In Crisis: Medical Students in the COVID-19 Pandemic

The Perceived Influence of the COVID-19 Pandemic on the Medical Education of Residents in 2021 and 2022

Background Recent studies reported how the COVID-19 pandemic influenced the medical education community. However, little is known about the further influence of the pandemic over time and about the impact across the different medical disciplines. Objective Our objective was to investigate how residents working in different disciplines and on different tracks (full- vs part-time) perceived the influence of the COVID-19 pandemic in 2021 and 2022 on their education. Methods The data were collected with a questionnaire (developed by the Swiss Federal Institute of Technology and the Swiss Institute for Medical Education) as part of the Swiss national annual survey on medical education. We assessed the influence of the pandemic on medical residents from different specialties in 2021 and 2022 with 3 items: global effect on education, available time for education, and effect on teaching. Results The questionnaire had a response rate of 70% (8496 of 12 137) in 2021 and 2022 (8823 of 12 604). In 2021, residents reported that the pandemic had a negative influence (3.5 of 5; P<.001; 95% CI 0.49, 0.53) and impaired their education. The negative influence declined (t=7.91; P<.001; 95% CI 0.07, 0.11) but remained noticeable in 2022 (3.4 of 5; P<.001; 95% CI 0.41, 0.44). This pattern of results was similar among the different medical specialties. In both years, residents working full-time reported a more severe influence of the pandemic than those working part-time (eg, in 2021 impaired education: 3.1 of 4 vs 2.9 of 4; P<.01; 95% CI -0.26, -0.14). Conclusions The negative influence of the pandemic declined across all medical disciplines.

The Influence of COVID on Emergency Medicine Career Choice: A Survey of Medical Students

Background The COVID-19 pandemic has led to substantial changes in the delivery of healthcare and medical education. Little is known about how the pandemic has altered medical students' perceptions in regard to career choice. Methods The authors developed and implemented a multi-center survey that evaluated medical students' preferred career choice before and during the coronavirus pandemic, as well as the influence of pandemic-related factors on that choice. The survey was distributed to all levels of medical students (MS) at nine medical schools across the country from November 2020 to January 2021 and represented a convenience sample. Preferred career choice was assessed through the use of a Likert scale and additional factors affecting career choice were solicited. The degree of interest before and during the pandemic, as well as factors influencing the shift, were treated as ordinal variables and compared using chi-squared testing. Cohen's Kappa statistic was calculated to assess the degree of shifts of interest in Emergency Medicine among students. The study was deemed exempt by the Institutional Review Board at the host institution, Sidney Kimmel Medical College at Thomas Jefferson University, and all participating sites. Results A total of 1431 of 6710 (21.3%) eligible students completed the survey. The COVID pandemic was cited as a reason for a changed interest in specialty by 193 (13.5%) students. The most common reason for specialty change was the students' clinical experience, followed by a desire to be on the front lines, and personal/family health concerns. There was a significant association between career change and degree of interest among students interested in emergency medicine (EM) as their future specialty before the COVID pandemic as well as during the COVID pandemic. Living with an immunocompromised individual had a significant association with a reduced interest in EM. There was a significant association between EM rotation completion and how interested students were in EM as their future specialty before the COVID pandemic and during the COVID pandemic. Among EM-interested students whose specialty interest was changed by the COVID pandemic, 34 (41.5%) became less favorable to EM, 28 (34.2%) stayed the same, and 20 (24.4%) students became more favorable to EM. Conclusions The impact of COVID-19 on medical students' career choice is a complicated matter that involves both personal and professional factors. It appears that there is a trend towards less interest in the field of EM with multifactorial influences, some of which are related to the COVID-19 pandemic.

Is simulation useful in preparing doctors-to-be for patient death: A narrative review

Clinical and communication skills involved in managing patient death are essential for medical practitioners, yet these skills are often neglected in undergraduate medical education. We aim to review current reported evidence of simulation-based education on medical students' preparedness and performance toward patient death. A narrative review of the literature on simulation-based education for medical students on patient death was conducted. Data on study design, simulation dimension, evaluation tool, and outcome were collected and summarized. Eleven prospective studies were included for narrative review. Simulation modalities included mannequins, standardized patients, and online virtual reality. Heterogeneity in the evaluation tool of simulation-based education was demonstrated. Ninety percent of studies concluded positive outcome of simulation on improving medical students' preparedness in patient death. No negative or adverse learner reaction was reported. Simulation-based education may safely improve medical students' competence in handling patient death. Current data and evaluation tools of education outcomes are sparse and heterogeneous. Future research is encouraged to explore this under-researched topic, amid increasing interest in the use of simulation in medical education.

Medical education during the COVID-19 pandemic: lessons for the orthopedic departments

BACKGROUND

After the Coronavirus pandemic, many educational routines were stopped for the safety of medical staff. To achieve educational goals, we have implemented new policies in our hospitals. In this study, we aimed to evaluate the effect of such strategies.

METHOD

This survey-based study uses questionnaires to assess newly implemented educational strategies. We surveyed 107 medical staff of the orthopedic department of Tehran University of Medical Sciences, including faculty members, residents, and students. The survey contained three series of questionnaires for these groups.

RESULTS

The maximum satisfaction for all three groups was observed in the platform and facilities for using e-classes, and the cost- and time-saving capabilities (Respectively, faculty members (FM): 81.8%, residents (R): 95.2%, students/interns (S/I): 87.0%; FM: 90.9%, R: 88.1%, S/I: 81.5%). The new policies have been shown to reduce the stress level of most trainees, increase the quality of knowledge-based education, increase the opportunity for reexamining educational content, expand discussion and research opportunities, and improve work conditions. There was a broad acceptance of the virtual journal clubs and morning reports. However, there were discrepancies between residents and faculty members on issues such as the evaluation of trainees, the new educational curriculum, and flexible shift schedules. Our strategies failed to improve skill-based education and patient treatment status. Most participants indicated that e-learning should be used with face-to-face training post-pandemic (FM: 81.8%, R: 83.3%, S/I: 75.9%).

CONCLUSION

Our efforts to optimize the educational system during this crisis have generally improved trainees' work conditions and educational experience. Most participants believed that e-learning and virtual methods should be used alongside traditional training as a complementary component after the pandemic.

From disobedience to struggle for adaptation: ​​nursing students' experiences of attending the clinical learning environment during Covid-19 pandemic

BACKGROUND

The Covid-19 pandemic has affected the clinical education of nursing students all over the world. Considering the importance of clinical education and clinical learning environment (CLE) in the education of nursing students, identifying the challenges and problems faced by these students during the covid-19 pandemic helps to plan more effectively in this regard. The aim of this study was to investigate the experiences of nursing students in CLEs during the Covid-19 pandemic.

METHODS

A descriptive qualitative research was conducted, which used a purposive sampling technique to recruit 15 undergraduate nursing students from Shiraz University of Medical Sciences between July 2021 and September 2022. Data were collected through in-depth semi-structured interviews. For data analysis, conventional qualitative content analysis based on Graneheim and Lundman approach was used.

RESULTS

The data analysis led to emergence of two themes of "disobedience " and "struggle for adaptation". The disobedience theme consists of two categories: "objection to attend CLE" and "patient marginalization". The theme of struggle for adaptation includes two categories: "using support sources" and "applying problem-oriented strategies".

CONCLUSION

At the beginning of the pandemic, the students were unfamiliar due to the disease, as well as fear of contracting themselves and infecting others, so they tried not to be in the clinical environment. However, they gradually tried to adapt to the existing conditions by applying support resources and using problem-oriented strategies. Policymakers and educational planners can use the results of this study to plan for solving the challenges of students during future pandemics and improve the condition of CLE.

Asymptomatic surveillance testing for COVID-19 in health care professional students: lessons learned from a low prevalence setting

The novel coronavirus disease of 2019 (COVID-19) pandemic has severely impacted the training of health care professional students because of concerns of potential asymptomatic transmission to colleagues and vulnerable patients. From May 27th, 2020, to June 23rd 2021; at a time when B.1.1.7 (alpha) and B.1.617.2 (delta) were the dominant circulating variants, PCR testing was conducted on 1,237 nasopharyngeal swabs collected from 454 asymptomatic health care professional students as they returned to their studies from across Canada to Kingston, ON, a low prevalence area during that period for COVID-19. Despite 46.7% of COVID-19 infections occurring in the 18-29 age group in Kingston, severe-acute-respiratory coronavirus-2 was not detected in any of the samples suggesting that negligible asymptomatic infection occurred in this group and that PCR testing in this setting may not be warranted as a screening tool.

Potential of Volunteering in Formal and Informal Medical Education-A Theory-Driven Cross-Sectional Study with Example of the COVID-19 Pandemic

Students' volunteering is an effective way to manage health crises, including pandemics. Due to the limited capacity of the healthcare system at the time of the COVID-19 outbreak, the engagement of students in volunteering services seemed invaluable. Based on different teaching-learning theories, in this survey study, we aimed to evaluate the potential of the volunteering service project launched by the Poznan University of Medical Sciences during the COVID-19 pandemic as a learning opportunity for undergraduate healthcare students. The results indicate the potential of involving students in volunteering activities for educational purposes, as well as other values, including attitudes and professional identity development, which could be difficult to realize using traditional teaching methods. However, stimulating students' reflectiveness seems necessary to reach its full educational effectiveness. Medical teachers should provide students with more opportunities for volunteering and service learning and consider making these a constant element of the curriculum beyond the COVID-19 pandemic.

Where there are challenges, there are opportunities: An undergraduate medical students' teaching concept for mental health in times of COVID-19

COVID-19 had a tremendous effect on medical education. Most teaching sessions had to be shifted online, posing additional stress and potential isolation on medical students. However, it also offered the promotion of innovative digital teaching concepts. In this article, an approach to undergraduate mental health training is presented and evaluated. The curriculum was designed according to Kern's six-step approach and consisted of asynchronous online material as well synchronous digital teaching and was accompanied by a plethora of newly developed teaching material (videos, fact sheets, etc.). Content covered the whole spectrum of diseases seen in a service of psychosomatic medicine and psychotherapy (i.e. anxiety, depression, trauma, somatoform and eating disorders, as well as motivational interviewing). Feedback from participants was collected, and exam results (written and practical) were compared to pre-COVID-19 times using t-tests for dependent and independent samples. Students were highly satisfied with the teaching (rating of 1.3 ± 0.6, n = 139 students). There was no significant difference from course evaluations before COVID-19 (1.5 ± 0.5, p > .05). The teaching also received an award in the students' competition "best digital teaching concept in summer term 2020". In the written exams, there was no significant difference between before COVID-19 (2.4 ± 0.45) and during COVID-19 times (1.6 ± 0.39; p > .05). In the practical objective structured clinical examination (OSCE), there was also no significant difference between students' judgement of the difficulty of the station (1.9 ± 0.22 vs 1.9 ± 0.31; p > .05) or how well-prepared they felt for the exam (2.0 ± 0.24 vs 2.0 ± 0.31; p > .05). However, there was a significant difference in terms of grades, with the pre-COVID-19 grades being significantly better (2.7 ± 0.37 vs 2.0 ± 0.44; p < .05), which reflects the difficulty of transferring practical skills training to an online setting. Students particularly valued the possibility of self-directed learning combined with personal guidance by departmental experts, reflecting the importance of wellbeing-centred medical education. The pandemic triggered overnight challenges for teaching mental health that may also offer the opportunity to think about worldwide teaching standards with easily accessible material and courses online. This may offer the opportunity to enthral medical students to become mental health specialists themselves.

Perceptions of undergraduate nursing students toward providing care to COVID-19 patients

Background

Undergraduate nursing students were inevitably recruited to provide care in response to overloaded hospitals with COVID-19 patients. The placement was potentially a stressful event and we aimed to understand the students' perception of direct nursing care during the pandemic.

Methods

This qualitative content analysis study carried out in 2020 (May-June) in Tehran, I.R. Iran. Using explanatory questions, we interviewed 15 undergraduate nursing students who provided direct care for at least 2 months to patients hospitalized with COVID-19 in the beginning of the pandemic to obtain their deep experiences. We applied the MAXQDA 10 to extract codes, used the qualitative content analysis method for investigation, and then applied the Lincoln and Guba criteria for rigor and trustworthiness. The study was approved by the National Committee for Ethics in Biomedical Research (IR.BMSU.REC.1399.070. available at: https://ethics.research.ac.ir).

Results

Four hundred and 54 codes were identified, which were then sorted into 12 categories underlying four main themes of "hard and unpredictable," "posttraumatic growth," "on the path to self-determination," and "commitment."

Conclusion

Even though the undergraduate nursing students experienced some stress in the beginning, with close support, their caregiving skills improved and they were able to meet the national healthcare needs. More studies are needed to confirm our findings regarding the experiences of the nursing students in combating COVID-19.

COVID as a catalyst: medical student perspectives on professional identity formation during the COVID-19 pandemic

BACKGROUND

As a result of the COVID-19 pandemic, a national decision was made to remove all medical students from clinical environments resulting in a major disruption to traditional medical education. Our study aimed to explore medical student perspectives of professional identity formation (PIF) during a nationally unique period in which there was no clinical training in medical undergraduate programs.

METHODS

We interviewed fifteen UBC medical students (years 1-4) regarding their perspectives on PIF and the student role in the setting of the COVID-19 pandemic. Data were analysed iteratively and continuously to create a codebook and identify themes of PIF based on interview transcripts.

RESULTS

We identified three key themes: (1) Medical students as learners vs contributing team members (2) Decreased competency as a threat to identity and (3) Doctors as heroes.

CONCLUSIONS

The impact of disruptions due to COVID-19 catalyzed student reflections on their role within the healthcare system, as well as the role of self-sacrifice in physician identity. Simultaneously, students worried that disruptions to clinical training would prevent them from actualizing the identities they envisioned for themselves in the future. Ultimately, our study provides insight into student perspectives during a novel period in medical training, and highlights the unique ways in which PIF can occur in the absence of clinical exposure.

Hand-Held Point-of-Care Ultrasound: A New Tool for Veterinary Student Self-Driven Learning in the Time of COVID-19

The coronavirus pandemic abruptly halted all in-person clerkships, or clinical rotations, for clinical veterinary students across the United States. Online clerkships in radiology offered the opportunity to expand the student's ability to interpret medical images but did not allow for the development of physical hands-on imaging skills recognized as core competencies in veterinary medicine. The present report highlights the value of providing veterinary students with a smartphone-associated Butterfly iQ point-of-care ultrasound during a 3-week self-driven virtual clerkship. During the virtual rotation, the student was able to develop the skills required to generate sufficient quality images using three horses residing on her property. The affordability, portability, ease of use of the Butterfly iQ and availability of animals made it possible to develop hands-on imaging skills when distance learning was required.

An online mindfulness intervention for medical students in South Africa: A randomised controlled trial

Background

Prior to the COVID-19 pandemic, an association was observed between medical students’ stress, possibly because of an intensive academic workload and clinical responsibilities, and mental ill health. The literature has shown the benefit of online mindfulness interventions for different mental health challenges. Unfortunately, there is a paucity of information on their benefit to medical students in South Africa.

Aim

The aim of this study was to explore whether medical students attending an online mindfulness-based intervention (MBI) would show improved resilience and stress management compared with attendance at an online supportive counselling (SC) programme. Secondary to this was the viability of the intervention, for which an in-depth understanding of participants’ experiences was sought.

Setting

The study setting was online through https://zoom.us/.

Methods

Forty-five participants were randomly allocated between two 6-week, teacher-facilitated groups. A repeated measures analysis of variance (ANOVA) of outcome, well-being, perceived stress and self-compassion scores conducted at three time points, as well as thematic analysis of participant feedback, contributed to quantitative and qualitative data.

Results

Participants in both the groups showed significant improvement over time in measures of well-being, perceived stress and subjective stress management. Participants in the mindfulness group showed a statistically significant treatment effect in mindfulness at programme completion. A decrease in self-compassion over time was observed in both the groups.

Conclusion

The results of this study indicate that in this South African medical student cohort, an online MBI and a SC programme are both feasible and show potential for reducing stress, increasing stress management and increasing resilience. Further study in this area is recommended.

Détresse et résilience des étudiants en médecine de Paris Saclay lors de la première vague de la pandémie de COVID-19

Les étudiants en médecine sont exposés à des risques psychosociaux responsables d’un plus haut niveau d’anxiété, de dépression, de syndrome d’épuisement professionnel que la population française de même âge. Lors de la première vague de la pandémie COVID-19 en France, un certain nombre d’entre eux se sont mobilisés pour venir en aide aux hôpitaux débordés. Au travers de cette expérience, ils ont rapporté une détresse psychologique modérée, laquelle était nuancée par différentes capacités de résilience. Cette étude explore les ressources et les difficultés d’étudiants en médecine de l’université Paris-Saclay (France) engagés lors de la première vague dans les services hospitaliers. Si l’exposition à la mort et les conditions de soins dégradés ont pu impacter leurs motivations à étudier, l’expérience a également permis à certains d’entre eux d’acquérir des compétences complémentaires, de participer à l’effort collectif, d’éviter le confinement généralisé et d’aider les autres soignants. La prise en compte de ces facteurs de résilience au regard des difficultés rencontrées (exacerbées par la crise sanitaire, mais qui existaient déjà avant cette dernière) permet de nourrir la réflexion sur l’amélioration de la qualité de vie des étudiants en médecine dans le système universitaire médical français.

Depression and suicidal ideation among medical students in a private medical college of Bangladesh. A cross sectional web based survey

This study was done to investigate the prevalence of depression and suicidal ideation among private medical students in Bangladesh. A total of 237 medical students participated in this cross-sectional web-based survey by e-questionnaire using the Google Form. The study was conducted from November 2020 to December 2020 at Enam Medical College and Hospital which is situated in Savar, Dhaka, Bangladesh. Out of 237 medical students, prevalence of depression was found 58.6%, and prevalence of suicidal ideation was found 27.4% which is higher than the global prevalence. Bivariate and multivariate analysis and logistic regression-based odds ratios (ORs) was done to see the association between grade of depression and suicidal thoughts with different variables. Association between grade of depression with family problems (x² = 16.716, P = 0.001), drug addiction (x² = 16.601, P = 0.001), committed relationship status (x² = 40.292, P = <0.001) were statistically significant. Whereas, the association between suicidal thoughts with family problems (x² = 29.881, P = <0.001), failed any subject during study (x² = 12.024, P = 0.007), alcohol uses (x² = 15.977, P = 0.001), drug addiction (x² = 22.633, P = <0.001), committed relationship status (x² = 35.219, P = <0.001) were statistically significant. However, medical students whom had to earn other than their family income were 2.3 times (OR: 2.285, 95% CL: 0.897, 5.820) greater prone to be depressed than those who do not had to earn by themselves. On the contrary, medical students who are single were 2.35 times (OR: 2.352, 95% CL: 0.926, 5.973) greater prone to have suicidal thoughts than the married students. This study showed that a large percentage of Bangladeshi medical students have been suffering from depression and suicidal ideation. Our recommendation for the authority of the medical colleges are, to build a system with counselling facilities inside every medical colleges in Bangladesh.

Psychological distress and well-being among students of health disciplines in Geneva, Switzerland: The importance of academic satisfaction in the context of academic year-end and COVID-19 stress on their learning experience

INTRODUCTION

University students' psychological health is linked to their academic satisfaction. This study aimed to investigate students' psychological health and academic satisfaction in the context of COVID-19 and academic year-end stress.

MATERIALS AND METHODS

Standardized self-filled scales for anxiety, depression, stress, psychological well-being, academic satisfaction (subjective assessment of students' quality of life in their educational setting), and an ad-hoc scale for stress on the learning experience due to COVID-19 were used in this cross-sectional study. Participants were first- to third-year students of eight different health-related tracks in Geneva, Switzerland. Descriptive statistics and hierarchical regression analyses were applied.

RESULTS

In June 2020, out of 2835 invited students, 433 (15%) completed the survey. Academic satisfaction was a stronger mental health predictor than COVID-19 stress on the learning experience, which mainly predicted stress and anxiety. Lower academic satisfaction scores were significantly associated with stress (β = -0.53, p < 0.001), depression (β = -0.26, p < 0.001), anxiety (β = -0.20, p < 0.001), while higher scores with psychological well-being (β = 0.48, p < 0.001). Identifying as female was strongly associated with anxiety and stress but not with depression or psychological well-being. Lower age was associated with stress only. The nature of the academic training had a lesser impact on mental health and the academic year had no impact.

CONCLUSIONS

Academic satisfaction plays a more substantial role than COVID-19 stress on the learning experience in predicting students' overall mental health status. Training institutions should address the underlying factors that can enhance students' academic satisfaction, especially during the COVID-19 period, in addition to ensuring that they have a continuous and adequate learning experience, as well as access to psychosocial services that help them cope with mental distress and enhance their psychological well-being.

Depression Among Medical Students in the United States During the COVID-19 Pandemic: The role of Communication Between Universities and Their Students

OBJECTIVE

Medical students are vulnerable to stress and depression during medical school and the COVID-19 pandemic may have exacerbated these issues. This study examined whether the risk of depression was associated with COVID-19 pandemic-related medical school communication.

METHODS

A 144 - item pilot cross-sectional online survey of medical students in the US, was carried out between September 1, 2020 and December 31, 2020. Items on stress, depression, and communication between students and their medical schools were included. This study examined associations of student perceptions of universities' communication efforts and pandemic response with risk of developing depression.

RESULTS

The sample included 212 students from 22 US states. Almost 50% (48.6%) were at risk of developing depression. Students felt medical schools transitioned well to online platforms, while the curriculum was just as rigorous as in-person courses. Students at risk of developing depression reported communication was poor more frequently compared to students at average risk. Students at risk of depression were also more than 3 times more likely to report their universities' communication about scholarships or other funding was poor in adjusted analyses.

CONCLUSION

Universities communicated well with medical students during the pandemic. However, this study also highlights the need for ongoing efforts to address student mental health by medical schools.

The impact of COVID-19 on professional identity

BACKGROUND

The COVID-19 pandemic has had a profound impact on medical care and medical student education as clinical rotations were halted and students' clinical activities were drastically curtailed. Learning experiences in medical school are known to promote identity formation through teamwork, reflection, and values-based community discussion. This study explored the impact of the COVID-19 pandemic on medical students' professional identity formation (PIF).

METHODS

Students in all cohorts of medical education were invited by email in May 2020 to submit a written reflection about their learning experiences and impact of the pandemic on their PIF. We used iterative individual and team reviews, known as the "immersion/crystallisation" method, to code and analyse the data.

FINDINGS

Twenty-six students (20%) submitted reflections in which they discussed "changing conceptions of the role and image of a physician," "views about medical education," and the "role of students in a pandemic." Students viewed physicians as altruistic, effective communicators, and pledged to be like them in the future. Their perceptions of virtual learning were mixed, along with considerations of lost interactions with patients, and wanting to be more useful as professionals-in-training.

DISCUSSION

COVID-19 has impacted students' views of themselves and reshaped their ideas, both negatively and positively, about the profession they are entering and their role(s) in it.

CONCLUSION

Exploring PIF and the impact of disruptions has allowed us to address the issues raised regarding clinical learning now and into the future. Reflection enhances PIF and unexpected events, such as COVID-19, offer opportunities for reflection and development.

An analysis of anatomy education before and during Covid-19: August-December 2020

Coronavirus disease-2019 (Covid-19) disrupted the in-person teaching format of anatomy. To study changes in gross anatomy education that occurred during August-December, 2020 compared to before the pandemic, an online survey was distributed to anatomy educators. The 191 responses received were analyzed in total and by academic program, geographic region, and institution type. Cadaver use decreased overall (before: 74.1 ± 34.1%, during: 50.3 ± 43.0%, P < 0.0001), as well as across allopathic and osteopathic medicine, therapy, undergraduate, and veterinary programs (P < 0.05), but remained unchanged for other programs (P > 0.05). Cadaver use decreased internationally and in the US (P < 0.0001), at public and private (P < 0.0001) institutions, and among allopathic medical programs in Northeastern, Central, and Southern (P < 0.05), but not Western, US geographical regions. Laboratories during Covid-19 were delivered through synchronous (59%), asynchronous (4%), or mixed (37%) formats (P < 0.0001) and utilized digital resources (47%), dissection (32%), and/or prosection (21%) (P < 0.0001). The practical laboratory examination persisted during Covid-19 (P = 0.419); however, the setting and materials shifted to computer-based (P < 0.0001) and image-based (P < 0.0001), respectively. In-person lecture decreased during Covid-19 (before: 88%, during: 24%, P = 0.003). When anatomy digital resources were categorized, dissection media, interactive software, and open-access content increased (P ≤ 0.008), with specific increases in BlueLink, Acland's Videos, and Complete Anatomy (P < 0.05). This study provided evidence of how gross anatomy educators continued to adapt their courses past the early stages of the pandemic.

Challenges in the clinical education environment during the outbreak of COVID-19: Development and psychometric testing

BACKGROUND

COVID-19 pandemic poses unique physical and emotional challenges in providing clinical education. Failure to identify the challenges and problems that students face in the clinical learning environment hinders their effective learning and growth. Consequently, the progress of their skills is affected. The aim of this study was to develop a challenge in the clinical education environment of medical students during the outbreak of COVID-19 questionnaire and to test its psychometric properties.

MATERIALS AND METHODS

This study is part of a larger study that was conducted using a combined consecutive method in Qazvin. In the first stage, a phenomenological study was performed with van Manen's method by interviewing 12 students at Qazvin University. To extract the items of the tool in the second stage, the concept was defined. Ultimately, the psychometric properties of the questionnaire were evaluated with face validity, content validity (quantitative and qualitative), construct validity (exploratory factor analysis), internal consistency (Cronbach's alpha), and test-retest reliability (intraclass correlation coefficient).

RESULTS

The initial tool had 70 questions. After validation, 53 items remained in the final questionnaire. Four extracted dimensions were as follows: "Inadequate professional competency," "Inefficient clinical planning" and "outcomes of learning-teaching activities," and "the challenges related to the stigma of medical staff." Cronbach's alpha for the whole questionnaire was 0.98 (range: 0.87-0.98). The test-retest (intraclass correlation coefficient) reliability was 0.98 (P < 0.001).

CONCLUSIONS

According to the obtained results, if the items of "Inadequate professional competency," "Inefficient clinical planning" and "outcomes of learning-teaching activities," and "the challenges related to the stigma of medical staff," the challenges of students' clinical education can be reduced during the COVID-19 outbreak.

Deploying Medical Students During the COVID-19 Pandemic

During the novel coronavirus pandemic outbreak, medical education has been inevitably disrupted, while the clinical exposure of many medical students has been hindered. The current article investigates the student role in this large-scale health crisis, in terms of providing for the continuity of medical training and addressing the growing needs of healthcare systems. By presenting different medical education policies implemented worldwide, new perspectives on student involvement are being illuminated. Even during pandemics, students should be motivated to actively serve. The formation of a clear framework for students' roles enhances the preparedness of the medical education community for related future challenges.

A Peer-Based Educational Intervention Effects on SARS-CoV-2 Knowledge and Attitudes among Polish High-School Students

To support high school students to develop knowledge they need to adhere to control measures during the pandemic, a peer-based educational intervention on SARS-CoV-2 was developed and its impact was evaluated. Multistage random sampling was used. The 50 min peer-based intervention was conducted by final year medical students. Baseline and post-intervention knowledge and attitudes were assessed. Significance was tested by McNemar's/Wilcoxon rank tests. Of 518 participants (mean age 17.8 years ± 0.43), 81.0% did not receive any school-based education on SARS-CoV-2. After intervention, the knowledge score improved from 65.2% to 81.6%, attitudes from 63.2% to 70.8% (both p < 0.0001). The effect size after the intervention compared to pre-intervention showed moderate improvement of knowledge, but not attitudes (d = 0.46 and d = 0.18, respectively). Pre- and post-intervention, females, students in non-science programs, living in cities < 250,000 inhabitants had lower knowledge, while fewer males, non-science program students, living in smaller cities presented positive attitudes. Before intervention, 67.0% students correctly named SARS-CoV-2 preventive methods and 73.6% were concerned COVID-19 is a serious disease; these improved after intervention (to 80.1% and 86.3%; p < 0.0001). The intervention was not very successful in increasing the intent to vaccinate for COVID-19 (pre-intervention 52.9%, post-intervention 56.4%; p < 0.007). Peer-based teaching for high school students can be effective in increasing SARS-CoV-2 knowledge and awareness. More efforts are needed to improve attitudes and enhance acceptance of vaccination against COVID-19.

Prevalence of insomnia and related psychological factors with coping strategies among medical students in clinical years during the COVID-19 pandemic

We explored the prevalence of insomnia, confirm the associated psychological factors and current coping strategies among undergraduate medical during their clinical years. This cross-sectional, quantitative, descriptive study was conducted at the department of medical education, college of medicine, King Saud University (KSU), Riyadh, Saudi Arabia. The participants (n = 463) were the 3rd to 5th year, and intern medical clinical students. We collected responses about sleep, using the Insomnia Severity Index (ISI). We also used Kessler-10 (K10), Psychological Distress and the Patient Health Questionnaire (PHQ-9). Items related to Coping strategies were also used from our previously published study and COVID-19 issues were explored using a self-developed questionnaire. According to the ISI ranking, 162 (34.9 %) of the participants had insomnia, among them 57.4% of females and 42.6% were males. Age groups between 22 and 25 have more sleeping disorder (43.2%) as compared to other age groups. 3rd-year students have more insomnia 36.41% as compared to other years. Individuals with insomnia symptoms were more likely (1.67 times higher) to be female students (OR = 1.67; P = 0.005) as compared to male students. A significantly high prevalence (3.37 times high) of insomnia was noted for those students or interns who have attended their clinical training irregularly as compare to regularly attending participants (OR = 2.32; P = 0.12) during COVID-19. Transition time i.e. year 3 of medical program was more stressful for the students and female students perceived stress and insomnia more than their male counterparts. It is important to address identified disorder early in order to reduce psychological morbidity and its harmful implications for medical students and young physicians.

Neurology podcast utilization during the COVID-19 pandemic

BACKGROUND

As medical education shifted to a virtual environment during the early coronavirus disease 2019 (COVID-19) pandemic, we evaluated how neurology podcasting may have been utilized during this period, and which features of podcasts have been more highly sought by a medical audience.

METHODS

We conducted a retrospective analysis of neurology-themed blogs and/or podcasts between April 2019 and May 2020. Programs were eligible if they reported mean monthly downloads > 2000, were affiliated with an academic society, or offered continuing medical education credit. Thirty-day download counts were compared between study months, with adjustment for multiple testing. Exploratory analyses were performed to determine which podcast features were associated with higher downloads.

RESULTS

Of the 12 neurology podcasts surveyed, 8 completed the survey and 5 met inclusion criteria. The median monthly download count was 2865 (IQR 869-7497), with significant variability between programs (p < 0.001). While there was a 358% increase in downloads during April 2020 when compared to the previous month, this was not significant (median 8124 [IQR 2913-14,177] vs. 2268 [IQR 540-6116], padj = 0.80). The non-significant increase in overall downloads during April 2020 corresponded to an increase in unique episodes during that month (r = 0.48, p = 0.003). There was no difference in 30-day downloads among episodes including COVID-19 content versus not (median 1979 [IQR 791-2873] vs. 1171 [IQR 405-2665], p = 0.28).

CONCLUSIONS

In this unique, exploratory study of academic neurology-themed podcasts, there was no significant increase in episode downloads during the early COVID-19 pandemic. A more comprehensive analysis of general and subspecialty medical podcasts is underway.

Medical students during the COVID-19 pandemic: Considerations and arguments on their clinical engagement

During the recent COVID-19 pandemic, the clinical exposure of medical students has been hindered while the impact on medical education is under investigation. The potential negative impact of medical students on transmission rates, along with the shortages of Personal Protective Equipment (PPE), their lack of proper training, and their limited ability to work independently, give rise to reasonable concerns regarding their involvement in pandemic management. Nevertheless, the heavy workload could soon provoke severe deficiencies in the frontline medical workforce. Hence, the possibility of covering gaps in human resources by effectively deploying students should not be rejected in advance. Additionally, a pandemic poses a valuable learning opportunity for high-quality medical education. The aim of this commentary is to present a discussion with supporters and opponents of medical student engagement in the pandemic management and their involvement in placements requiring physical contact with patients. We also attempt to elucidate the necessary conditions for the students' possible involvement in clinical settings.

Evaluating Effectiveness of YouTube Videos for Teaching Medical Students CPR: Solution to Optimizing Clinician Educator Workload during the COVID-19 Pandemic

(1) Background: This study aimed to evaluate the effectiveness of using a pre-existing video on CPR to support preclinical resuscitation education for medical students; (2) Methods: In total, 129 students selected to learn CPR using a pre-existing YouTube video or the conventional screencast video by their university faculties. All students responded to the pre- and post-training multiple-choice questionnaire on the basic knowledge of CPR, and, based on their responses, an analysis of covariance (ANCOVA) was conducted to assess the comparability of effectiveness across learning modalities. (3) Results: Among the students, 49 (38.0%) students selected the YouTube video to learn about CPR and were treated as the intervention group. The mean pre-test scores and post-test scores of the YouTube and the instructor's video groups were 6.43 and 6.64, and 9.06 and 9.09, respectively. After controlling for the pre-test score effects, the results of ANCOVA did not show statistically significant differences between groups (p = 0.927), indicating comparable performance between groups that used YouTube and the instructor's videos. (4) Conclusion: Utilizing YouTube videos is a useful teaching strategy for teaching CPR knowledge, which would reduce the burden on faculty of creating screencast lecture videos for online learning on resuscitation.

Outcomes of a Student-Led Telemedicine Clinic in Response to COVID-19

In response to the coronavirus disease-2019 (COVID-19) pandemic, we developed and launched a student-led telemedicine program in Chelsea. From April to November 2020, over 200 student volunteers contacted over 1000 patients to assess COVID-19 symptoms, provide counseling, and triage patients. Through a retrospective cohort study, we determined that student triage decision was associated with patient outcomes, including hospitalization status, COVID-19 test administration, and COVID-19 test result. These results quantify the outcomes of a student-led telemedicine clinic to combat the ongoing pandemic and may serve as a model for implementation of similar clinics to alleviate mounting health care system burden.

Attitude of Medical Students About Their Role and Social Accountability in the COVID-19 Pandemic

Background: In this study, we aimed to explore the attitude of medical students toward their role and social accountability in this pandemic era. An online survey was developed to elicit information on (1) the role of medical students in the pandemic era; (2) Medical education in the "new normal," and (3) the impact of COVID-19 on medical students. Methods: The online survey, developed by a team consisting of three medical students, three psychiatry residents, and three professors of psychiatry, was conducted on 574 participants (213 medical students, 180 graduates, and 181 professors) in the University of Ulsan College of Medicine, Seoul, South Korea. Anxiety symptom rating scales, including the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale and the Generalized Anxiety Disorder-7 (GAD-7) scale, were applied to measure participant anxiety level. Results: Medical students indicated their willingness to join the healthcare response to the COVID-19 pandemic, if requested; however, graduates and professors recommended that medical students continue their training rather than join the pandemic healthcare response. In the new normal era, medical education has had to change appropriately. Moreover, adequate knowledge of COVID-19 infection and spread must be considered for the continuation of clinical clerkships during the pandemic. Overall, medical students who indicated anxiety about treating possible or confirmed cases of COVID-19 rated higher on the SAVE-6 scale. Finally, medical students who reported that COVID-19 had an impact on their studies and daily life rated higher on the general anxiety scale (GAD-7). Conclusion: Social accountability is an important issue for medical students in the pandemic era. At the same time, non-disruption of their academic calendar would ensure continuous availability of component medical professionals, which is important for adequate future healthcare responses.

Medical Education During the COVID-19 Pandemic

All aspects of medical education were affected by the COVID-19 pandemic. Several challenges were experienced by trainees and programs alike, including economic repercussions of the pandemic; social distancing affecting the delivery of medical education, testing, and interviewing; the surge of patients affecting redeployment of personnel and potential compromises in core training; and the overall impact on the wellness and mental health of trainees and educators. The ability of medical teams and researchers to peer review, conduct clinical research, and keep up with literature was similarly challenged by the rapid growth in peer-reviewed and preprint literature. This article reviews these challenges and shares strategies that institutions, educators, and learners adopted, adapted, and developed to provide quality education during these unprecedented times.

The Role of Medical Students During COVID-19 Era. A Review

BACKGROUND AND AIM OF THE WORK

Since December 2019, the world has been facing the coronavirus (COVID-19) pandemic crisis. The rapid and effortless spread of the virus has led the World Health Organization to adopt unprecedented large-scale preventive measures. Our aim is to investigate the impact of COVID-19 on the mental health of medical students, and to evaluate their awareness and aptitude for contributing to the fight against COVID-19 contagion.

METHODS

PubMed electronic database was employed for the research using the following terms: "medical students and COVID-19", "mental health of medical students and COVID-19", "knowledge of medical students and COVID-19", "preventive behavior of medical students and COVID-19".

RESULTS

Twenty-one articles were included; ten assess the knowledge of medical students on COVID-19, seven present whether they demonstrate appropriate preventive behavior according to global guidelines, seven examine the impact of the pandemic on their mental health, five examine their role on the side of trained healthcare workers. Some articles combine more than one of the above mentioned domains.

CONCLUSIONS

Medical students seem to demonstrate an adequate level of knowledge upon COVID-19 and implement proper strategies to prevent its spread. Further training is essential to improve some aspects in this field. Social media has proven to be the optimal source of information for medical students, which is incompatible with their future careers as doctors. The pandemic had a negative impact on medical students, expressed as fear regarding the virus spread; nevertheless, many have felt the need to assist healthcare systems under appropriate precautions.

The impact of death and dying on the personhood of medical students: a systematic scoping review

BACKGROUND

The re-introduction of medical students into healthcare systems struggling with the COVID-19 pandemic raises concerns as to whether they will be supported when confronted with death and dying patients in resource-limited settings and with reduced support from senior clinicians. Better understanding of how medical students respond to death and dying will inform educationalists and clinicians on how to best support them.

METHODS

We adopt Krishna's Systematic Evidence Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on the impact of death and dying on medical students. This structured search process and concurrent use of thematic and directed content analysis of data from six databases (Split Approach) enhances the transparency and reproducibility of this review.

RESULTS

Seven thousand six hundred nineteen were identified, 149 articles reviewed and 52 articles included. The Split Approach revealed similar themes and categories that correspond to the Innate, Individual, Relational and Societal domains in the Ring Theory of Personhood.

CONCLUSION

Facing death and dying amongst their patients affect how medical students envisage their personhood. This underlines the need for timely, holistic and longitudinal support systems to ensure that problems faced are addressed early. To do so, there must be effective training and a structured support mechanism.

A Near-Peer Educational Model for Online, Interactive Learning in Emergency Medicine

Introduction

The COVID-19 pandemic led to a large disruption in the clinical education of medical students, particularly in-person clinical activities. To address the resulting challenges faced by students interested in emergency medicine (EM), we proposed and held a peer-led, online learning course for rising fourth-year medical students.

Methods

A total of 61 medical students participated in an eight-lecture EM course. Students were evaluated through pre- and post-course assessments designed to ascertain perceived comfort with learning objectives and overall course feedback. Pre- and post-lecture assignments were also used to increase student learning.

Results

Mean confidence improved in every learning objective after the course. Favored participation methods were three-person call-outs, polling, and using the “chat” function. Resident participation was valued for “real-life” examples and clinical pearls.

Conclusion

This interactive model for online EM education can be an effective format for dissemination when in-person education may not be available.

Association of COVID-19 Pandemic with undergraduate Medical Students' Perceived Stress and Coping

Purpose

The COVID-19 pandemic poses a major challenge for medical students’ learning and has become a potential stressor, with a profound influence on their psychological well-being. We aimed to determine the effect of the current pandemic on undergraduate medical students’ learning. We also explored the association of their stress level with coping strategies, educational, and psychological variables.

Materials and Methods

This is a cross-sectional design study, and participants were the 1st to 5th year medical students. A self-administered questionnaire (18 items) and a well-known Kessler 10 Psychological Distress questionnaire (10 items) were used to collect the data related to perceived stress with an association of educational, psychological, and coping variables.

Results

The prevalence of overall stress was significantly higher (χ²= 16.3; P=0.000) in female medical students, ie, (40%) as compared to the male students (16.6%), and was highest (48.8%) during the 3rd medical year. It was also noted that the most effective strategy, embraced by students to cope with the severe stress, was “indulging in religious activities” (OR= 1.08; P=0.81). Furthermore, 22.3% of students had perceived severe stress as they did not prefer online learning. Similarly, those students who have not believed or refused the online learning or disagree in “there is pleasure in the study due to COVID” they have significantly higher stress (χ²=39.7; P=0.000) 21.5% mild, 17.8% of moderate, and 21.2% severe.

Conclusion

We found that the COVID-19 pandemic has induced stress and changes in medical students’ educational attitudes and strategies. The results exhibited that the predominance of stress is higher in females than males, and also more stress was perceived by the students during their transitional year, ie, 3rd medical year (from pre-clinical to clinical) and also the respondents who regularly did religious meditation were at lower levels of stress. COVID-19’s influence on medical education and students’ well-being will be felt at an extended level, which necessitates an appropriate plan for preparedness.

Student Hotline Improves Remote Clinical Skills and Access to Rural Care

Introduction

During the COVID-19 pandemic, medical schools needed to redirect students to alternative educational opportunities. The University of Nevada, Reno School of Medicine addressed this issue by forming a partnership with rural counties in northern Nevada to create a multicounty COVID-19 hotline clinical experience. Medical students staffed the hotline and assisted the underserved rural populations of northern Nevada by providing counseling and education via telehealth. With the support of preceptors, students completed screening forms with patients, utilized audio-only physical exam skills and clinical decision making to triage potential patients to the appropriate level of care.

Methods

We utilized retrospective pre- and postassessments to assess medical students' comfort level with several hotline tasks before and after their experience as a hotline volunteer.

Results

Results indicate significant improvements after hotline training and experience in students' comfort level with answering questions about SARS-CoV-2 (P=.006); screening patients for SARS-CoV-2 (P=.0446); assessing exam findings using audio only format ( P=.0429); triaging patients (P=.0103); and addressing financial access to care barriers ( P=.0127).

Conclusion

Participation in the multicounty COVID-19 hotline improved students' comfort levels in all areas, with significant improvement in answering questions about SARS-CoV-2, conducting audio-only exams, screening and triaging patients, and addressing financial barriers to care. Participation allowed students to further hone their clinical skills during a pandemic. This experience can serve as a model for similar projects for other academic institutions to train their medical students while providing outreach, particularly to underserved populations such as rural communities.

Medical students' perspectives on recommencing clinical rotations during coronavirus disease 2019 at one institution in South Korea

PURPOSE

Clinical rotations of medical students across the world have inevitably been affected due to the coronavirus disease 2019 (COVID-19) pandemic. The aims of this study were to explore medical students' perception on the school's response and management of clinical rotation during the COVID-19 pandemic and on how it had affected the quality of their education.

METHODS

An online questionnaire was distributed to third year medical students at one institution whose clinical rotations re-started during the pandemic. The questions asked about the students' satisfaction with the school's policy and feelings of safety, and the impact of COVID-19 on clinical learning.

RESULTS

The students' perception on the school's response to the pandemic was mixed. Re-commencement of the clinical rotations and procurement of personal protective equipment was positive but a third of students still felt unsafe. The decreased number of hospital patients did not seem to have impacted their overall clinical education with praise on the role of the supervising physicians. Seventy-six-point seven percent of students conferred the positive educational opportunities on medical professionalism presented to them only as the clinical rotation during the ongoing pandemic.

CONCLUSION

Our observations on the re-commencement of clerkship during this pandemic may help equip medical institutions on future public health crisis.

Contribution and dilemmas of Medical undergraduate students in combating disease outbreaks: COVID 19 and previous outbreaks

COVID 19 has brought several challenges for each individual, changing the world's perception of health-care professionals. People are hailing health-care professionals as heroes, worthy of praise and gratitude. However, the pandemic has overburdened the health-care system. In this situation, the undergraduate medical students are being used as a crucial part of the health-care team in various ways. Involvement of medical undergraduates in situations of natural disaster is not new. In fact, a review of history of previous natural disasters reveals that this has been normal every time health systems have been overburdened. In the present situation of COVID 19, these students have a crucial role to play in helping frontline workers combat the crisis. Though the students would like to render their services, they are in a state of dilemma, as their roles are not defined clearly and their training to combat the pandemic is inadequate, as it was in previous outbreaks. This highlights a need to introduce module-based training for medical graduates to contribute effectively in combating future outbreaks.