item differences across semesters were examined using contingency tables and Chi² tests. Mean values were compared using the independent samples t-test; answer frequencies in retrospective and prospective concerns were compared using contingency tables and Chi² tests with Yates' correction.

RESULTS

In the summer semester 2020, 1565 students and in winter semester 2020/21, 1727 students took part in the survey. Students' main prospective concern was lack of social exchange between fellow students (70%), but also with teachers. Second and third most often concerns were a lack of practical training (68%) and lack of integration of on-site digital teaching (50%). Approximately 7% of the students lacked sufficient access to technical equipment.. Approximately 39% of the students lacked a sufficient internet connection for synchronous digital teaching, 17% for asynchronous digital teaching. On-site teaching was the preferred form of teaching (60%), and there was a preference for asynchronous (24%) over synchronous (15%) digital teaching. Teaching recordings (79%) were particularly popular to complement future on-site teaching.

CONCLUSIONS

The following areas of education under COVID-19 conditions are highly important to medical students: adequacy of information sharing, integration of opportunities for exchange with fellow students and teachers, possibility to perform practical trainings. After the normalization of the pandemic situation, on-site teaching should be supplemented with blended learning concepts such as the inverted classroom model. Percentages of results are rounded averages from summer and winter semesters.

A hierarchy of needs for remote undergraduate medical education: lessons from the medical student experience

PURPOSE

The disruption of undergraduate medical education (UME) by the COVID-19 pandemic has sparked rapid, real-time adjustments by medical educators and students. While much is known about online teaching in general, little guidance is available to medical educators on how to adapt courses not originally designed for the online environment. To guide our faculty in this transition we conducted a needs assessment of students enrolled in virtual courses across all 4 years of UME training.

METHODS

Using a mixed-methods approach, we conducted a single-institution virtual learning needs assessment in May and June of 2020. We developed and disseminated a survey to assess student experiences with virtual learning. We conducted quantitative and qualitative analysis of responses (n = 255 or 39%) to identify emergent themes.

RESULTS

We identified six interdependent themes that need to be met for medical students to fully reach their learning potential: access to stable internet and quiet study spaces, flexible course design with asynchronous, self-paced components, clear expectations for engagement with content and each other, a sense of connectedness with faculty and peers, synchronous classes that maximize interactivity, and assessments that foster a sense of learning over performance. Interpersonal relationships with faculty and peers affected students' sense of learning more than any other factor.

CONCLUSIONS

Based on our findings we propose a hierarchy of needs for virtual learning that provides guidance on adapting existing medical school courses to the remote setting and overcoming common challenges. We highlight opportunities for how virtual elements may enrich in-person courses going forward, including in the clinical setting. Although the solutions required to meet the threshold of need at each level may differ based on the context, attending to these same fundamental needs can be extrapolated and applied to learners across a range of environments beyond the virtual.

Impact of COVID-19 pandemic in surgical training of Junior Residents in general surgery

Background

The pandemic caused by SARS-CoV2 has had a huge impact on our health system. Due to both cancellation of elective surgery and restructuring in departments at most medical centers, surgical residents face a potential training deficit in their specialty.This study aims to objectively analyze and quantify the impact of the pandemic on the surgical activity of residents, in the setting of emergency and elective surgery, to assess whether this period has really supposed a training deficit.

Material and methods

A descriptive analysis is proposed, comparing the number of procedures performed by residents of our department during the year prior to the pandemic and during the pandemic, clustering them into different subgroups.

Results

The results give an optimistic outlook. In the first place, in elective surgery, despite the lower procedures performed in absolute numbers, the proportional participation of residents in the scheduled surgeries increased in all the subgroups analyzed, finding statistically significant differences and finally approaching the total number of procedures in both periods, without relevant differences in the comparison. As for emergency surgery, residents also increased their proportional participation in most subgroups, in this case reaching more total procedures, even in absolute numbers.

Conclusion

Therefore, the results seem to indicate that the teaching effort made by staff surgeons of the department has managed to palliate, in most of the subgroups analyzed, the decrease in surgical activity that the pandemic has produced, so, at least in the area of surgical practice, the impact of the pandemic has probably been reduced comparing to previous expectations.

How far has the digitization of medical teaching progressed in times of COVID-19? A multinational survey among medical students and lecturers in German-speaking central Europe

BACKGROUND

To ensure successful medical education despite the COVID-19 pandemic, the demand for online instruction has substantially increased. Fast and efficient teaching in a digital format poses a great challenge for medical students and lecturers as well as the universities.

OBJECTIVE

The aim of this study is to capture the readiness of medical students and faculty members to participate in rapidly- evolving online education.

METHODS

This cross-sectional study is based on two questionnaires distributed among medical students and associate deans for education in Germany, Austria and Switzerland. Questions included decision- making questions, categorical questions, and open-ended questions, all addressing the frequency and format of the digital education offered, the perceived quality of digital education, and medical student satisfaction with digital education. Questions about missing content and areas for improvement from the perspectives of medical students were included. The associate deans were asked for their opinions about the impact of the pandemic on teaching, the organizational setup and implementation of digital education by universities, and plans for future initiatives.

RESULTS

Three thousand and thirty medical students (m = 752 and f = 2245) from 53 universities participated in the study. The study showed that 92% of students were affected by the pandemic, and 19% of the students viewed the changes as entirely negative. 97% of the medical students were able to participate in digital courses, but only 4% were able to learn exclusively online. For 77% of the medical students, digital offerings accounted for over 80% of the education offered. In terms of content, medical students complained about a lack of practical teaching, such as contact with patients, lecturers, fellow medical students, and a poor perceived quality of teaching due to dubbing, frequent changeover of seminars, problem-oriented learning groups and in-person teaching, a lack of interaction possibilities and a lack of technical equipment, such as lecturers' knowledge and server capacities, at the universities. Overall, almost half of the medical students (42%) rated the implementation of digital teaching at their universities as good or very good. Forty-one of the 53 associate deans responded to the questionnaire, and 35 felt medical education was influenced by the pandemic. The associate deans (80%; 33/41) felt that the digitalization of medical education was negatively influenced by the pandemic. Only 44% (18/41) felt that their universities were well or very well positioned for digital teaching. All the associate deans believe that digital teaching in medicine will continue after the pandemic.

CONCLUSIONS

In the German-speaking world, the rapid conversion of medical teaching to a digital format has been well implemented in many cases. The perceived quality of the implementation of digital education still lacks practical relevance and the use of new digital media, such as learning games, VR, and online question time. The digital format of medical education will likely continue beyond the COVID-19 pandemic.

Exploration on College Ideological and Political Education Integrating Artificial Intelligence-Intellectualized Information Technology

In recent years, with the vigorous development and application of Artificial Intelligence (AI), the application of AI in education is becoming more and more extensive. This study makes a theoretical analysis of AI-Intellectualized Information Technology (IT). Discrete Cosine Transform (DCT)-Based Speech Recognition (SR) and Genetic Algorithm (GA)-Based Image Recognition (IR) are used to analyze the College Ideological and Political Education (IAPE). The research findings prove that the advantages of integrating AI-intellectualized IT on College IAPE outweigh the disadvantages. The improvement of technological development, which accounts for 71.17% of undergraduate gains, is the most significant, and the smallest gain is technology coverage, which is 36.80%. Overall, 57.21% are interested in new technology, and the students' enthusiasm accounts for 30.77%. Most of the students focus on the innovation performance of technology, accounting for 75.92%. With an average influence of 89.04% on undergraduates, technology has the largest impact, followed by 85.78% on students with masters or higher degrees. The largest impact of diversified teaching methods for all students is 62.48%. This study provides some reference values for AI-intellectualized IT research and analysis, as well as students' IAPE.

An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study

BACKGROUND

Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students' confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods.

OBJECTIVE

To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19-safe environment using SimMan 3G.

METHODS

Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session.

RESULTS

In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature.

CONCLUSIONS

Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally.

Virtual Interactive Surgical Skills Classroom: A Parallel-group, Non-inferiority, Adjudicator-blinded, Randomised Controlled Trial (VIRTUAL)

OBJECTIVE

This study evaluated the efficacy of virtual classroom training (VCT) in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training.

DESIGN

This was a parallel-group, non-inferiority, prospective randomised controlled trial with three intervention groups conducted in 2021. There were three intervention groups with allocation ratio 1:1:1. Outcome adjudicators were blinded to intervention assignment. Interventions consisted of 90-minute training sessions. VCT was delivered via the BARCO weConnect platform, FFT was provided in-person by expert instructors and CBL was carried out by participants independently. The primary outcome was post-intervention Objective Structured Assessment of Technical Skills score, adjudicated by two experts and adjusted for baseline proficiency. The assessed task was to place three interrupted sutures with hand-tied knots.

SETTING

This multicentre study recruited from five medical schools in London.

PARTICIPANTS

Inclusion criteria were medical student status and access to a personal computer and smartphone. One hundred fifty-nine eligible individuals applied online. Seventy-two participants were randomly selected and stratified by subjective and objective suturing experience prior to permuted block randomization.

RESULTS

Twenty-four participants were allocated to each intervention, all were analysed per-protocol. The sample was 65.3% female with mean age 21.3 (SD 2.1). VCT was non-inferior to FFT (adjusted difference 0.44, 95% CI: -0.54 to 1.75, delta 0.675), VCT was superior to CBL (adjusted difference 1.69, 95% CI: 0.41-2.96) and FFT was superior to CBL (adjusted difference 1.25, 95% CI: 0.20-2.29). The costs per-attendee associated with VCT, FFT and CBL were £22.15, £39.69 and £16.33 respectively. Instructor hours used per student for VCT and FFT were 0.25 and 0.75, respectively.

CONCLUSIONS

VCT provides greater accessibility and resource efficiency compared to FFT, with similar educational benefit. VCT has the potential to improve global availability and accessibility of surgical skills training.

The effects of COVID-19 on Canadian surgical residents' education and wellness

BACKGROUND

The COVID-19 pandemic has challenged health care systems. We sought to comprehend the impact of the COVID-19 pandemic on surgical residents' education and mental well-being across Canada.

METHODS

An online 51-question survey was distributed to surgical residents across all 17 Canadian post- graduate surgical residency programs. The questionnaire contained questions concerning demographic factors, perceived effects of COVID-19 pandemic on surgical training and residents' mental health (categorically demonstrating whether it improved, stayed the same, or worsened). Health habits were measured as continuous variables and compared before and during the pandemic. Additionally, participants reported the performance of wellness offices' response to their needs during this crisis.

RESULTS

A total of 122 out of 650 (19%) residents from all surgical specialities anonymously completed the survey. The majority (68%) reported a worsening in their surgical training. 94% of participants favored online teaching as a complementary method to in-person teaching. As to health habits, 38% reported a rise in their alcohol consumption and time spent seated. Only a minority (25%) felt happier and 41% reported experiencing more anxiety in comparison to surgical training pre-COVID-19. Merely 14% reported benefitting from wellness programs.

CONCLUSION

The COVID-19 pandemic had a negative effect on the perceived quality of surgical training, education, and resident mental health. There is an urgent need to reconsider the implemented measures in medical education and urge us to develop better agendas to face the current or future waves.

Effect of COVID-19 on Female Pelvic Medicine and Reconstructive Surgery Fellowship Education and Training

The COVID-19 pandemic has caused a noticeable disruption in national medical and surgical care, including medical training.

Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic - A BEME systematic review: BEME Guide No. 71

BACKGROUND

Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face 'classroom' activities for postgraduate learners.

METHODS

Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned.

RESULTS

Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher's use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment.

CONCLUSIONS

This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.

Validation of Use of Flipped Classroom for Surgery Core Clerkships

BACKGROUND

The flipped classroom (FC) is an integrated learning paradigm that equips students with self-directed study materials before scheduled meeting times allowing for the deeper application of acquired knowledge with an instructor. There is limited data on the application of FC to clinical undergraduate medical education and particularly as it applies to a surgical clerkship.

METHODS

This study is a four-year retrospective study that includes two cohorts of students who matriculated through two training paradigms, traditional classroom (TC) and FC. Information regarding the FC cohort was collected from June 2018 to July 2020 (N=166). A two-year matched historical cohort of students enrolled in the clerkship and taught with the TC paradigm from June 2016 to July 2018 was used for comparison (N=157). The primary aim of this study is to assess the National Board of Medical Examiners (NBME) surgery shelf performance when the FC model is utilized compared to the TC model. This study will validate a prior similar study that had a smaller cohort with different secondary endpoints. Therefore, the secondary aim of this study assesses how teaching style can affect other performance metrics of a rotation (such as clinical performance, quizzes, Objective Structured Clinical Examinations (OSCE), and practicums) and how time was utilized by faculty, staff, and students.

RESULTS

There was no difference in overall NBME surgery shelf performance when comparing the FC to the traditional classroom teaching (68.94 vs 70.34, P= 0.1667). Likewise, there was no difference in quiz performance. The FC did allow instructors to spend more time in other clinical components of the curriculum leading to a significant difference in student practicum (84.2 vs 88.26, P = 0.0186) and OSCE grades (87.54 vs 90.58, P <0.0001).

CONCLUSION

The surgery NBME shelf performance is not compromised by FC and therefore can be used as an alternative to traditional classroom setting for teaching medical knowledge to surgery clerkship students. In addition, the FC can improve time management for instructors allowing for improved teaching and development in other components of the surgery curriculum.

Oral Manifestations in SARS-CoV-2 Positive Patients: A Systematic Review

The COVID-19 pandemic has severely affected the human population by revealing many health problems, including within the oral cavity. This systematic review was designed to answer the question "Is there a relationship between oral manifestations and SARS-CoV-2 infection?". Following the inclusion and exclusion criteria, twenty-seven studies were included (according to PRISMA statement guidelines). Based on the meta-analysis, nearly two-thirds of the SARS-CoV-2 positive patients reported oral symptoms, in particular taste alterations, xerostomia and ulcerations (54.73% [95% CI: 46.28-63.04%], 37.58% [95% CI: 26.35-49.53%], and 21.43% [95% CI: 13.17-31.06%], respectively). In conclusion, despite the conducted systematic review, the increased prevalence of oral manifestations in SARS-CoV-2 infection cannot be clearly established due to the possible association of other factors, e.g., individual or environmental factors.

Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action

Telemedicine has facilitated the delivery of affordable and accessible health care. However, little has been discussed about its use in gender-affirming care (GAC). Telemedicine has the potential to overcome many barriers encountered by transgender individuals such as limited geographic access to care and financial constraints, which have both been exacerbated by the COVID-19 pandemic. Telemedicine may also enhance opportunities for training in gender-affirming surgery. A systematic review of the literature on telehealth and GAC was performed. Identified uses of telehealth included: an electronic teleconsultation service, a virtual peer health consultation service, and an open online course on LGBT+ rights and health care for health care providers and laypeople. As the medical and health care communities adjust to the new reality of health care, efforts should be made to effectively incorporate telemedicine into GAC.

Gauging the effects of COVID-related changes to the medical student surgical clerkship experience: a mixed-methods study

Purpose

This study sought to understand the medical student experience on the restructured surgical clerkship during the COVID-era to provide guidance for future scenarios affecting student participation in clinical activities.

Methods

Medical students completing an anonymous 70-question survey at the conclusion of their surgical clerkship from June 2019 to October 2020 were divided into 2 cohorts: students completing their clerkship prior to March 2020 and after June 2020. Quantitative assessment was performed to evaluate the clerkship performance and perceptions. Resulting findings were used to construct an interview guide and conduct semi-structured interviews.

Results

Fifty-nine medical students rotated through the surgical clerkship prior to COVID and 23 during the COVID-era. No differences in perception of the surgical clerkship, participation in essential activities, or shelf examination scores were found. Students completing their clerkship during the COVID-era reported a lower perception of interaction and professional relationships with attending and resident surgeons (p = 0.03). Qualitatively, students completing their clerkship during the COVID-era struggled to balance clinical experiences with personal wellness and noted that building relationships with faculty was substantially more difficult.

Conclusions

There does not appear to be a difference in the level of participation in essential clerkship activities nor a diminished perception of learning between students completing their surgical clerkship before or during the pandemic. However, there does appear to be a difference in the relationships formed between students and attending surgeons. Altered didactic structures and apprenticeship-type rotations may help mitigate such effects.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44186-022-00015-2.

Healthcare Simulation: A Key to the Future of Medical Education - A Review

AIM

Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education.

PURPOSE

To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides.

CONCLUSION

Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.

Perceived Didactic Curricular Effectiveness of In-Person vs. Virtual Formats amongst Fourth-Year Dental Students

Purpose: The COVID-19 pandemic altered the methodologies of dental education delivery, resulting in both immediate and more enduring changes. To assess student perceptions of learning effectiveness, graduating dental students from the class of 2020 were surveyed to identify student comfort with technology and content retention, individual motivation and mental focus, and access to resources pertaining to an abrupt transition to a virtual learning didactic seminar approach in March 2020. Methods: a voluntary, 18-question electronic survey was distributed to fourth-year dental students prior to graduation to assess perceptions of learning outcomes and preferences of a virtual seminar format relative to previous in-person didactic seminars experienced. Results: 34 of 80 dental students (42.5%) completed the electronic survey. Comfort and retention of concepts through virtual learning were reported ≥ by 91% and 85% of the respondents, respectively. Increased distractions and multitasking were reported with virtual learning in 56% and 71%, respectively. Desires to have all teaching conducted through virtual learning platforms was reported at 21%. Conclusions: the positive student responses obtained when comparing virtual to in-person seminars in the survey assessment demonstrates the long-term potential for such delivery modalities to be intentionally incorporated into an evolving predoctoral curriculum in a hybrid nature.

Impact of COVID-19 pandemic on medical education in Greece: A cross-sectional study

BACKGROUND

Medical education was widely affected by the Coronavirus disease 2019 (COVID-19) pandemic. Long-distance learning was implemented over the traditional educational paradigm. Clinical clerkships were canceled, and evaluation methods were altered. This study aims to assess this multifaceted impact on the Greek undergraduate medical community.

METHODS

A cross-sectional survey study was conducted. All undergraduate medical students at Greek Universities were addressed using social media. The data were post-stratified according to the population's male-to-female ratio and underwent descriptive and inferential statistical analysis. Associations were determined using chi-square and Fisher's exact test. A linear regression model was developed to investigate the factors that contributed to the overall impact of the pandemic on medical education.

RESULTS

A total of 905 responses were analyzed, representing 9.8 % of Greece's medical students. Most reported decreased duration of laboratory (n =711, 78.5 %) and clinical (n =526, 96.7 %) practice. The majority stated that their ability to perform practical skills was affected negatively (n =805, 89.0 %). The impact on student's education was positively associated with their psychological impact. Therefore, a more negative effect on the student's education was observed on those whose psychology was affected more negatively [β =0.49, 95 % confidence interval (CI): 0.40, 0.58, p <0.001). Additionally, the pandemic's overall impact on medical education was much more unfavorable for the clinical than the pre-clinical students (β =-0.30, 95 % CI: -0.40, -0.20, p <0.001).

CONCLUSIONS

This study's findings agree that the COVID-19 pandemic has severely impacted the education and personal life of medical students, especially in the advanced years. An insight into their specific needs to overcome the impact on their education is provided. The necessity of future mitigating actions is underlined. Emphasis should be given to clinical skills and enhancing the students' adaptive behavior to attenuate the consequences on their psychology, social life, and future healthcare provider careers. HIPPOKRATIA 2022, 26 (2):55-61.

Tangible effects of the COVID-19 pandemic: A fall in dexterity amongst surgical trainees?

Background

The coronavirus pandemic has had an indisputable impact on surgical training. The qualitative effect on the perceived confidence and capability of trainees has been widely reported. In order to fully delineate the scope of the problem, quantitative data is also required.

Methods

This cross-sectional study collected compared data on the laparoscopic skills (pre- and post-pandemic) of first-year urology residents in the United Kingdom, who attended the annual Urology Simulation Boot Camp (USBC) in 2018 and 2019 (pre-pandemic), and 2021 (post-pandemic).

Results

Pre-pandemic group performance was significantly better in 2 out of 4 tasks (Task 3 p < 0.001) (Task 4 p = 0.003) during the practice session. During the assessment, pre-pandemic group performance was better (p = 0.017) for Task 2 and significantly faster (p = 003) for Task 4.

Conclusions

Our results provide evidence to support the notion that the coronavirus pandemic has had a tangible and detrimental effect on the technical skills of surgical trainees.

Priorities for content for a short-course on postoperative care relevant for low- and middle-income countries: an e-Delphi process with training facilitators

Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately affecting low- and middle-income countries. Various short courses have been developed to improve patient outcomes in low- and middle-income countries, but none specifically to address postoperative care and complications. We aimed to identify key features of a proposed short-course addressing this topic using a Delphi process with low- and middle-income country anaesthesia providers trained as short-course facilitators. An initial questionnaire was co-developed from literature review and exploratory workshops to include 108 potential course features. Features included content; teaching method; appropriate participants; and appropriate faculty. Over three Delphi rounds (panellists numbered 86, 64 and 35 in successive cycles), panellists indicated which features they considered most important. Responses were analysed by geographical regions: Africa, the Americas, south-east Asia and Western Pacific. Ultimately, panellists identified 60, 40 and 54 core features for the proposed course in each region, respectively. There were high levels of consensus within regions on what constituted core course content, but not between regions. All panellists preferred the small group workshop teaching method irrespective of region. All regions considered anaesthetists to be key facilitators, while all agreed that both anaesthetists and operating theatre nurses were key participants. The African and Americas regional panels recommended more multidisciplinary healthcare professionals for participant roles. Faculty from high-income countries were not considered high priority. Our study highlights variability between geographical regions as to which course features were perceived as most locally relevant, supporting regional adaptation of short-course design rather than a one-size-fits-all model.

Trends and Innovations of Simulation for Twenty First Century Medical Education

In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.

Live-streaming otolaryngology surgical procedures for virtual medical student rotations

Background

The coronavirus disease 2019 pandemic created challenges in surgical education that expedited the development of virtual learning. Virtual rotations have been one such solution. However, they require co-ordination and technological equipment to create a meaningful, interactive experience for students.

Methods

Various otolaryngology surgical procedures were live-streamed during a two-week virtual rotation for medical students. A mobile audiovisual cart comprising a computer mounted with a webcam and microphone/speaker were utilised to live-stream from four sources: video-assisted telescope operating monitor (‘VITOM’) exoscope, microscope, endoscope and room camera. A dedicated faculty member, who was not the operating surgeon, was present to facilitate students’ understanding of the procedure.

Conclusion

A wide breadth of otolaryngology surgical procedures were live-streamed via a mobile audiovisual computer, including views of the room, endoscopic views, microscopic views and open views via an exoscope (video-assisted telescope operating monitor). This virtual rotation set-up, along with the dedicated faculty facilitator, reduced the burden on the operating surgeon and enhanced students’ learning experience.

A Pilot Study on the Feasibility of Developing and Implementing a Mobile App for the Acquisition of Clinical Knowledge and Competencies by Medical Students Transitioning from Preclinical to Clinical Years

Due to the COVID-19 pandemic and the consequent restrictions, universities have had to adapt their curricula substantially to new schemes in which remote learning is of the essence. In this study, we assess the feasibility of developing a mobile app supplementary to the distant teaching paradigm for the “Cardiology” module of the “General Pathology” subject in undergraduate Medical Education, and we evaluate its impact and acceptability. A cohort of volunteer second-year medical students (n = 44) had access to the app, and their opinions on its utility (1−10) were collected. Additionally, the students were invited to refer their expected satisfaction (1−10) with a blended learning methodology overlapping this new tool with the traditional resources. The average expected satisfaction had been compared to the average satisfaction obtained by just the traditional methodology in other modules from the same subject. Through a qualitative approach, we defined the strengths and weaknesses of the tool. Seventy-seven percent of the participants rated at 8/10 or more the potential learning value of the application and, if used as a supplement to traditional teaching, it would also statistically improve the satisfaction of students (6.52 vs. 8.70, p < 0.001). Similarly, the qualitative data corroborated the benefits of such innovation. Multidisciplinary collaborations are encouraged to develop teaching innovations, although further research should aim to better define the effectiveness of learning with these resources.

Medical education and mental health during COVID-19: a survey across 9 countries

OBJECTIVES

To investigate students' experience with medical education alongside their mental and physical health since the onset of the COVID-19 pandemic across nine countries.

METHODS

A cross-sectional online survey was distributed by local collaborators to 2,280 medical students across 148 medical schools in Brazil, Chile, Colombia, Germany, Italy, Japan, Mexico, Spain, and Venezuela using non-probability convenience sampling from June 22 to July 24, 2020. Students answered questions regarding teaching, internet use, COVID-19, physical and mental well-being. A multivariate logistic regression examined factors associated with depressed mood, insomnia, and headache.

RESULTS

Academic teaching shifted to a virtual (67%, n=1,534) or hybrid environment (23%, n=531), whilst bedside teaching was suspended or cancelled (93%, n=2,120). Across all countries students were equally satisfied with the teaching modality, quantity, quality, and the evaluation system of in-person, hybrid, and online curricula. Negative changes in mental (40% (n=912) insomnia, 57% (n=1,300) emotional irritability, 47% (n=1,072) emotional instability, 41% (n=935) anhedonia, 40% (n=912) depressed mood) and physical (36% (n=821) headache, 57% (n=1,299) ocular tiredness, 49% (n=1,117) backache) health symptoms were frequently observed. Positive associations between the number of daily screen hours and depressed mood (adjusted odds ratio (AOR)=1.09, 95%CI: 1.05-1.12, p<.001), insomnia (AOR=1.08, 95%CI: 1.05-1.11, p<.001), and headache (AOR=1.11, 95%CI: 1.07-1.14, p<.001) were identified.

CONCLUSIONS

Students' experience with digital and hybrid medical curricula was diverse during the pandemic. Education modality, quantity, and quality were positively evaluated. However, students' mental and physical health worsened. Besides bedside teaching, faculties ought to digitalize and strengthen social communities and extend support services for students.

A Novel Interactive Virtual Medical Student Clinical Rotation for Ophthalmology

Objective This article describes a novel clinical rotation that uses technology to create a remote ophthalmology learning experience with the goal of improving virtual exposure to medical and surgical ophthalmic training for medical students.

Methods Our unique curriculum incorporates mobile-mounted tablets which allow students to virtually participate in inpatient consults, clinic, and ophthalmic surgery. An adaptable mounting device attached to the slit lamp allows students to observe examinations in real time, enhancing recognition of ocular pathologies. Students participate in a robust curriculum that includes independent learning modules, video lectures, interactive modules, podcasts, and surgical video rounds. Students engage with residents and faculty in interactive-guided lectures and case-based discussions that focus on the American Academy of Ophthalmology white paper teaching objectives. Students are mailed surgical instruments and participate in surgical modules and faculty-led virtual wet laboratories.

Results Our unique virtual curriculum combines didactic learning, interactive content, and novel technology applications such as mobile tablets, slit lamp-mounted devices, and faculty-led virtual wet laboratories.

Conclusion Virtual technologies can be utilized to enhance ophthalmology medical student education in a safe and effective way during the coronavirus disease 2019 pandemic, and to improve educational access in the future.

At-home medical student simulation: achieving knot-tying proficiency using video-based assessment

Purpose

Due to the pandemic, we restructured our medical student knot-tying simulation to a virtual format. This study evaluated curriculum feasibility and effectiveness.

Methods

Over 4 weeks, second-year medical students (n = 229) viewed a video tutorial (task demonstration, errors, scoring) and self-practiced to proficiency (no critical errors, < 2 min) using at-home suture kits (simple interrupted suture, instrument tie, penrose drain model). Optional virtual tutoring sessions were offered. Students submitted video performance for proficiency verification. Two sets of 14 videos were viewed by two surgeons until inter-rater reliability (IRR) was established. Students scoring "needs remediation" attended virtual remediation sessions. Non-parametric statistics were performed using RStudio.

Results

All 229 medical students completed the curriculum within 1-4 h; 1.3% attended an optional tutorial. All videos were assessed: 4.8% "exceeds expectations", 60.7% "meets expectations", and 34.5% "needs remediation." All 79 needing remediation due to critical errors achieved proficiency during 1-h group sessions. IRR Cohen's κ was 0.69 (initial) and 1.0 (ultimate). Task completion time was 56 (47-68) s (median [IQR]); p < 0.01 between all pairs. Students rated the overall curriculum (79.2%) and overall curriculum and video tutorial effectiveness (92.7%) as "agree" or "strongly agree". No definitive preference emerged regarding virtual versus in-person formats; however, 80.2% affirmed wanting other at-home skills curricula. Comments supported home practice as lower stress; remediation students valued direct formative feedback.

Conclusions

A completely virtual 1-month knot-tying simulation is feasible and effective in achieving proficiency using video-based assessment and as-needed remediation strategies for a large student class.

The impact of COVID-19 on the well-being, education and clinical practice of general practice trainees and trainers: a national cross-sectional study

BACKGROUND

COVID-19 has changed General Practice (GP) education as well as GP clinical activities. These changes have had an impact on the well-being of medical trainees and the role of GP plays in the society. We have therefore aimed to investigate the impact that COVID-19 has had on GP trainees and trainers in four domains: education, workload, practice organization and the role of GP in society.

DESIGN

a cross-sectional study design was used.

METHODS

The Interuniversity Centre for the Education of General Practitioners sent an online survey with close-ended and open-ended questions to all GP trainees and trainers in Flanders, active in the period March - September 2020. Descriptive statistics were performed to analyze the quantitative data and thematic analysis for the qualitative data.

RESULTS

216 (response 25%) GP trainees and 311 (response 26%) trainers participated. GP trainees (63%, N = 136) and trainers (76%, N = 236) reported new learning opportunities since the COVID-19 pandemic. The introduction of telehealth consulting and changing guidelines required new communication and organizational skills. Most of the GP trainees (75%, n = 162) and trainers (71%, n = 221) experienced more stress at work and an overload of administrative work. The unfamiliarity with a new infectious disease and the fact that COVID-19 care compromised general GP clinical activities, created insecurity among GP trainers and trainees. Moreover, GP trainees felt that general GP activities were insufficiently covered during the COVID-19 pandemic for their training in GP. GP trainers and trainees experienced mutual support, and secondary support came from other direct colleagues. Measures such as reducing the writing of medical certificates and financial support for administrative and (para) medical support can help to reprioritize the core of GP care. COVID-19 has enhanced the use of digital learning over peer-to-peer learning and lectures. However, GP trainees and trainers preferred blended learning educational activities.

CONCLUSIONS

COVID-19 has created learning opportunities such as telehealth consulting and a flexible organization structure. To ensure quality GP education during the pandemic and beyond, regular GP care should remain the core activity of GP trainees and trainers and a balance between all different learning methods should be found.

The Use of Social Media to Deliver Surgical Education in Response to the COVID-19 Pandemic

BACKGROUND

As clinical rotations were disrupted by the COVID-19 pandemic, with surgical specialty being the one most severely affected among all disciplines, social media had become increasingly used for surgical education. We aimed to identify and present the application of social media as an essential tool for surgical education during the COVID-19 pandemic.

MATERIALS AND METHODS

A literature review was conducted using PubMed/MEDLINE and EMBASE databases for potentially eligible articles published until April 2021. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

A total of 23 articles were identified and systematically reviewed that related to the application of social media use in surgical education during the COVID-19 pandemic. These may be grouped into 3 discrete categories (online learning, scientific research, networking) and 14 topics (online resources, virtual conferencing, preparing for exams, etc.).

CONCLUSIONS

Social media has played a multidimensional critical role in training surgical students and residents in the COVID-19 era, with special superiority that cannot be substituted by other online tools.

A Double-Flipped Virtual Classroom Format for Medical Students Learning Ophthalmology: An Approach to Clinical Rotations in the Context of COVID-19

Purpose The aim of this study was to assess efficacy of a virtual, double-flipped clinical rotation in ophthalmology for medical students during the coronavirus disease 2019 (COVID-19) pandemic.

Methods We instituted a virtual, reverse-classroom clinical elective for eight medical students interested in ophthalmology as a career. The course included required prework, interactive case-based discussions, and follow-up quizzes (first flip) entirely prepared and delivered by the students as teachers (second flip). After completion of the course, we surveyed students on five domains: (1) Autonomy and Leadership, (2) Self-Efficacy, (3) Impact on Career Selection, (4) Quality of Educational Experience, and (5) Clear Goals and Feedback using a Likert scale of 1–5 (5 being the most positive). We also asked open-ended questions regarding the overall experience, that is, strengths, weaknesses, and future recommendations for the course. Due to the small N and exploratory nature of the study, no formal statistical inference was performed.

Results Seven students responded to the survey. Aggregated mean survey scores for each domain are represented in parentheses. Responses were very positive in regard to “Autonomy and Leadership” (4.5), “Impact on Career Selection” (4.1), “Quality of Educational Experience” (5.0), and “Clear Goals and Feedback” (4.4). “Self-Efficacy,” which had an emphasis on ability to perform an eye exam and basic knowledge of ophthalmology, had a lower mean (3.4). The subjective responses were also very positive, but similarly alluded to the limitation of learning examination skills virtually.

Conclusions A medical school clinical elective can be successfully executed in a virtual format with an emphasis on student-directed learning. The novel “double-flipped” approach was highly rated by our small sample size. However, there remained a glaring limitation in the ability to transfer clinical skills in the virtual format. In the context of limited in-person contact due to the COVID-19 pandemic, we believe that the double-flipped, virtual format was a viable replacement for a traditional clinical rotation.

Maximizing Benefit of Virtual Learning: Lessons from the COVID-19 Pandemic

Introduction

The coronavirus disease 2019 pandemic has profoundly impacted surgical education. We assessed resident perceptions of our virtual academic program, which consists of daily lectures or case conferences held via a videoconferencing platform.

Methods

A survey evaluating attitudes and practices for virtual academics was administered to general surgery residents. A focus group was conducted to identify benefits, barriers to engagement, and opportunities for improvement for virtual education. A total of 19 residents completed the education survey, and seven residents participated in the focus group.

Results

While expressing preference toward in-person academics (84.2%), residents felt the virtual academics were of good quality (median rating 4/5) and preferred virtual academics to no academic sessions (94.7%). Of respondents, 57.9% believe that the coronavirus pandemic negatively impacted their surgical education. They believe their American Board of Surgery In-Training Examination preparation was not impacted. Residents preferred using a computer over a phone for academics (79% versus 16%). The focus group identified the benefits of virtual academics, including the ability to participate while away and having recordings available. Areas for improvement included reinforcement of protected time for academics, requiring cameras be on, increasing in-lecture polls, and creation of an online repository of recordings for review. Residents hoped a virtual component of academics and recordings would continue past the pandemic.

Conclusions

Although virtual academics are not the preferred mode of learning in our residency, there are multiple unintended benefits. We recommend a hybrid academic model with in-person didactics and recorded video for later review.

The GI Simulated Clinic in the Era of COVID-19: a Comparison of Virtual to In-Person Delivery

The COVID-19 pandemic has significantly impacted medical education; thus, there is a need to better understand the effectiveness of virtual learning compared to in-person learning. This is a single-center, cross-sectional study of first-year medical students who attended a gastroenterology simulated clinic activity in person in 2018 and 2019 or virtually in 2020. Participants were surveyed on the activity's relevance and effectiveness. Students' assessment of the virtual clinic's effectiveness and relevance was not significantly different from the in-person version of the activity. In addition, most students rated the virtual clinic as effective for learning about telemedicine.

A Nationwide Virtual Research Education Program for Medical Students in Pakistan: Methodological Framework, Feasibility Testing, and Outcomes

Introduction: Equipping young medical trainees with fundamental research skills can be a promising strategy to address the need for professionals who can understand and responsibly communicate evolving scientific evidence during a pandemic. Despite an ardent interest to partake in research, most educational institutions in Pakistan and other low-middle income countries have not yet adopted a comprehensive strategy for research skills education. The authors aimed to design and assess the feasibility of implementing the first nation-wide virtual research workshop for medical students in Pakistan.

Methods: The course “Beginners Guide to Research,” designed as a nation-wide virtual research workshop series, was conducted for medical students across Pakistan in June 2020. Four interactive live workshops took place online on alternate days from June 22nd, 2020, to June 27th, 2020, each lasting 1–2 h. Outcomes included: (i) reach, (ii) efficacy as indexed by pre-post change in score pertaining to knowledge and application of research and (iii) self-rated perceptions about understanding of research on a Likert scale.

Results: 3,862 participants enrolled from 41 cities and 123 institutions. Enrolled participants belonged to the following provinces: Sindh (n = 1,852, 48.0%), Punjab (n = 1,767, 45.8%), Khyber Pakhtunkhwa (n = 109, 2.8%), Azad Jammu and Kashmir (n = 84, 2.2%) Balochistan (n = 42, 1.1%). We also saw a few registrations from international students (n = 8, 0.2%). Mean (SD) age of enrolled medical students was 21.1 (2.1) years, 2,453 (63.5%) participants were female and 2,394 (62.0%) were from private-sector medical colleges. Two thousand ninety-three participants participants filled out all four pre-test and post-test forms. The total median knowledge score improved from 39.7 to 60.3% with the highest improvements in concepts of research bioethics and literature search (p < 0.001) with greater change for females compared to males (+20.6 vs. +16.2%, p < 0.001) and private institutions compared to public ones (+16.2 vs. +22.1%, p < 0.001).

Conclusion: The overwhelming enrollment and significant improvement in learning outcomes (>50% of baseline) indicate feasibility of a medical student-led research course during a pandemic, highlighting its role in catering to the research needs in the LMICs.

Does livestreaming surgical education have the future? Development and participant evaluation of a national COVID-19 livestreaming initiative

Backgrounds

COVID-19 related reduction of surgical procedures jeopardizes learning on the job of surgical residents. Many educators resorted to digital resources in the search for alternatives. However, these resources are often limited to the extent they offer resident-surgeon interaction like a joint surgical performance does. Here we present a roadmap of livestreaming surgical procedures, and evaluate how surgical livestreams on human cadavers address the unmet educational needs of surgical residents in our Dutch nationwide initiative.

Methods

Technical and organizational feasibility, and definition of outcome deliverables for the livestream series and per livestream were essential in livestream development. Faculty selected interventions, lecture contents, and participant preparations. Appropriate location, technical setup, and support were imperative for a stable, high-quality stream with integrated interaction, while maintaining digital privacy. A survey was sent to livestream participants to evaluate each livestream, and allow for constant improvement during the broadcasting of the series. Only surveys which were completed by surgical residents were included in the analysis of this study.

Results

Each livestream attracted 139–347 unique viewers and a total of 307 surveys were completed by participants (response rate of 23–38% per livestream). Sixty percent of surveys (n = 185) were completed by surgical residents. Livestreams were highly valued (appreciation 7.7 ± 1.1 and recommendation 8.6 ± 1.1), especially the live procedures combined with interaction and theoretical backgrounds. Criticized were technical difficulties and timing of the livestreams between 5 and 7 pm, which interfered with clinical duties.

Conclusion

Livestreaming surgical procedures on human cadavers is a valid and valued solution to augment resident education. Digital privacy and a stable, high-quality interactive stream are essential, as are appropriate moderation and relevant lectures. While livestreaming cannot replace hands-on training in the operating room, it enables surgeon-resident interaction which is key in education—and missed in pre-recorded surgical procedures which are currently available online.

Development of a remote learning educational model for international Emergency Medicine trainees in the era of COVID-19

Background

The COVID-19 pandemic has pressured post-graduate medical education programs to shift from traditional in-person teaching to remote teaching and learning. Remote learning in medical education has been described in the literature mostly in the context of local in-country teaching. International remote medical education poses unique challenges for educators, especially in low-middle income countries (LMICs) who need continued Emergency Medicine (EM) specialty development. Our objective is to describe the development and implementation of our remote educational curriculum for EM trainees in West Bengal, India, and to assess trainee satisfaction with our remote learning curriculum.

Methods

Our curriculum was developed by adapting remote learning techniques used in Western post-graduate medical education, conducting literature searches on remote learning modalities, and through collaboration with local faculty in India. We assessed resident satisfaction in our curriculum with feedback surveys and group discussions.

Results

The remote educational curriculum had overall high trainee satisfaction ratings for weekly livestream video lectures and throughout our monthly educational modules (median ratings 9-10 out of a 10-point Likert scale). Qualitative feedback regarding specific lecture topics and educational modules were also received.

Conclusions

International remote education in LMICs poses a unique set of challenges to medical educators. Residents in our study reported high satisfaction with the curriculum, but there is a lack of clarity regarding how a remote curriculum may impact academic and clinical performance. Future studies are needed to further evaluate the efficacy and academic and clinical implications of remote medical education in LMICs.

Social Media Tools for the Development of Pre-Service Health Sciences Researchers during COVID-19 in Pakistan

The development of health sciences researchers has immense significance during a pandemic to control, manage, and prevent future outbreaks of the disease. This study focused on the use of social media tools (SMT) among pre-service health sciences researchers to complement their research competencies (RCT) and research completion levels (RC) during COVID-19. This study used the Vitae research development framework (RDF) to measure research competencies as a mediator between the use of social media tools and research completion levels among post-graduate health sciences students. A cross-section survey research approach was adopted to collect data from the post-graduate students (n = 410) enrolled in health sciences departments at universities in Pakistan. The SmartPLS 3.3.8 software was used to analyze data through Partial least square structural equation modeling (PLS-SEM). The results revealed that different social media tools such as communication, information management, and multimedia have a direct influence on the research competencies of the pre-service researchers and have an indirect effect on the research completion levels. Health sciences institutions may devise social-media-based instructional strategies to develop post-graduate students' research competencies, such as personal effectiveness, research governance, and research engagement, to help them compile their research and complete their degree program in time during an emergency.

Novel do-it-yourself low-cost abdominal laparoscopy entry simulator for gynaecology trainees

The COVID-19 pandemic has affected gynaecology trainees in the United Kingdom by reducing operating theatre experience. Simulators are widely used for operative laparoscopy but not for practising laparoscopic-entry techniques. We devised a low-cost simulator to help trainees achieve the skill. Our aim was to pilot this low-cost simulator to perform Royal College of Obstetricians and Gynaecologists (RCOG) supervised learning events.

A single-centre pilot study involving six gynaecology trainees in a structured training session. Interactive PowerPoint teaching was followed by trainees’ demonstration of laparoscopic entry for a supervised learning event and personalized feedback. Participants completed pre- and post-course questionnaires.

All the trainees found the training useful to the score of 10 (scale of 1–10) and recommended this to be included in Deanery teaching. Personalized feedback was described as the most useful. The simulator was rated as good as a real-life patient relative to the skill being taught.

Gynaecology trainees are affected by lack of hands-on experience in the operating theatre for performing laparoscopic entry. A low-cost abdominal laparoscopy entry simulator can help deliver the RCOG curriculum, enabling trainees to achieve required competencies.