Perception from students regarding online synchronous interactive teaching in the clinical year during COVID-19 pandemic.

AIM: The global pandemic of COVID-19 has led to extensive practice of online learning. Our main objective is to compare different online synchronous interactive learning activities to evaluate students' perceptions. Moreover, we also aim to identify factors influencing their perceptions in these classes. METHODS: A cross-sectional, questionnaire-based study focusing on clinical year medical students' perceptions and feedback was conducted between February 2021 -June 2021 at the University of Hong Kong. Online learning activities were divided into bedside teaching, practical skill session, problem-based learning (PBL) or tutorial, and lecture. A questionnaire based on the Dundee Ready Education Environment Measure (DREEM) was distributed to 716 clinical year students to document their perceptions. RESULTS: One hundred responses were received with a response rate of 15.4% (110/716, including 96 from bedside teaching, 67 from practical skill session, 104 from PBL/tutorial, and 101 from lecture). For the mean score of the DREEM-extracted questionnaire, online PBL/tutorial scored the highest (2.72 ± 0.54), while bedside scored the lowest (2.38 ± 0.68, p = 0.001). Meanwhile, there was no significant difference when we compared different school years (p = 0.39), age (p = 0.37), gender (p = 1.00), year of internet experience (<17 vs ≥17 years p = 0.59), or prior online class experience (p = 0.62). When asked about students' preference for online vs face-to-face classes. Students showed higher preferences for online PBL/tutorial (2.06 ± 0.75) and lectures (2.27 ± 0.81). Distraction remains a significant problem across all four learning activities. A multivariate analysis was performed regarding students' reported behavior in comparison with their perception through the DREEM-extracted questionnaire. The results showed that good audio and video quality had a significant and positive correlation with their perception of online bedside teaching, practical skill sessions, and PBL/tutorial. It also showed that the use of the video camera correlated with an increase in perception scores for lectures. CONCLUSION: The present analysis has demonstrated that students' perception of different online synchronous interactive learning activities varies. Further investigations are required on minimizing distraction during online classes.

A prospective case-control study on online teaching of ultrasonography skills to medical students during COVID-19 pandemic.

INTRODUCTION: A new Online interactive Ultrasound Teaching (OUT) was developed in our institution in March 2021 during COVID-19 outbreak. METHODS: This is a case control study on 65 final year medical students to compare OUT with conventional face-to-face ultrasound tutorials. There were 31 female and 34 male students. Median age was 23 years old (Range 21-30). Students were randomly assigned into two different teaching groups. Competency in conducting ultrasonic exam was assessed by Objective Structured Assessment of Ultrasound Skills (OSAUS). RESULTS: 32 students were randomized into the control group (face to face teaching) while 33 students were randomized into the case group (OUT). Baseline demographic characteristics were comparable between the two groups (p > 0.05).The median score of the blinded OSAUS assessment was 5.5 (Range 3-7). There were 4 (6.2%) students who failed in the assessment (scored <4 out of 7), and 10 (15.4%) students scored full marks in the assessment.The medians scores were 5.5 (Range 3-7), and 6 (Range 3-7) (p = 0.8057) in the control and case groups respectively. 6 (18.8%) students in the control group scored full mark, comparing to 4 (12.1%) students in the case group (p = 0.5105). 2 students from each group failed the assessment (p = 1). CONCLUSION: Ultrasonographic skills performance was comparable between students who were taught by OUT and conventional face-to-face tutorial.

Cross-sectional case-control study on medical students' psychosocial stress during COVID-19 pandemic in Hong Kong.

INTRODUCTION: COVID-19 pandemic has resulted in significant changes in pedagogy for undergraduate medical curriculum. Many physical clinical teachings have been replaced by online pedagogy. This study aims to evaluate the relation between medical students' stress during COVID-19 pandemic and their academic performance at the final examination. METHODS: This is a cross-sectional questionnaire-based study. Student's stress level were evaluated by the COVID-19 Student Stress Questionnaire (CSSQ). Correlation of stress level and students' performance at the final examination was performed. RESULTS: 110 out of 221 (49.8%) final-year medical students responded to the questionnaire, 13 students failed in the final examination (case) while 97 students passed in the final MBBS examination (control).Baseline demographic data between case and control were comparable. The median age for both cases and controls were 24 years.Compared to controls, cases reported higher levels of stress in all domains, namely in relation to risk of contagion, social isolation, interpersonal relationships with relatives, university colleagues and professors, academic life, and sexual life. Notably, a significantly higher proportion of cases reported academic-related stress compared to controls (p < 0.01), with 100% of cases perceiving their academic studying experience during the COVID-19 pandemic to be "very" or "extremely" stressful, compared to 35.1% of controls. CONCLUSION: Increased stress to academic and study during COVID-19 was associated with worse examination outcome at the final examination. Extra academic support will be needed to cater students' need during the pandemic.

COVID-19 vaccine associated axillary lymphadenopathy - A systematic review.

INTRODUCTION: ; COVID-19 vaccines are commonly administered intramuscularly to the arm. Axillary lymphadenopathy has been reported as an adverse event after COVID-19 vaccination. In patients with breast cancers who received COVID-19 vaccination, presence of ipsilateral (or contralateral) lymphadenopathy poses diagnostic dilemma. This systematic review aims to evaluate the incidence and clinical characteristics of vaccine associated axillary lymphadenopathy. METHODS: ; The systematic review was conducted with accordance to the PRISMA statement. The search terms used were "Vaccine" OR "Vaccination" AND "Lymphadenopathy" OR "Lymph node" AND "Covid-19″. RESULTS: ; 31 studies or reports were identified using the predefined keywords from the systematic review protocol. After excluding irrelevant papers (such as guidelines, reviews, opinions and commentaries), 10 studies or reports were included in the review.Pooled incidence of clinically detectable lymphadenopathy after COVID-19 vaccination was 91/22,532 (0.4%). Mean size of the vaccine associated axillary lymphadenopathy was 18.2 mm (Range 16 - 21 mm). Mean duration from vaccination to occurrence of axillary lymphadenopathy was 6.9 days (Range 2 - 18 days). In a study on 119 patients, enlarged axillary lymphadenopathy resolves in 4 to 5 weeks. CONCLUSION: ; Vaccine associated axillary lymphadenopathy is not uncommon. Management of it is based on multidisciplinary decision with patient demographics, vaccination history and radiological finding being taken into account. Additional imaging and biopsy may lead to unnecessary healthcare burden. Proper arrangement of vaccination and imaging regarding timing and laterality should be advocated to avoid confusion and patient anxiety.

Distance education for anatomy and surgical training - A systematic review.

Rapid development of COVID-19 has resulted in a massive shift from traditional to online teaching. This review aims to evaluate the effectiveness of distance learning on anatomy and surgical training. This systematic review was conducted in line with the PRISMA statement and current methodological literature. The databases CINAHL, Cochrane, EMBASE and Pubmed were searched using the search terms "Distant learning" OR "Distance learning" AND "Anatomy OR Surgery". 182 non-duplicate studies were identified. 20 studies were included for qualitative analysis. 10 studies evaluated students' performance with distance learning. 3 studies suggested that students' learning motivation improved with distance learning pedagogy. 5 studies found improved student performance with distance learning (performance or task completion time) when compared to conventional physical method. While 2 other studies found non-inferior student performance. 10 studies evaluated students' feedback on distance learning. Most feedbacks were positive, with flexibility, efficiency, increased motivation and better viewing angles as the most-liked features of distance teaching. 4 studies pointed out some limitations of distance learning, including the lack of personal contact with tutor, poor network and reduced student concentration. 7 studies evaluated tutors' feedback on distance learning. Tutors generally liked online platforms for the ease of tracking silent students, monitoring performance and updating fast-changing knowledge. Yet the lack of hands-on experience for students, technical issues and high costs are the main concerns for tutors. In conclusion, distance learning is a feasible alternative for anatomy and surgical teaching.

Online teaching of basic surgical skills to medical students during the COVID-19 pandemic: a case-control study.

PURPOSE: Medical education has been disrupted by the COVID-19 pandemic in many countries, with face-to-face lectures replaced by pre-recorded videos. However, surgical skills training cannot be replaced easily by videos, as a high level of tutor-student interaction is required. Thus, we developed a new web-based surgical skill learning session (WSSL). This case-control study evaluates the surgical skills competency of medical students taught by the WSSL. METHODS: This case-control study compares WSSL with face-to-face tutorials. Students were assigned randomly to one of two groups according to the teaching method. Independent blinded assessment was performed by a standardized marking scheme, modified from the Objective Structured Assessment of Technical Skills (OSATS) global rating scale. RESULTS: We recruited 62 final-year medical students into the study, with 33 randomized to the face-to-face teaching group (control group), and 29 to the WSSL group(case group) according to their student number. The baseline demographic characteristics of the two groups were comparable. The mean score at the clinical competency assessment of the control group was 4.8/5 (range 4-5) and that of the case group was 4.7/5 (range 4-5) (p = 1). There were no difficulties with program or hardware installation reported by the WSSL students. CONCLUSIONS: Surgical skills performance was comparable between students who were taught by the WSSL and those taught by conventional face-to-face tutorials.

Distant surgical teaching during COVID-19 - A pilot study on final year medical students.

Introduction: Due to the COVID-19 outbreak, all on-site undergraduate medical teaching activities in Hong Kong have been suspended. A new web-based surgical skills learning (WSSL) for basic surgical skills training that were normally taught face-to-face was developed. Methodology: Basic surgical skills were taught with normal face-to-face tutorial to 30 final year medical students prior to the outbreak. The same group of students were invited to join the online WSSL using Zoom. Evaluation of WSSL was performed by a standardized questionnaire. Results: Thirty final year medical students (16 female, 14 male students) were recruited into the study. Median age was 23 (range 22-24). Most of them believed that WSSL is easy to follow. When compared to face-to-face teaching. Most students (N = 22, 73.4%) felt that WSSL was just as difficult/easy as conventional teaching for learning instrumental knots. Students were asked to evaluate WSSL by using a Likert scale of 1 to 10 (with 10 being highly recommended). Twelve (40%) students highly recommended WSSL (Score 9 to 10), 15 students (50%) slightly recommended WSSL (Score 6-8). Conclusion: Web-based surgical skills learning is a feasible alternative for face-to-face surgical skills teaching.