"SARS-Ed": severe acute respiratory syndrome and the impact on medical education

Use of online educational resources before and during the COVID-19 era in oral and maxillofacial surgery

Restrictions to traditional face-to-face meetings were mandated by many government authorities during the COVID-19 pandemic, impacting the delivery of educational training sessions for maxillofacial surgery trainees in the traditional group manner. An online survey was designed to review what effect the pandemic had on the use and uptake of online educational sources amongst a representative cohort of maxillofacial surgery trainees in higher specialist training. Their attitudes and satisfaction with online resources were considered. The use of live sources such as webinars and pre-recorded materials (e.g. YouTube videos) was investigated. Engagement with online sources was considered prior to, and then during the pandemic. Alterations in the behaviour of trainees were demonstrated, with increasing online resource use seen once the COVID-19 pandemic took hold. Online pre-recorded resource use increased by 26% during the pandemic, with the median number of hours watched per month increasing from 1-5 h to 5-10 h (p < 0.001). Engagement with live online sources (webinars) increased by 52% and median time watched increased from 15 h per month to 10-20 h per month (p < 0.001). Trainees expressed satisfaction with the quality and flexibility of the resources. There was a firmly positive response to live webinars with regard to teaching quality, audio and video quality, ease of access and relevance to training needs. Pre-recorded and live online resources may prove a useful alternative or adjunct to face-to-face teaching when regulations limit or restrict social interactions.

Training infectious diseases senior residents during COVID-19: The impact and the lessons learnt

BACKGROUND

The COVID-19 pandemic had major impact on the training of Infectious Diseases (ID) residents across the globe. They were part of the frontline staff, while at the same time training to be ID physicians. This study focused on identifying their capability, i.e. the ability to adapt existing competencies to new situations, which is now recognised as an essential element of professional practice.

AIM

This study explored what ID residents learnt and how they learnt as they adapted to working in this unpredictable and challenging COVID-19 pandemic.

METHODS

This qualitative explorative study was based in the Infectious Diseases Senior Residency Programme across three training institutions in Singapore. Individual semi-structured interviews were conducted. Data were analysed using a template analysis technique.

RESULTS

Nine ID residents participated in this study. They learnt to engage with uncertainty in a meaningful way by relying on prior training and rapidly learning how to most effectively learn (metacognition). Learning was enhanced by collaboration between multidisciplinary health professionals, strong leadership and intrinsic motivation from personal interest in ID. They learnt through observing how senior faculty approached and managed the COVID-19 situation.

CONCLUSION

When learning for future capability in a rapidly evolving situation, role-modelling and mentoring are essential as available information resources may still not provide the learning from skilled doctors with actual experiences managing complex, uncertain situations.

COVID-lateral Damage: Impact of the Post-COVID-19 Era on Procedural Training in Emergency Medicine Residency

Introduction: Hospitalizations during the coronavirus 2019 (COVID-19) pandemic peaked in New York in March-April 2020. In the months following, emergency department (ED) volumes declined. Our objective in this study was to examine the effect of this decline on the procedural experience of emergency medicine (EM) residents compared to the pre-pandemic period. Methods: We conducted this multicenter, retrospective cohort study of patients seen and key procedures performed by EM residents at hospitals spanning three Accreditation Committee for Graduate Medical Education-approved EM residencies in New York City and Nassau County, NY. We obtained numbers of procedures performed during May-July 2020 and compared them to the same time period for 2019 and 2018. We a priori classified critical care procedures-cardioversion, central lines, chest tubes, procedural sedation, and endotracheal intubation. We also studied "fast-track" procedures-fracture/joint reduction, incision and drainage (I&D), laceration repairs, and splints. Results: Total number of critical care procedures in the months following the COVID-19 peak decreased from 694 to 606 (-12.7%, 95% confidence interval [CI] 10.3-15.4%), compared to an increase from 642 to 694 (+8.1%, 95% CI 6.1-10.5%) the previous year (difference -9.3%). Total number of fast-track procedures decreased from 5,253 to 3,369 (-35.9%, 95% CI 34.6-37.2%), compared to a decrease from 5,333 to 5,253 (-1.5%, 95% CI 1.2-1.9%) the year before (difference -36.3%). Specific critical care procedures performed in 2020 compared to the mean of 2019 and 2018 as follows: cardioversion -33.3%; central lines +19.0%; chest tubes -27.9%; procedural sedation -30.8%; endotracheal intubation -13.8%. Specific fast-track procedures: reductions +33.3%; I&D -48.6%; laceration repair -17.3%; and splint application -49.8%. Conclusion: Emergency medicine residents' critical and fast-track procedural experience at five hospitals was reduced during the months following the COVID-19 peak in comparison to a similar period in the two years prior. Training programs may consider increasing simulation-lab and cadaver-lab experiences, as well as ED and critical care rotations for their residents to offset this trend.

Fear, health impacts, and life delays: residents' certification exam year experience

BACKGROUND

Residency training is associated with risks of burnout and impaired well-being. This may be due to multiple factors, including navigating various transitions. Chief among these is the transition to independent practice which, in Canada, involves a certification exam administered by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada. This qualitative study explored the experience of residents in their examination year, including residents impacted by pandemic-related examination postponment, to understand how these experiences may impact residents' well-being.

METHODS

Qualitative description methodology was used for this study. Participants were residents and physicians in independent practice from McMaster University and the University of Toronto. In depth, semi-structured, one-on-one interviews were conducted by one of the investigators. Each was transcribed, reviewed, and coded by two members of the investigating team.

RESULTS

Five themes were identified. Examinations were perceived to be a significant stressor, and the extent of preparation involved was viewed as a threat to one's physical and mental well-being. Participants identified a culture of fear surrounding the exam, as well as a perception that exam preparation requires significant sacrifice which can exacerbate the impacts of the exam year. Personal and professional supports were identified as important protective factors.

CONCLUSION

This study has identified unique challenges in the examination year, and its impact on the well-being of residents immediately before they enter independent practice. Residents also experienced significant learning and a sense of accomplishment through their preparation for the examination. The COVID-19 pandemic had a unique impact on one cohort of residents. This should prompt medical education institutions to examine the support provided to residents, the culture surrounding certification examinations, and mitigation strategies for future examination disruptions.

Medical students' perceptions of learning and working on the COVID-19 frontlines: '… a confirmation that I am in the right place professionally'

The COVID-19 pandemic caused complex and enduring challenges for healthcare providers and medical educators. The rapid changes to the medical education landscape forced universities across the world to pause traditional medical training. In Basel, Switzerland, however, medical students had the opportunity to work on the COVID-19 frontlines. Our purpose was to understand how they perceived both learning and professional identity development in this novel context. We conducted semi-structured interviews with 21 medical students who worked in a COVID-19 testing facility at the University Hospital of Basel. Using constructivist grounded theory methodology, we collected and analyzed data iteratively using the constant comparative approach to develop codes and theoretical themes. Most participants perceived working on the pandemic frontlines as a positive learning experience, that was useful for improving their technical and communication skills. Participants particularly valued the comradery amongst all team members, perceiving that the hierarchy between faculty and students was less evident in comparison to their usual learning environments. Since medical students reported that their work on the pandemic frontlines positively affected their learning, the need to create more hands-on learning opportunities for medical students challenges curriculum developers. Medical students wish to feel like full-fledged care team members rather than observing sideliners. Performing simple clinical tasks and collaborative moments in a supportive learning environment may promote learning and professional development and should be encouraged in the post-pandemic era.

Elective surgeries during and after the COVID-19 pandemic: Case burden and physician shortage concerns

The COVID-19 pandemic had a significant impact on several aspects of global healthcare systems, particularly surgical services. New guidelines, resource scarcity, and an ever-increasing demand for care have posed challenges to healthcare professionals, resulting in the cancellation of many surgeries, with short and long-term consequences for surgical care and patient outcomes. As the pandemic subsides and the healthcare system attempts to reestablish a sense of normalcy, surgical recommendations and advisories will shift. These changes, combined with a growing case backlog (postponed surgeries + regularly scheduled surgeries) and a physician shortage, can have serious consequences for physician health and, as a result, surgical care. Several initiatives are already being implemented by governments to ensure a smooth transition as surgeries resume. Newer and more efficient steps aimed at providing adequate surgical care while preventing physician burnout, on the other hand, necessitate a collaborative effort from governments, national medical boards, institutions, and healthcare professionals. This perspective aims to highlight alterations in surgical recommendations over the course of the pandemic and how these changes continue to influence surgical care and patient outcomes as the pandemic begins to soften its grip.

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The COVID-19 pandemic had a significant impact on several aspects of surgical care.

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New surgical recommendations amidst an ever-increasing demand for care pose, short and long-term consequences for surgical care and patient outcomes.

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As the pandemic subsides, these changes, combined with a growing case backlog and a physician shortage, can have serious consequences for physician health and, as a result, surgical care.

Twelve tips for medical students to enhance clinical skills learning during disrupted placements

Disruption to healthcare settings can present a significant challenge to traditional, face-to-face models of learning in medical education. Reductions in undergraduate medical students' clinical exposure, whether due to periods of increased healthcare demand, localised service changes or infectious disease outbreaks, are likely to result in fewer opportunities to develop key clinical and practical skills. Proficiency in these skills is often essential to progression and future practice, creating a broad incentive for students to develop techniques to maintain and refine their clinical skills during disrupted placements. These tips, based on our experiences as senior medical students, are intended to help students on disrupted placements to engage in reflective practice, discover ways to facilitate further opportunities for clinical skills learning, and to make the most of clinical skills learning opportunities that they do receive.

Assessment of the opinions and experiences of anatomy educators regarding the distance anatomy education in medical facilities under the effect of COVID-19 in Turkey

PURPOSE

Aim of this research is to assess the perceptions and views of the anatomy lecturers (educators) of the medical faculties in Turkey on undergraduate distance anatomy education during the COVID-19.

METHODS

Anatomy educators nationwide were invited to the online questionnaire developed by the authors. Ninety-one anatomy educators participated in the questionnaire. Views of the participants were evaluated by Likert-type questions and open-ended questions. Distance anatomy education experiences of the participants between March and July 2020 were evaluated.

RESULTS

Participants found face-to-face education more beneficial than distance education courses conducted with video recordings. They also reported that they agreed synchronous lessons were more beneficial than asynchronous lessons. They agreed that time management was a positive result. However, they were concerned about the adverse effects of the interruption of formal anatomy education regarding quality. The experience of distance anatomy education applied during the COVID-19 pandemic has revealed the demand for distance theoretical anatomy education supported by video recordings and face-to-face practical anatomy education methods (blended) for the post-pandemic period.

CONCLUSION

There is much research focusing on the students regarding the effects of the COVID-19 pandemic on anatomy education. The experiences and the suggestions of the anatomy educators are also important. The findings of the current research have revealed the positive approach to distance theoretical anatomy education and face-to-face practical anatomy education methods (blended) for the post-pandemic period.

Evaluation of views and perceptions of the medical faculty students about distance anatomy education during the COVID-19 pandemic

PURPOSE

This study aimed to investigate the students' opinions about the distance anatomy education given in our faculty at the COVID-19 pandemic and present our department's experiences.

METHODS

An online questionnaire designed for medical faculty students. The questionnaire was applied to 355 volunteer medical faculty students. The questionnaire consisted of demographics, five-point Likert items, and open-ended questions. The questionnaire was applied between August and September 2020. Distance anatomy education activities were evaluated during March and July 2020.

RESULTS

Results showed face-to-face theoretical anatomy education was found to be more effective than distance anatomy education conducted with recorded lecture videos. Even though the positive aspects of distance anatomy education stand out in topics, such as time management, it has been stated that cadaver and laboratory education has been disrupted. Most of the students agreed that they spent more time on supplementary resources during distance anatomy education.

CONCLUSION

The COVID-19 pandemic has provided an unexpected experimental environment. The demand for a blended method, which consists of distance (supported by video recordings) theoretical anatomy education and face-to-face practical anatomy education for the post-pandemic period comes to the fore. Distance anatomy education brings some problems with it due to its nature, and it is essential to seek unique solutions to them. Evaluating the perceptions of the parties will play an essential role in solving the problems of distance anatomy education and in the formation of future anatomy education styles.

Impact of the COVID-19 Pandemic on the Clinical Learning Environment: Addressing Identified Gaps and Seizing Opportunities

The clinical learning environment (CLE) encompasses the learner's personal characteristics and experiences, social relationships, organizational culture, and the institution's physical and virtual infrastructure. During the COVID-19 pandemic, all 4 of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizing the CLE in the post-COVID-19 world.

COVID-19 Impact on Surgical Resident Education and Coping

BACKGROUND

Healthcare systems and surgical residency training programs have been significantly affected by the novel coronavirus disease 2019 (COVID-19) pandemic. A shelter-in-place and social distancing mandate went into effect in our county on March 16, 2020, considerably altering clinical and educational operations. Along with the suspension of elective procedures, resident academic curricula transitioned to an entirely virtual platform. We aimed to evaluate the impact of these modifications on surgical training and resident concerns about COVID-19.

MATERIALS AND METHODS

We surveyed residents and fellows from all eight surgical specialties at our institution regarding their COVID-19 experiences from March to May 2020. Residents completed the survey via a secure Qualtrics link. A total of 38 questions addressed demographic information and perspectives regarding the impact of the COVID-19 pandemic on surgical training, education, and general coping during the pandemic.

RESULTS

Of 256 eligible participants across surgical specialties, 146 completed the survey (57.0%). Junior residents comprised 43.6% (n = 61), compared to seniors 37.1% (n = 52) and fellows 19.3% (n = 27). Most participants, 97.9% (n = 138), anticipated being able to complete their academic year on time, and 75.2% (n = 100) perceived virtual learning to be the same as or better than in-person didactic sessions. Participants were most concerned about their ability to have sufficient knowledge and skills to care for patients with COVID-19, and the possibility of exposure to COVID-19.

CONCLUSIONS

Although COVID-19 impacted residents' overall teaching and clinical volume, residency programs may identify novel virtual opportunities to meet their educational and research milestones during these challenging times.

The educational and psychological impact of the COVID-19 pandemic on medical students: A descriptive survey at the American University of Beirut

ABSTRACT

The SARS- CoV-2 virus has been a public health crisis since its emergence in 2019. It has affected nearly all aspects of life. Education has been particularly hit, and a lot of effort has been put to implement more and more virtual platforms through online classes, meetings and conferences. Medical education has also been affected, especially because of the need for hands-on education, specifically in the clinical setting of the last 2 years. This had a huge psychological impact on the medical students currently enrolled in medical schools around the globe.In this descriptive study, we sent all medical students at the American University of Beirut Faculty of Medicine (AUBFM) an online anonymous survey by email. The survey started with general questions (age, gender and medical school year), followed by 3 sections that contain questions pertaining to the attitudes of medical students towards clinical rotations and online classes. Data was then analyzed using SPSSv24 and was then reported as percentages.Students were almost equally divided among the medical school classes (Med 1, 2, 3, and 4). The majority of clinical students (Med 3 and Med 4) reported that they feel nervous during their rotations in the hospital. Moreover, they reported that they have increased their use of disinfectants and personal protective equipment since the emergence of the pandemic. Moreover, the majority of medical students reported that they feel more stressed after shifting to online classes. Medical students also reported that they would be willing to go back to on-campus classes.This study aimed at describing the response of medical students at AUBFM to the COVID-19 pandemic in terms of stress. Limited data exists in the literature concerning the psychological impact of the COVID-19 pandemic on medical students in the middle East. Medical students reported that they feel more stressed and nervous during their clinical rotations and after the shift to online education, affecting their academic and social life. Further studies using a larger sample size are needed.

The educational and psychological impact of the COVID-19 pandemic on medical students: A descriptive survey at the American University of Beirut

The SARS- CoV-2 virus has been a public health crisis since its emergence in 2019. It has affected nearly all aspects of life. Education has been particularly hit, and a lot of effort has been put to implement more and more virtual platforms through online classes, meetings and conferences. Medical education has also been affected, especially because of the need for hands-on education, specifically in the clinical setting of the last 2 years. This had a huge psychological impact on the medical students currently enrolled in medical schools around the globe.In this descriptive study, we sent all medical students at the American University of Beirut Faculty of Medicine (AUBFM) an online anonymous survey by email. The survey started with general questions (age, gender and medical school year), followed by 3 sections that contain questions pertaining to the attitudes of medical students towards clinical rotations and online classes. Data was then analyzed using SPSSv24 and was then reported as percentages.Students were almost equally divided among the medical school classes (Med 1, 2, 3, and 4). The majority of clinical students (Med 3 and Med 4) reported that they feel nervous during their rotations in the hospital. Moreover, they reported that they have increased their use of disinfectants and personal protective equipment since the emergence of the pandemic. Moreover, the majority of medical students reported that they feel more stressed after shifting to online classes. Medical students also reported that they would be willing to go back to on-campus classes.This study aimed at describing the response of medical students at AUBFM to the COVID-19 pandemic in terms of stress. Limited data exists in the literature concerning the psychological impact of the COVID-19 pandemic on medical students in the middle East. Medical students reported that they feel more stressed and nervous during their clinical rotations and after the shift to online education, affecting their academic and social life. Further studies using a larger sample size are needed.

When disruption strikes the curriculum: Towards a crisis-curriculum analysis framework

INTRODUCTION

COVID-19 has severely disrupted health professions training globally. This pandemic has been preceded by several other interferences on a smaller scale, setting the scene for crises in perpetuity. With a reactive stance adopted, these crises may result in rapid shifts to curricula, minimizing the opportunity for thorough planning and critical analyses.

GUIDANCE FROM THE LITERATURE

Recognizing the limited frameworks available to provide structure to such curricular crises responses, we drew on the literature to develop a crisis-curriculum analysis framework. The work of the SPICES model by Harden et al., the four-dimensional framework by Steketee et al., and Deverell's crisis-induced learning, was used to develop the framework.

CRISIS-CURRICULUM ANALYSIS FRAMEWORK

The framework provides a structured approach to curriculum analysis in the face of disruption. It is designed to meet the needs of the global health professions education community, currently in the midst of a crisis. Accompanied by a step-wise guideline, this framework is suitable for educators requiring a practically-orientated approach to curriculum analysis.

CONCLUSION

Recognizing that curriculum analysis is but one part of crisis-management, we argue that this crisis-curriculum analysis framework may align well with strengthening institutional readiness as educators seek to refine and entrench curricular practices adopted during COVID-19.

Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners

BACKGROUND

The evidence surrounding the impact of COVID-19 on medical learners remains anecdotal and highly speculative despite the anticipated impact and potential consequences of the current pandemic on medical training. The purpose of this study was to explore the extent that COVID-19 initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training.

METHODS

A cross-sectional survey of medical learners was conducted between March 25-June 14, 2020, shortly after the World Health Organization declared COVID-19 a pandemic.

RESULTS

6492 learners completed the survey from 140 countries. Most medical schools removed learners from the clinical environment and adopted online learning, but students reported concerns about the quality of their learning, training progression, and milestone fulfillment. Residents reported they could be better utilized and expressed concerns about their career timeline. Trainees generally felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some felt that contributing to healthcare during a pandemic was beyond the scope of a learner. Significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses as well as the impact of COVID-19 learner wellness and state-trait anxiety.

CONCLUSIONS

The disruption to the status quo of medical education is perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial empirical insights into the areas that warrant future research as well as consideration for current and future policy planning.

Impact of the COVID-19 Pandemic on the Psychological Distress of Medical Students in Japan: Cross-sectional Survey Study

Background

The COVID-19 pandemic has negatively affected medical education. However, little data are available about medical students’ distress during the pandemic.

Objective

This study aimed to provide details on how medical students have been affected by the pandemic.

Methods

A cross-sectional study was conducted. A total of 717 medical students participated in the web-based survey. The survey included questions about how the participants’ mental status had changed from before to after the Japanese nationwide state of emergency (SOE).

Results

Out of 717 medical students, 473 (66.0%) participated in the study. In total, 29.8% (141/473) of the students reported concerns about the shift toward online education, mostly because they thought online education would be ineffective compared with in-person learning. The participants’ subjective mental health status significantly worsened after the SOE was lifted (P<.001). Those who had concerns about a shift toward online education had higher odds of having generalized anxiety and being depressed (odds ratio [OR] 1.97, 95% CI 1.19-3.28) as did those who said they would request food aid (OR 1.99, 95% CI 1.16-3.44) and mental health care resources (OR 3.56, 95% CI 2.07-6.15).

Conclusions

Given our findings, the sudden shift to online education might have overwhelmed medical students. Thus, we recommend that educators inform learners that online learning is not inferior to in-person learning, which could attenuate potential depression and anxiety.

Cerebral vessel anatomy as a predictor of first-pass effect in mechanical thrombectomy for emergent large-vessel occlusion

OBJECTIVE

Mechanical thrombectomy is effective in acute ischemic stroke secondary to emergent large-vessel occlusion, but optimal efficacy is contingent on fast and complete recanalization. First-pass recanalization does not occur in the majority of patients. The authors undertook this study to determine if anatomical parameters of the intracranial vessels impact the likelihood of first-pass complete recanalization.

METHODS

The authors retrospectively evaluated data obtained in 230 patients who underwent mechanical thrombectomy for acute ischemic stroke secondary to large-vessel occlusion at their institution from 2016 to 2018. Eighty-six patients were identified as having pure M1 occlusions, and 76 were included in the final analysis. The authors recorded and measured clinical and anatomical parameters and evaluated their relationships to the first-pass effect.

RESULTS

The first-pass effect was achieved in 46% of the patients. When a single device was employed, aspiration thrombectomy was more effective than stent retriever thrombectomy. A larger M1 diameter (p = 0.001), decreased vessel diameter tapering between the petrous segment of the internal carotid artery (ICA) and M1 (p < 0.001), and distal collateral grading (p = 0.044) were associated with first-pass recanalization. LASSO (least absolute shrinkage and selection operator) was used to generate a predictive model for recanalization using anatomical variables.

CONCLUSIONS

The authors demonstrated that a larger M1 vessel diameter, low rate of vessel diameter tapering along the course of the intracranial ICA, and distal collateral status are associated with first-pass recanalization for patients with M1 occlusions.

The impact of COVID-19 on surgical training: a systematic review

Background

Coronavirus disease (COVID-19) has caused global disruption to health care. Non-urgent elective surgical cases have been cancelled, outpatient clinics have reduced and there has been a reduction in the number of patients presenting as an emergency. These factors will drastically affect the training opportunities of surgical trainees. The aim of this systematic review is to describe the impact of COVID-19 on surgical training globally.

Methods

The review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched.

Results

The searches identified 499 articles, 29 of which were included in the review. This contained data from more than 20 countries with 5260 trainees and 339 programme directors. Redeployment to non-surgical roles varied across studies from 6% to 35.1%. According to all of the studies, operative experience has been reduced. Knowledge learning had been switched to online platforms across 17 of the studies and 7 reported trainees had increased time to devote to educational/academic activities. All of the studies reporting on mental health report negative associations with increased stress, ranging from 54.9% to 91.6% of trainees.

Conclusions

The impact of COVID-19 on surgical trainees has been experienced globally and across all specialities. Negative effects are not limited to operative and clinical experience, but also the mental health and wellbeing of trainees. Delivery of surgical training will need to move away from traditional models of learning to ensure trainees are competent and well supported.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10151-020-02404-5.

Feasibility of virtual reality behavior skills training for preservice clinicians

Effective training procedures include behavioral skills training (BST), which involves providing written and verbal instructions, modeling of the skill, rehearsal of the skill, and feedback on the performance. This training typically involves in vivo experience in which trainees and students are exposed to risks such as proximity to infectious disease, behavioral issues such as aggression, and errors in teaching performance. Conducting BST in a virtual reality (VR) context involving virtual individuals with problem behavior may be an effective means of mitigating these risks. The purpose of this study was to examine the feasibility of training students to conduct functional communication training (FCT) in a VR environment using BST. We trained 13 preservice college students to implement FCT for attention and escape functions. We found VR BST was effective at increasing correct steps performed of FCT to mastery criterion levels with all participants. Future researchers should examine generalization and maintenance of VR BST.

Neurosurgery training in India during the COVID-19 pandemic: straight from the horse's mouth

OBJECTIVE

The COVID-19 pandemic has forced medical professionals throughout the world to adapt to the changing medical scenario. The objective of this survey was to assess the change in neurosurgical training in India following the COVID-19 pandemic.

METHODS

Between May 7, 2020, and May 16, 2020, a validated questionnaire was circulated among neurosurgical residents across India by social media, regarding changes in the department's functioning, patient interaction, surgical exposure, changes in academics, and fears and apprehensions associated with the pandemic. The responses were kept anonymous and were analyzed for changes during the COVID-19 pandemic compared to before the pandemic.

RESULTS

A total of 118 residents from 29 neurosurgical training programs across 17 states/union territories of the country gave their responses to the survey questionnaire. The survey revealed that the surgical exposure of neurosurgical residents has drastically reduced since the onset of the COVID-19 pandemic, from an average of 39.86 surgeries performed/assisted per month (median 30) to 12.31 per month (median 10), representing a decrease of 67.50%. The number of academic sessions has fallen from a median of 5 per week to 2 per week. The survey uncovered the lack of universal guidelines and homogeneity regarding preoperative COVID-19 testing. The survey also reveals reluctance toward detailed patient examinations since the COVID-19 outbreak. The majority of respondents felt that the COVID-19 pandemic will hamper their operative and clinical skills. Fear of rescheduling or deferring of licensing examinations was significantly higher among those closest to the examination (p = 0.002).

CONCLUSIONS

The adverse impact of the pandemic on neurosurgical training needs to be addressed. While ensuring the safety of the residents, institutes and neurosurgical societies/bodies must take it upon themselves to ensure that their residents continue to learn and develop neurosurgical skills during these difficult times.

Medicine and surgery residents' perspectives on the impact of COVID-19 on graduate medical education

The COVID-19 crisis has had an unprecedented impact on resident education and well-being: social distancing guidelines have limited patient volumes and forced virtual learning, while personal protective equipment (PPE) shortages, school/daycare closures, and visa restrictions have served as additional stressors. Our study aimed to analyze the effects of COVID-19 crisis-related stressors on residents' professional and personal lives. In April 2020, we administered a survey to residents at a large academic hospital system in order to assess the impact of the pandemic on residency training after >6 weeks of a modified schedule. The primary outcome was to determine which factors or resident characteristics were related to stress during the pandemic. Our secondary goals were to examine which resident characteristics were related to survey responses. Data were analyzed with regression analyses. Ninety-six of 205 residents completed the survey (47% response rate). For our primary outcome, anxiety about PPE (P < 0.001), female gender (P = 0.03), and the interaction between female gender and anxiety about PPE (P = 0.04) were significantly related to increased stress during the COVID-19 pandemic. Secondary analyses suggested that medicine residents were more comfortable than surgical residents using telemedicine (P > 0.001). Additionally, compared to juniors, seniors believed that the pandemic was more disruptive, modified schedules were effective, and virtual meetings were less effective while virtual lectures were more effective (all P ≤ 0.05) Furthermore, the pandemic experience has allowed seniors in particular to feel more confident to lead in future health crises (P ≤ 0.05). Medicine and surgery residency programs should be cognizant of and closely monitor the effects of COVID-19 crisis-related factors on residents' stress and anxiety levels. Transparent communication, telemedicine, online lectures/meetings, procedure simulations, advocacy groups, and wellness resources may help to mitigate some of the challenges posed by the pandemic.

Tips for pandemic response planning for Internal Medicine training programs

This article was migrated. The article was marked as recommended. The current Coronavirus Disease 2019 (COVID-19) pandemic has strained hospital systems and training programs across the world. As capacity issues mount and trainees are called upon to provide frontline medical care, programs and institutions have had to rapidly evolve to redefine the trainee experience. To that end, there is a paucity of literature regarding how healthcare training programs should operate during a global pandemic. Here, we aim to describe twelve evidence-based recommendations for coordinating a cohesive, systematic approach to pandemic response planning for Internal Medicine residency training programs. These tips encompass inpatient and outpatient practices, provider safety, resuscitation, virtual education programming and resident wellbeing. Though many of these considerations or recommendations were not described during the COVID-19 pandemic, these tips have been described previously in the literature, are applicable to the current pandemic and could be easily extrapolated to future crises.

Coordinated responses of academic medical centres to pandemics: Sustaining medical education during COVID-19

Background: The Corona Virus Disease-19 (COVID-19) has been declared a pandemic by the World Health Organization (WHO). We state the consolidated and systematic approach for academic medical centres in response to the evolving pandemic outbreaks for sustaining medical education.Discussion: Academic medical centres need to establish a 'COVID-19 response team' in order to make time-sensitive decisions while managing pandemic threats. Major themes of medical education management include leveraging on remote or decentralised modes of medical education delivery, maintaining the integrity of formative and summative assessments while restructuring patient-contact components, and developing action plans for maintenance of essential activities based on pandemic risk alert levels. These core principles must be applied seamlessly across the various fraternities of academic centres: undergraduate education, residency training, continuous professional development and research. Key decisions from the pandemic response teams that help to minimise major disruptions in medical education and to control disease transmissions include: minimising inter-cluster cross contaminations and plans for segregation within and among cohorts; reshuffling academic calendars; postponing or restructuring assessments.Conclusions: While minimising the transmission of the pandemic outbreak within the healthcare establishments is paramount, medical education and research activities cannot come to a standstill each time there is a threat of one.

Optimizing resilience and wellbeing for healthcare professions trainees and healthcare professionals during public health crises - Practical tips for an 'integrative resilience' approach

Public health crises, including pandemics, are associated with significant health risk and concomitant stress, fear, decreased sense of control, and uncertainty. Deleterious impact on both physical and mental health can result, including for healthcare professionals and health professions trainees. Changes in governmental policies and hospital protocols for healthcare professionals as well as disruption of educational formats and requirements for trainees can ensue. Difficult anxiety-provoking realities of public health crises including pandemics which involve caring for many seriously ill patients, moral distress including difficult care decisions, personal health risk, and/or potential risk to one's family can take a dire toll on the mental health of healthcare professionals at all stages of the professional lifecycle. Educational disruptions can create significant anxiety for trainees about completing requirements and achieving competencies. Within this, coping skills may be challenged and strengths may be elucidated as well. Such crises create an imperative for medical educators to support trainees' wellbeing through adaptive flexibility for curriculum innovation and culturally sensitive resilience and wellbeing interventions. Strategies ('tips') to optimize resilience and wellbeing with an integrative resilience approach of individual, learning environment, and organization/systems factors are presented.

Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic

The COVID-19 pandemic has disrupted healthcare systems around the world, impacting how we deliver medical education. The normal day-to-day routines have been altered for a number of reasons, including changes to scheduled training rotations, physical distancing requirements, trainee redeployment, and heightened level of concern. Medical educators will likely need to adapt their programs to maximize learning, maintain effective care delivery, and ensure competent graduates. Along with a continued focus on learner/faculty wellness, medical educators will have to optimize existing training experiences, adapt those that are no longer viable, employ new technologies, and be flexible when assessing competencies. These practical tips offer guidance on how to adapt medical education programs within the constraints of the pandemic landscape, stressing the need for communication, innovation, collaboration, flexibility, and planning within the era of competency-based medical education.

"The storm has arrived": the impact of SARS-CoV-2 on medical students

In a few weeks, the global community has witnessed, and for some of us experienced first-hand, the human costs of the COVID-19 pandemic. There is incredible variability in how countries are choosing to thwart the disease's outbreak, sparking intense discussions around what it means to teach and learn in the era of COVID-19, and more specifically, the role medical students play in the midst of the pandemic. A multi-national and multi-institutional group made up of a dedicated medical student from Austria, passionate clinicians and educators from Switzerland, and a PhD scientist involved in Medical Education from Canada, have assembled to summarize the ingenious ways medical students around the world are contributing to emergency efforts. They argue that such efforts change COVID-19 from a "disruption" to medical students learning to something more tangible, more important, allowing students to become stakeholders in the expansion and delivery of healthcare.

Continuing medical education during a pandemic: an academic institution's experience

The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution's experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year's end.

The Challenges of “Continuing Medical Education” in a Pandemic Era

Closure of medical schools or the barring of “live patient” contact during an epidemic or pandemic is potentially disruptive to medical education. During the SARS epidemic, the use of web-based learning, role play, video vignettes and both live and mannequin-based simulated patients minimised disruptions to medical education. This article examines the pedagogical innovations that allow clinical teaching to continue without medical students examining actual patients, and proposes a contingency plan in the event of future outbreaks that may necessitate similar containment measures. Key words: Infection control, Medical education, Pandemic, Strategies

Evaluating "ED STAT!": a novel and effective faculty development program to improve emergency department teaching

OBJECTIVES

Effective clinical teaching in emergency departments (EDs) presents unique challenges. No validated approaches to enhancing ED teaching have been reported. The authors evaluated the effectiveness of a novel one-day evidence-based, skills-oriented faculty development course tailored to ED teachers (ED STAT!).

METHODS

The authors invited all inaugural course registrants to participate in this program evaluation study. The authors assessed participants' knowledge change and perceived change in teaching behavior using a multiple-choice and short-answer question examination, a teaching behaviors questionnaire, and a survey for satisfaction. Data were gathered before, immediately after, and one month after the course. Mean scores were compared using the Wilcoxon signed rank test, and qualitative results were analyzed via a grounded theory approach.

RESULTS

Thirty-one individuals from a variety of academic and community EDs completed the May 2005 course; 28 participated in the pre-evaluation and postevaluation, and 22 participated in the one-month postevaluation. Multiple-choice scores increased from pre-evaluation to one-month postcourse by 15.1% (p < 0.001, effect size large: d = 1.53). Short-answer scores increased by 17.2% (p = 0.001, effect size large: d = 0.90). After one month, 55% of participants reported an increased amount of teaching, 86% perceived this teaching to be of a greater quality, and 82% had shared new strategies with colleagues. The course would be recommended to a colleague by 96.3% of respondents.

CONCLUSIONS

ED STAT! improves participants' knowledge about ED-specific teaching strategies, and this improvement is maintained at one month. Participants reported high satisfaction and a positive effect on teaching behavior.