Digital clinical placements: Student perspectives and preparedness for placements.

BACKGROUND: In May 2020, first-year students at Imperial College School of Medicine attended a 'digital hospital placement'. Occurring in the early months of the COVID-19 pandemic, this replaced their first planned hospital placement. The authors analysed student experiences to understand how a digital hospital placement impacted self-perceived clinical and professional development and whether it improved preparedness for face-to-face hospital placements. METHODS: Three hundred ten students participated in this week-long digital placement, which integrated clinical skills, communication and professional behaviour domains. It aimed to prepare students for safe participation in clinical environments. Resources included self-directed and peer learning, virtual simulations (Oxford Medical Simulation) and staff-led debriefing. Surveys were administered after the digital placement and after students' first face-to-face placement to collect quantitative and qualitative data. A reflexive thematic analysis was conducted. RESULTS: Eighty-three and twenty-nine students completed the postdigital and post-face-to-face placement evaluation respectively. Quantitative results indicated a high self-rated achievement of learning objectives and enthusiasm for digital placements; 83% of respondents supported digital simulations as part of regular medical education. Qualitative analysis identified three superordinate themes: (1) domain integration in digital placements helped students feel better prepared; (2) digital experiential learning is ideally suited to early clinical learning; and (3) virtual placements are a compliment, not an alternative, to face-to-face placements. CONCLUSION: Digital placements are a promising means of supporting the challenging transition from classroom learner to clinical learner. They provide a feasible and scalable option for building student confidence and improving preparedness.

Use of Sugammadex in an octagenerian with Myaesthenia Gravis undergoing emergency laporotomy.

BACKGROUND: Myaesthenia Gravis is an autoimmune disorder that results in increased sensitivity to neuromuscular blockers. Anaesthesia and surgery in patients with Myaesthenia Gravis is associated with an increased incidence of complications, including post operative ventilation. We report the successful use of intra-operative train of four ratio monitoring and Sugammadex to reverse rocuronium induced neuromuscular blockade in an elderly octagenarian with Myaesthenia Gravis undergoing an emergency laporotomy. CASE REPORT: An 87year old man with Myaesthenia Gravis underwent an emergency laporotomy for a perforated sigmoid diverticulum. Induction of anaesthesia was performed with 100µg of fentanyl, 120mg propofol and 25mg rocuronium. Intraoperative boluses of 5mg rocuronium were guided by train of four ratio of 50%. At the end of the procedure 4mg/kg of Sugammadex was given to reverse neuromuscular blockade as observed by return of four twitches on the train of four. He was then successfully extubated and did not require any post operative ventilation. CONCLUSION: We report the successful use of intra-operative neuromuscular monitoring and Sugammadex to reverse rocuronium induced neuromuscular blockade in an elderly octagenarian with Myaesthenia Gravis undergoing emergency laporotomy.