COVID-19 Implications on Clinical Clerkships and the Residency Application Process for Medical Students

Confounding factors affecting the clinical decision-making of nursing and midwifery students post-pandemic COVID-19: cross-sectional study in Jordan

BACKGROUND

The ability of a nurse to make effective clinical decisions is the most important factor that can affect the treatment quality. However, several factors can affect the ability of nursing and midwifery students to make effective clinical decisions.

OBJECTIVES

This study aims to identify the confounding factors that may affect the clinical decision making of nurses and thus patient outcomes after the COVID-19 pandemic in Jordan.

METHODS

A descriptive cross-sectional design was employed in this study. An online self-administered questionnaire was distributed to 269 nursing and midwifery students selected through purposive sampling, 224 of whom completed the questionnaire. The valid and reliable nursing decision-making instrument, which consisted of 24 items, was employed to gather the data, and descriptive statistics and simple linear regression were employed for the data analysis. Data was collected from November to the end of December 2022.

RESULTS

Among the respondents, 72.8% were female, and the average age was 20.79 years (SD = 1.44). The vast majority of the respondents (94.6%) was unmarried, and 74.1% were pursuing a nursing degree. The simple linear regression analysis showed that clinical decision making had a negative and significant relationship with social media usage of an average of 6 h a day (β=-0.085). Moreover, the male nursing students obtained lower clinical decision-making scores (β= -0.408) compared with the female nursing students.

CONCLUSION

Social media usage and gender have a considerable effect on the clinical decision making of the nursing and midwifery students. Therefore, the confounding factors that can affect the clinical decision making of nurses should be discussed further, and strategies to address such factors should be implemented.

Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

As future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.

METHODS

We systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg's and Egger's tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.

RESULTS

We identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%-49%) and 48% (95% CI, 43%-52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%-32%) and 30% (95% CI, 26%-35%), respectively. There was high heterogeneity between studies, with I2 ranging from 99.58%-99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.

CONCLUSIONS

We demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

The Impact of COVID-19 on Mental Health in Medical Students: A Cross-Sectional Survey Study in Italy

Background: This study aimed to assess the impact of the COVID-19 pandemic in terms of the prevalence of anxiety, depression and stress symptoms in Italian medical students and to identify the associated factors. Design and Methods: A cross-sectional online survey was administered to second-sixth year medical students of the University of Torino, collecting data on the students' sociodemographics, COVID-19 exposure, anxiety, depression and stress symptoms. Three hierarchical regressions adjusted for age, gender and year of study were executed. Results: The sample size was 1359. The prevalence of anxiety, depression symptoms, moderate perceived stress and severe perceived stress was 47.8%, 52.1%, 56.2% and 28.4%, respectively. The factors associated with mental health symptoms were: being a woman, a family history of psychiatric disorders, living off-site, competitive/hostile climates and unsatisfying friendships among classmates, poor relationships with cohabitants, negative judgment of medical school choice, fear of COVID-19 infection, feelings of loneliness, distressing existential reflections, and a worsening psychological condition related to the pandemic. Being in the fourth or sixth year constituted a protective factor for depression symptoms. Conclusions: Mental health in medical students was associated with both COVID-independent and COVID-related factors. Accessibility to effective interventions must be increased to counteract these changes.

The impact of COVID-19 on medical students

Objective

The outbreak of COVID-19 has disrupted social order and placed a heavy burden on the healthcare system. The pandemic also has an unprecedented impact on medical students.

Methods

We searched PubMed for articles related to COVID-19 and medical students from January 2020 to December 2022. A total of 5358 studies were retrieved and after screening, 176 studies were finally included in this review.

Results

The impact of COVID-19 on medical students is widespread and profound. First reflected in the transformation of educational models. In the early days, education model quickly shifted from offline to online. In terms of clinical exposure, most students have been suspended from internships, while in some areas with staff shortages they have the opportunity to continue clinical work. Scientific research of medical students is also difficult to carry out due to COVID-19. The epidemic has also seriously damaged students' mental health, and this impact won't simply disappear with the improvement of the epidemic situation. The career intentions of medical students may also become firmer or change due to COVID-19. International medical electives have also been negatively affected by COVID-19 due to travel restriction. Even in the postpandemic era, with the gradual resumption of work, production and school, medical students are still affected in some ways by COVID-19.

Conclusion

The COVID-19 pandemic has had a profound impact on both the education of medical students and their personal development. Through COVID-19, we should reflect on what models of medical education should be developed in the future. Based on the experiences learned from COVID-19, we believe that a more flexible blended education model may be the most promising.

Perception and attitude towards online clinical modules: a cross-sectional study among medical students from two countries

COVID-19 has deeply affected the world in various aspects including the education system worldwide. In this study, we intended to explore the merits and demerits of online clinical learning and its effect on medical education from a student's perspective. The study also assessed the perception and attitude of final-year medical students towards online clinical modules. This observational study was carried out in the Department of Community Medicine, Kasturba Medical College, Manipal (KMC) in collaboration with King's College London, UK (KCL). In our study, a total of 42 students were enrolled, with 37 students from KMC and 5 students from KCL. 81% of students reported that they were not willing to continue the online mode of learning. The abrupt switch to e-learning without prior preparedness has exposed some pitfalls that must be attended to. Contrary to other fields, the medical field places high importance on offline clinical teaching which has recently been impacted by online teaching. The survey responses were analyzed for improvisation of online clinical modules as well as to come up with better ideas and outcomes since this mode of learning may have to continue till the spread of the disease is under control.

Beyond COVID-19: the impact of recent pandemics on medical students and their education: a scoping review

INTRODUCTION

Over the past two years, coronavirus disease (COVID-19) has greatly altered medical student education as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality medical education. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared medical educators for COVID-19? This scoping review investigated the educational and personal impact of recent pandemics on medical students.

METHODS

This review followed the PRISMA-ScR guidelines for scoping reviews. Nine databases including PubMed, ERIC, and EMBASE were systematically searched using keywords and subject headings related to medical students and SARS, H1N1, MERS, Ebola, Zika, and COVID-19. Studies were limited to research studies published between 2000 and 2020 and in English. Based on exclusion and inclusion criteria, all studies were independently screened by two reviewers first by the title/abstract and then via full text. Data were extracted from the included studies and analyzed qualitatively using thematic analysis.

RESULTS

A total of 174 studies fit the criteria. Seven major themes emerged from those studies: educational adaptations and online modifications, knowledge and attitudes of students, mental wellness of students, student involvement and use of telehealth, student vaccination, physical wellness of students, and stigma.

CONCLUSION

This review provided insights into how medical students were affected by recent pandemics and their perceptions of pivoting to online education, mental health, and knowledge of the diseases. Additionally, this review showcases the various educational adaptations that emerged uniquely during the COVID-19 pandemic, such as telehealth services or video conferencing tools, that can be utilized in a post-pandemic environment.

COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents

The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.

Are First-Year Emergency Medicine Residents Still Behind on Level 1 Care-Based Milestones?

Background The Accreditation Council for Graduate Medical Education defines Level 1 as "the resident demonstrates milestones expected of an incoming resident," yet a previous study of emergency medicine (EM) interns showed most were not meeting Level 1 milestones. In addition, previous research indicates that residents often provide more favorable self-assessments when compared to faculty assessments. Our study, performed in July 2022, aims to determine whether incoming EM residents remain behind on Level 1 care-based milestones and if resident self-assessments are consistent with faculty assessments. Methodology This is an observational study involving five distinct EM residency programs. Incoming interns were directly assessed by faculty for behaviors associated with the care-based milestones for EM using a standardized survey. Interns were asked to complete this same survey regarding their own performance. Results Faculty completed a total of 101 assessments on 49 residents. Of the 49 residents, 39 completed self-evaluations (80%). Achievement of Level 1 ranged from 25% to 82%. Residents had significantly higher self-assessments than faculty assessments on PC-1, PC-5a, and PC-6a. Faculty assessments were significantly higher than resident self-assessments on PC-6b. Conclusions Greater than 75% of incoming interns were able to meet Level 1 milestones in three of seven care-based milestones. However, there is a generalized trend toward overall improvement when compared to previous studies. Residents continue to demonstrate higher self-assessments than faculty in three separate care-based milestones and faculty rated residents significantly higher in one care-based milestone. This is consistent with previous studies.

A Virtual National Diversity Mentoring Initiative to Promote Inclusion in Emergency Medicine

INTRODUCTION

Trainees underrepresented in medicine (URiM) face additional challenges seeking community in predominantly white academic spaces, as they juggle the effects of institutional, interpersonal, and internalized racism while undergoing medical training. To offer support and a space to share these unique experiences, mentorship for URiM trainees is essential. However, URiM trainees have limited access to mentorship from URiM faculty. To address this gap, we developed a national virtual mentoring program that paired URiM trainees interested in emergency medicine (EM) with experienced mentors.

METHODS

We describe the implementation of a virtual Diversity Mentoring Initiative (DMI) geared toward supporting URiM trainees interested in EM. The program development involved 1) partnering of national EM organizations to obtain funding; (2) identifying a comprehensive platform to facilitate participant communication, artificial intelligence-enabled matching, and ongoing data collection; 3) focusing on targeted recruitment of URiM trainees; and (4) fostering regular leadership meeting cadence to customize the platform and optimize the mentorship experience.

CONCLUSION

We found that by using a virtual platform, the DMI enhanced the efficiency of mentor-mentee pairing, tailored matches based on participants' interests and the bandwidth of mentors, and successfully established cross-institutional connections to support the mentorship needs of URiM trainees.

Relationship Between Residency Match Distance From Medical School and Virtual Application, School Characteristics, and Specialty Competitiveness

INTRODUCTION

The COVID-19 pandemic has disrupted the residency match process by eliminating away rotations and changing from in-person to virtual interviews. In this study, we explore the impact of the COVID-19 pandemic on the geographic match distance of United States (US) senior medical students across all specialties.

METHODS

We collected publicly available student match data between 2018 and 2021 from US allopathic medical schools and calculated match distance between medical school and residency training using a novel metric - the "match space." Match space was codified by whether the student matched at their home institution, home state, adjacent state, same or adjacent US census division (non-adjacent state) or skipped at least one US census division. Adjusting for covariates, ordinal logistic regression correlated school and specialty characteristics with match distance pre- and post-pandemic for all specialties. We defined and ranked specialty competitiveness using predictive values from factor analysis.

RESULTS

A total of 34,672 students representing 66 medical schools from 28 states matched into 26 specialties in 50 states and Canada. Fifty-nine percent of students were from public institutions, and 27% of schools ranked in the top 40 for research. The mean percentage of in-state students by school was 60.3% (range 3-100%). Match space was lower after the pandemic (adjusted odds ratio (OR) 0.94, 95% CI 0.90-0.98; p=0.006), from schools with higher in-state percentages (OR 0.74, 95% CI 0.72-0.76), from top National Institutes of Health-funded institutions (OR 0.88, 95% CI 0.85-0.92), from the Northeast (OR 0.71, 95% CI 0.67-0.75; Midwest reference), and the West (OR 0.67, 95% 0.60-0.74). Match space was higher for students graduating from private schools (OR 1.11, 95% CI 1.05-1.19), from the South (OR 1.62, 95% CI 1.2-1.33), and matching into more competitive specialties (OR 1.08, 95% CI 1.02-1.14). The top five most competitive specialties were Plastic Surgery, Neurosurgery, Dermatology, Orthopedic Surgery, and Otolaryngology. Internal Medicine ranked eighth.

CONCLUSIONS

After the COVID-19 pandemic, students graduating from US allopathic schools matched closer to their home institution. Students attending public schools, schools with more in-state matriculants, and schools with higher research rankings also matched closer to their home institutions. Specialty competitiveness and US census region also impacted match distance. Our study adds insight into how geographic match patterns were influenced by school, specialty choice, and the pandemic.

Are medical students happy despite unhappy conditions: a qualitative exploration of medical student cohorts during disruptive conditions

BACKGROUND

Shortly after the World Health Organization declared the SARS-CoV-2 outbreak a worldwide pandemic, medical school governing bodies issued guidance recommending pausing clinical rotations. Prior to the availability of COVD-19 vaccines, many schools implemented exclusively online curriculums in the didactic and clinical years. These unprecedented events and paradigm changes in medical education could contribute to trainee burnout, wellness, and mental health.

METHODS

This single-institution study interviewed first, second, and third-year medical students from a medical school in the southwestern United States. A semi-structured interview was conducted with paper-based Likert scale questions rating perceived happiness were administered both at the time of the interview and one year later in order to understand how their student experience and happiness were impacted. In addition, we asked participants to describe any major life events they experienced since the first interview.

RESULTS

Twenty-seven volunteers participated in the original interview. Twenty-four from the original cohort participated in the one-year follow-up. Happiness as a sense of self and who you "should be" was challenged during the pandemic and changes in happiness over time were not systematic across classes. Stress was caused not only by the pandemic which was experienced by all, but by a tripartite state of individual circumstances, academic workload requirements, and the world at large. Primary themes from the interviews were clustered around the individual, learner, and future professional levels and focused on the primacy of relationships, emotional wellness, stress management, professional identity, and impacts of educational disruptions. These themes created risk factors for developing imposter syndrome. Students demonstrated resiliency across cohorts and were able to utilize a variety of strategies to achieve and maintain both physical and mental health, but the primacy of relationships both personally and professionally was noted.

CONCLUSION

Medical students' identities as individual persons, a learner, and future medical professionals were all impacted by the pandemic. The results from this study suggest that the COVID-19 pandemic and changes in the learning format and environment may create a new risk factor in the development of imposter syndrome. There is also an opportunity to re-consider resources to achieve and maintain wellness during a disrupted academic environment.

Perspectives toward e-learning system during Covid-19 pandemic among medical Colleagues, Egypt: A Cross-sectional survey.. [DOI: 10.21203/rs.3.rs-2413281/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: WHO declared the outbreak of COVID-19, which affected the educational system stopping it in Egypt. To maintain the educational process, E-learning was a suggested solution. This study aimed to assess students' satisfaction regarding e-learning experience and effectiveness of this system on medical education in Egyptian universities. Methods: A cross-sectional survey was conducted among medical schools in Egypt during 2020–2021. It was conducted through an online questionnaire composed of four sections: Demographic characteristics, quality of internet connection, the academic characteristics of the participants, and evaluation of the effectiveness of e-learning. We compared the effectiveness of e learning among the clinical and the academic students, and private and governmental universities. Results: Among 90592 medical students in Egypt, 6393 students from 28 universities filled out the questionnaire with a 96.6% response rate. The age of participants ranged from 16 to 29 years old. Also, about 59.3% of them were females. The blended e-learning was the most applied by universities (43.1%), followed by partial type (33.4%), and full type (23.6%). About 73.7% of students had "always/often" constant internet connection. Forty percent of students were "dissatisfied/not satisfied at all", 38.3% showed "neutral" satisfaction, while 21.7% were "satisfied or highly satisfied". There was a significant difference regarding internet connection and availability favoring urban areas compared to rural areas (p<0.001). There was a significant difference favoring the academic education over the clinical education regarding the effectiveness of online learning (p<0.01) and private education over governmental regarding the effectiveness of online learning (p<0.001). Conclusion: E-learning was better for academic education than for clinical education. It was better for private universities than governmental ones. Also, students in rural areas had worse availability and quality internet connection compared with those in urban areas.

Digital adaptation of teaching disaster and deployment medicine under COVID-19 conditions: a comparative evaluation over 5 years

BACKGROUND

The COVID-19 pandemic has not only brought many aspects of disaster medicine into everyday awareness but also led to a massive change in medical teaching due to the necessity of contact restrictions. This study aimed to evaluate student acceptance of a curricular elective module on disaster and deployment medicine over a 5-year period and to present content adjustments due to COVID-19 restrictions.

METHODS

Since 2016, 8 semesters of the curricular elective module took place in face-to-face teaching (pre-COVID-19 group). From the summer semester of 2020 to the summer semester of 2021, 3 semesters took place as online and hybrid courses (mid-COVID-19 group). Student attitudes and knowledge gains were measured using pretests, posttests, and final evaluations. These data were statistically compared across years, and new forms of teaching under COVID-19 conditions were examined in more detail.

RESULTS

A total of 189 students participated in the module from the summer semester of 2016 through the summer semester of 2021 (pre-COVID-19: n = 138; mid-COVID-19: n = 51). There was a high level of satisfaction with the module across all semesters, with no significant differences between the groups. There was also no significant difference between the two cohorts in terms of knowledge gain, which was always significant (p < 0.05). COVID-19 adaptations included online seminars using Microsoft Teams or Zoom, the interactive live-streaming of practical training components, and digital simulation games.

CONCLUSION

The high level of satisfaction and knowledge gained during the module did not change even under a digital redesign of the content offered. The curricular elective module was consistently evaluated positively by the students, and the adaptation to online teaching was well accepted. Experiences with digital forms of teaching should also be used after the COVID-19 pandemic to create digitally supported blended learning concepts in the field of deployment and disaster medicine and thus further promote the expansion of teaching in this important medical field.

The Consequences of the Pandemic on Medical Students’ Depressive Symptoms and Perceived Stress: A Repeated Cross-Sectional Survey with a Nested Longitudinal Subsample

This study aimed to explore the impact of the pandemic on medical students’ mental health in Italy using a repeated cross-sectional survey with a nested longitudinal subsample (first timepoint: 2018; second: 2020/2021). Three research questions (RQs) were investigated. Study 1 (longitudinal sub-sample) explored whether medical students had higher levels of depressive symptoms and stress during the pandemic compared with a pre-pandemic period (RQ1) and what variables were associated with these conditions during the pandemic adjusting for baseline levels (RQ2). Study 2 (repeated cross-sectional data) aimed to examine whether medical students had higher levels of these conditions during the pandemic compared with their same-year peers during a pre-pandemic period (RQ3). In Study 1, higher levels of depressive symptoms and stress were shown during the pandemic (RQ1). Multivariable models highlighted associations between poor mental health and worsening of the judgment of medical school choice, worsened psychological condition due to the pandemic, economic repercussions due to the pandemic, and baseline levels of symptoms (RQ2). In Study 2, our findings reported higher levels of depressive symptoms and stress during the pandemic, also adjusting for other variables (RQ3). In conclusion, depressive symptoms and stress were greater during the pandemic. The most relevant variables were pandemic-related items and medical school choice judgment.

Student Satisfaction and Self-Efficacy in a Novel Online Clinical Clerkship Curriculum Delivered During the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic has caused significant disruption to medical education and clinical training and resulted in stressors that impede student learning. This study aimed to assess student satisfaction and self-efficacy in a novel online clinical clerkship curriculum delivered during the COVID-19 pandemic.

METHODS

Fourth- and fifth-year medical students completed an online survey in January 2021 covering the following areas: student satisfaction, self-efficacy, and perceived effectiveness of online versus face-to-face learning.

RESULTS

Just over half of students (51%) were satisfied with online clerkship delivery. However, fewer than half of students (46%) believed online learning effectively increased their knowledge, compared to 56% of students who believed face-to-face learning was effective. The perception of the effectiveness of online learning and face-to-face teaching for clinical skills was 18% and 89%, respectively (p < 0.0001). Few students perceived online teaching to be effective for developing social competencies (27%) compared to face-to-face instruction (67%) (p < 0.001). In addition, mean self-efficacy scores were higher for persons who perceived online teaching to be effective for increasing knowledge, improving clinical skills, and developing social competencies. Overall, students' perception of online learning was strongly associated with online self-efficacy.

CONCLUSION

Student satisfaction and perceived self-efficacy in online learning were higher than reported acceptance of online clerkship curriculum.

Trends in Residency Applicant Volume in Otolaryngology-Head and Neck Surgery and Peer Specialties

OBJECTIVE

To evaluate the 2020 to 2021 Otolaryngology residency application cycle in the context of recent trends.

STUDY DESIGN

Retrospective data analysis.

SETTING

Disruptions caused by the COVID-19 pandemic may significantly alter trends among residency applicants, especially in highly competitive and/or smaller specialties.

METHODS

Applicant and residency statistics from Electronic Residency Application Service (ERAS) and National Residency Matching Program (NRMP) were extracted from the 2016 to 2021 and 2011 to 2021, respectively. Trends in Otolaryngology-Head and Neck Surgery (OHNS) were compared to peer specialties (PS) including Dermatology, Neurological Surgery, Orthopedic Surgery, and Integrated Pathway for Plastic and Reconstructive Surgery (PRS). The ratio of the number of applicants per positions (APP) was used to reflect the degree of competition.

RESULTS

Between 2011 and 2021, the number of OHNS programs and positions expanded less than those of PS and General Surgery. The increase in the APP ratio was significantly greater for OHNS compared to those Dermatology, Orthopedic Surgery, General Surgery and all PGY1 residency positions for both US MD and all applicants (P < .01 for each). OHNS expansion of US MD (P = .046), but not all applicants (P = .169), outgrew that of Neurosurgery.

CONCLUSION

The 2020 to 2021 cycle affected by the COVID-19 pandemic saw a continuation of the recent trend in the expanding OHNS applicant pool. OHNS remains one of the specialties with the highest APP ratio and has observed a significant growth compared to PS since 2018. Understanding and anticipating trends in residency application cycles is critical for designing processes to optimize the best fit between applicants and programs.

To Wait or Two Weeks: The Relationship Between Step 2 CK Scores and the Length of Dedicated Study Time Within a Longitudinal Interleaved Clerkship Curriculum

Introduction: Graduate medical education program directors report that United States Medical Licensing Examination (USMLE) Step 2 CK exam scores will likely have greater importance in the future selection of residents due to USMLE Step 1 transitioning to a pass/fail score as early as January 2022. With emphasis moving to the Step 2 exam, it is important to examine factors that maximize student Step 2 CK performance, such as third-year curriculum models and exam timing. This study analyzes whether or not Step 2 performance is affected by a specific length of dedicated study time within a Longitudinal Interleaved Clerkship (LInC) curriculum.

Methods: A regression model was used to predict Step 2 scores for 102 students using previous performance measures. Actual and predicted scores were compared to indicate which students overperformed or underperformed on Step 2. A t-test was used to compare the mean difference between predicted and actual performance of students who had two weeks or less of dedicated study time for Step 2 CK versus students who had a longer dedicated study period. 

Results: Students who completed Step 2 with two weeks or less of dedicated study significantly overperformed (t(100)=2.06, p=0.042) on the exam (Mean=1.61, SD=9.21) compared to students who had more than two weeks of dedicated study (Mean=-1.67, SD=6.44) in a LInC curriculum.

Conclusion: Although studies of Step 2 preparation time have shown the importance of taking Step 2 soon after completion of clinical rotations, this study adds a specific timeframe. Our findings show that a dedicated study period of two weeks or less for Step 2 CK within a LInC curriculum is associated with better performance. This study was limited to a LInC curriculum and may not apply to other clinical year curricula.

Going virtual: effectiveness of virtual opportunities in engaging applicants for plastic surgery residencies

Purpose

During the COVID-19 pandemic, virtual events led by residency programs have eased deficits formed by the lack of in-person opportunities. Despite their anecdotal success, there is yet a study on their utility and value, as perceived by attendees. Therefore, we sought to investigate engagement rates of virtual opportunity posts via Instagram, equipping residency programs with recommendations for future virtual event planning.

Methods

The 40 PRS residency programs with the highest number of followers on Instagram were inspected for posts regarding virtual opportunities. The virtual opportunities were classified by type, medium, and intended audience. The number of opportunities within each classification was analyzed, along with the like/comment to follower ratios, and compared via ANOVA tests.

Results

A total of 141 virtual opportunities were evaluated, with the most events occurring in August (21.6%). The highest engagement rates occurred in May and June, with the most common virtual opportunity being meet and greets with residents (39.2%). The most prevalent medium for virtual events was Zoom, used in 84.7% of events. The intended audience was frequently medical students (80.6%), with a significant difference in engagement between audience groups (p < 0.05).

Conclusion

The pandemic has disrupted the status quo of resident recruitment. In light of these findings, residency programs should consider instilling virtual opportunities for medical students as a standard practice. Peak times to broadcast events are May or June due to higher engagement. To address attendee burnout, programs should limit events to familiar ones, such as Zoom meet and greets with residents.

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

Purpose

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Mental health and self-determination profiles of the diverse population of medical students in Malaysia during the COVID-19 pandemic

Introduction

Medical schools throughout the world were forced to modify their programming during the COVID-19 pandemic. In Malaysia, virtual learning plans were implemented for non-clinical programming, while clinical posting modifications were designed to meet local SOPs. The prolonged enforcement of these modifications to undergraduate medical education will have affected student experiences, including well-being. Since these feelings can relate to perceived relatedness, autonomy, and competence, it is important to identify any potential factors that may lead to reduced intrinsic motivation in students. It is also important to consider how demographic features may contribute to student perspectives, which can be studied using the unique diversity represented by Malaysian students.

Methods

A quantitative survey was distributed to Malaysian medical students to assess their overall wellbeing, autonomy in educational decision making, student experiences, and position on changes to graduation timing. Intrinsic components were identified using Principal Component Analysis and were aligned with the three needs for self-determination, namely relatedness, autonomy, and competence. Finally, trends in responses for participants from various sub-populations were assessed using ANOVA testing.

Results

Responses were collected from 442 students representing 23 accredited Malaysian medical schools. Upon validation and reliability testing, eight components were identified with themes relating to: mental health, social concerns, communication, timing of modifications, depth of learning, and student-centred learning. Of these, gender was related to mental health, student-centred learning, and delayed graduation, while stage was related to student-centred learning and delayed graduation in addition to concerns about depth of learning and timing of modifications. Interestingly, ethnicity was related to differences in opinions about delayed graduation and income was related to social concerns.

Conclusion

The results of this study indicate that, while students were satisfied in general with the content and delivery of their programmes given the circumstances, there is evidence to suggest negative effects on emotional wellbeing and expression of student voice, due to the modifications that were made. Additionally, these feelings related to the three motivational needs, suggesting that students were experiencing a dampened motivational profile during the pandemic. Further, motivational profiles were distinct between student sub-groups, providing insight for developing appropriate and inclusive accommodations moving forward.

Risk Factors Associated with Poor Computer-based Testing (CBT) Scores - Comparing Students' Performance "Without/With COVID-19" and Backgrounds

Objective

The present study compared students' CBT scores during the 2-year period before ("without COVID-19") and 2-year period during ("with COVID-19") the COVID-19 pandemic, and analyzed factors associated with poor results.

Materials

A total of 530 students (368 males and 162 females), who had taken CBT within the period between 2018 and 2021.

Methods

Analysis was performed based on the questionnaire results, and the students' performance was compared between "without/with COVID-19" to identify the causes of poor CBT scores.

Results

The overall mean IRT score was 515.5±85.4. The without and with COVID-19 groups' scores were 495.7±85.9 and 534.4±80.8, respectively (p<0.01). Among all students, 43 (8.1%) had IRT scores lower than 400 as poor CBT scores; 27 (10.4%) without and 16 (5.9%) with COVID-19, revealing a decrease in the latter. The multivariate analysis of the risk of students having poor CBT scores showed that students with poor performance during the third year (odds ratio:7.02), starting preparation for CBT late (2.19), and not taking any practice examination (4.58) are more likely to have poor CBT results.

Conclusions

Due to the COVID-19 pandemic, students spent more time on online home study, and this may have consequently improved their CBT scores. Such learning performance is desirable for medical students, but they have lost the opportunity to gain valuable experiences that they could have acquired through extracurricular activities, such as club activities. In this respect, we cannot simply be pleased by the improvement in students' CBT scores.

The Impact of COVID-19 Pandemic on the Learning Outcomes of Medical Students in Taiwan: A Two-Year Prospective Cohort Study of OSCE Performance

Background/Aims: To avoid the negative impacts of the COVID-19 pandemic on clinical clerkship, supplemental teachings such as digital materials in the scenario-based distal simulations were implemented. This study utilized the OSCE (objective-structured clinical examination) to evaluate the impact of COVID-19 pandemic on the learning outcome of medical students from the regular group (class of 2020) and pandemic-impacted group (class of 2021). Methods: All medical students serially took, firstly, the mock-OSCE, secondly, the mock-OSCE, and the national OSCE. Then, the serial OSCE scores were compared between groups. Results: Although with similar scores in the first mock OSCE, the regular group (n = 78) had a higher average score in the national OSCE than the pandemic-impacted group (n = 80) (872.18 vs. 834.96, p = 0.003). In terms of improvement, the performances of the regular group were also better than the pandemic-impacted group between the second mock OSCE and the national OSCE (79.10 vs. 38.14, p = 0.014), and between the second mock OSCE and the national OSCE (125.11 vs. 77.52, p = 0.003). While separating distinct genres, the regular group had more of a score increment in standardized patient-based stations between the second mock OSCE and the national OSCE (regular vs. pandemic-impacted: 57.03 vs. 18.95, p = 0.003), as well as between the first mock OSCE and the national OSCE (75.97 vs. 26.36, p < 0.001), but there was no significant difference among the skill-based stations. In particular, the scores of the emergency medicine associated station in the national OSCE of the pandemic-impacted group was lower. Conclusions: Our study implies that the pandemic significantly hampered the learning outcomes of final year medical students in their clinical participation. Especially facing the COVID-19 pandemic, more supplemental teachings are needed to compensate the decreasing emergency medicine exposure.

Investigation of the Cognitive Attitudes and Behaviors of Medical Post-graduates in Clinical Practice During the COVID-19 Pandemic in China

The cognitive attitudes and behaviors of medical post-graduates may be influenced by the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study was used from a questionnaire survey in hospitals affiliated with the Zhejiang University School of Medicine. Questionnaire was distributed online including demographic information, cognitive attitudes, and personal protective behaviors. Moreover, personal protective behaviors such as wearing protective equipment were compared between different academic major and gender, respectively. A total of 176 valid questionnaires were obtained. Of the medical post-graduates in this study, (1) 89.67% believed that the COVID-19 pandemic had an impact on their clinical internships, and 40.34% expressed concerns about their infection on inadequate personal protection; (2) 91.48% took personal protection in hospital and 86.36% enhanced personal hygiene; (3) There were no statistically differences in the personal protection by academic major and gender (p > 0.05). This study suggests that the COVID-19 pandemic had an impact on the medical post-graduates' clinical practice, and affected their cognitive attitudes and behaviors. As such, universities and hospitals should increase pandemic prevention training and investment, provide more psychological counseling to their medical post-graduates to reduce their psychological burden, and take measures to reduce the influence of the COVID-19 pandemic on their medical post-graduates' clinical practice.

Decline in Pediatric Shelf Examination Performance During COVID-19

Background

Medical student education has been impacted by the ongoing coronavirus 2019 (COVID-19) pandemic. Medical students were removed from clinical settings, and the censuses in pediatric hospitals decreased. While there have been studies starting to evaluate these effects on medical students training in surgical subspecialties, the literature in pediatrics is limited.

Objective

This study analyzed third-year medical students’ National Board of Medical Examiners (NBME) Clinical Science Pediatrics Shelf Exam scores at the conclusion of their core pediatric clerkship. We compared the exam scores before COVID-19 pandemic to those during the pandemic. We hypothesized that the ongoing COVID-19 pandemic would have a negative impact on NBME shelf exam scores and that shelf exam failure rates would increase.

Methods

Institutional Review Board approval was obtained prior to initiation of this study. We conducted a retrospective review of medical student pediatric shelf exam scores from June 2017 to December 2020 from one large, single institution. We adjusted scores for block schedule timing and standardized them based on national norms published for the year prior. We compared two groups: those who completed their pediatric clerkship experiences before pandemic (predominantly in-person learning) vs. those who completed it during the pandemic (predominantly virtual learning). Groups were compared using chi-square and analysis-of-variance testing.

Results

We included 991 medical students, 772 before COVID-19 and 219 during COVID-19. Of these, 19 of 772 (2.5%) students failed the exam prior to COVID-19 compared to 19 of 219 (8.7%) during COVID-19 (p < 0.001). Students who completed their pediatric clerkship during COVID-19 were 3.77 times more likely to fail their end-of-clerkship NBME shelf exam (p < 0.001).

Conclusions

Students who completed their core pediatric clerkship in a predominantly virtual platform during the COVID-19 pandemic were significantly more likely to fail their end-of-clerkship NBME shelf exam. Increased failure rates may suggest issues with acquisition and retainment of pediatric medical knowledge throughout the clerkship, creating knowledge gaps in the foundation of their pediatric experience. Long-term effects of virtual learning platforms will need to be studied further.

The perceived impact of the Covid-19 pandemic on medical student education and training - an international survey

BACKGROUND

The Covid-19 pandemic led to significant changes and disruptions to medical education worldwide. We evaluated medical student perceived views on training, their experiences and changes to teaching methods during the pandemic.

METHODS

An online survey of medical students was conducted in the Autumn of 2020. An international network of collaborators facilitated participant recruitment. Students were surveyed on their perceived overall impact of Covid-19 on their training and several exposure variables. Univariate analyses and adjusted multivariable analysis were performed to determine strengths in associations.

RESULTS

A total of 1604 eligible participants from 45 countries took part in this survey and 56.3% (n = 860) of these were female. The median age was 21 (Inter Quartile Range:21-23). Nearly half (49.6%, n = 796) of medical students were in their clinical years. The majority (n = 1356, 84.5%) were residents of a low or middle income country. A total of 1305 (81.4%) participants reported that the Covid-19 pandemic had an overall negative impact on their training. On adjusted analysis, being 21 or younger, females, those reporting a decline in conventional lectures and ward based teaching were more likely to report an overall negative impact on their training (p ≤ 0.001). However, an increase in clinical responsibilities was associated with lower odds of participants reporting a negative impact on training (p < 0.001). The participant's resident nation economy and stage of training were associated with some of the participant training experiences surveyed (p < 0.05).

CONCLUSION

An international cohort of medical students reported an overall significant negative impact of the Covid-19 pandemic on their undergraduate training. The efficacy of novel virtual methods of teaching to supplement traditional teaching methods warrants further research.

We're Not Sure We Like It but We Still Want More: Trainee and Faculty Perceptions of Remote Learning During the COVID-19 Pandemic

OBJECTIVE

In this study, the authors aim to compare perceptions of remote learning versus in-person learning among faculty and trainees at a single institution during the COVID-19 pandemic and to evaluate the impact that a brief faculty training on best practices in online teaching would have on faculty attitudes towards remote learning.

METHODS

The authors conducted an attitude survey on remote learning among trainees and faculty members approximately 3 months after the transition from in-person to remote learning. The authors then conducted a faculty training on best practices in online teaching followed by an evaluation survey. Study findings were examined descriptively and by Fisher's exact testing.

RESULTS

The response rates for the attitudes survey were 68% among trainees and 61% among faculty. Trainees and faculty perceived in-person learning more favorably than remote learning across a variety of domains, including overall enjoyment, interpersonal connection, ability to communicate, and concentration. Despite these trends, only 10% of trainees and 14% of faculty felt that all lectures would be most effectively delivered in-person when this becomes possible again. The response rate for the faculty training evaluation survey was 16%. Compared to non-attendees, faculty attendees reported more confidence in their ability to teach remotely (89% vs 56%, p=0.02) but not increased optimism (89% vs 63%, p=0.06).

CONCLUSIONS

The study findings suggest that both trainees and faculty perceive remote learning negatively compared to in-person learning but still feel that some lectures should be delivered remotely even after a return to in-person learning is possible.

Virtual medical student education and recruitment during the COVID-19 pandemic

Due to the immediate need for social distancing, as well as widespread disruption in clinical practices, brought on by the novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic, medical student education rapidly shifted to a virtual format, which resulted in a variety of innovative and remotely accessible practices to address new restrictions on face-to-face education. Educators approached curriculum design seeking to replicate as much of the in-person experience as possible, and were faced with overcoming the challenges of replacing the innately hands-on nature of surgery with virtual operative and skills experiences. Restrictions on in-person visiting electives expedited the role of virtual education as a notable opportunity for medical student education and recruitment, with a variety of approaches to engaging undergraduate medical learners, including the use of live-streaming operative cases, virtual didactic curricula, and a rise in podcasts; web-based conferences; and virtual journal clubs. In addition to education, virtual outreach to medical students has become an essential tool in trainee recruitment and selection, and ongoing application of novel educational platforms will allow for new opportunities in multi-institutional collaboration and exchange with a multitude of benefits to future vascular surgery trainees. Our aim was to outline the resources and practices used to virtually teach and recruit medical students and the benefits of virtual rotations to the program and students.

Virtual Interviews in the Era of COVID-19: Expectations and Perceptions of Orthopaedic Surgery Residency Candidates and Program Directors

Background:

Orthopaedic surgery residency program directors (PDs) and candidates consider interviews to be central to the application process. In-person interviews are typical, but virtual interviews present a potentially appealing alternative. Candidate and PD expectations and perceptions of virtual interviews during the 2020/2021 orthopaedic surgery application cycle were assessed.

Methods:

Candidates and PDs were surveyed electronically. Questions covered pre–virtual-interview and post–virtual-interview expectations and perceptions, and past in-person experiences (PDs and reapplicants) on the relative importance of application components, ability to assess fit, interview costs, and preferred interview mode. Identical questions allowed between-group comparisons.

Results:

Responses included n = 29 PDs and n = 99 candidates. PDs reported diminished ability to assess candidate fit; social, clinical, and surgical skills; and genuine interest in the virtual context (each p ≤ 0.01). They placed greater importance on research and less on the interview in the virtual vs. in-person context (each p = 0.02). Most candidates (78%) reported fair/good ability to demonstrate potential and were better able to assess research opportunities than expected (p < 0.01). Candidates expected virtual interviews to increase the importance of research, transcripts, and recommendations (for each, p ≤ 0.02) and decrease the importance of the interview itself (p < 0.01). Compared with PDs, candidates overvalued research, United States Medical Licensing Examination scores, transcripts, and recommendations (each p ≤ 0.02) and may have slightly undervalued the virtual interview (p = 0.08). Most candidates (81%) and PDs (79%) preferred in-person interviews, despite both groups reporting monetary savings.

Conclusions:

Despite cost savings associated with virtual interviews, orthopaedic surgery residency PDs and candidates identified reduced abilities to assess candidate or program fit and displayed a preference for in-person interviews.

Exploring a novel approach to surgery clerkship didactics during the COVID-19 pandemic: A qualitative study

Background

The COVID-19 pandemic brings unforeseen challenges in medical education. The current study aims to: 1) describe third-year medical students’ experiences with the novel Shelf-Exam-Type Question Didactics (SET QD) before (in-person) and during (virtual) COVID-19.

Methods

In this qualitative study using grounded theory, we conducted purposive sampling and used 23 in-depth semi-structured interviews. Audio recordings were transcribed verbatim and the Atlas.Ti software was used to manage the thematic analysis.

Results

There are three themes and eight subthemes that emerged: 1) The SET QD Framework (sub-themes: questions as learning opportunities; interleaving; notable clinical scenarios; team learning; accountability). 2) Experienced Educator (subtheme: transformational teaching). 3) Virtual Accessibility (sub-themes: alleviating time constraints, and mitigating life-stressors).

Conclusions

Medical students regarded SET QD as impactful for shelf exam preparation, clinical preparation, and long-term retention of the material. This novel virtual didactic method may be used in non-surgical clerkships as well.

Self-learning on COVID-19 among medical students in Bhutan: A cross-sectional study

Background

Bhutan lacks a medical school and all medical students are trained in Sri Lanka, Bangladesh and India. When the COVID-19 pandemic led to the closure of medical schools in these countries in March–April 2020, the medical students were repatriated to Bhutan. Upon return, they were kept in government-sponsored facility quarantine for 21 days. This study assessed their knowledge on COVID-19 as a part of self-learning and their attitude towards participation in government's health response to COVID-19.

Methods

This was a cross-sectional study among medical students who had returned to the country. The survey was conducted through an online questionnaire while the students were in facility quarantine. The sample size calculated was 129 and convenient sampling was used. Knowledge was assessed using 20 questions, each scored 1/20. Knowledge was considered “good” if the cumulative score was ≥80%, “satisfactory” if ≥60–79% and “poor” if <60%. Correlation between knowledge score and duration of clinical clerkship was tested using Pearson's correlation coefficient. Attitude of students towards their willingness to participate in the national COVID-19 response was tested using rating scales. Data were analysed using Stata 13.1.

Results

120 medical students responded to the survey (response rate = 93%). Eighty-eight (74%) had good knowledge, 28 (23%) had satisfactory knowledge and only four (3%) had poor knowledge on COVID-19. The students scored high on the symptomatology, mode of transmission, prevention and treatment options and on local epidemiology; and scored low on the forms of mechanical ventilation and on home-management of non-critical cases. The knowledge score correlated with the duration of clinical clerkship they had undertaken (r = 0.326, p = 0.001). The primary source of information were social media sites (102, 85%), television (94, 78%) and newspapers (76, 63%). The majority (78, 65%) were willing to participate in the government's COVID-19 response but could not identify what roles they could play. The fear of contracting COVID-19 was reported by eight students (7%).

Conclusions

Medical students had good knowledge on COVID-19 and had self-learned through social media, television and newspapers. The students held positive attitude towards participation in the government's COVID-19 response.

Case item creation and video case presentation as summative assessment tools for distance learning in the pandemic era

BACKGROUND

There is an urgent need for more diverse methods for student evaluation, given the sudden shift to online learning necessitated by the coronavirus disease 2019 (COVID-19) pandemic. Innovative assessment tools will need to cover the required competencies and should be used to drive self-learning. Self-assessments and peer assessments may be added to the traditional classroom-based evaluations to identify individual insecurities or overconfidence. Identification of these factors is essential to medical education and is a focus of current research.

METHODS

A modified operational assessment was introduced for the evaluation of third-year medical students. This intervention has facilitated sustained education and has promoted interactive student learning. Members of the entering class of 2017 participated in an integrated team and a competency-based online project that involved innovative item creation and case presentation methods.

RESULTS

The new assessment process has been implemented successfully with positive feedback from all the participants; a usable product has been generated.

CONCLUSIONS

We created new assessment tools in response to the COVID-19 pandemic that have been used successfully at our institution. These tools have provided a framework for integrated and interactive evaluations that can be used to facilitate the modification of traditional assessment methods.

Impact of the COVID-19 pandemic on Caribbean Medical Students: A cross-sectional study

The COVID-19 pandemic has introduced a wide range of challenges to numerous institutions around the world. One of these vital programs being affected is Caribbean medical schools. To continue to train future physicians, Caribbean medical schools have been forced to deliver lectures through video chat, delaying clinical training years as well as exams. Reveal current shortcomings in medical education to improve future learning strategies based on student perspectives.

To further explore the impact of COVID-19 on medical training in the Caribbean, a cross sectional designed survey was constructed and made available for completion to numerous 2nd, 3rd and 4th year medical students between the dates of Feb 2nd, 2021, and April 1st, 2021. Students reported being less time efficient and paying less attention during online lectures. Many students reported having their Comp, Step 1, Clinical rotations, and research projects delayed because of the lockdown. Most students ranked 10/10 on anxiety and depression scores during the lockdown. The changes made to the Caribbean Medical school system due to the Pandemic have shown to be less effective than previous methods of instruction. It is crucial for programs to consider this for the future to optimize learning and continue to produce highly trained medical professionals even in the face of adversity.

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Existing digital platforms are generally not considered effective replacements.

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Increased deprivation of focus, interest, and time management skills.

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Tremendous strain on mental health of 3rd and 4th year Caribbean Medical Students.

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Concern for achieving mastery and competency in core clinical knowledge and skills.

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Certainty of attaining residency positions remains questionable.

Student support systems for undergraduate medical students during the COVID-19 pandemic: a systematic narrative review of the literature

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has boosted medical students' vulnerability to various problems. Given the stressful nature of medical disciplines, considerable attention must be paid to student support systems during pandemics. This study aimed to review the current literature regarding medical student support systems systematically.

METHODS

We performed a systematic review of six databases and grey literature sources in addition to a hand search in the references of the articles on April 5, 2021. We included all studies about support for undergraduate medical students delivered in response to the COVID-19 pandemic. In conducting this review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

A total of 3646 articles were retrieved from the databases, and 16 additional papers were extracted from other sources. After removing duplicates, we screened 2434 titles and abstracts according to our criteria. Among them, 32 full-text articles were assessed for eligibility. Ultimately, 10 studies were included for review. We identified two major themes: (a) academic support and (b) mental health support. All of the included studies utilized online methods whether for transitioning from previous support systems or developing novel approaches. Students and faculty members seemed to be receptive to these new systems. Despite indicating outstanding program outcomes, most studies merely described the positive effects of the program rather than providing a precise evaluation.

CONCLUSION

There are several methods of supporting medical students who are experiencing unprecedented changes in their educational trajectory. Due to substantial differences in undergraduate medical education in different regions of the world, cultural and contextual-oriented support is indispensable for developing a safe learning environment. Future research should investigate the question of the extent to which online support can supersede in-person strategies.

The deep impact of the COVID-19 pandemic on medical students: An online cross-sectional study evaluating Turkish students' anxiety

AIM

Coronavirus Disease 2019 (COVID-19) changed the delivery of medical education in Turkey by moving to an emergency remote teaching system and led to many challenges for future doctors. In this study, we aimed to explore the impact of the COVID-19 pandemic on medical students, to assess their anxiety level and their main anxiety sources related to this pandemic.

METHODS

A Google Form was distributed to medical students using the virtual snowball sampling method. The form included the Beck Anxiety Inventory and additional 19 questions on sociodemographic characteristics, perceived level of knowledge about the epidemic, self-risk perceptions of COVID-19 and their anxiety levels about some other topics related to COVID-19.

RESULTS

Overall, 3105 medical students with a mean age of 22.37 ± 2.46, took the survey. Amongst the participants, only 32% of the students defined their knowledge about the precautions that should be taken during an epidemic disease as acceptable. Students reported highest anxiety level for the continuing spread of COVID-19 in Turkey and transmitting coronavirus to another person. Clinically significant anxiety prevalence was 23.2%. Regression analysis revealed that factors that increased the risk of being anxious included being female, being other than a 5th-year student, thinking that being a medical student would increase the risk of coronavirus transmission or being uncertain about it, being exposed to a patient with COVID-19 or being uncertain about it, being anxious about the continuing spread of COVID-19 in Turkey, being anxious about acquiring COVID-19, being anxious for graduating and being on active duty, being anxious about a medical training interruption.

CONCLUSION

Our results suggest that anxiety is prevalent amongst Turkish medical students during the COVID-19 pandemic and they have a weak preparedness for a pandemic such as COVID-19. Based on our results, new strategies should be implemented for medical education and for alleviating students' anxiety levels.

Medical Student's Perspective Regarding Undergraduate Surgical Education with Special Reference to Pandemic

The COVID-19 pandemic has disrupted teaching in medical schools across the world. Online learning has become the core method of teaching during this pandemic. The aim of this study was to investigate the impact of this mode of education among medical students in India. A survey was conducted by distributing online questionnaires to medical students across India. Data gathered from the survey was analyzed using SPSS® version 16. The overall response rate of survey was 58.4%. Practical training was most severely affected by online classes (93.32%) as compared to theory classes (60.93%). A total of 71.98% students agreed that canceling of physical medical conferences adversely affected the building up of their resumes while only 28.79% agreed that virtual conferences and meetings enhanced their learning. A total of 56.81% agreed that online exams adversely affected their performance. A total of 46.79% feels that online classes using simulated patients and simulation technology is not useful but 41.90% think that simulated teaching should be a part of the medical curriculum. A majority of the students (87.66%) had technical issues with online classes and 89.72% complained of poor concentration during online teaching due to distractions. A total of ~75% felt that the pandemic has adversely affected the availability of research opportunities and development of skills, ethics, communication, and behavior. Online education has adversely affected all aspects of learning, performance in exams, research, and the overall future plans of students. Moving forward from this pandemic, in order to maximize the benefits of both face-to-face and online teaching, we suggest medical schools resort to a hybrid pattern.

The impact of COVID-19 pandemic on training and mental health of residents: a cross-sectional study

BACKGROUND

Residency programs have been impacted by the Coronavirus disease 2019 (COVID-19) pandemic. In this study we aim to investigate and evaluate the impact of the pandemic on residents as well as residency training programs.

METHODS

This was a cross-sectional study including a survey of 43 questions prepared on Google forms and electronically distributed among a convenience sample of residents training at a tertiary center in North Jordan during the COVID-19 pandemic. Data were collected in the period between October 30th and November 8th of 2020. The survey included questions that addressed the impact of the pandemic on residents' health as well as training programs. The study participants included residents in training at KAUH in 2020 and were stratified according to the type of residency program (surgical residents (SRs) and non-surgical residents (NSRs)). Statistical methods included descriptive analysis, Chi-square or Fisher's exact test, Mann Whitney U test, and Cramer's V and r statistics as measures of effect sizes.

RESULTS

Of all 430 residents, 255 (59%) responded to the survey. A total of 17 (7%) of residents reported being infected with COVID-19 and a significant difference was reported between SRs and NSRs (10% vs 4%, V = .124 "small effect" (95% CI; .017-.229), p = 0.048). Approximately, 106 (42%) reported a decrease in the number of staff working at the clinic and 164 (64%) reported limited access to personal protective equipment during the pandemic. On a 4-point Likert scale for the feeling of anxiety, the median was 2 (2-3 IQR) in the NSRs group, vs 2 (1-2 IQR) in the SRs groups, with the NSRs being more likely to feel anxious (r = 0.13 "small effect" (95% CI; 0.007-0.249), p = .044). Similarly, the proportion of residents who reported feeling anxious about an inadequacy of protective equipment in the work area was significantly greater in the NSRs group (90.3% vs 75.2%; V = .201 "small effect" (95% CI; .078-.313), p = .001), as well as the proportion of residents who reported feeling increased stress and anxiety between colleagues being also significantly higher in the NSRs group (88.1% vs 76%; V = .158 "small effect" (95% CI; .032-.279), p = .012).

CONCLUSION

The burden of the ongoing pandemic on the mental health status of residents is very alarming and so providing residents with psychological counseling and support is needed. Also, critical implications on the flow of residency training programs have been noticed. This necessitates adapting and adopting smart educational techniques to compensate for such limitations.

Beyond Sociodemographic and COVID-19-Related Factors: The Association Between the Need for Psychological and Information Support from School and Anxiety and Depression

BACKGROUND In addition to sociodemographic and COVID-19- related factors, the needs of school support, including material, psychological and information support, have seldom been discussed as factors influencing anxiety and depression among college students during the COVID-19 pandemic. MATERIAL AND METHODS In this cross-sectional study, 3351 college students from China were surveyed through questionnaires about their sociodemographic and COVID-19 characteristics, the needs of school support, and their experiences with anxiety and depression. RESULTS Anxiety and depression were reported by 6.88% and 10.50% of students, respectively. Married, higher education, non-medical, and urban students had significantly higher risks of anxiety or depression. Additionally, symptoms such as cough and fever, especially when following a possible contact with suspected individuals, quarantine history of a personal contact, going out 1-3 times a week, not wearing a mask, and spending 2-3 hours browsing COVID-19-related information were significantly associated with the occurrence of anxiety or depression. Those who used methods to regulate their emotional state, used a psychological hotline, and who had visited a psychiatrist showed higher anxiety or depression. Those who used online curricula and books, used preventive methods for COVID-19, and who had real-time information about the epidemic situation of the school showed lower anxiety and depression. CONCLUSIONS In addition to sociodemographic and COVID-19-related aspects, students' needs for psychological assistance and information from schools were also associated with anxiety and depression among college students.

Medical Student Perceptions of the Learning Environment, Quality of Life, and the School of Medicine's Response to the COVID-19 Pandemic: A Single Institution Perspective

PURPOSE

Responding to the COVID-19 pandemic, American medical schools made swift changes to clinical education based on guidelines provided by the Association of American Medical Colleges. The purpose of this study was to collect medical student perceptions of the solely online learning environment, their quality of life (QoL), and the pandemic response by their School of Medicine (SoM) to provide suggestions to inform medical schools' responses during the continuation of this pandemic and the next.

METHODS

Between April 29, 2020 and May 16, 2020, the authors distributed a 60-item questionnaire that assessed demographics, learning environment, QoL, and the SoM response. Likert-type items were analyzed on an item-by-item basis, whereas themes were identified for open-ended questions.

RESULTS

A total of 330 medical students (of 632; 52.2%) responded. Those who responded had positive perceptions of the online learning environment with moderate QoL disruptions to concentration and sleep. Although most students perceived being able to contribute meaningfully to the healthcare setting, they viewed themselves as underutilized. Three themes encapsulated both positive and negative perceptions of the SoM's response-communication, learning environment, and empathy and support.

CONCLUSION

These findings provide insight into medical student perceptions of their learning environment and QoL as they acclimated to changes resulting from the COVID-19 pandemic. Results can help inform a SoM's response during the continuation of the COVID-19 pandemic as well as during future pandemics or crises. Follow-up surveys of medical students at multiple institutions across the USA and abroad will be essential to better characterize student perceptions.

The COVID-19 pandemic as a catalyst for medical education innovation: A learner's perspective

The COVID‐19 pandemic has been transformative for healthcare and medical education. Physician trainees and the education system that serves them adapted quickly so that trainees could finish the academic year on time and advance to the next phase of training without compromising clinical competency or public safety. Systemic changes have had the most significant impact on telemedicine training, virtual learning, secure testing, and the interview process for residency and fellowship training positions. Trainees are now getting regular, supervised practice experience with telemedicine. Some secure testing is being done remotely, without jeopardizing examination test items or trainee assessment. Attending physicians are experimenting with novel ways to engage learners with video for virtual rounds to keep the rounding team safe. Finally, the interview process for medical school, residency, and fellowship programs, which has traditionally been an expensive and travel‐laden process, has been made completely virtual for the first time ever. These changes have disadvantages, including a lack of social connection, potential distraction when learning remotely, and limited contact with a potential training program when interviewing by video. This perspective paper, written by a senior internal medicine resident, details his firsthand experience with these changes during the pandemic. It also looks forward to how the current changes will likely change medical education permanently and for the better.

Assessing the Psychological Impacts of COVID-19 in Undergraduate Medical Students

Medical education has been uniquely affected by the Novel Coronavirus Disease 2019 (COVID-19). As the pandemic's psychological impacts on medical students remain unclear, this study assessed COVID-19's impacts on undergraduate medical students' stress and anxiety. A nationwide, online survey was administered via email chains between June-August 2020 to first-fourth year medical students in the United States. Demographics, 4-point Perceived Stress Scale that measures stress, 7-point Generalized Anxiety Disorder Scale that measures anxiety, and the impacts of social, health, and academic stressors due to COVID-19 were collected. Of the 852 students who participated, 66.1% experienced mild, moderate, or severe anxiety. Mean PSS-4 score was 7.25/16. Stress was highest in second- through fourth-year students. Students with preexisting mental health conditions had significantly higher stress and anxiety scores, and higher percentage of stress attributed to COVID-19. Trust in government institutions during COVID-19 was the highest stressor in first- and second-year students. Delay/availability of standardized exams was the highest stressor for third-year students. Impact on rotations/residencies was the highest stressor for fourth-year students. Understanding how students' anxiety and stress have changed due to COVID-19 will allow educators to identify students in need and guide recommendations on the implementation of psychological interventions and support strategies.

Designing and Implementing a Novel Virtual Rounds Curriculum for Medical Students' Internal Medicine Clerkship During the COVID-19 Pandemic

INTRODUCTION

During the COVID-19 pandemic, third-year medical students were temporarily unable to participate in onsite clinical activities. We identified the curricular components of an internal medicine (IM) clerkship that would be compromised if students learned solely from online didactics, case studies, and simulations (i.e., prerounding, oral presentations, diagnostic reasoning, and medical management discussions). Using these guiding principles, we created a virtual rounds (VR) curriculum to provide IM clerkship students with clinical exposure during a virtual learning period.

METHODS

Held three times a week for 2 weeks, VR consisted of three curricular components. First, clerkship students prerounded on an assigned hospitalized patient by remotely accessing the electronic health record and calling into hospital rounds. Second, each student prepared an oral presentation on their assigned patient. Third, using videoconferencing, students delivered these oral presentations to telemedicine VR small groups consisting of three to four students and three tele-instructors. Tele-instructors then provided feedback on oral presentations and taught clinical concepts. We assessed the effectiveness of VR by anonymously surveying students and tele-instructors.

RESULTS

Twenty-nine students and 34 volunteer tele-instructors participated in VR over four blocks. A majority of students felt VR improved their prerounding abilities (86%), oral presentation abilities (93%), and clinical reasoning skills (62%). All students found small group to be useful.

DISCUSSION

VR allowed students to practice rounding skills in a supportive team-based setting. The lessons learned from its implementation could facilitate education during future pandemics and could also supplement in-person clerkship education.

Global Health Education Amidst COVID-19: Disruptions and Opportunities

This viewpoint examines the impact of COVID-19 travel bans and remote education on the global health education of students from high-income countries (HIC) and low- and middle-income countries (LMIC) and explores potential opportunities for strengthening global health education based upon more dispersed and equitable practices. Global health is unique in the opportunities it can offer to students during the pandemic if programs can manage and learn from the pandemic’s many challenges. Global health educators can: shift to sustainable remote engagement and mobilize resources globally to facilitate this; collaborate with partners to support the efforts to deal with the current pandemic and to prepare for its next phases; partner in new ways with health care professional students and faculty from other countries; collaborate in research with partners in studies of pandemic related health disparities in any country; and document and examine the impact of the pandemic on health care workers and students in different global contexts. These strategies can help work around pandemic travel restrictions, overcome the limitations of existing inequitable models of engagement, and better position global health education and face future challenges while providing the needed support to LMIC partners to participate more equally.

An Educational Network for Surgical Education Supported by Gamification Elements: Protocol for a Randomized Controlled Trial

Background

Traditionally, medical students have learned surgical skills by observing a resident physician or surgeon who is performing the technique. Due to inconsistent practice opportunities in the clinical setting, a disparity of skill levels among students has been observed. In addition, the poor availability of faculty professors is a limiting factor in teaching and adequately preparing medical students for their clerkship years. With the ongoing COVID-19 pandemic, medical students do not have access to traditional suturing learning opportunities. Didactic courses are available on videoconferencing platforms; however, these courses do not include technical training.

Objective

Our overarching goal is to evaluate the efficacy and usability of web-based peer-learning for advanced suturing techniques (ie, running subcuticular sutures). We will use the Gamified Educational Network (GEN), a newly developed web-based learning tool. We will assess students’ ability to identify and perform the correct technique. We will also assess the students’ satisfaction with regard to GEN.

Methods

We will conduct a prospective randomized controlled trial with blinding of expert examiners. First-year medical students in the Faculty of Medicine of Université de Montréal will be randomized into four groups: (1) control, (2) self-learning, (3) peer-learning, and (4) peer-learning with expert feedback. Each arm will have 15 participants who will learn how to perform running subcuticular sutures through videos on GEN. For our primary outcome, the students’ ability to identify the correct technique will be evaluated before and after the intervention on GEN. The students will view eight videos and rate the surgical techniques using the Objective Structured Assessment of Technical Skills Global Rating Scale and the Subcuticular Suture Checklist as evaluation criteria. For our secondary outcomes, students will anonymously record themselves performing a running subcuticular suture and will be evaluated using the same scales. Then, a survey will be sent to assess the students’ acceptance of the intervention.

Results

The study will be conducted in accordance with the Declaration of Helsinki and has been approved by our institutional review board (CERSES 20-068-D). No participants have been recruited yet.

Conclusions

Peer learning through GEN has the potential to overcome significant limitations related to the COVID-19 pandemic and the lack of availability of faculty professors. Further, a decrease of the anxiety related to traditional suturing classes can be expected. We aim to create an innovative and sustainable method of teaching surgical skills to improve the efficiency and quality of surgical training in medical faculties. In the context of the COVID-19 pandemic, the need for such tools is imperative.

Trial Registration

ClinicalTrials.gov NCT04425499; https://clinicaltrials.gov/ct2/show/NCT04425499

International Registered Report Identifier (IRRID)

PRR1-10.2196/21273

Addressing the Covid-19 Burden on Medical Education and Training: The Role of Telemedicine and Tele-Education During and Beyond the Pandemic

Medical students are the future of sustainable health systems that are severely under pressure during COVID-19. The disruption in medical education and training has adversely impacted traditional medical education and medical students and is likely to have long-term implications beyond COVID-19. In this article, we present a comprehensive analysis of the existing structural and systemic challenges applicable to medical students and teaching/training programs and the impact of COVID-19 on medical students and education. Use of technologies such as telemedicine or remote education platforms can minimize increased mental health risks to this population. An overview of challenges during and beyond the COVID-19 pandemic are also discussed, and targeted recommendations to address acute and systemic issues in medical education and training are presented. During the transition from conventional in-person or classroom teaching to tele-delivery of educational programs, medical students have to navigate various social, economic and cultural factors which interfere with their personal and academic lives. This is especially relevant for those from vulnerable, underprivileged or minority backgrounds. Students from vulnerable backgrounds are influenced by environmental factors such as unemployment of themselves and family members, lack of or inequity in provision and access to educational technologies and remote delivery-platforms, and increased levels of mental health stressors due to prolonged isolation and self-quarantine measures. Technologies for remote education and training delivery as well as sustenance and increased delivery of general well-being and mental health services to medical students, especially to those at high-risk, are pivotal to our response to COVID-19 and beyond.