Clinical academic research in the time of Corona: A simulation study in England and a call for action

Challenges imposed by the COVID-19 pandemic on the Obstetrics and Gynecology residency program: a mixed-methods Swedish survey in the COPE Staff cohort study

BACKGROUND

To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes.

METHODS

As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis.

RESULTS

Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 ± 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents.

CONCLUSION

The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in Sweden. Residents were concerned over the negative impact of the pandemic on their training program and senior residents reported more missed educational opportunities as compared to junior residents. Program directors, head of institutions and clinical supervisors can use the problem areas pinpointed by this study to support residents and compensate for missed educational opportunities. While hands-on-training and operating time cannot be compensated for, the authors hope that the findings of the study can help develop new strategies to minimize the negative impact of the current and future pandemics on resident education and work situation.

Carceral ethnography in a time of pandemic: Examining migrant detention and deportation during COVID-19

Each year the United States government detains and deports hundreds of thousands of people who prior to their removal are held in confinement for an average of 55 days. The short and long-term effects of the coronavirus pandemic on migrant detention and deportation continue to be evaluated in real time, including how we can best study it. This paper provides a timely analysis on the relationship between immigration enforcement and confinement, public health emergencies, and ethnographic methods. It makes two contributions. The first is methodological and focuses on the challenges and opportunities of ethnographic methods in carceral settings when pandemic-related protocols have raised additional challenges to conventional in-person prison ethnography. The second contribution is empirical and documents how we adapted ethnographic methods to an interdisciplinary research design and to the exigencies of the pandemic to study the spread of the coronavirus in four immigrant detention facilities in New Jersey, USA.

iBlock: An Intelligent Decentralised Blockchain-based Pandemic Detection and Assisting System

The recent COVID-19 outbreak highlighted the requirement for a more sophisticated healthcare system and real-time data analytics in the pandemic mitigation process. Moreover, real-time data plays a crucial role in the detection and alerting process. Combining smart healthcare systems with accurate real-time information about medical service availability, vaccination, and how the pandemic is spreading can directly affect the quality of life and economy. The existing architecture models are become inadequate in handling the pandemic mitigation process using real-time data. The present models are server-centric and controlled by a single party, where the management of confidentiality, integrity, and availability (CIA) of data is doubtful. Therefore, a decentralised user-centric model is necessary, where the CIA of user data is assured. In this paper, we have suggested a decentralized blockchain-based pandemic detection and assistance system (iBlock). The iBlock uses robust technologies like hybrid computing and IPFS to support system functionality. A pseudo-anonymous personal identity is introduced using H-PCS and cryptography for anonymous data sharing. The distributed data management module guarantees data CIA, security, and privacy using cryptography mechanisms. Furthermore, it delivers useful intelligent information in the form of suggestions and alerts to assist the users. Finally, the iBlock reduces stress on healthcare infrastructure and workers by providing accurate predictions and early warnings using AI/ML.

Healthcare Workers Bioresource: Study outline and baseline characteristics of a prospective healthcare worker cohort to study immune protection and pathogenesis in COVID-19

Background: Most biomedical research has focused on sampling COVID-19 patients presenting to hospital with advanced disease, with less focus on the asymptomatic or paucisymptomatic. We established a bioresource with serial sampling of health care workers (HCWs) designed to obtain samples before and during mainly mild disease, with follow-up sampling to evaluate the quality and duration of immune memory. Methods: We conducted a prospective study on HCWs from three hospital sites in London, initially at a single centre (recruited just prior to first peak community transmission in London), but then extended to multiple sites 3 weeks later (recruitment still ongoing, target n=1,000). Asymptomatic participants attending work complete a health questionnaire, and provide a nasal swab (for SARS-CoV-2 RNA by RT-PCR tests) and blood samples (mononuclear cells, serum, plasma, RNA and DNA are biobanked) at 16 weekly study visits, and at 6 and 12 months. Results: Preliminary baseline results for the first 731 HCWs (400 single-centre, 331 multicentre extension) are presented. Mean age was 38±11 years; 67% are female, 31% nurses, 20% doctors, and 19% work in intensive care units. COVID-19-associated risk factors were: 37% black, Asian or minority ethnicities; 18% smokers; 13% obesity; 11% asthma; 7% hypertension and 2% diabetes mellitus. At baseline, 41% reported symptoms in the preceding 2 weeks. Preliminary test results from the initial cohort (n=400) are available: PCR at baseline for SARS-CoV-2 was positive in 28 of 396 (7.1%, 95% CI 4.9-10.0%) and 15 of 385 (3.9%, 2.4-6.3%) had circulating IgG antibodies. Conclusions: This COVID-19 bioresource established just before the peak of infections in the UK will provide longitudinal assessments of incident infection and immune responses in HCWs through the natural time course of disease and convalescence. The samples and data from this bioresource are available to academic collaborators by application  https://covid-consortium.com/application-for-samples/.

The impact of COVID-19 on Medical education and Medical Students. How and when can they return to placements?

This article was migrated. The article was marked as recommended. The defining feature of 2020 will be the early and mid-stages of the covid-19 pandemic, declared by the World Health Organisation on 11 th March. Rapid worldwide exponential spread continues and by 15 April, more than 1 900 000 cases and 123 000 deaths had been reported worldwide (WHO, 2020). Health services have coped to varying degrees. One common feature has been the withdrawal of routine care (Iacobucci, 2020a) and 'non-essential' staff including learners, although many have returned to undertake care roles. As the likely timeframe for stabilisation of health services becomes clearer, certainly in the United Kingdom (UK) (Iacobucci, 2020b), medical educators need to rapidly get the teaching of the next generation of health care workers back on track if they are to enter health services as confident and competent practitioners in 2020 and 2021. Although a 'whole world' experience, the effects of covid-19 sit in national contexts. We detail the issues for the UK in re-starting and re-inventing medical education, noting that the principles, if not necessarily the detail, will be common across the world.