A virtual COVID-19 ophthalmology rotation

Self-assessment, and not continuous training, improves basic open suturing skills

BACKGROUND

To develop and maintain suturing skills, clinical exposure is important. When clinical exposure cannot be guaranteed, an adequate training schedule for suturing skills is required. This study evaluates the effect of continuous training, 'reflection before practice' and self-assessment on basic open suturing skills.

METHODS

Medical students performed four basic suturing tasks on a simulation set up before ('pre-test') and after their surgical rotation ('after-test'). Participants were divided in three groups; the 'clinical exposure group' (n = 44) had clinical exposure during their rotation only, the 'continuous training group' (n = 16) completed a suturing interval training during their rotation and the 'self-assessment group' (n = 16) also completed a suturing interval training, but with the use of reflection before practice and self-assessment. Parameters measured by a tracking system during the suturing tasks and a calculated 'composite score' were compared between groups and test-moments.

RESULTS

A significantly better composite score was found at the after-test compared to the pre-test for all groups for all basic suturing tasks (0.001 ≤ p ≤ 0.049). The self-assessment group scored better at the pre-test than the other two groups for all tasks, except for 'knot tying by hand' (0.004 ≤ p ≤ 0.063). However, this group did not score better at the after-test for all tasks, compared to the other two groups. This resulted in a smaller delta of time ('transcutaneous suture', p = 0.013), distance ('Donati suture' and 'intracutaneous suture', 0.005 ≤ p ≤ 0.009) or composite score (all tasks, except for knot tying by hand, 0.007 ≤ p ≤ 0.061) in the self-assessment group.

CONCLUSION

Reflection before practice and self-assessment during continuous training of basic open suturing tasks, may improve surgical skills at the start of the learning curve.

Flipped Classroom Based on Outcomes-Based Education Improves Student Engagement and Clinical Analysis Competence in Undergraduates Ophthalmology Clerkship

Objective

To investigate the effectiveness of flipped classrooms (FC) based on outcomes-based education (OBE) on clinical ophthalmology clerkships.

Methods

Ninety-nine undergraduates were non-randomly assigned to the FC based on the OBE (FC-OBE) group or traditional lecture (TL) group in the ophthalmology clerkship. Pre- and post-tests were performed to assess student learning outcomes. Anonymous questionnaires were collected to compare students' attitudes and classroom engagements between the two groups.

Results

More participants agreed FC-OBE was helpful in developing teamwork ability and knowing the work standard. Teaching staff in the FC-OBE classroom received higher evaluations. More participants in the FC-OBE group had higher classroom engagement in skills and emotions than in the TL group. The post-class test scores, mainly case analysis scores were higher in the FC-OBE group than in the TL group.

Conclusion

FC-OBE classroom improves student engagement and clinical analysis competence in undergraduate ophthalmology clerkship.

Management of COVID-19 in Ophthalmology

From its outbreak in early 2020, the new SARS-CoV-2 infection has deeply affected the entire eye care system for several reasons. Since the beginning of the COVID-19 pandemic, ophthalmologists were among the "high-risk category" for contracting the SARS-CoV-2 infection based on the notion that the eye was suspected to be a site of inoculation, infection, and transmission. Clinical ophthalmologists have been required to learn and promptly recognize the ocular manifestations associated with the COVID-19 disease, with its treatments and vaccinations. Restriction measures, lockdown periods, guidelines to prevent SARS-CoV-2 infection transmission, and the use of telemedicine and artificial intelligence modalities have induced profound modifications. These changes, which are most likely to be irreversible, influence routine clinical practice, education, and research, thus giving rise to a "new ophthalmology in the COVID era". This book chapter aims to provide several notions regarding COVID-19 in ophthalmology, including the SARS-CoV-2 virus infection and transmission modalities; the ocular manifestation associated with the COVID-19 disease; the drugs and vaccines used for COVID-19; the precautions adopted in the ophthalmic practice to limit the spread of the virus; the consequences of the pandemic on the ophthalmic patients, clinicians, and the entire eye care system; and, the future of ophthalmology in the era of "COVID new normal".

The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions

OBJECTIVE

This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges.

METHODS

A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles.

RESULTS

Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning.

CONCLUSION

In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.

Virtual Adaptation of Empathetic Communication Training for Pediatric Interns

OBJECTIVE

Evaluate feasibility and effectiveness of virtual adaptation of in-person simulation-based empathetic communication training.

METHODS

Pediatric interns participated in virtual training session then completed post-session and 3 months follow up surveys.

RESULTS

Self-reported preparedness on the skills all improved significantly. The interns report the educational value as extremely high both immediately after and 3 months after training. 73% of the interns report using the skills at least weekly.

CONCLUSION

A 1 day virtual simulation-based communication training is feasible, well received, and similarly effective as in-person training.

The Utility of a Virtual Emergency Medicine Elective for Visiting Medical Students

Background Away rotations allow emergency medicine (EM)-bound fourth-year medical students to experience a residency program's educational culture and influence the ranking of residency programs. The financial cost and geographic distance have limited student participation in away electives. In recent years, COVID-19 pandemic-related restrictions on away rotations resulted in the creation of multiple virtual courses. Despite the lifting of restrictions, these courses may still have utility in helping students circumvent barriers to away rotations. Limitations of previously described courses include insufficient student-faculty interaction, which influences students' understanding of the educational environment. We sought to develop and evaluate a virtual EM elective for fourth-year medical students, focused on student-faculty interaction including precepted patient contact. Methodology We developed a two-week virtual EM elective for fourth-year medical students incorporating teaching sessions designed to optimize student-faculty interactions and attending-supervised telemedicine visits. After completion of the course, students completed an anonymous course evaluation. Results Course evaluations showed that the course improved students' understanding of our residency's educational environment by providing students with access to our residency program. The most frequently cited factors preventing participation in a traditional away elective were financial cost, limit in the allowed number of away rotations, and challenges in finding housing. Conclusions We believe this course may be an effective way of improving visiting students' understanding of the educational culture of our EM residency program. Thus, although pandemic-related restrictions have been lifted, this course may serve as a valuable adjunct to the traditional away EM rotation.

Perception of Saudi undergraduate medical students on telemedicine training and its implementation

BACKGROUND

The use of telemedicine has increased considerably in healthcare delivery, especially during this time of the coronavirus disease 2019 (COVID-19) pandemic. It has, therefore, become necessary to train medical students to better equip them for this new means of healthcare delivery. The aim of the present study was to assess the perception of undergraduate medical students on telemedicine training.

MATERIALS AND METHODS

A cross-sectional study was conducted on a total of 521 undergraduate medical students studying in the Eastern Region of Saudi Arabia. Data were collected via a self-administered pretested questionnaire comprising two main sections: demographics and knowledge and opinions regarding telemedicine training.

RESULTS

About 73% students think that the use of telemedicine for patient care will increase in the future, and 59.3% think that the medical students should be trained in telemedicine. Majority of the students (78%) opined that telemedicine training should be optional and 58% said it should be taught during the clinical phase of the undergraduate curriculum. The best telemedicine training course learning objectives medical students opined to be included were: telemedicine practical skills (70.2%), legal aspects of telemedicine practice (68.3%), and potential positive and/or negative use of telemedicine tools and methods (67.6%). Telemedicine skills students would like to learn how to effectively engage patients, knowledge about telemedicine regulations and the consequences of breaching them.

CONCLUSION

Medical students are aware of the importance of incorporating telemedicine training into the medical curriculum. Training these students is vital to ensure their competence as physicians in their future clinical careers, that is make them a digitally health-literate future workforce.

Self-directed learning: Alternative for traditional classroom learning in undergraduate ophthalmic education during the COVID-19 pandemic in China

In recent years, the COVID-19 pandemic has led to a shift in medical education from traditional face-to-face to online or remote learning, which provided challenges to faculty and students that have traditionally given face-to-face instruction. Self-directed learning (SDL) has gained popularity in undergraduate education such as nursing and adult education. Although the application of SDL in many medical teachings is practical, the application of SDL in undergraduate ophthalmology education has not been well investigated. COVID-19 pandemic led to changes in the learning style of undergraduate medical students to adapt to the shift from traditional classroom learning (TCL) to online or remote learning. Self-directed learning is a process in which individuals take the initiative in diagnosing their learning needs, formulating learning goals, identifying resources for learning, choosing and implementing appropriate learning strategies and evaluating learning outcomes. This study compared students' perspectives and study outcomes of the SDL and TCL to preliminarily investigate the effect of SDL in undergraduate ophthalmology education. The students showed equal perspectives and satisfaction with both learning models. There was no difference in learning outcomes at the end of the study. The students with different interests in ophthalmology had different perspectives on SDL and TCL. Self-directed learning is an essential alternative to traditional classroom learning in undergraduate ophthalmic education during the COVID-19 pandemic in China.

Graduating Medical Students' Experiences with Away (In-Person and Virtual) Rotations During COVID-19: Analysis of the Association of American Medical Colleges (AAMC) 2021 Graduation Questionnaire (GQ)

OBJECTIVE

The COVID-19 pandemic disrupted students' opportunities for away rotations (ARs). Schools and specialty organizations innovated by supplementing in-person ARs (ipARs) with virtual ARs (vARs). We sought to determine how ipAR and vAR completion varied by intended specialty among 2021 graduates.

DESIGN

Using de-identified Association of American Medical Colleges 2021 Graduation Questionnaire (GQ) data, we examined AR completion by specialty and community-based school attendance (among other variables) in univariate analysis and multivariable logistic regression models.

SETTING

Students graduating from MD-degree granting U.S. medical schools were invited to complete the 2021 GQ, administered electronically on a confidential basis.

PARTICIPANTS

Our study included data for 15,451 GQ respondents (74% of all 2021 graduates).

RESULTS

Among GQ respondents, 18% (2,787/15,451) completed ARs: 8% (1,279/15,451) ipAR only, 8% (1,218/15,451) vAR only, and 2% (290/15,541) both. In univariate analysis, specialty and community-based school attendance (each p < 0.001), among other variables, were associated with ipAR and with vAR. In multivariable logistic regression, surgical specialties associated with greater odds of AR completion (vs. general surgery reference) included neurological surgery (ipAR: adjusted odds ratio [AOR]=1.9, 95% confidence interval [CI]=1.1-3.3; vAR AOR=3.1, 95% CI=1.9-4.9), ophthalmology (ipAR: AOR=2.3, 95% CI=1.6-3.3; vAR: AOR=2.5, 95% CI=1.7-3.7), orthopedic surgery (ipAR: AOR=2.5, 95% CI=1.8-3.4; vAR: AOR=12.4, 95%CI=9,2-16.5), otolaryngology (ipAR: AOR=1.8, 95% CI=1.2-2.8; vAR: AOR=4,8, 95% CI=3.4-6.9), plastic surgery (ipAR: AOR=2.1, 95% CI=1.2-3.5; vAR: AOR=13.9, 95% CI=9.3-20.7) and urology (ipAR: AOR=2,1, 95% CI=1.4-3.2; vAR: AOR=11.9, 95% CI=8.4-16.8). Community-based medical school attendance was also associated with greater odds of ipAR (AOR=4.6, 95% CI=3.1-6.7) and vAR (AOR=1.8, 95% CI=1.4-2.3).

CONCLUSIONS

The prevalence of AR completion was low. Differences we observed by specialty and medical school type aligned well with recommended circumstances for ipARs for the class of 2021. Substantial specialty-specific differences in vAR completion suggest that various surgical specialties were among the early innovators in this regard.

Development and evaluation of an online surgical elective for medical students

BACKGROUND

Decreased experiential learning opportunities exacerbated by the COVID-19 pandemic have increased development of online surgical educational courses. To what extent may such courses provide exposure to broad and accessible surgical education?

METHODS

Surge is a 6-week online surgical elective hosted within a virtual learning environment, covering all surgical specialties. Course content is mapped to the Royal College of Surgeons' Undergraduate Curriculum in Surgery. Each week consultant surgeons discuss their specialty in short videos on anatomy, pathology and lifestyle of a surgeon. Students also engage with learning activities; further reading lists; formative quizzes and live sessions including suturing practice. Participants were medical students undertaking third-year electives at the University of Sheffield. Pre- and post-course questionnaires investigated student interest in surgery, understanding of steps required to pursue a surgical career and confidence in surgical environments. Qualitative data was collected via free-text responses and analysed with content analysis. Quantitative data was collected using 5-point Likert scales (1 = Strongly Disagree; 5 = Strongly Agree) and analysed using the Wilcoxon signed-rank test.

RESULTS

Twenty-two students participated in Surge over five 6-week cohorts. Examination of free-text responses revealed students gained increased understanding of available surgical career options. Students felt better informed regarding different surgical specialties (median score 2.5 vs. 4, p = 0.000) and steps required to develop a surgical portfolio (median score 2 vs. 5, p = 0.000). Additionally, confidence in understanding of relevant intraoperative steps improved (median score 3 vs. 4, p = 0.000).

CONCLUSION

These data demonstrate Surge increased student confidence and understanding of surgical careers despite reduced in-person opportunities to engage with surgical education. Surge will continue to be developed and evaluated on a larger scale.

Curriculum Innovations: "Eye"-ing Enhanced Educational Methods for Neurology Trainees: Pilot of an Online, Case-based Neuro-ophthalmology Interactive Workshop

Introduction and Problem Statement

Common and potentially life-threatening neurologic conditions often present with neuro-ophthalmologic manifestations. Given the growing shortage of neurologists, and specifically neuro-ophthalmologists, it is important that students who will be at the front lines of these complaints are comfortable assessing such patients. We developed a neuro-ophthalmology learning intervention composed of an interactive workshop that discussed novel, online case-based modules. We assessed (1) the subjective and objective improvement in the understanding of neuro-ophthalmologic manifestations of common neurologic conditions and (2) satisfaction with the educational tool.

Objectives

The objectives of this study were to identify and describe common neuro-ophthalmologic manifestations of neurologic conditions, to explain the differential diagnosis, diagnostic workup, and evidence-based treatment of common neuro-ophthalmologic conditions, and to use interactive, case-based discussion to foster an enjoyable, student-focused e-learning environment via the 20/20 SIM platform.

Methods and Curriculum Description

Our study team, composed of ophthalmology and neurology faculty, developed cases for 5 common and high-stake neurologic conditions with neuro-ophthalmologic manifestations and published them on 2020SIM.com. The cases served as the basis of our educational intervention, a 1-hour virtual interactive workshop for neurology clerkship students. Students completed optional, anonymous pretests and posttests and an exit survey to assess subjective and objective neuro-ophthalmology knowledge improvement and satisfaction with the educational tool.

Results and Assessment Data

A total of 145 students participated; 86% (n = 125), 70% (n = 102), and 61% (n = 88) completed at least part of the pretest, posttest, and exit survey, respectively. The mean knowledge score increased from 7.5 to 8.5/10, p = 0.00014. Students reported a subjective increase in knowledge of neuro-ophthalmology (70%, n = 62) and wished to see a similar learning tool for other specialties (92%, n = 81). More than half (64%, n = 56) enjoyed the workshop, approximately three-quarters (73%, n = 64) preferred the interactive session to traditional didactics, and almost all (92%, n = 81) students recommended the learning sessions in the future.

Discussion and Lessons Learned

Medical students experienced subjective and objective improvement in their understanding of neuro-ophthalmologic manifestations of common neurologic conditions. In addition, they rated the intervention favorably in relation to traditional didactics and recommended a similar platform in other specialties. The integration of interactive online learning tools, such as the SIM platform, into curricular workshops may offer a favorable and effective strategy to increase exposure to topics with less curricular time.

Implementation and Assessment of an Informal Virtual Elective for Medical Student Radiation Oncology Exploration During the COVID19 Pandemic: a Brief Report

Subspecialty exposure during medical school can be limited. Moreover, the COVID19 pandemic prevented most onsite elective medical student (MS) rotations during 2020. Therefore, we sought to create and assess the efficacy of an informal virtual elective (IVE) for MSs to explore radiation oncology (RO) at our institution. We created IVE activities including invitations to resident didactics, a faculty lecture series, and interactive virtual events with residents and faculty. MSs were offered RO resident and faculty mentors and the opportunity to deliver a lecture. Pre- and post-IVE evaluation surveys were sent to 27 4th year MSs. Surveys utilized importance ordering (1=most important; reported as median (interquartile range), free response, and Likert-type questions (5 = extremely, 1=not at all). Our IVE, held from July to October 2020, had a median of 11 students (range 7-18) attend each activity. Pre- and post-IVE surveys were completed by 22/27 (81%) and 20/27 (74%) MSs, respectively. In pre-IVE, MSs reported participating in the IVE for faculty/resident interaction (1.5 [1, 2]), networking (3 [2, 3]), and learning (4 [3-5]). In post-IVE, MSs reported benefit from faculty mentors (5 [4, 5]), delivering a presentation (5 [3-5]), and faculty lectures (4.5 [4, 5]). In post-IVE, MSs preferred a full onsite away elective (16, 80%) over an official virtual elective (1, 5%) or IVE (3, 15%). Overall, MSs reported that the IVE provided an adequate introduction to RO at our institution (4 [4, 5]). Alternative virtual elective experiences allow MSs to informally evaluate medical subspecialties and could be offered even if formal elective opportunities are available.

Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care

Purpose of Review

In this article, we reviewed the impact resulting from the COVID-19 pandemic on the traditional model of care in ophthalmology.

Recent Findings

Though virtual eye care has been present for more than 20 years, the COVID-19 pandemic has established a precedent to seriously consider its role in the evolving paradigm of vision and eye care. New hybrid models of care have enhanced or replaced traditional synchronous and asynchronous visits. The increased use of smart phoneography and mobile applications enhanced the remote examination of patients. Use of e-learning became a mainstream tool to continue accessing education and training.

Summary

Teleophthalmology has demonstrated its value for screening, examining, diagnosing, monitoring treatment, and increasing access to education. However, much of the progress made following the COVID-19 pandemic is at risk of being lost as society pushes to reestablish normalcy. Further studies during the new norm are required to prove a more permanent role for virtual eye care.

Central Retinal Artery Occlusion in Rhino-Orbital-Cerebral Mucormycosis: An Inflammatory-Prothrombotic State

PURPOSE

The aim was to evaluate patient profiles of rhino-orbital-cerebral mucormycosis (ROCM) cases with central retinal artery occlusion (CRAO) postcoronavirus disease 2019.

DESIGN

A nonrandomized retrospective case-control study.

METHODS

The ROCM cases presenting with CRAO were compared with a control ROCM group without CRAO at a tertiary care center. Demography, systemic status, clinical features, histopathology, imaging, and blood profile were assessed for any specific risk factors.

RESULTS

A total of 12 patients were seen in the CRAO group and 16 in the non-CRAO group. The male-to-female ratio was 3:1 with a mean age of 49.5 years. In the CRAO group, 75% had diabetes mellitus with mean hemoglobin A1c of 9.03%, and 66.7% had received steroid treatment. All cases were histopathologically confirmed positive for mucor. There was a significant difference in mean D-dimer and serum ferritin between the 2 groups, with higher level in the CRAO group. All patients with CRAO had light perception-negative vision, with total ophthalmoplegia and proptosis seen in 66.7% of cases. Four patients had orbital apex involvement, 5 had cavernous sinus involvement, and 8 had intracranial involvement in the CRAO group.

CONCLUSIONS

Inflammatory markers D-dimer and serum ferritin were significantly associated with CRAO, suggestive of hyperinflammatory and hypercoagulable state. A high index of suspicion should be maintained in cases with elevated markers and prophylactic anticoagulants can be started to prevent CRAO in a subset of patients.

Learning From the 2021 Ophthalmology Match: Virtual Residency Matching During the COVID-19 Pandemic

BACKGROUND

The effect of virtual interviews on residency match outcomes during the COVID-19 pandemic is unknown. Examining the ophthalmology match may help inform all specialties undergoing virtual interviews.

OBJECTIVE

To determine the impact of allopathic applicant match characteristics in the first year of the virtual residency Match process.

METHODS

Using the Association of University Professors of Ophthalmology match database, a retrospective review was conducted of all allopathic applicants to ophthalmology residency programs in the United States from the 2016 through the 2021 match cycles. Demographic information, interview numbers, and match outcomes were compared between the 2016-2020 (in-person) and 2021 (virtual) cycles.

RESULTS

A total of 3343 allopathic applicants were analyzed. Applicants in the 2021 Match applied to significantly more programs than 2016-2020 applicants did (78.7±23.6 vs 73.1±22.7, P<.001). Among matched and unmatched applicants, there was no significant difference in the number of interviews granted or completed. There was a significant reduction in the match rate between the 2016-2020 and 2021 Match cycles (81.3% vs 76.6%, P=.0009). A subanalysis of applicants who went to medical schools with ophthalmology residency programs (N=2308) found that the home institution match rate was significantly higher for the 2021 Match compared to the aggregate 2016-2020 Matches (26.1% vs 20.6%, respectively, P=.015).

CONCLUSIONS

Significantly more applicants to ophthalmology residency programs matched at their home institutions in the 2021 virtual match cycle compared to the previous 5 years without influencing the interview numbers granted and attended.

Otolaryngology-Head and Neck Surgery clinical electives in undergraduate medicine: a cross-sectional observational study

BACKGROUND

Otolaryngology-Head and Neck Surgery (OHNS) electives provide medical students opportunities for knowledge acquisition, mentorship, and career exploration. Given the importance of electives on medical student education, this study examines OHNS clinical electives prior to their cancellation in 2020 due to the COVID-19 pandemic.

METHODS

An anonymous 29-question electronic survey was created using the program "Qualtrics." Themes included elective structure and organization, elective clinical and non-clinical teaching, evaluation of students, and the influence of electives on the Canadian Residency Match (CaRMS). The survey was distributed through the Canadian Society of Otolaryngology e-newsletter and e-mailed to all OHNS undergraduate and postgraduate program directors across Canada.

RESULTS

Forty-two responses were received. The vast majority of respondents felt that visiting electives were important and should return post-COVID-19 (97.6%). Most said they provide more in-depth or hands-on teaching (52.4% and 59.6%, respectively). However, there was great variability in the feedback, types of teaching and curriculum provided to elective students. It was estimated that 77% of current residents at the postgraduate program that responders were affiliated with participated in an elective at their program.

CONCLUSIONS

Prior to the cancellation of visiting electives in 2020 due to the COVID-19 pandemic, electives played an important role in OHNS undergraduate medical education and career planning for students wishing to pursue a career in OHNS. Electives also provide the opportunity for the evaluation of students by OHNS postgraduate programs.

Ophthalmology teaching in Australian medical schools: A national survey

PURPOSE

To survey the current educational trends and methods of ophthalmology teaching in Australian undergraduate and postgraduate medical schools.

MATERIALS AND METHODS

Cross-sectional survey; National online survey distributed to Australian university undergraduate and post-graduate medical schools from November 2020 to March 2021. The survey encompassed 35 questions on student demographics, teaching methods, core theoretical topics, clinical skills, and assessment methods in ophthalmology. One survey per institution completed by the relevant individual responsible for curriculum.

RESULTS

Total response rate of 90.48% (19 of 21 medical schools) was received with good representation across Australia. Ophthalmology rotations were required in 63.3% (n = 12), while 36.7% (n = 7) did not have mandatory terms. This compares favourably to the USA (16%), Canada (35.7%) and equivalent to UK (65%). 74% (n = 14) state ophthalmology is not a priority in the curriculum. All respondents reported student exposure to at least one clinical day in ophthalmology, with total teaching time ranging from less than six hours (36.9%), up to greater than two weeks (10.5%). Overall, only 31.6% reported utilisation of the International Council of Ophthalmology (ICO) curriculum in curricular development.

CONCLUSIONS

Ophthalmology medical school teaching in Australia remains reasonable when compared internationally, but there is significant variation amongst universities. Incorporation of the ICO curriculum and development of shared resources would enhance medical graduates' competence.

Evaluation of a Role for Virtual Neurosurgical Education for Medical Students Over 2 Years of a Global Pandemic

BACKGROUND

Subinternships are critical experiences for medical students applying into neurosurgery to acquire knowledge of the field and network with colleagues. During the coronavirus disease 2019 pandemic, in-person rotations were suspended for 2020 and reduced for 2021. In 2020, our department developed a neurosurgical course to address this need. The course was continued in 2021, enabling assessment of student perceptions as the pandemic progresses.

METHODS

The virtual course consisted of weekly 1-hour seminars over a 3- to 4-month period. Prior to starting, participants were sent a comprehensive survey assessing their backgrounds, experiences, and confidences in core concepts across neurosurgical subdisciplines. Participants also completed postcourse surveys assessing the course's value and their confidence in the same topics. Responses from students completing both precourse and postcourse surveys were included, analyzed in pairwise fashion, and compared across course years.

RESULTS

Students shared similar baseline characteristics in terms of demographics, educational background, and exposure to neurosurgery prior to the course. In the 2020 and 2021 cohorts, quality ratings for presentations were favorable for all seminars, and participants reported significantly increased confidence in core topics across all neurosurgical disciplines after the course (2020: 3.36 ± 0.26, P < 0.0001; 2021: 3.56 ± 0.93, P = 0.005). Most participants felt the course would remain useful following the pandemic in both the 2020 (96.9%) and 2021 (100.0%) cohorts.

CONCLUSIONS

Survey results suggest that the course adds value for students seeking a basic didactic curriculum to supplement their education, and perhaps, an online curriculum for medical students would still be beneficial going forward as in-person rotations resume.

Application of Virtual Reality Technology in Clinical Practice, Teaching, and Research in Complementary and Alternative Medicine

Background

The application of virtual reality (VR) in clinical settings is growing rapidly, with encouraging results. As VR has been introduced into complementary and alternative medicine (CAM), a systematic review must be undertaken to understand its current status.

Aim

This review aims to evaluate and summarize the current applications of VR in CAM, as well as to explore potential directions for future research and development.

Methods

After a brief description of VR technology, we discuss the past 20 years of clinical VR applications in the medical field. Then, we discuss the theoretical basis of the combination of VR technology and CAM, the research thus far, and practical factors regarding usability, etc., from the following three main aspects: clinical application, teaching, and scientific research. Finally, we summarize and propose hypotheses on the application of VR in CAM and its limitations.

Results

Our review of the theoretical underpinnings and research findings to date leads to the prediction that VR and CAM will have a significant impact on future research and practice.

Conclusion

Although there is still much research needed to advance the science in this area, we strongly believe that VR applications will become indispensable tools in the toolbox of CAM researchers and practitioners and will only grow in relevance and popularity in the era of digital health.

Providing an interactive undergraduate elective on safety culture online - concept and evaluation

BACKGROUND

The COVID-19 pandemic has made it more difficult to maintain high quality in medical education. As online formats are often considered unsuitable, interactive workshops and seminars have particularly often been postponed or cancelled. To meet the challenge, we converted an existing interactive undergraduate elective on safety culture into an online event. In this article, we describe the conceptualization and evaluation of the elective.

METHODS

The learning objectives of the safety culture elective remained unchanged, but the teaching methods were thoroughly revised and adapted to suit an online setting. The online elective was offered as a synchronous two-day course in winter semester 2020/21 during the "second wave" of the COVID-19 pandemic in Germany. At the end of each day, participating students evaluated the elective by completing an online survey. Items were rated on a six-point Likert scale. We used SPSS for data analysis.

RESULTS

Twenty medical undergraduates completed the elective and rated it extremely positively (1.1 ± 0.2). Students regard safety culture as very important and felt the learning objectives had been achieved. Moreover, they were very satisfied with the design and content of the elective, and especially with interactive elements like role-play. Around 55% of participants would recommend continuing to offer the online elective after the pandemic.

CONCLUSIONS

It makes sense to offer undergraduate medical students online elective courses on safety culture, especially during a pandemic. The elective described here can serve as a best practice example of how to teach safety culture to undergraduates, especially when physical presence is unfeasible. Electives requiring a high degree of interaction can also function well online.

Effect of the BOPPPS model combined with case-based learning versus lecture-based learning on ophthalmology education for five-year paediatric undergraduates in Southwest China

BACKGROUND

To investigate the effect of the bridge-in, objective, preassessment, participatory learning, post assessment, and summary (BOPPPS) model combined with case-based learning (CBL) on ophthalmology teaching for five-year paediatric undergraduates.

METHODS

The effects of the BOPPPS model combined with CBL (BOPPPS-CBL) and traditional lecture-based learning (LBL) on ophthalmology teaching were compared among students in a five-year programme. The questionnaire surveys of the students were collected and statistically analysed after the class. The final examination scores, including on elementary knowledge and case analysis, in the two groups were analysed.

RESULTS

There were no statistically significant differences between the teachers and students in the baseline data. More students agreed that the BOPPPS-CBL model helped develop their problem-solving skills, analytical skills and motivation for learning better than the LBL model. There was no significant difference in learning pressure between the two groups. The final examination scores of the BOPPPS-CBL group were significantly higher than those of the LBL group. The overall course satisfaction of the BOPPPS-CBL group was obviously higher than that of the LBL group.

CONCLUSIONS

The BOPPPS-CBL model is an effective ophthalmology teaching method for five-year paediatric undergraduates.

Digital Education in Ophthalmology

ABSTRACT

Accessibility to the Internet and computer systems has prompted the gravitation towards digital learning in medicine, including ophthalmology. Using the PubMed database and Google search engine, current initiatives in ophthalmology that serve as alternatives to traditional in-person learning with the purpose of enhancing clinical and surgical training were reviewed. This includes the development of teleeducation modules, construction of libraries of clinical and surgical videos, conduction of didactics via video communication, and the implementation of simulators and intelligent tutoring systems into clinical and surgical training programs. In this age of digital communication, teleophthalmology programs, virtual ophthalmological society meetings, and online examinations have become necessary for conducting clinical work and educational training in ophthalmology, especially in light of recent global events that have prevented large gatherings as well as the rural location of various populations. Looking forward, web-based modules and resources, artificial intelligence-based systems, and telemedicine programs will augment current curricula for ophthalmology trainees.

Tips to optimize digital education in ophthalmology: Results from ESASO survey

PURPOSE

To identify audience and faculty preferences to optimize digital education sessions in ophthalmology.

METHODS

We distributed an online survey to ophthalmology trainees and specialists worldwide. The survey investigated respondents' preferences on various findings of hypothetical digital educational sessions. Data were analyzed using descriptive statistics, Fisher's exact probability and ANOVA tests.

RESULTS

The survey was completed by 655 respondents, from 53 different countries. According to most respondents, the optimal duration and timeframe for a valuable digital education session would be 30-60 min, without a break (52%), in the evening time-slot (6-8 p.m.) (45%) of a weekday (Monday-Thursday) (46%), regardless of age (p-value = 0.84, 0.39, 0.89, respectively) and job position (p-value = 0.31, 0.29, 0.08, respectively). The availability of webinars and recorded surgical videos/clinical cases, associated with live discussion, represented the most important opportunity of digital educational channels for 46% and 42% of respondents, respectively.

CONCLUSION

Appropriate planning of timing and structure of digital educational ophthalmology sessions may optimize their effectiveness. Using multiple e-learning formats may be helpful to ensure the continuity of learning activities, also in view of a long-term replacement of traditional in-person education.

An Orthopaedic Virtual Clinical Clerkship for Visiting Medical Students: Early Successes and Future Implications

OBJECTIVE

The visiting orthopaedic clerkship is viewed by both students and program directors as an important part of the orthopaedic surgery residency application process, despite being criticized as costly and inefficient. Restrictions due to the COVID-19 pandemic prevented students from participating in in-person clerkships at institutions other than at their home programs, necessitating a virtual replacement for the in-person orthopaedics clerkship experience. It remains unclear how the virtual clerkships will affect the application process this year, and moving forward. We describe and review our institution's initial experience with a virtual orthopaedic clerkship. We hypothesize that students would view the virtual clerkship as valuable, and that students would see a role for such clerkships going forward.

DESIGN

A virtual orthopaedic surgery clerkship was created and students were invited to enroll. Thirty-one 4th-year medical students participated. Each clerkship included 8 two-hour sessions. Each session was moderated by a faculty member, and participants included only medical students. Students presented virtual cases, which provided the basis for the discussion and education. At the conclusion of each clerkship, students were given an anonymous survey assessing various aspects of the clerkship.

RESULTS

Twenty-seven students responded to the survey. Overall, 15 students rated the experience as outstanding, 11 excellent, and 1 good. Twenty-two students saw a role for virtual clerkships moving forward, and five students did not see a role moving forward. Student reported strengths of the clerkship included direct faculty interaction, structured curriculum, and student-centered discussions. Lack of hands-on experience was cited as the biggest weakness.

CONCLUSIONS

Students valued the opportunity for a virtual clerkship, and most could envision a role for such virtual clerkships moving forward. We suggest that virtual clerkships may be a cost-effective and useful tool in helping both students and programs navigate the residency selection process.

An Academic Ophthalmology Curriculum as a Model for Introducing Preprofessional Students to Careers in Ophthalmology

Ophthalmology is one of the most rewarding and fulfilling medical careers in medicine due to the broad practice scope (including a combination of medicine and surgery); patient population (treatment of pediatric and adult patients); diverse patient and pathology mix (healthy eye exams, refractions, and pathology); high patient and provider satisfaction rates; and highly specialized technology and treatments. Unfortunately, academic exposure to ophthalmology as a career in medical school curricula has had a global decline for decades. While most of the evidence-based interventions found in the literature have resulted in enhanced educational outcomes, ophthalmology exposure should be initiated earlier which provided an impetus for developing and implementing a structured curriculum for introducing preprofessional students to careers in ophthalmology. Educational programs offered in the pipeline from high school to college can reach students who are still undecided about higher education and career choices, thus providing an opportunity for increasing the numbers of students in medical and health professions. We describe a structured, academic curriculum model for pregraduate and undergraduate students to enhance interest and to increase academic exposure to basic clinical, research, and educational domains in ophthalmology. The Houston Methodist Hospital (HMH) Academic Institute offers an unparalleled 10-week summer student research program that matches HMH faculty members with students from multiple levels (e.g., high school, college undergraduates, and medical school). Students undergo prerequisite virtual training; attend weekly didactic lectures given by mentors, invited speakers, and other local leaders; shadow health care providers in active clinical settings as observers; participate in active research projects; present at local conferences; and are encouraged to eventually publish their work. We describe the structured curriculum from our first Summer Internship Program for High Schoolers in ophthalmology. To our knowledge an ophthalmology internship program for preprofessional students has not been previously published in the literature.

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.

Development and Implementation of an International Virtual Didactic Series for Physical Medicine and Rehabilitation Graduate Medical Education During COVID-19

ABSTRACT

Coronavirus disease of 2019 presented significant challenges to residency and fellowship programs. Didactic lectures were particularly affected as redeployment of faculty and trainees, limitations on in-person gathering, and other barriers limited opportunities for educational engagement. We sought to develop an online didactic series to address this gap in graduate medical education.Lecturers were recruited via convenience sample and from previous Association of Academic Physiatrists presenters from across the United States and Canada; these presented via Zoom during April and May 2020. Lecturers and content reflected the diverse nature of the specialty. Learning objectives were adapted from the list of board examination topics provided by the American Board of Physical Medicine and Rehabilitation.Fifty-nine lectures were presented. Maximum concurrent live viewership totaled 4272 and recorded lecture viewership accounted for an additional 6849 views, for a total of at least 11,208 views between the date of the first lecture (April 9, 2020) and May 1, 2021. Live viewers of one of the lectures reported participating from several states and 16 countries.The Association of Academic Physiatrists-led virtual didactics augmented graduate medical education during the coronavirus disease of 2019 pandemic, and data confirm that the lectures have continued to enjoy a high level of viewership after the cessation of live lectures.

Impact of the COVID-19 pandemic on the clinical training of last year medical students in Mexico: a cross-sectional nationwide study

BACKGROUND

The COVID-19 pandemic has brought unprecedented changes to medical education. However, no data are available regarding the impact the pandemic may have on medical training in Mexico. The aim of our study was to evaluate and identify the medical school students' perceptions of the changes in their clinical training due to the pandemic in Mexico.

METHODS

This was a cross-sectional study where a previous validated online survey was translated and adapted by medical education experts and applied to senior medical students from March to April of 2021. The 16-item questionnaire was distributed online combining dichotomous, multiple-choice, and 5-point Likert response scale questions. Descriptive and multivariate analyses were performed to compare the student's perceptions between public and private schools.

RESULTS

A total of 671 responses were included in the study period. Most participants were from public schools (81%) and female (61%). Almost every respondent (94%) indicated it was necessary to obtain COVID-19 education, yet only half (54%) received such training. Students in private schools were less likely to have their clinical instruction canceled (53% vs. 77%, p = 0.001) and more likely to have access to virtual instruction (46% vs. 22%, p = 0.001) when compared to students from public schools. Four out of every five students considered their training inferior to that of previous generations, and most students (82%) would consider repeating their final year of clinical training.

CONCLUSIONS

The impact of the COVID-19 on medical education in Mexico has been significant. Most final-year medical students have been affected by the cancellation of their in-person clinical instruction, for which the majority would consider repeating their final year of training. Efforts to counterbalance this lack of clinical experience with virtual or simulation instruction are needed.

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

There is increasing information available about the effects of the SARS-CoV-2 virus on the systemic and ocular health of patients, as well as the effects of delayed health care. This mini-review summarizes the potential complications and treatments of COVID-19. Systemic findings include respiratory illness, risk of thromboembolic events, and neurologic findings. Some patients may develop persistent symptoms even after the infection resolves. Effective treatment options include glucocorticoids, antivirals, interleukin-6 antagonists, monoclonal antibodies, Janus kinase inhibitors and vaccines. Potential ocular findings of COVID-19 include conjunctivitis, cranial nerve palsies, and microvascular changes in the retina; most symptoms resolved over time. During the lockdown periods, teleophthalmology was utilized to triage non-urgent issues; patients who did present to emergency departments tended to have more severe disease with worse visual prognoses. While transient delays in outpatient ophthalmic care may be tolerated in some patients, others experienced significant vision loss with interruptions in treatments. Resumption of ophthalmic care as soon as possible may help mitigate the effects of delayed care due to the pandemic.

Effect of the COVID-19 pandemic on the residency match among surgical specialties

Background

Despite unprecedented changes to undergraduate medical education and the residency selection process during the COVID-19 pandemic, there is little objective evidence on how the pandemic affected match outcomes such as matched applicant characteristics, interview distribution, geographic clustering, and associated costs. We investigated COVID-19’s impact on the residency match by comparing surgery applicants’ characteristics, interview distribution, and related costs from 2018 to 2020 to 2021.

Methods

Data from the Texas Seeking Transparency in Applications to Residency initiative were analyzed. Descriptive statistics, bivariate testing, and sensitivity analysis were performed to compare matched applicants in surgical specialties from 2018–2020 to 2021.

Results

This study included 5,258 applicants who matched into 10 surgical specialties from 2018 to 2021. In 2021, there was a decrease in proportion of students who reported a geographic connection to their matched program (38.4% vs 42.1%; P = .021) and no significant difference in number of interviews attended (mean [SD], 13.1 [6.2] vs 13.3 [4.7]; P = .136) compared to prior years. Applicants in 2021 had more research experiences and fewer honored clerkships (both P < .001), and these associations persisted in sensitivity analysis. Matched applicants in 2021 reported significantly lower total costs associated with the residency application process compared to 2018 to 2020 (mean [SD] $1,959 [1,275] vs $6,756 [4,081]; P < .001).

Conclusion

Although COVID-19 appeared to result in a reduction in number of honored clerkships, it may have provided more opportunities for students to engage in research. Overall, the adoption of virtual interviews and away rotations may have successfully mitigated some of the adverse consequences of the pandemic on the residency match for surgical specialties.

Perceptions of a Virtual Visiting Ophthalmology Elective in the COVID-19 Era

Background  The coronavirus disease 2019 (COVID-19) pandemic was a disruption for all aspects of medical education, especially for clinical students preparing for residency applications. Clinical rotations are essential for a student's specialty choice, especially for subspecialties such as ophthalmology where students may not get significant exposure during preclinical years. The cancellation of home and visiting ophthalmology electives due to the pandemic brought a need for newer, innovative ideas of instruction. Methods  A 4-week not-for-credit virtual elective was developed at the Department of Ophthalmology for visiting medical students and was offered from August to October 2020. Visiting fourth-year medical students were paired with faculty and resident mentors for one-on-one virtual mentoring, in addition to participation in departmental conferences and research opportunities. Surveys were distributed to students and mentors, and results were analyzed using Microsoft Excel and GraphPad Prism 9. Results  A total of 12 visiting fourth-year medical students participated in the virtual elective, 67% of whom did not have a home ophthalmology program. There was a significant increase in students' perception of their ophthalmology knowledge, with all of students reporting that the elective contributed to this. Students (100%) were "very satisfied" with their faculty mentors on a five-point Likert scale, with high satisfaction from faculty and resident mentors toward students also. The two required events in the elective, the journal club and case virtual conferences, were highly rated from students and mentors. Conclusion  The virtual ophthalmology elective, which was developed to address medical education gaps due to the COVID-19 pandemic, was favorably viewed by all who participated. As dedicated ophthalmology instruction time has decreased over the years, it may become increasingly more important to turn to virtual resources for ophthalmology instruction and mentorship.

Impact of COVID-19 pandemic on ophthalmology medical student teaching: educational innovations, challenges, and future directions

Graduate medical education (GME) in ophthalmology has faced and overcome many challenges over the past years, and 2020 has been a game-changer. Although the severe acute respiratory syndrome coronavirus pandemic disrupted medical education globally, ophthalmic educators rapidly transformed their curricula to novel and effective virtual learning formats. Thus, while the COVID-19 outbreak has been one of the most significant challenges faced in the history of medical education, it has also provided an impetus to develop innovative teaching practices, bringing with it unprecedented success in allowing medical students to continue their education in ophthalmology despite these challenges. We review and appraise novel educational interventions implemented by various institutions in response to the COVID-19 pandemic, highlighting their effectiveness, challenges and proposing future directions beyond the pandemic. Many of these innovations will persist even after the end of the pandemic because they have proven that face-to-face learning is not required for all aspects of the ophthalmic GME curriculum. As ophthalmic educators harness the power of educational technology it is critical that their novel educational initiatives are incorporated into competency-based curricula with assessments mapped to the competencies. Future research should focus on evaluating the impact of this transformation to virtual learning environments on student performances as well as implementing longitudinal assessment strategies for clinical competence in workplace-based practice.

The Virtual Team Member: Remote Engagement of Medical Students in COVID-19 Care

Background

Medical education abruptly changed in the setting of the COVID-19 pandemic, impacting experiential learning in clinical clerkship as medical students were removed from direct patient interactions and care team participation. Re-configuring a hospital clinical rotation using virtual care platforms allowed students to re-engage in the clinical environment and actively participate in patient care.

Methods

During the height of the pandemic, we implemented a 4-week "virtual team member" (VTM) inpatient medicine elective for medical students in their second year and above to participate in acute patient care during the height of the COVID-19 pandemic. Tasks included providing daily updates to patients and family members along and care coordination. Faculty experts in infectious disease, mental health, ethics, and patient safety incorporated weekly didactic video talks throughout the elective. Student feedback was obtained anonymously through pre-, mid-, and post-elective questionnaires.

Results

A total of 26 students enrolled in the two 4-week blocks, with 85% in the 2nd year. Survey response rates for the pre, mid, and post-rotation questionnaires were 96%, 77%, 58% respectively. Of the 15 students who completed the post-survey, the majority strongly and somewhat agreed that the elective met expectations (12/15, 80%), was worthwhile (14/15, 93%) and met goals (12/15, 80%). Best parts of the elective most frequently cited by students were patient care and teamwork. Working remotely was the greatest challenge.

Conclusions

Designing a virtual role for students successfully allowed students to re-engage in the acute care setting and connect with patients and participate in COVID-19 care.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-021-01422-8.

Applicant Perceptions Regarding the 2020 to 2021 Virtual Ophthalmology Residency Interview and Match Season

Background The coronavirus disease 2019 pandemic has significantly impacted medical education, notably the mandate for all residency programs to implement virtual (rather than in-person) residency interviews. Understanding residency applicants' perceptions and approach to this novel virtual interview season will be beneficial as potential future interview formats are considered.

Objective The aim of this study was to examine perceptions of the 2020 to 2021 ophthalmology residency match applicants regarding the virtual interview season prior to the start of the interview season.

Patients and Methods Ophthalmology residency applicants during the 2020 to 2021 cycle were invited to complete the survey between October 20 and 29, 2020. Respondent demographic information, perceived importance of various application details in a normal versus virtual interview season, strengths and limitations of virtual interviews, and preferences for optimal virtual interview format were obtained.

Results There were 337 survey respondents, with at least 50% of the survey completed by 190 applicants (56%). Of these, 73% of respondents applied to more than 60 ophthalmology residency programs, and 78% felt that the evaluation of candidates would be impacted by the virtual interview format. Regardless of interview format, United States Medical Licensing Examination Step 1 score and letters of recommendation were perceived to be the two most important factors related to matching at an applicant's top ranked programs. The primary limitation of a virtual interview season was the inability to experience a program's culture in person, while largest strength was cost savings.

Conclusion The ophthalmology residency match is a competitive process made potentially more complex by a novel virtual interview format. A detailed postcycle analysis will be important to optimize future interview seasons.

Changes to ophthalmic clinical care during the coronavirus disease 2019 pandemic

PURPOSE OF REVIEW

Given the impact that society as a whole, and medicine specifically, has experienced as a result of the COVID-19 pandemic, an examination of clinical care changes enacted in the field of ophthalmology is of interest to the specialty.

RECENT FINDINGS

In order to adapt to the reality of the COVID-19 pandemic, measures, such as broadening telehealth capabilities, adopting universal masking, careful sanitation procedures, applying virtual teaching in academic environments, and deferring elective surgeries were put in place. These were aimed at reducing person-to-person spread of SARS-CoV-2. Though best efforts were made at triaging ophthalmic emergencies during these times, unfortunate delays in care were observed in some circumstances. Finally, a prospective study interrogating the risk of spread at slit lamp distances for short periods of time was encouraging, suggesting low risk of transmissibility, though limited by a small case-positive sample size.

SUMMARY

Significant changes have been made in the design and delivery of ophthalmic care during the COVID-19 pandemic. Some of these, such as telemedicine, may provide value in a postpandemic world.

The potential impact of 5G telecommunication technology on ophthalmology

Advances in information and communication technology (ICT) are having an increasing impact on the practice of ophthalmology. Successive generations of 4G networks have provided continued improvements in bandwidth and download speeds. Fibre-optic networks were promised as the next step in the development of a faster and more reliable network. However, due to considerable delays in their widespread implementation, original expectations have not been met. Currently, the new 5G network is on the verge of widespread release and aims to offer previously unparalleled bandwidth, speed, reliability and access. This review aims to highlight the potential profound impact near instantaneous communication (the 5G network) may have on ophthalmology and the delivery of eyecare to the global population. Conversely, if the new network fails to deliver as intended, the wireless network itself may become yet another obstacle to adopting next-generation technologies in eyecare.

A Proposed Model for a Comprehensive Virtual Sub-Internship in Vascular Surgery

OBJECTIVE

Understand challenges, advantages, and applications of a vascular surgery virtual sub-internship (VSI) curriculum.

METHODS

Our institution hosted 25 students for 4-week VSI rotations. We held two sessions, one in July 2020 and another in August 2020. The students participated in a curriculum centered around Zoom® and phone interactions with residents and faculty. The curriculum included selected readings, surgical videos, group didactics and 1-on-1 mentorship. Anonymous pre-rotation and post-rotation self-assessments were used to ascertain achievement of learning objectives and utility of educational tools implemented during the rotation. Faculty and resident mentors were also surveyed to assess their experience.

RESULTS

With the exception of knot tying techniques (p=0.67), students reported significant improvement in their understanding vascular surgery concepts after the virtual elective (p < 0.05). The highest ranked components of the course were interpersonal including interaction with faculty, mentorship, and learning the program culture. The lowest ranked components of the course were simulation training and research opportunities. Rating of utility for aspects of the course were consistent with ranking of components, with faculty interaction having the highest average rating. The ideal number of hours for daily virtual interaction reported by students ranged from 3 to 6 with a median of 4. Overall, the majority of mentors were satisfied with virtual course. However, they did report limited ability to assess student personality and fit for the program. The number of hours per week spent by mentors on the virtual vascular surgery rotation ranged from 2 to 7 with a median of 4. Fourteen out of seventeen mentors reported that having a virtual student was significant addition to their existing workload.

CONCLUSIONS

Overall, our student and mentor feedback were positive. Several challenges inherent to the virtual environment still need to be refined, however the goals of a VSI are distinct and should be explored by training programs. With changes to healthcare in the United States in the horizon and the arrival of SARS-CoV2 pandemic constraints, implementing a virtual away rotation may be an acceptable platform for adapting our recruitment strategies.

Virtual Away Rotations Increase Access to Radiation Oncology

The COVID-19 pandemic altered the workplace for medical education. As restrictions ease, the opportunities provided by virtual rotations remain. Radiation oncology rotations based on virtual participation with patients (consultations, follow-ups, and brachytherapy), contouring and reviewing external beam plans, didactics, and unstructured office hours have been well received at multiple institutions. Virtual rotations decrease barriers to access including lack of a radiation oncology department at one's home institute and the high cost of travel and housing. Furthermore, rotations can be adapted to preclinical students and those with prior radiation oncology rotation experience. However, the virtual format creates and exacerbates several challenges including technical difficulties with electronic medical record or treatment planning software, lack of the spontaneous interactions common to in-person rotations, and unexpected delays in the clinic. We recommend early scheduled time with information technology services to troubleshoot any potential issues, scheduled office hours with faculty and videoconferencing with nonphysician team members to mitigate omission of in-person introductions, and provision of complete contact information for all staff scheduled to meet with students to facilitate communication when unexpected clinic issues arise. Although we are all excited for quarantine restrictions to safely be lifted, we support the continued development of virtual away rotations as a flexible, more affordable option to increase exposure to the field.

Student Survey Results of a Virtual Medical Student Course Developed as a Platform for Neurosurgical Education During the Coronavirus Disease 2019 Pandemic

Background

Before the coronavirus disease 2019 (COVID-19) pandemic, medical students training in neurosurgery relied on external subinternships at institutions nationwide for immersive educational experiences and to increase their odds of matching. However, external rotations for the 2020–2021 cycle were suspended given concerns of spreading COVID-19. Our objective was to provide foundational neurosurgical knowledge expected of interns, bootcamp-style instruction in basic procedures, and preinterview networking opportunities for students in an accessible, virtual format.

Methods

The virtual neurosurgery course consisted of 16 biweekly 1-hour seminars over a 2-month period. Participants completed comprehensive precourse and postcourse surveys assessing their backgrounds, confidence in diverse neurosurgical concepts, and opinions of the qualities of the seminars. Responses from students completing both precourse and postcourse surveys were included.

Results

An average of 82 students participated live in each weekly lecture (range, 41–150). Thirty-two participants completed both surveys. On a 1–10 scale self-assessing baseline confidence in neurosurgical concepts, participants were most confident in neuroendocrinology (6.79 ± 0.31) and least confident in spine oncology (4.24 ± 0.44), with an average of 5.05 ± 0.32 across all topics. Quality ratings for all seminars were favorable. The mean postcourse confidence was 7.79 ± 0.19, representing an improvement of 3.13 ± 0.38 (P < 0.0001).

Conclusions

Feedback on seminar quality and improvements in confidence in neurosurgical topics suggest that an interactive virtual course may be an effective means of improving students' foundational neurosurgical knowledge and providing networking opportunities before application cycles. Comparison with in-person rotations when these are reestablished may help define roles for these tools.

Virtual Pathology Elective Provides Uninterrupted Medical Education and Impactful Pathology Education During the COVID-19 Pandemic

As students do not qualify as essential health care workers, medical education faced severe disruptions during the COVID-19 pandemic including initial suspension of all in-person lectures and on-site rotations. Our Pathology Department was among the first at Northwestern to offer a completely virtual rotation with the goals of: (1) providing a comprehensive introduction to the practice of anatomic and clinical pathology, (2) emphasizing uninterrupted and continued excellence in education, and (3) minimizing exposure risk during the pandemic. The innovative 2-week curriculum incorporated diverse teaching modalities including live and recorded lectures; live and recorded video demonstrations; interactive small group discussions; interactive virtual sign-outs; and written and multimedia assignments, quizzes, and projects. The virtual elective ran from March to July 2020 with 52 total participating medical students. On post-rotation evaluations, students rated the pathology virtual elective 4.7/5.0 compared to other virtual rotations and 4.0/5.0 compared to all rotations (including in-person and virtual). Furthermore, continual improvements were made to the established framework based on rotation feedback such that curriculum content was more abundant and more favorably rated by the last cohort when compared to the first. Finally, although students identified interest in over 10 different medical specialties, all participants expressed increased interest in choosing pathology as a specialty and better understanding of pathology's role in patient care. We hope our detailed description of creating and evaluating a completely virtual elective rotation serves as a model for other departments to improve pathology education and visibility.

Knowledge, Risk Perception, and Preventive Behaviors Related to COVID-19 Pandemic Among Undergraduate Medical Students in Egypt

With the deteriorating situation during the COVID-19 pandemic, healthcare workers and medical students posted in wards are also supposed to be at risk of getting infected. This study aimed to evaluate knowledge, risk perception, and preventive behaviors related to the COVID-19 pandemic among undergraduate medical students in Egypt. This is a cross-sectional observational study using an anonymous online questionnaire. The survey was conducted through a link shared on social networking sites. Data were collected from 19 June 2020 to 26 June 2020. The medical students of Suez Canal University fulfilled the inclusion criteria and agreed to participate in the study were included by using convenience and snowball sampling technique (283 students). The total related knowledge score was 80.9%. The majority (83%) feel that coronavirus infection is a life-threatening illness. About 86.9% of the students perceived a COVID-19-infected person as a serious threat to society. However, three-quarters of the students (76.3%) perceived risk of infection with COVID-19 during ward rotations. About 92% of the students are practicing preventive behaviors. Female senior students have higher percentages in regard to related knowledge and practicing preventive behaviors. Students who received education about Covid-19 and students perceived higher risk of infection were more adherent to preventive measures. There is a moderate correlation between related knowledge and practicing preventive behaviors. Medical students have good knowledge, practice preventive behaviors, and perceive risk of being infected. The direction to raise knowledge and awareness will enhance practicing preventive behaviors to control the disease.