Healthcare leadership development during a pandemic: do not stop, adapt

Research carried out in 2016 by two of the authors of this article investigated the role that leadership ‘theory’ plays within an individual's leadership development and identified other components of clinical leadership programmes that are key to enabling the development of future leaders. While early career doctors identified leadership theories and concepts as important within their development as clinical leaders, these must be closely tied to real-life practices and coupled with activities that aim to develop an increased self-awareness, understanding of others, clinical exposure and leadership tools that they can use in practice. During a healthcare crisis, such as a global pandemic, maintaining a focus on leadership development (particularly for more junior clinicians) might not be seen as important, but leadership is needed to help people and organisations ‘get through’ a crisis as well as help develop leadership capacity for the longer term. This article, drawing from contemporary literature, the authors' own research and reflections, discusses how leadership development needs to continually adapt to meet new demands and sets out tips for those involved with clinical leadership development.

Pediatric Training Crisis of Emergency Medicine Residency during the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) is an emerging viral disease that has caused a global pandemic. Among emergency department (ED) patients, pediatric patient volume mostly and continuously decreased during the pandemic period. Decreased pediatric patient volume in a prolonged period could results in inadequate pediatric training of Emergency Medicine (EM) residents. We collected data regarding pediatric patients who were first seen by EM resident physicians between 1 February 2019, and 31 January 2021, which was divided into pre-epidemic and epidemic periods by 1 February 2020. A significant reduction in pediatric patients per hour (PPH) of EM residents was noted in the epidemic period (from 1.55 to 0.81, p < 0.001). The average patient number was reduced significantly in the classification of infection (from 9.50 to 4.00, p < 0.001), respiratory system (from 84.00 to 22.00, p < 0.001), gastrointestinal system (from 52.00 to 34.00, p = 0.007), otolaryngology (from 4.00 to 2.00, p = 0.022). Among the diagnoses of infectious disease, the most obvious drop was noted in the diagnosis of influenza and enterovirus infection. Reduced pediatric patient volume affected clinical exposure to pediatric EM training of EM residency. Changes in the proportion of pediatric diseases presented in the ED may induce inadequate experience with common and specific pediatric diseases.

Self-Efficacy and Readiness Towards Early Clinical Exposure Among Nursing Students

Background: Early Clinical Exposure is a learning approach that integrates classroom learning with the clinical practice at the students' academic stage. Based on an interview with 3rd-semester Nursing Students, the results showed that they had low self-efficacy and readiness towards early clinical exposure. Objective: This study aims to evaluate self-efficacy and readiness towards early clinical exposure among nursing students of Universitas Muhammadiyah Purwokerto (UMP). The study design was a cross-sectional study involving 218 undergraduate students at a private Islamic university in their third semester. Methods: Data were collected using an online questionnaire of Google Form developed by the researcher, and the questions were valid and reliable based on a reliability test. The sampling method in this study was the total sampling technique. There were 50 questions of the item in the questionnaire and 6 items for demographic data. Result: The majority of pupils showed strong self-efficacy (98.2%) according to the findings of this study and moderate self-efficacy (1.8%). The majority of students presented high readiness (97.7%) and moderate readiness (2.3%). According to the correlation test results, a correlation (r = 0.545, p0.05) was found between self-efficacy and readiness for early clinical exposure. Conclusion: The higher the student's self-efficacy is, the more the readiness will be to face the practice of early clinical exposure.

Telegram Education for Surgical Learning and Application (TESLA): An exploratory study (Preprint)

BACKGROUND The COVID-19 pandemic disrupted medical education, shifting a huge portion of learning online. Social media platforms have long been well-integrated into medical education. However, Telegram’s role in medical education remains relatively unexplored. A Telegram channel titled “Telegram Education for Surgery Learning and Application (TESLA)” focusing on General Surgery education was created to supplement medical students’ learning. It encompassed weekly multiple-choice questions and resources such as illustrations and journal articles. OBJECTIVE This study explored students’ experience of TESLA and their views on the role of messaging apps in medical education. METHODS We invited thirteen medical students from Lee Kong Chian School of Medicine, Singapore who were in the TESLA channel for at least a month to participate in individual semi-structured interviews. The interviews were conducted via video conference using an interview guide. Interviews were transcribed and analysed by two researchers using inductive thematic content analysis. RESULTS Three themes were identified: (1) Learning as a medical student, (2) The role of mobile learning in medical education and (3) TESLA for surgical education. Students shared that pandemic-related safety measures such as reduced clinic allocations and the inability to cross between wards led to a decrease in clinical exposure. Students used a variety of messaging and study apps to aid their medical education. Telegram was preferred over other messaging apps. Concerning the use of TESLA, students felt that the questions were clinically relevant and of appropriate difficulty. Students offered suggestions for improvement relating to the organization, content and format of TESLA. CONCLUSIONS Medical students found TESLA useful as a supplementary learning instrument in surgical education. They were supportive of integrating TESLA into formal undergraduate education and using Telegram as an educational tool in other areas of medicine. In line with our findings, we outlined recommendations for the use of Telegram in medical education.

Medical students positions regarding resource allocation in times of crisis

Objective To compare the perspectives of medical students in the preclinical and clinical phases of medical training on the issue of rationing scarce medical resources in times of crisis. Methods Questionnaire-based cross-sectional study. Results A total of 201 participants took part in the study, with 100 participants in the preclinical phase group, and 101 in the clinical phase group. A multivariable analysis found that just 14.9% (n = 34) of the clinical phase students were willing to give a short-supplied blood unit to the first-arrived patient to the emergency department when more patients are expected compared to 63.9% in the preclinical group (n = 62) ( p < 0.001, OR = 0.75 95% CI: 0.029−0.192). Seventy-four percent (n = 74) of the clinical phase students were found to be willing to remove a patient from a respirator to allocate it to an ill child compared to 35.7% (n = 35) in the preclinical phase group ( p < 0.001, OR = 4.168 95% CI: 1.931−8.998). Of the clinical phase group, 46.6% (n = 41) were willing to allocate a short supplied flu medicine to a patient with poor prognosis compared to 57.7% (n = 56) in the preclinical phase group ( p = 0.04, OR = 0.457 95% CI: 0.216−0.966). Conclusion Clinical exposure during training may affect the way medical students make ethical decisions, independent of age, sex, as well as marital and parental status.

COVID-19 Impact on Intern Exposure to Common Inpatient Diagnoses

OBJECTIVE We sought to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical exposure of pediatric interns to common pediatric inpatient diagnoses. METHODS We analyzed electronic medical record data to compare intern clinical exposure during the COVID-19 pandemic from June 2020 through February 2021 with the same academic blocks from 2017 to 2020. We attributed patients to each pediatric intern on the basis of notes written during their pediatric hospital medicine rotation to compare intern exposures with common inpatient diagnoses before and during the pandemic. We compared the median number of notes written per intern per block overall, as well as for each common inpatient diagnosis. RESULTS Median counts of notes written per intern per block were significantly reduced in the COVID-19 group compared with the pre–COVID-19 group (96 [interquartile range (IQR): 81–119)] vs 129 [IQR: 110–160]; P &lt; .001). Median intern notes per block was lower in the COVID-19 group for all months except February 2021. Although the median number of notes for many common inpatient diagnoses was significantly reduced, they were higher for mental health (4 [IQR: 2–9] vs 2 [IQR: 1–6]; P &lt; .001) and suicidality (4.5 [IQR: 2–8] vs 0 [IQR: 0–2]; P &lt; .001). Median shifts worked per intern per block was also reduced in the COVID-19 group (22 [IQR: 21–23] vs 23 [IQR: 22–24]; P &lt; .001). CONCLUSIONS Our findings reveal a significant reduction in resident exposure to many common inpatient pediatric diagnoses during the COVID-19 pandemic. Residency programs and pediatric hospitalist educators should consider curricular interventions to ensure adequate clinical exposure for residents affected by the pandemic.

Medical students’ perceptions and coping strategies during the first wave of the COVID-19 pandemic: studies, clinical implication, and professional identity

Background The unfolding of the COVID-19 pandemic during spring 2020 has disrupted medical education worldwide. The University of Geneva decided to shift on-site classwork to online learning; many exams were transformed from summative to formative evaluations and most clinical activities were suspended. We aimed to investigate the perceived impact of those adaptations by the students at the Faculty of Medicine. Methods We sent an online self-administered survey to medical students from years 2 to 6 of the University of Geneva, three months after the beginning of the pandemic. The survey explored students’ main activities during the first three months of the pandemic, the impact of the crisis on their personal life, on their training and on their professional identity, the level of stress they experienced and which coping strategies they developed. The survey consisted of open-ended and closed questions and was administered in French. Results A total of 58.8% of students responded (n = 467) and were homogeneously distributed across gender. At the time of the survey, two thirds of the participants were involved in COVID-19-related activities; 72.5% voluntarily participated, mainly fueled by a desire to help and feel useful. Many participants (58.8%) reported a feeling of isolation encountered since the start of the pandemic. Main coping strategies reported were physical activity and increased telecommunications with their loved ones. Most students described a negative impact of the imposed restrictions on their training, reporting decreased motivation and concentration in an unusual or distraction-prone study environment at home and missing interactions with peers and teachers. Students recruited to help at the hospital in the context of increasing staff needs reported a positive impact due to the enriched clinical exposure. Perceived stress levels were manageable across the surveyed population. If changed, the crisis had a largely positive impact on students’ professional identity; most highlighted the importance of the health care profession for society and confirmed their career choice. Conclusion Through this comprehensive picture, our study describes the perceived impact of the pandemic on University of Geneva medical students, their training and their professional identity three months after the start of the pandemic. These results allowed us to gain valuable insight that reinforced the relevance of assessing the evolution of the situation in the long run and the importance of developing institutional support tools for medical students throughout their studies.

Exploring medical students’ perceptions of the challenges and benefits of volunteering in the intensive care unit during the COVID-19 pandemic: a qualitative study

ObjectivesIn March 2020, the WHO declared SARS-CoV-2 a pandemic. Hospitals across the world faced staff, bed and supply shortages, with some European hospitals calling on medical students to fill the staffing gaps. This study aimed to document the impact of volunteering during the COVID-19 pandemic on students’ professional development, resilience and future perceived career choices.DesignThis is a retrospective, qualitative study of student reflections, using purposive sampling.The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences recruited 26 medical student volunteers to assist in pronation and supination of ventilated patients affected by SARS-CoV-2. These students were invited to complete an anonymous survey based on their experiences as volunteers. Thematic analysis was performed on these written reflections.ResultsThe results showed that volunteering during the COVID-19 pandemic developed key skills from RCSI’s medical curriculum, significantly fostered medical students’ resilience and guided their career choices. Major areas of development included communication, teamwork, compassion and altruism, which are not easily developed through the formal curriculum. A further area that was highlighted was the importance of evidence-based health in a pandemic. Finally, our respondents were early stage medical students with limited clinical exposure. Some found the experience difficult to cope with and therefore supports should be established for students volunteering in such a crisis.ConclusionThese results suggest that clinical exposure is an important driver in developing students’ resilience and that volunteering during a pandemic has multiple benefits to students’ professional development and professional identity formation.

Evaluation of the Confidence and Competency of House Officers in Rapid Sequence Intubation (ECCHO-RSI) in Emergency Department of Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre during COVID-19 Pandemic

Rapid sequence intubation (RSI) is a procedural skill that house officers (HO) in Malaysia need to learn during their training in emergency department (ED) posting. This study aimed to evaluate the confidence and competency of HO in RSI after completed training in the ED of a university hospital during the COVID-19 pandemic. A prospective cross-sectional study was conducted among 44 HO. When they begin their posting in ED, a pre-test was done with a questionnaire to evaluate their knowledge and confidence level. A post-test was conducted three months later with a similar questionnaire. They underwent an objective structured clinical examination to evaluate their skill. A feedback survey form was filled in by the HO regarding their satisfaction in training in emergency rotation. The mean score for pre-test and post-test were 8.75 ± 3.005 and 14.86 ± 2.258, respectively (P = 0.000). There was an improvement in knowledge level and confidence level between pre-test and post-test (all P = 0.000). 43.2% were competent in knowledge, while 65.9% were competent in skill. 35 house officers filled in the feedback survey form. It showed that 42.9% (n = 15) were very satisfied and 28.6% (n = 10) were satisfied with the training in ED. There was an improvement in knowledge and confidence level in RSI among the HO after ED rotation. The clinical exposure in intubating real patients was limited among HO due to the COVID-19 pandemic. The training of HO for RSI in ED needs to be further improvised to optimize their learning process.