Adaptations in clinical examinations of medical students in response to the COVID-19 pandemic: a systematic review.

INTRODUCTION: Clinical examinations (assessments) are integral to ensuring that medical students can treat patients safely and effectively. The COVID-19 pandemic disrupted traditional formats of clinical examinations. This prompted Medical Schools to adapt their approaches to conducting these examinations to make them suitable for delivery in the pandemic. This systematic review aims to identify the approaches that Medical Schools, internationally, adopted in adapting their clinical examinations of medical students in response to the COVID-19 pandemic. METHODS: Three databases and four key medical education journals were systematically searched up to 22 October 2021; a grey literature search was also undertaken. Two reviewers independently screened at title, abstract stage and full text stage against predefined eligibility criteria. Discrepancies were resolved by discussion and involvement of senior authors. Risk of bias assessment was performed using an adapted version of a pre-existing risk of bias assessment tool for medical education developments. Results were summarised in a narrative synthesis. RESULTS: A total of 36 studies were included, which documented the approaches of 48 Medical Schools in 17 countries. Approaches were categorised into in-person clinical examinations (22 studies) or online clinical examinations (14 studies). Authors of studies reporting in-person clinical examinations described deploying enhanced infection control measures along with modified patient participation. Authors of studies reporting online clinical examinations described using online software to create online examination circuits. All authors reported that adapted examinations were feasible, scores were comparable to previous years' student cohorts, and participant feedback was positive. Risk of bias assessment highlighted heterogeneity in reporting of the clinical examinations. CONCLUSIONS: This review identified two broad approaches to adapting clinical examinations in the pandemic: in-person and online. Authors reported it was feasible to conduct clinical examinations in the pandemic where medical educators are given sufficient time and resources to carefully plan and introduce suitable adaptations. However, the risk of bias assessment identified few studies with high reporting quality, which highlights the need for a common framework for reporting of medical education developments to enhance reproducibility across wider contexts. Our review provides medical educators with the opportunity to reflect on past practises and facilitate the design and planning of future examinations.

Superusers of Self-Paced Online Learning on OpenWHO.

INTRODUCTION: OpenWHO provides open-access, online, free and real-time learning responses to health emergencies, which includes capacitating healthcare providers, first liners, medical students and even the general public. During the pandemic and to date, an additional 40 courses for COVID-19 response have led to a massive increase in the number of learners and a change in user's trends. This paper presents initial findings on enrollment trends, use and completion rates of health emergency courses offered on OpenWHO. METHODS: The enrolment data statistics were drawn from OpenWHO's built-in reporting system, which tracks learners' enrolments, completion rates, demographics and other key course-related data, This information was collected from the beginning of the OpenWHO launch in 2017 up until October 2021. RESULTS: Average course completion rate on OpenWHO including all courses and languages was equal to 45.9%. Nearly half (46.4%) of all OpenWHO learners have enrolled in at least 2 courses and 71 000 superusers have completed at least 10 courses on the platform. CONCLUSION: WHO's learning platform during the pandemic registered record high completion rates and repeat learners enrollment. This highlights the massive impact of the OpenWHO online learning platform for health emergencies and the tangible knowledge transfer and access to health literacy.

The Pandemic and Beyond: Innovation in Cardiovascular Training to Improve Quality of Education and Trainees' Well-being.

During the first 2 years of the coronavirus-19 pandemic, many changes and innovations occurred to overcome the challenges associated with the pandemic and improve cardiovascular training. This review highlights the literature on the pandemic response regarding cardiovascular fellowship education and identifies areas of need to ensure future opportunities for fellows to achieve competency and career advancement. Specifically, we describe the recent changes to the four cornerstones of cardiovascular training: core content education, procedural training, career development, and the well-being of trainees.

Medical Education During the COVID-19 Pandemic.

All aspects of medical education were affected by the COVID-19 pandemic. Several challenges were experienced by trainees and programs alike, including economic repercussions of the pandemic; social distancing affecting the delivery of medical education, testing, and interviewing; the surge of patients affecting redeployment of personnel and potential compromises in core training; and the overall impact on the wellness and mental health of trainees and educators. The ability of medical teams and researchers to peer review, conduct clinical research, and keep up with literature was similarly challenged by the rapid growth in peer-reviewed and preprint literature. This article reviews these challenges and shares strategies that institutions, educators, and learners adopted, adapted, and developed to provide quality education during these unprecedented times.

Competency-Based Medical Education: Considering Its Past, Present, and a Post-COVID-19 Era.

Advancement toward competency-based medical education (CBME) has been hindered by inertia and a myriad of implementation challenges, including those associated with assessment of competency, accreditation/regulation, and logistical considerations. The COVID-19 pandemic disrupted medical education at every level. Time-in-training sometimes was shortened or significantly altered and there were reductions in the number and variety of clinical exposures. These and other unanticipated changes to existing models highlighted the need to advance the core principles of CBME. This manuscript describes the impact of COVID-19 on the ongoing transition to CBME, including the effects on training, curricular, and assessment processes for medical school and graduate medical education programs. The authors outline consequences of the COVID-19 disruption on learner training and assessment of competency, such as conversion to virtual learning modalities in medical school, redeployment of residents within health systems, and early graduation of trainees based on achievement of competency. Finally, the authors reflect on what the COVID-19 pandemic taught them about realization of CBME as the medical education community looks forward to a postpandemic future.

We Have No Choice but to Transform: The Future of Medical Education After the COVID-19 Pandemic.

Medical education exists to prepare the physician workforce that our nation needs, but the COVID-19 pandemic threatened to disrupt that mission. Likewise, the national increase in awareness of social justice gaps in our country pointed out significant gaps in health care, medicine, and our medical education ecosystem. Crises in all industries often present leaders with no choice but to transform-or to fail. In this perspective, the authors suggest that medical education is at such an inflection point and propose a transformational vision of the medical education ecosystem, followed by a 10-year, 10-point plan that focuses on building the workforce that will achieve that vision. Broad themes include adopting a national vision; enhancing medicine's role in social justice through broadened curricula and a focus on communities; establishing equity in learning and processes related to learning, including wellness in learners, as a baseline; and realizing the promise of competency-based, time-variable training. Ultimately, 2020 can be viewed as a strategic inflection point in medical education if those who lead and regulate it analyze and apply lessons learned from the pandemic and its associated syndemics.

Ethics and Well-Being: The Health Professions and the COVID-19 Pandemic.

The COVID-19 pandemic has had a profound impact on health professionals, adding to the moral suffering and burnout that existed prepandemic. The physical, psychological, and moral toll of the pandemic has threatened the well-being and integrity of clinicians. The narrative of self-sacrifice and heroism bolstered people early on but was not sustainable over time. For health professions students, the learning environment changed dramatically, limiting opportunities in direct patient care and raising concerns for meeting training requirements. Learners lost social connections and felt isolated while learning remotely, and they witnessed ethical tensions between patient-centered care and parallel obligations to public health. Worries about transmission of the virus and uncertainty about its management contributed to their moral suffering. Educators adjusted curricula to address the changing ethical landscape. Preparing learners for the realities of their future professional identities requires creation of interprofessional moral communities that provide support and help develop the moral agency and integrity of its members using experiential and relational learning methods. Investing in the well-being and resilience of clinicians, implementing the recommendations of the National Academy of Medicine, and engaging learners and faculty as cocreators of ethical practice have the potential to transform the learning environment. Faculty need to be trained as effective mentors to create safe spaces for exploring challenges and address moral adversity. Ethics education will need to expand to issues related to health systems science, social determinants of health, and public health, and the cultivation of moral sensitivity, character development, professional identity formation, and moral resilience.

The need for changes in medical education and the perception of teachers before the Covid-19 pandemic / Necessidade de mudanças na educação médica e a percepção de professores antes da pandemia da Covid-19 / Necesidad de cambios en la educación médica y la percepción de profesores antes de la pandemia de Covid-19

Este estudo objetiva analisar questões da educação médica evidenciadas pelas medidas de distanciamento social provocadas pela pandemia do coronavírus19 associadas às percepções de professores de medicina sobre esses mesmos aspectos, em um momento prévio à eclosão da crise sanitária. Realizamos um recorte de resultados de uma pesquisa de natureza qualitativa e conduzimos a discussão com base na triangulação de dados entre observações de campo e entrevistas com professores. A pandemia reacendeu debates sobre a relevância de conteúdos, a utilização de tecnologias digitais para fins pedagógicos e o valor do trabalho colaborativo. Além disso, resgatou questões que envolvem habilidades de comunicação e a saúde de estudantes nas práticas do cuidado. Discutiremos a experiência passada articulando-a às experiências recentes e o que poderemos recolher para (re)construirmos os rumos da formação dos médicos.(AU)

El objetivo de este estudio es analizar cuestiones de la educación médica puestas en evidencia por las medidas de distancia social adoptadas por la pandemia del coronavirus 19, asociadas a las percepciones de profesores de medicina sobres esos mismos aspectos, en un momento previo a la eclosión de la crisis sanitaria. Realizamos un recorte de resultados de una investigación de naturaleza cualitativa y dirigimos la discusión a partir de la triangulación de datos entre observaciones de campo y entrevistas con profesores. La pandemia reencendió debates sobre la relevancia de contenidos, la utilización de tecnologías digitales para fines pedagógicos y el valor del trabajo colaborativo. Además, rescató cuestiones que envuelven habilidades de comunicación y la salud de estudiantes en las prácticas del cuidado. Discutiremos la experiencia pasada articulándola con las experiencias recientes y lo que podremos recoger para (re)construir los rumbos de formación de los médicos.(AU)

This study aims to analyze medical education issues evidenced by the measures of social distancing due to the coronavirus pandemic19, associated with the perceptions of medical professors about these same aspects, in a moment prior to the outbreak of the health crisis. We focused in the results of a qualitative research and conducted a discussion based on the triangulation of data between field observations and interviews with professors. The pandemic has rekindled debates about the relevance of contents, the use of digital technologies for educational purposes and the value of collaborative work. Additionally, it provoked the emergence of issues involving communication skills and the health of students in care practices. We discuss past experiences articulating them with recent experiences and what we can collect to (re)build the direction of medical training.(AU)

Future of Education or Present Reality?

CONTEXT.­: The main focus of education in most pathology residency and subspecialty pathology fellowships is the light microscopic examination of pathology specimens. Classes with multiheaded scopes are the most popular among pathology trainees. Until recently, it was difficult to imagine that this educational approach could change. In the beginning of March 2020, our country faced a serious challenge, which all of us now know as the coronavirus disease 2019 (COVID-19) pandemic. The rules of social distancing and work from home were applied. These types of restrictions were implemented in almost all parts of our life, including work and pathology education. OBJECTIVE.­: To share our experience in the Department of Hematopathology at the University of Texas MD Anderson Cancer Center during the COVID-19 pandemic. We describe our experience in modifying our approaches to education. We show how we overcame many obstacles to learning by building one of the largest virtual hematopathology educational platforms via Cisco WebEx and using social media, in particular Twitter. These tools facilitated the learning of hematopathology by medical students, pathology trainees, and practicing pathologists from all over the world. DATA SOURCES.­: During the first 3 months of the pandemic (April, May, and June, 2020), we evaluated the visitor attendance to the MD Anderson Cancer Center Hematopathology Virtual Educational Platform using data collected by the Cisco WebEx Web site. To determine the impact that the platform had on medical education for the hematopathology community on Twitter, the analytic metrics obtained from Symplur LLC (www.symplur.com, April 27, 2020) were used via its Symplur Signals program. CONCLUSIONS.­: Our experience using the MD Anderson Hematopathology Virtual Platform showed that there is substantial global interest and desire for virtual hematopathology education, especially during the COVID-19 pandemic.

Preparing for medical education after the COVID-19 pandemic: insightology in medicine.

It is necessary to reflect on the question, "How to prepare for medical education after coronavirus disease 2019 (COVID-19)?" Although we are preparing for the era of Education 4.0 in line with the 4th industrial revolution of artificial intelligence and big data, most measures are focused on the methodologies of transferring knowledge; essential innovation is not being addressed. What is fundamentally needed in medicine is insightful intelligence that can see the invisible. We should not create doctors who only prescribe antispasmodics for abdominal pain, or antiemetic drugs for vomiting. Good clinical reasoning is not based on knowledge alone. Insightology in medicine is based on experience through Bayesian reasoning and imagination through the theory of mind. This refers to diagnosis of the whole, greater than the sum of its parts, by looking at the invisible using the Gestalt strategy. Identifying the missing process that links symptoms is essential. This missing process can be described in one word: context. An accurate diagnosis is possible only by understanding context, which can be done by standing in someone else's shoes. From the viewpoint of medicine, Education 4.0 is worrisome because people are still clinging to methodology. The subject we should focus on is "human", not "artificial" intelligence. We should first advance the "insightology in medicine" as a new paradigm, which is the "essence" that will never change even when rare "phenomena" such as the COVID-19 outbreak occur. For this reason, we should focus on teaching insightology in medicine, rather than teaching medical knowledge.

Training in infectious diseases across Europe in 2021 - a survey on training delivery, content and assessment.

OBJECTIVES: To define the status of infectious diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist trainees and describe the content, delivery and evaluation of postgraduate training in ID in different countries. METHODS: Structured web-based questionnaire surveys in March 2021 of responsible national authorities, specialist societies and individual country representatives to the Section of Infectious Diseases of the European Union for Medical Specialties. Descriptive analysis of quantitative and qualitative responses. RESULTS: In responses received from 33/35 (94.3%) countries, ID is recognized as a specialty in 24 and as a subspecialty of general internal medicine (GIM) in eight, but it is not recognized in Spain. The number of ID specialists per country varies from <5 per million inhabitants to 78 per million inhabitants. Median length of training is 5 years (interquartile range 4.0-6.0 years) with variable amounts of preceding and/or concurrent GIM. Only 21.2% of countries (7/33) provide the minimum recommended training of 6 months in microbiology and 30% cover competencies such as palliative care, team working and leadership, audit, and quality control. Training is monitored by personal logbook or e-portfolio in 75.8% (25/33) and assessed by final examinations in 69.7% (23/33) of countries, but yearly reviews with trainees only occur in 54.5% (18/33) of countries. CONCLUSIONS: There are substantial gaps in modernization of ID training in many countries to match current European training requirements. Joint training with clinical microbiology (CM) and in multidisciplinary team working should be extended. Training/monitoring trainers should find greater focus, together with regular feedback to trainees within many national training programmes.