Impact of COVID-19 on Medical Education: Perspectives From Students

Understanding Barriers and Motivations: Enhancing Support for UK Medical Students' Participation in Foreign Medical Electives

Purpose

This study aimed to explore UK medical students' preferences, motivations, and barriers regarding international electives and to evaluate the impact of an online planning event designed to address these. Additionally, this study examined trends in UK medical students completing foreign electives over the past decade.

Methods

Freedom of Information requests were sent to 46 UK medical universities requesting data on the number of students undertaking foreign electives over the past 10 years. Attendees at a peer-led event regarding electives completed a survey on their motivations and challenges in doing a foreign elective, followed by a post-event feedback form. Results were analysed using the Python Scipy package.

Results

Of the 103 respondents, 76.7% preferred to undertake an international elective, while 21.36% preferred a combination of the UK and international locations. Non-academic reasons were significant motivators for undertaking a foreign elective, while safety and financial concerns were major deterrents. The online event received positive feedback, with participants appreciating the utility of the event in aiding their understanding of the elective planning process.

Conclusion

UK medical students show a strong preference for international electives, despite significant barriers, particularly related to safety and finances. The peer-led event proved to be effective in supporting students' planning of electives.

Balancing tradition and innovation: rethinking the dichotomy in anatomy teaching

Medical education has undergone a significant reform in response to evolving health care demands, technological advancements, and emerging research in biomedical and education sciences. The teaching methods in anatomy, a core component of medical education, have notably changed, with traditional cadaveric dissection being increasingly replaced by digital and hybrid alternatives. Despite research indicating no significant difference in short-term knowledge retention between students who engaged in cadaveric dissection and those engaging in alternative methods, dissection uniquely fosters professionalism, empathy, and ethical awareness - traits essential for holistic medical education. This review critically examines the dichotomy between traditional and innovative teaching methods in anatomy education, questioning the assumption that traditional methods hinder progress in modern health care. The findings suggest that changes in medical education are primarily influenced by organizational issues, which frequently results in an incomplete implementation of innovative teaching approaches. The inconsistent application of innovative teaching methods makes it difficult to assess their effectiveness and compare them with traditional methods. Reliable data on their long-term impact can only be generated by randomized controlled trials and longitudinal studies. In the meantime, we need to ensure that current medical students receive high-quality education by incorporating best practices from diverse teaching methods based on valuable insights from experienced educators and current students' learning preferences.

Metaverse technologies in acute care medical education: A scoping review

Background

The concept of the metaverse is a virtual world that immerses users, allowing them to interact with the digital environment. Due to metaverse's utility in collaborative and immersive simulation, it can be advantageous for medical education in high-stakes care settings such as emergency, critical, and acute care. Consequently, there has been a growth in educational metaverse use, which has yet to be characterized alongside other simulation modalities literature. This scoping review aims to provide a comprehensive overview of all research describing metaverse use in education for emergency, critical, and acute care.

Methods

We used Arksey and O'Malley's framework with the Levac et al. modifications to conduct a scoping review by searching these five databases (MEDLINE, EMBASE, ERIC, Web of Science, and Education Source). The framework comprises six steps: (1) identifying the research question; (2) identifying relevant literature; (3) study selection; (4) data extraction; (5) collating, summarizing, and reporting data; and (6) consultation with key informants. Relevant themes and trends were extracted and mapped for reporting.

Results

The search yielded 8175 citations, which ultimately led to data extraction from 65 articles. Studies evaluated metaverse programs for the learning and assessment of both technical skills (management of code blue, sepsis, stroke, etc.) and nontechnical skills (e.g., interprofessional collaboration, communication, critical decision making). Barriers to metaverse implementation include technical challenges and difficulty evaluating educational effectiveness.

Conclusions

The results of this scoping review highlight the current applications of metaverse as an educational tool, its identified strengths and weaknesses, and further comparison between metaverse and other educational modalities such as high-fidelity simulation. This work provides direction for future primary and secondary research that can aid educational programmers and curriculum planners in maximizing metaverse potential in emergency, critical, and acute medical education.

Resilience in Medical Education: Examining the Effects of the COVID-19 Pandemic on Pre-clerkship Curriculum Outcomes and Learner Perceptions at the University of Hawai'i John A. Burns School of Medicine

The transition to virtual learning formats during the COVID-19 pandemic necessitated substantial curricular adjustments to the University of Hawai'i John A. Burns School of Medicine. This study compares student satisfaction and academic performance between the pre-pandemic (up through March 25, 2020) and pandemic (after March 25, 2020) periods. Standard end of course surveys for first year (M1) and second year (M2) courses and exam scores were compared between the pre-pandemic and pandemic groups. The median exam scores for problem-based learning generally increased for M1 and M2 courses during the pandemic, whereas Anatomy scores showed variability with some declining and some remaining stable or inclining. End-course evaluations indicated a significant decrease in student-perceived effectiveness for PBL, Lecture and Anatomy during the initial pandemic period. However, survey ratings for the learning environment improved in later courses, suggesting adaptation over time. Notably, Anatomy exam scores and course ratings improved significantly later in the pandemic which may be attributed to the development of virtual resources and early introduction of in-person sessions. This study provides insight into the dynamic effects of the pandemic on medical education, enhancing understanding of student experiences and academic outcomes during this challenging time. This study underlines adaptations in the curriculum that were effective, highlighting the resilience of the curriculum and students in maintaining quality education during the pandemic.

Impact of online expert interview-based research training on medical trainees' knowledge and confidence: a mixed-methods design

BACKGROUND

Research training is important for medical trainees, because it improves their critical thinking, problem-solving, and the application of scientific principles to clinical practice. The COVID-19 Pandemic, which limited trainees' access to hospitals, had also disrupted traditional research training. The International Emergency Medicine Education Project introduced the online Fundamentals of Research in Medicine course to support trainees. The course was designed as an expert interview. This format intended to foster a relaxed learning environment and promote experience sharing rather than transferring only factual information about research. This study assesses the course's effect on participants' perceived knowledge and confidence in research concepts.

METHODS

A prospective observational mixed-methods research was conducted through the International Emergency Medicine Education Project's online platform. Pre- and post-course surveys measured participants' perceived knowledge and confidence levels across 16 research-related topics. Quantitative survey data were analysed using the Wilcoxon Signed-Rank test, and qualitative feedback was evaluated to explore participants' experiences.

RESULTS

A total of 272 participants enrolled in the course. 168 participants started, and 52 (19.2%) completed the pre- and post-surveys and the course completion exam. Medical students and interns, as well as participants from Africa and Asia, comprised the majority. Most participants were from India. 78.8% of the participants were from low-income or lower-middle-income countries. Participants' perceived knowledge and confidence significantly improved after completing the course, p < 0.001, with large effect sizes (-0.902 and - 0.819, respectively). Qualitative feedback highlighted the course's clarity, simplicity, and effectiveness of the informal interview format. Some participants suggested adding more visual aids and detailed explanations for complex topics.

CONCLUSIONS

The online course, designed as an interview format, effectively enhanced participants' perceived research knowledge and confidence. Future studies should incorporate objective measures of research skill acquisition from online courses and evaluate the long-term impact on participants' academic and professional development.

Perspectives of work readiness among Australian health students trained during the COVID-19 pandemic

BACKGROUND

To explore perspectives of work readiness, including readiness to work rurally, among health students trained in Australia during the COVID-19 pandemic.

METHODS

Participants were allied health, medicine, and nursing students in the later years of their degree (third, fourth or final year of an undergraduate entry to practice degree, or second year of postgraduate entry to practice degree), where training is clinically immersive. These students had completed a University Department of Rural Health facilitated rural and remote placement between January 2021 and October 2022. They participated in a cross-sectional online survey (n = 426), comprising Likert-scale questions. Interested survey respondents participated in a semi-structured interview (n = 34). Multiple logistic regression was conducted to examine the predictors of work readiness within the survey, and interview data was analysed via reflexive thematic analysis.

RESULTS

Among survey respondents, 69.7% felt they would be ready to be a health practitioner when the time came to graduate and 71.8% felt clinically prepared to work in a rural location. Concerns about having developed enough clinical skills on placements to competently practice on graduation and being able to continue studying their course during the pandemic were both predictive of work readiness and feeling clinically prepared to work rurally. Four themes reflecting factors impacting work readiness were developed from interview data: (1) 'I'd estimate probably a 20-30% reduction in face-to-face handling practice over the course of all of my placements' encompassed student concerns regarding the collective impact of cancelled placements and lower patient attendance at healthcare facilities on clinical skill development; (2) 'Two and a half years of sitting behind a computer' related to student experiences of superficial learning and cohort disconnectedness due to online course delivery and loss of on campus simulations; (3) 'I'll still need like a lot of support in my grad year' related to students recognising the need for support and supervision post-qualifying to bridge the gaps in their learning; and (4) 'We are the COVID nurses' encompassed student recognition of skills gained including communication skills, competence with technology and telehealth, knowledge of infection control, and work readiness skills (e.g. adaptability and resilience) as a result of training during the global pandemic.

CONCLUSIONS

Universities can support work readiness during pandemic circumstances by fostering clinical skills development through continuation of quality placement experiences and face-to-face curriculum delivery. Although health graduates trained during the pandemic are likely to have a range of additional work ready skills, health services will need to proactively support their transition into the workforce in the coming years.

The Impact of the COVID-19 Pandemic on Geographic Placement of Applicants to General Surgery Residency Programs

OBJECTIVE

COVID-19 greatly influenced medical education and the residency match. As new guidelines were established to promote safety, travel was restricted, visiting rotations discontinued, and residency interviews turned virtual. The purpose of this study is to assess the geographic trends in distribution of successfully matched General Surgery applicants prior to and after the implementation of pandemic guidelines, and what we can learn from them as we move forward.

DESIGN

This was a retrospective review of 129 Accreditation Council for Graduate Medical Education (ACGME) accredited, academic General Surgery Residency Programs across 46 states and the District of Columbia. Categorically matched residents' medical schools (i.e., home institutions), medical school states, and medical school regions as defined per the Association of American Medical Colleges (AAMC), were compared to the same geographic datapoints as their residency program. Preliminary residents were excluded. Residents in the 2018, 2019, and 2020 cycles were sub-categorized into the "pre-COVID" group and residents in the 2021 and 2022 applications cycles were sub-categorized into the "post-COVID" group. The percentages of residents who matched at their home institution, in-state, and in-region were examined.

SETTING

Multiple ACGME-accredited, university-affiliated General Surgery Residency Programs across the United States of America.

PARTICIPANTS

A total of 4033 categorical General Surgery residents were included.

RESULTS

Of 4033 categorical residents who matched between 2018 and 2022, 56.1% (n = 2,263) were in the pre-COVID group and 43.9% (n = 1770) were in the post-COVID group. In the pre-COVID group 14.4% (n = 325) of residents remained in-home (IH), 24.4% (n = 553) in-state (IS), and 37.0% (n = 837) in- region (IR), compared to 18.8% IH (n = 333), 27.8% IS (n = 492), and 39.9% IR (n = 706) in the post-COVID group, respectively. Significant increases for IH and IS resident matching at 4.5% and 3.4%, respectively, were noted in the post-COVID period (p < 0.05).

CONCLUSION

The COVID-19 pandemic, and the ensuing changes adopted to promote safety, significantly impacted medical student opportunities and the General Surgery residency application process. General Surgery match data over the last 5 years reveals a statistically significant increase in the percentage of applicants matching at in-home and in-state institutions after the pandemic.

General surgery educational resources for Jordanian medical students

Background

To outline the resources deemed most beneficial to medical students during their general surgery clerkship, as well as to examine their link to students' general surgery scores and the usage of artificial intelligence in general surgery study.

Methods

A retrospective survey of Jordanian medical students from six universities was done between March and June 2023 using a 7-item questionnaire covering questions concerning general surgery study methods and scores. Descriptive statistics were used to evaluate demographic data. Chi-square is used to evaluate categorical data, with a P value <0.05 deemed significant.

Results

The average age of respondents was 23.3 years, and 54.2 % of the respondents were females, 47.8 % were from Mutah University. Most students (48.2 %) relied on tutor lectures. Students who studied through instructor lectures had the highest grades (9 % excellent, 17 % very good), followed by students who studied using surgery textbooks (6.8 % and 14.6 %, respectively). The relationship between the study method and academic achievement was statistically significant (P < 0.05).

Conclusions

Traditional face-to-face learning with instructor lectures and surgery textbooks is still the most efficient approach to attain the greatest scores. Medical students are still underutilizing artificial intelligence.

The attitudes of Syrian Private University Medical Students towards E-Learning during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

The COVID-19 pandemic has had a significant impact on the education sector, leading to the closure of colleges and schools and disrupting the learning process for an uncertain duration. In response, electronic learning has emerged as a suitable method for continuing the educational process during the lockdown. This study aimed to assess the attitudes, practices, and barriers to e-learning among medical students at Syrian Private University.

METHODS

A cross-sectional survey study was conducted at the Faculty of Medicine of the Syrian Private University (SPU) in Damascus, Syria. The study used a convenience sampling approach and was carried out from June 2021 to January 2022. Data were collected using a self-administered questionnaire structured into two sections. The first section included 12 sociodemographic questions. The second section assessed students' attitudes, practices, and barriers related to e-learning, and consisted of 14 questions on attitudes, 11 questions on practices, and 9 questions on barriers.

RESULTS

Of the 519 participating students, over half (55.1%) exhibited a negative attitude towards e-learning. However, more than 60% reported engaging in e-learning activities such as downloading educational content and participating in virtual study groups. The main barriers identified were unstable internet connections (92.7%) and challenges in communication with educators (82.7%). Bionomical logistic regression revealed that negative attitudes were predicted by housing status, academic year, health status, lack of engagement with colleagues in e-learning practices, and the reported barriers of difficulty adjusting learning style, lack of technical skills, poor communication with educators, limited access to devices, and limited space conducive for studying (P < 0.05).

CONCLUSION

While medical students at SPU were actively engaged in e-learning, over half held negative attitudes. These negative attitudes were associated with the various barriers that students reported. The findings can inform stakeholders in our institution and other Syrian universities about the challenges of implementing e-learning in medical colleges.

Shifting tides in cardiology fellowship: an analysis of trends and the virtual interview revolution, 2017 to 2021

Introduction

This investigation aimed to delineate the trends in cardiology fellowship applications and match rates between 2017 and 2021, with a particular focus on the effect of the COVID-19 pandemic.

Methods

Utilizing data from the National Resident Matching Program and the American Board of Internal Medicine covering 6693 applicants, we conducted chi-square tests to assess match rate variations. IBM SPSS version 23 was used for statistical analysis.

Results

The study noted an increase in matched US MD applicants (from 482 in 2017 to 549 in 2021, P = 0.0001) but a decrease in their match rate (from 89.8% to 83.1%). Matched US DO applicants rose significantly from 60 in 2017 to 103 in 2021 (P = 0.0001). A decline in first-choice matches and an increase in matches beyond the third choice were observed after the shift to virtual interviews.

Conclusions

The study's analysis of cardiology fellowship trends from 2017 to 2021 underscores the escalating competitiveness in this field and signals a critical need for further research.

Effect of the COVID-19 Pandemic on Medical Student Performance and Evaluation Scores

In March 2020, the University of Hawaii John A. Burns School of Medicine suspended in person clinical teaching due to the SARS-CoV-2 (COVID) pandemic. During this period, virtual cases, telehealth participation, and online cases were incorporated into medical education. We have examined the effects of educational outcomes of third and fourth year students throughout clerkship performance, national standardized test scores, and our local fourth year OSCE examination. We found that USMLE step 2 scores were higher in the COVID-affected group. Patient logs in the COVID-affected group were lower for internal medicine, family medicine, OBGYN, and psychiatry clerkships. Clerkship performance grades in the COVID-affected group were lower for OBGYN and higher for surgery and psychiatry, but not different in other clerkships. USNBME subject specific examination scores in the COVID-affected group were higher for internal medicine, surgery, family medicine and psychiatry, but not different in all other specialties. For the fourth year OSCE, students in the COVID-affected group performed better on note taking and worse on physical examination. Future investigations will be needed to explore how our COVID-affected medical students perform in residency and beyond.

Do we really apply evidence-based-recommendations to spine surgery? Results of an international survey

OBJECTIVE

This international survey investigated Evidence-Based Medicine (EBM) in spine surgery by measuring its acceptance among spine surgeons. It assessed their understanding of EBM and how they apply it in practice by analyzing responses to various clinical scenarios..

MATERIALS AND METHODS

Following the CHERRIES guidelines, an e-survey was distributed to multiple social media forums for neurosurgeons and orthopedic surgeons on Facebook, LinkedIn, and Telegram and circulated further through email via the authors' network. Three hundred participants from Africa, Asia, Europe, North America, and Oceania completed the survey.

RESULTS

Our study revealed that 67.7% (n = 203) of respondents used EBM in their practice, and 97.3% (n = 292) believed training in research methodology and EBM was necessary for the practice of spine surgery. Despite this endorsement of using EBM in spine surgery, we observed varied responses to how EBM is applied in practice based on example scenarios. The responders who had additional training tended to obey EBM guidelines more than those who had no additional training. Most surgeons responded as always or sometimes prescribing methylprednisolone to patients with acute spinal cord injury. Other significant differences were identified between geographical regions, training, practice settings, and other factors.

CONCLUSIONS

Most respondents used EBM in practice and believed training in research methodology and EBM is necessary for spine surgery; however, there were significant variations on how to use them per case. Thus, the appropriate application of EBM in clinical settings for spinal surgery must be further studied.

Integration of Virtual and Traditional Medical Education: Scholarship Pivots from the COVID-19 Pandemic

Background

The coronavirus disease 2019 (COVID-19) pandemic required an unprecedented transformation of medical education, shifting from traditional, in-person learning to distanced, online learning. This study aimed to review changes to medical education and describe the advantages and disadvantages of virtual medical education experienced by medical students during the pandemic.

Methods

An online survey study was conducted at two medical schools, University of Michigan Medical School in the United States and Koc University School of Medicine in Turkey. Medical students completed questionnaires regarding their educational experience before and during the pandemic. Survey instruments were designed to assess differences in the educational curriculum, study methods, clinical skills self-evaluations, perceptions of the quality of in-person and online learning, and overall satisfaction.

Results

A total of 184 medical students completed the survey. There was an increase in the use of online study tools since the pandemic. There was no statistically significant difference in self-reported assessments of clinical preparedness and overall clinical competence during surgical clerkship. The percentage of students interested in pursuing a career in surgery has nearly doubled from 34% to 63%. A majority of students (83%) believed that the time available for self-study and research increased during the pandemic. Fifty-two percent of students believed that online education is less efficacious than in-person education, but 86% of students still preferred a blended approach.

Conclusions

Medical schools have continued to update their curricula following the COVID-19 pandemic. This study illustrates the transformations in medical education to ensure that the most effective and suitable teaching is delivered.

Graduating Medical Students' Perceptions of the COVID-19 Pandemic's Impact on Their Medical School Experiences and Preparation for Careers as Physicians: A National Study

PURPOSE

The COVID-19 pandemic resulted in unprecedented changes to the medical education learning environment. The graduating class of 2021 was particularly affected. To better understand how students were affected, the authors explored positive and negative experiences described by graduating U.S. medical students.

METHOD

Using the conceptual framework of affordances, the authors examined narrative responses to 2 new open-ended questions on the Association of American Medical Colleges 2021 Graduation Questionnaire in which graduating students described the pandemic's positive and negative effects on their medical school experiences and career preparation. Conventional content analysis was used to identify affordances and themes in responses.

RESULTS

Of 16,611 Graduation Questionnaire respondents, 8,926 (54%) provided narrative responses. Of these 8,926 respondents, responses from 2,408 students (27%) were analyzed. Students described positive and negative perceptions of affordances, centering around virtual learning, social connection, and transition to residency. Fewer in-person and increased virtual clinical rotations offered students flexible scheduling, allowing them greater opportunity to explore academic and professional interests. Additionally, students' sense of isolation from their medical school was alleviated when schools exercised intentional open communication and student involvement in decision making. Although many described a diminished sense of preparedness for residency due to limited access to in-person clinical experiences and to assessing residencies largely through virtual away rotations and interviews, the sense of community, adaptability, and resiliency gained through varied activities reinforced students' professional identity and commitment to medicine during a time of much uncertainty.

CONCLUSIONS

This national exploration of students' pandemic experiences highlights what students value as fundamental elements of medical education and student support and describes how innovation can improve long-standing practices. These findings, guided by students' insights, can help inform the work of educational leaders as they consider which innovations should remain to continue enhancing student learning, engagement, and well-being.

Using ChatGPT in Psychiatry to Design Script Concordance Tests in Undergraduate Medical Education: Mixed Methods Study

Background

Undergraduate medical studies represent a wide range of learning opportunities served in the form of various teaching-learning modalities for medical learners. A clinical scenario is frequently used as a modality, followed by multiple-choice and open-ended questions among other learning and teaching methods. As such, script concordance tests (SCTs) can be used to promote a higher level of clinical reasoning. Recent technological developments have made generative artificial intelligence (AI)-based systems such as ChatGPT (OpenAI) available to assist clinician-educators in creating instructional materials.

Objective

The main objective of this project is to explore how SCTs generated by ChatGPT compared to SCTs produced by clinical experts on 3 major elements: the scenario (stem), clinical questions, and expert opinion.

Methods

This mixed method study evaluated 3 ChatGPT-generated SCTs with 3 expert-created SCTs using a predefined framework. Clinician-educators as well as resident doctors in psychiatry involved in undergraduate medical education in Quebec, Canada, evaluated via a web-based survey the 6 SCTs on 3 criteria: the scenario, clinical questions, and expert opinion. They were also asked to describe the strengths and weaknesses of the SCTs.

Results

A total of 102 respondents assessed the SCTs. There were no significant distinctions between the 2 types of SCTs concerning the scenario (P=.84), clinical questions (P=.99), and expert opinion (P=.07), as interpretated by the respondents. Indeed, respondents struggled to differentiate between ChatGPT- and expert-generated SCTs. ChatGPT showcased promise in expediting SCT design, aligning well with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, albeit with a tendency toward caricatured scenarios and simplistic content.

Conclusions

This study is the first to concentrate on the design of SCTs supported by AI in a period where medicine is changing swiftly and where technologies generated from AI are expanding much faster. This study suggests that ChatGPT can be a valuable tool in creating educational materials, and further validation is essential to ensure educational efficacy and accuracy.

Online versus in-person surgical near-peer teaching in undergraduate medical education during the COVID-19 pandemic: A mixed-methods study

Background and Aims

The coronavirus disease 2019 (COVID-19) pandemic stimulated a paradigm shift in medical and surgical education from in-person teaching to online teaching. It is unclear whether an in-person or online approach to surgical teaching for medical students is superior. We aim to compare the outcomes of in-person versus online surgical teaching in generating interest in and improving knowledge of surgery in medical students. We also aim the quantify the impact of a peer-run surgical teaching course.

Methods

A six-session course was developed by medical students and covered various introductory surgical topics. The first iteration was offered online to 70 UK medical students in March 2021, and the second iteration was in-person for 20 students in November 2021. Objective and subjective knowledge was assessed through questionnaires before and after each session, and also for the entire course. Data were analyzed from this mixed-methods study to compare the impact of online versus in-person teaching on surgical knowledge and engagement.

Results

Students in both iterations showed significant improvement of 33%-282% across the six sessions in knowledge and confidence after completing the course (p < 0.001). There was no significant difference in the level of objective knowledge, enjoyment, or organization of the course between online and in-person groups, although the in-person course was rated as more engaging (mean Likert score 9.1 vs. 9.7, p = 0.033).

Discussion

Similar objective and subjective surgical teaching outcomes were achieved in both iterations, including in "hands-on" topics such as suturing, gowning, and gloving. Students who completed the online course did not have any lower knowledge or confidence in their surgical skills; however, the in-person course was reported to be more engaging. Surgical teaching online and in-person may be similarly effective and can be delivered according to what is most convenient for the circumstances, such as in COVID-19.

Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment

Problem: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. Intervention: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. Context: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. Impact: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners' awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. Lessons Learned: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.

No knowledge gap in human physiology after remote teaching for second year medical students throughout the Covid-19 pandemic

The COVID-19 pandemic had a disruptive effect on higher education. A critical question is whether these changes affected students' learning outcomes. Knowledge gaps have consequences for future learning and may-in health professionals' education-also pose a threat to patient safety. Current research has shortcomings and does not allow for clear-cut interpretation. Our context is instruction in human physiology in an undergraduate medical program from high stakes end of term examinations. The sequence of imposed measures to slow the COVID-19 pandemic created a natural experiment, allowing for comparisons in performance during in-person versus remote instruction.In a two-factorial design, mode of instruction (in-person vs. remote) and mode of assessment (in-person vs. remote) were analyzed using both basic (non-parametric statistics, T-tests) and advanced statistical methods (linear mixed-effects model; resampling techniques). Test results from a total of N = 1095 s-year medical students were included in the study.We did not find empirical evidence of knowledge gaps; rather, students received comparable or higher scores during remote teaching. We interpret these findings as empirical evidence that both students and teachers adapted to pandemic disruption in a way that did not lead to knowledge gaps.We conclude that highly motivated students had no reduction in academic achievement. Moreover, we have developed an accessible digital exam system for secure, fair, and effective assessments which is sufficiently defensible for making pass/fail decisions.

Underrepresentation of African Americans in Plastic Surgery: Examining Demographics, Specialty Factors, and Medical School Experiences

BACKGROUND

Racial representation among medical trainees translates into physicians that are able to communicate with diverse patient populations and are perceptive to health disparities. This is important within plastic surgery where an optimal physicianpatient relationship is essential to health outcomes.

OBJECTIVE

The purpose of this study is to address underrepresentation of African Americans (AA) in plastic surgery through improving understanding of factors that may contribute to AA medical student interest in plastic surgery.

DESIGN

This was a voluntary, cross-sectional survey. An online survey was designed to collect information on demographics, specialty factor importance, medical school experiences, and plastic surgery interest among medical students. The survey was distributed to medical students within three national medical organizations between August 2018 and February 2019. The following groups of respondents were statistically COMPARED: AAs interested vs. AAs not interested in plastic surgery and AA vs. Caucasian medical students both interested in plastic surgery.

SETTING

Online survey for medical students in the United States.

PARTICIPANTS

All 428 participants were medical students that belonged to at least 1 of the 3 national medical organizations between August 2018 and February 2019.

RESULTS

The survey was completed by 428 participants of which 142 were excluded for incomplete surveys, leaving 286 (66.8%) participants to be included in the study. Among AA medical students, 128 (75.3%) were not interested in Plastic Surgery and 42 (24.7%) were interested. The 2 groups were similar demographically but differed significantly across multiple specialty factors and medical school experiences (p < 0.05). When compared to interested Caucasian medical students (n = 30), interested AA medical students differed significantly in demographics, specialty factors, and medical school experiences (p < 0.05).

CONCLUSIONS

This study supports the implementation of medical school interventions emphasizing specialty factors and medical school experiences unique to AA medical students interested in plastic surgery to promote their application into the specialty.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

Medical Students' Perceptions Towards Online Teaching During the Covid-19 Pandemic: A Cross-Sectional Study from Saudi Arabia

Background

The Covid-19 has made a huge impact on higher education. Online teaching and learning became essential to deliver educational activities in all areas including medical education. In this study, we aimed to investigate medical students' perceptions on the role of online teaching and learning in facilitating medical education.

Material and Methods

A cross-sectional study using a self-administered online questionnaire was conducted. Students eligible were medical students across all years at Imam Abdulrahman Bin Faisal University, Saudi Arabia. Perceptions analysis was conducted using SPSS software.

Results

A total of 563 students participated in the study (prominent category female 64%, n = 361). There was a significant increase in the number of hours devoted to online learning during the pandemic. Live lectures/tutorials platform via zoom showed the highest rate of interaction compared to pre-recorded lectures and learning materials uploaded on blackboard. 50% of the students disagreed that online teaching is as effective as face-to-face teaching. The greatest perceived enjoyable aspect included the online accessibility of materials. Whereas the most frequent perceived barrier to online learning included internet connection. 17% of students reflected a poor understanding of scientific materials through online PBL. More than 50% of students revealed that online theoretical lectures are as good as classroom or better. Whereas the majority (70%) were unable to learn clinical skills online. The results indicated high impact on students' physical activities (80%). Impacts were higher on pre-clinical students' health and social life than on clinical students.

Conclusion

Our findings reported that during emergency situations due to the pandemic, online teaching enables the continuity of medical education and provides adequate efficiency. The use of live online platforms showed high level of interaction. However, some barriers need to be addressed especially at the clinical skills development level to maximize the benefit of online teaching and learning.

Underrepresented in medicine students' perspectives on impactful medical education

BACKGROUND

Exploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture.

METHODS

We conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, "What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?" We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation.

RESULTS

Of 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a 'just' healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health.

CONCLUSION

Our learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students.

Frequency of Student Resource Use and Academic Performance in Preclerkship Education: A Survey Study

Medical students have unprecedented access to a large variety of learning resources, but patterns of resource use, differences in use across education cohorts, and the relationship between resource use and academic performance are unclear. Therefore, the purpose of the current study was to evaluate student resource use and its relationship to academic performance during preclerkship years. First-year and second-year medical students completed a 10-question electronic survey that assessed likelihood of using outside resources recommended by others, reasons for using outside resources, frequency of use of resources, and use of outside resources for specific disciplines. Outcomes were compared between the 2 cohorts of students. First-year students were more likely to use instructor-produced resources and self-generated study resources, and second-year students were more likely to use board review resources. Although differences were found between cohorts for frequency of use of certain resources, correlations between resource use and academic performance were modest. Overall, our results indicated that student use of study resources changed between the first and second years of medical school. These results suggest opportunities for medical educators to guide students in the selection and effective use of outside resources as they mature as self-regulated learners. Further, since students seem to extensively use external resources for learning, institutions should consider calibrating their curriculum and teaching methods to this learning style and providing high-quality, accessible resource materials for all students to reduce the potential impact of socioeconomic factors on student performance.

Factors Associated with Anxiety, Depression, and Stress in Peruvian University Students during the COVID-19 Pandemic

During the COVID-19 pandemic, university students have adopted measures that completely transformed their educational environment, and this has generated an increase in psychological stress. The present study aimed to identify the factors associated with anxiety, depression, and stress in students at a university in Peru during the COVID-19 pandemic in 2020. We conducted a cross-sectional analytical study in students in Lima, Peru. The DASS-21 scale was used to measure levels of depression, anxiety, and stress and associate it with socio-educational and COVID-19-related variables using generalized linear models with Poisson distribution, log link, and robust variance. Of 400 students surveyed, 19.2%, 23.2% and 17.2% of students presented depression, anxiety, and stress, respectively. The frequency of depression (PR = 0.91, 95%CI: 0.84-0.99), anxiety (PR = 0.90, 95%CI: 0.83-0.99) and stress (PR = 0.92, 95%CI: 0.86-0.99) was lower in women. The students of the engineering and business faculty presented a higher frequency of anxiety (PR = 1.11, 95%CI: 1.00-1.22). There was a greater frequency of presenting anxiety, depression and stress in students who worked in a different area of health or did not work. Our results suggest the importance of promoting mental health awareness campaigns in university students due to the constant academic load they have.

International medical electives during and after the COVID-19 pandemic - current state and future scenarios: a narrative review

Background

International medical electives are an important and popular component of the academic curriculum in many medical schools and universities worldwide. The purpose of abroad electives is to provide medical students with an opportunity to gain a better understanding of education and healthcare in an international context. The COVID-19 pandemic, however, has substantially changed the international elective landscape. Travel restrictions, closures of international elective programs and the expansion of virtual methods for education caused a widespread disruption to abroad electives. A comprehensive analysis with regard to other consequences for abroad electives, however, has not been done before. Thus, we sought to a) summarize the current transformation of the international medical elective and b) to address potential challenges for post-pandemic international medical electives.

Methods

The methodology employed is a multidisciplinary narrative review of the published and grey literature on international electives during the last two years of the COVID-19 pandemic.

Results

Students worldwide had electives postponed or canceled. Apart from evident immediate pandemic-related consequences (such as the substantial decline in global electives and impaired elective research opportunities for educators), there are other several problems that have received little attention during the last two years. These include challenges in the elective application process, poorly-understood consequences for host institutions, and growing global (ethical) disparities that are likely to increase once elective programs will gradually re-open. There is ample evidence that the post-pandemic elective landscape will be characterized by increasing elective fees, and a more competitive seat-to-applicant ratio. Ethical problems for international electives arising from an unequal global vaccine distribution will pose an additional challenge to students and elective coordinators alike.

Conclusion

The COVID-19 pandemic transformed the international medical elective landscape in an unprecedented way, and future generations of medical students will face a series of additional challenges when applying for global medical electives.

Medical Students' Stress and Uncertainty During the COVID-19 Pandemic

The COVID-19 pandemic triggered extraordinary levels of stress and uncertainty nationwide. In the current study, we use stress and coping theory and uncertainty management theory to examine how medical students coped with the stress and uncertainty associated with the disruption COVID-19 created in their training. Students completed a mixed-methods cross-sectional online survey one week after shifting to online instruction due to COVID-19. The survey included a measure of coping strategies and a series of open-ended questions designed to capture barriers and facilitators of coping and uncertainty management. In total, 360 students from one US medical school completed the survey. Students relied most frequently on coping strategies of distraction, acceptance, planning, positive reframing, and emotional support. However, coping strategies differed significantly by year in training. Personal uncertainty emerged as the most salient form of uncertainty. This uncertainty resulted from the loss of structure and resources, disruption of academic timelines, and, ultimately, disrupted identity as a (future) physician. Students described important barriers and facilitators of coping and uncertainty management. The barriers included constant exposure, inadequate information, rumination, and extreme responses. The facilitators included distraction, avoidance, instrumental support, emotional support, network support, and positive reframing. Overall, our results suggest that medical students experienced significant uncertainty related to their professional skills and identities as future physicians and faced many dilemmas coping with stress and managing uncertainty, mainly related to information and social support.

Mental Health and Wellbeing in Lithuanian Medical Students and Resident Doctors During COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a negative effect on mental health and subjective psychological wellbeing. One of the most affected population is medical students, reporting higher levels of depression, anxiety, sleep difficulties, and overall poorer wellbeing. However, the relationship between depression, anxiety, and sleep difficulties, and subjective psychological wellbeing has not been extensively researched in medical students in the context of COVID-19 pandemic. The aim of this study was to investigate the associations between depression, anxiety, and sleep quality, and subjective psychological wellbeing.

METHODS

In total, 524 medical students and resident doctors (78.6% female, mean age 24 ± 3 years old) participated in an online survey between December 2020 and February 2021. Participants completed the WHO-Five Wellbeing Index Questionnaire, the Pittsburgh Sleep Quality Index questionnaire, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder Assessment-7.

RESULTS

Multivariable logistic regression analysis showed that female participants' worse subjective psychological wellbeing was associated with sleep difficulties [odds ratio (OR) = 2.39, 95% CI = 1.37-4.18, p = 0.002], higher depression (OR = 6.13, 95% CI = 3.46-10.88, p < 0.001), and anxiety symptoms (OR = 2.95, 95% CI = 1.66-5.22, p < 0.001). In male participants, analysis revealed an association between worse subjective psychological wellbeing and higher depression scores (OR = 9.94, 95% CI = 3.29-30.03, p < 0.001).

CONCLUSION

Sex differences are an important factor to consider when evaluating subjective psychological wellbeing. Clinicians should be aware of significant contributors, such as sleep patterns anxiety, and depression, to subjective psychological wellbeing.