Physician trainee research collaboratives: a mixed methods exploration of UK experience.

BACKGROUND: Physician trainee research collaboratives (TRCs) help trainees develop research skills and establish peer networks. We aimed to identify the structure, activity and views of physician TRCs in the UK. METHODS: Representatives from physician TRCs in the UK were invited to complete an online survey and participate in a focus group. RESULTS: Representatives from 23 physician TRCs completed the survey. There was wide variation in collaborative structure, senior input and funding resources. Seventy-four per cent of physician TRCs had published peer-reviewed articles, with 70% reporting ongoing projects at the time of the survey. The survey and focus group identified improved patient care, research and leadership skills as benefits of collaborative work; while institutional and consultant support, limited time for research, funding opportunities and restrictions on group authorship were cited as challenges to collaborative success. CONCLUSION: Physician TRC activity continues to grow and demonstrates a dynamic approach to research for all trainees.

Civilian walking blood bank emergency preparedness plan.

BACKGROUND: The current global pandemic has created unprecedented challenges in the blood supply network. Given the recent shortages, there must be a civilian plan for massively bleeding patients when there are no blood products on the shelf. Recognizing that the time to death in bleeding patients is less than 2 h, timely resupply from unaffected locations is not possible. One solution is to transfuse emergency untested whole blood (EUWB), similar to the extensive military experience fine-tuned over the last 19 years. While this concept is anathema in current civilian transfusion practice, it seems prudent to have a vetted plan in place. METHODS AND MATERIALS: During the early stages of the 2020 global pandemic, a multidisciplinary and international group of clinicians with broad experience in transfusion medicine communicated routinely. The result is a planning document that provides both background information and a high-level guide on how to emergently deliver EUWB for patients who would otherwise die of hemorrhage. RESULTS AND CONCLUSIONS: Similar plans have been utilized in remote locations, both on the battlefield and in civilian practice. The proposed recommendations are designed to provide high-level guidance for experienced blood bankers, transfusion experts, clinicians, and health authorities. Like with all emergency preparedness, it is always better to have a well-thought-out and trained plan in place, rather than trying to develop a hasty plan in the midst of a disaster. We need to prevent the potential for empty shelves and bleeding patients dying for lack of blood.

MAIT cell activation augments adenovirus vector vaccine immunogenicity.

Mucosal-associated invariant T (MAIT) cells are innate sensors of viruses and can augment early immune responses and contribute to protection. We hypothesized that MAIT cells may have inherent adjuvant activity in vaccine platforms that use replication-incompetent adenovirus vectors. In mice and humans, ChAdOx1 (chimpanzee adenovirus Ox1) immunization robustly activated MAIT cells. Activation required plasmacytoid dendritic cell (pDC)-derived interferon (IFN)-α and monocyte-derived interleukin-18. IFN-α-induced, monocyte-derived tumor necrosis factor was also identified as a key secondary signal. All three cytokines were required in vitro and in vivo. Activation of MAIT cells positively correlated with vaccine-induced T cell responses in human volunteers and MAIT cell-deficient mice displayed impaired CD8+ T cell responses to multiple vaccine-encoded antigens. Thus, MAIT cells contribute to the immunogenicity of adenovirus vectors, with implications for vaccine design.

An Educational Experiment Resulting from COVID-19: The Use of At-Home Waxing and Webinars for Teaching a 3-Week Intensive Course in Tooth Morphology to First Year Dental Students.

PURPOSE: To report the outcomes of presenting a 3-week intensive course in tooth morphology to first year dental students using "at-home" waxing projects and webinars. MATERIALS AND METHODS: Students were provided with the instrumentation and materials required to complete 5 waxing projects at home during the 3-week course. In the same time period, the didactic content was presented via 11 webinar sessions. A postcourse survey provided student perspectives regarding this new experience. RESULTS: Students were able to effectively complete high-quality waxing projects at home by using step-by-step images and videos but the survey indicated an overwhelming preference for in-person faculty feedback. Webinars based on the students having studied the 3D Tooth Atlas and an instructor reviewing content in the Atlas was effective in teaching the didactic aspect of tooth morphology as evidenced by the student grades and survey results. However, most of the students indicated a preference for physically going to class and being able to interact with faculty and classmates as opposed to online webinars. The condensed 3-week version of the course was part of an expanded 4-week student orientation and worked well, allowing other clinical precursor courses to occur before their usual time in the curriculum, thereby allowing students to begin earlier patient treatment. CONCLUSIONS: The at-home waxing exercises produced very good results by having the students use step-by-step images and videos in the 3D Tooth Atlas. However, the students indicated a strong preference for personal faculty feedback that was not available at home. Students effectively learned the didactic aspects of tooth morphology through the webinars with accompanying use of the 3D Tooth Atlas but again most students prefer physically going to class and being able to interact with faculty and classmates. These preferences for contact with classmates and faculty supports the natural human desire for personal interactions with other human beings.

The role of the future physician: building on shifting sands.

The role of the future physician in the NHS is of interest to current doctors, patients, policymakers and the wider public. Amid the COVID-19 pandemic, it has never been more clear that the healthcare needs of the population, and the technical and scientific advances with which to solve them, are rapidly evolving and the medical workforce must adapt to these changes to deliver personalised healthcare. This article considers the current challenges that need to be addressed to deliver a future physician-led healthcare service that works for its patients. Key themes are expanded upon, including the changing healthcare workforce, digital and technological innovation, service delivery, complex conditions and changing patient demographics. The impact and challenges of the ongoing COVID-19 pandemic on these factors are highlighted. Avenues for development are suggested, both in postgraduate medical training and the health service as a whole. These changes will be required to deliver the physicians of the future, imbued with the skills and attributes they will need to provide a high standard of care in the mid-21st century.