COVID-19-Related Disruptions Are an Opportunity for Reflection on the Role of Research Training in Psychiatric Residency Programs

This commentary describes COVID-19-related disruptions and responsive accommodations to facilitate a research project required to complete postgraduate psychiatry training in a resource-limited small island developing state. After providing context concerning the impact of the pandemic on medical education, we focus on implications for postgraduate training in psychiatry. Lessons learned from this experience have relevance for ongoing discussions concerning the role and implementation of research training in residency programs. Research skills are essential for evidence-based practice as well as academic careers. Longitudinal integration of research training and flexibility of research requirements are needed in postgraduate psychiatry to balance residents' development of research skills with demands of clinical service.

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

Purpose The COVID-19 pandemic has caused significant disruption to medical education and clinical training and resulted in stressors that impede student learning. This study aimed to assess student satisfaction and self-efficacy in a novel online clinical clerkship curriculum delivered during the COVID-19 pandemic. Methods Fourth- and fifth-year medical students completed an online survey in January 2021 covering the following areas: student satisfaction, self-efficacy, and perceived effectiveness of online versus face-to-face learning. Results Just over half of students (51%) were satisfied with online clerkship delivery. However, fewer than half of students (46%) believed online learning effectively increased their knowledge, compared to 56% of students who believed face-to-face learning was effective. The perception of the effectiveness of online learning and face-to-face teaching for clinical skills was 18% and 89%, respectively (p < 0.0001). Few students perceived online teaching to be effective for developing social competencies (27%) compared to face-to-face instruction (67%) (p < 0.001). In addition, mean self-efficacy scores were higher for persons who perceived online teaching to be effective for increasing knowledge, improving clinical skills, and developing social competencies. Overall, students’ perception of online learning was strongly associated with online self-efficacy. Conclusion Student satisfaction and perceived self-efficacy in online learning were higher than reported acceptance of online clerkship curriculum.

Technology as Treatment: Use of Virtual Complementary and Integrative Therapies by Patients in Neurology

Objective: Given the reductions in in-person visits and the increases in teleneurology visits, we sought to determine whether patients increased their use of virtual complementary and integrative therapies. Background: Patients with neurological disorders may seek treatment options in addition to those recommended by their providers. Prior to the COVID-19 pandemic, about half of patients from populations that sought care in neurology tried complementary and integrative therapies (CITs). Design/Methods: By examining two separate datasets that included cohorts of patients with neurological disorders, we assessed patients' use of virtual (and non-virtual) CITs and determined whether there were clinical characteristics that predicted their use. The two studies that comprised this report included one that examined patient and provider experiences with teleneurology visits, and another that assessed patients with a history of COVID-19 infection who presented for neurologic evaluation. Results: Patients who postponed medical treatment for non-COVID-19-related problems during the pandemic were more likely to seek CITs. Virtual exercise, virtual psychotherapy and relaxation/meditation smartphone applications were the most frequent types of virtual CITs chosen by patients. In both studies, age was a key demographic factor associated with mobile/virtual CIT usage. Conclusions: Data from our investigations demonstrated that, in addition to its other roles in teleneurology, CIT-related technologies may be utilized in the treatment of neurologic conditions.

Strategies for Behavioral Research in Neurology: Lessons Learned During the COVID-19 Pandemic and Applications for the Future

Objective: The study has three aims: 1) highlight challenges of clinical behavioral trials in neurology during the COVID-19 pandemic, 2) determine approaches to maximize generalizability of pandemic-era studies, and 3) offer strategies for future successful behavioral trials. Background: Behavioral therapies are safe, effective treatments for many neurological conditions. However, over 20,000 clinical trials have been affected by the COVID-19 pandemic, with high impact on behavioral studies that require increased in-person interactions to deliver the therapeutic intervention. Design/Methods: We reviewed existing literature on clinical trials to evaluate the pandemic's influences upon clinical behavioral studies in neurology, including study design, participant recruitment, demographics, and adherence. Using Pubmed and Google Scholar, we conducted a search of peer-reviewed articles based on the following key terms: “pandemic clinical trials,” “neurology,” “inequities,” and “adherence.” The review focused on 43 articles published from 2000 to 2021. Results: Common themes surrounding the pandemic's impact are noted in the following statements. Social-distancing guidelines disrupted protocols for behavioral studies, given difficulty shifting from in-person to virtual settings. Traditional routes of recruitment (e.g., brochures) were hindered, whereas digital methods (e.g., social media) were popularized. Transforming trials into virtual settings resulted in the exclusion of some diverse participants without access to required digital tools. Adherence has been affected variably, with increased rates for participants with more flexible schedules versus possible decreased adherence/motivation for those with pandemic-related psychological changes (e.g., depression). onclusions: Future clinical behavioral trials might: 1) broaden recruitment using newly popularized digital techniques, 2) improve trial access for diverse populations, 3) expand protocols to include virtual and in-person participation, 4) increase patient adherence and retention, and 5) incorporate measures to evaluate for mood- and anxiety-related comorbidities into statistical analysis. As these strategies are integrated, more research is needed to devise methods to protect clinical trials from pandemic-related or other disruptions in the future.