Impact of the COVID-19 pandemic on the clinical training of last year medical students in Mexico: a cross-sectional nationwide study

Background The COVID-19 pandemic has brought unprecedented changes to medical education. However, no data are available regarding the impact the pandemic may have on medical training in Mexico. The aim of our study was to evaluate and identify the medical school students’ perceptions of the changes in their clinical training due to the pandemic in Mexico. Methods This was a cross-sectional study where a previous validated online survey was translated and adapted by medical education experts and applied to senior medical students from March to April of 2021. The 16-item questionnaire was distributed online combining dichotomous, multiple-choice, and 5-point Likert response scale questions. Descriptive and multivariate analyses were performed to compare the student’s perceptions between public and private schools. Results A total of 671 responses were included in the study period. Most participants were from public schools (81%) and female (61%). Almost every respondent (94%) indicated it was necessary to obtain COVID-19 education, yet only half (54%) received such training. Students in private schools were less likely to have their clinical instruction canceled (53% vs. 77%, p = 0.001) and more likely to have access to virtual instruction (46% vs. 22%, p = 0.001) when compared to students from public schools. Four out of every five students considered their training inferior to that of previous generations, and most students (82%) would consider repeating their final year of clinical training. Conclusions The impact of the COVID-19 on medical education in Mexico has been significant. Most final-year medical students have been affected by the cancellation of their in-person clinical instruction, for which the majority would consider repeating their final year of training. Efforts to counterbalance this lack of clinical experience with virtual or simulation instruction are needed.

Undergraduate Nursing Student Perspectives About Challenges in Clinical Education in Jordan: A Cross-Sectional Descriptive Study

Introduction: Clinical education is an essential element in a baccalaureate nursing program, providing nursing students with the required knowledge, skills, abilities, and attitudes that are required to deliver professional nursing care after graduation. Objective: The purpose of this study was to identify the student perceived challenges associated with nursing instruction in the clinical environment. Methods: A cross-sectional descriptive design was used to identify the challenges associated with clinical instruction from the nursing students’ perspective. Convenience sampling was used to recruit 187 nursing students from three universities in Jordan, including one public and two private. Results: The major challenges to clinical education were fear of committing mistakes; lack of facilities for students; lack of knowledge among community and patients about the nursing profession; fear of infection; lack of availability of equipment in the clinical setting; students’ lack of preparedness and skills in planning care; and lack of collaboration from clinical staff. Conclusion: Identifying the challenges is necessary to formulate strategies to address them, to improve curriculum designed and clinical education for nursing students accordingly.

Survey analysis to determine the impact of evidence informed practice education upon East Asian medicine faculty clinical instruction and students’ skills, knowledge, attitudes and behaviors within a master’s degree program

Background Between 2013 and 2018 Pacific College of Health and Science (formerly Pacific College of Oriental Medicine) trained faculty and developed curriculum in evidence informed practice (EIP), with support from a grant from the National Institutes of Health (NIH). A three-credit (45 h) Foundations of EIP course, and online EIP learning modules (developed as part of a previous NIH R25 award), were used for faculty and student training. In addition, EIP was incorporated into 73% of the East Asian medicine degree program. Clinical integration of EIP in the College clinic was enhanced by improving access to reference sources, including additional EIP-related questions to the patient intake forms, requiring the use of a patient-centered outcome instrument, and assessing students’ clinical EIP competencies. Methods Master’s degree students’ self-reported EIP skills, knowledge, attitudes and behaviors were assessed before and after taking the Foundations of EIP course using a 17-question paper-based survey with an additional open-ended comments section. The survey was administered in 29 courses across all three Pacific College campuses. Clinical faculty self-reported EIP instruction, focusing on the EIP content and instructional approaches that were utilized, was evaluated on the New York City campus using a paper-based survey before and after changes were made to enhance the clinical integration of EIP. Results A total of 1181 completed EIP-course surveys consisting of 657 pre-EIP course surveys and 524 post-EIP course surveys were analyzed. There was a statistically significant improvement in students’ EIP skills, knowledge and behaviors after completing the EIP course. Students’ perception of the importance of EIP was high before and after the EIP course. Little change in Faculty’s EIP-related clinical instruction was evident following the EIP-related changes that were made to the Clinic. Conclusion Our study suggests that the three-credit (45 h) EIP course was effective at improving the EIP skills, knowledge and behaviors of this group of East Asian medicine students who were undertaking a master’s degree that qualified them for licensure in acupuncture in the US. These students also demonstrated a high level of recognition for the importance of research and EIP both before and after the course. Training faculty clinical supervisors and providing greater access to evidence sources in the College clinic did not appear to increase EIP instructional activity.

Development of a Remote Online Collaborative Medical School Pathology Curriculum with Clinical Correlations, across Several International Sites, through the Covid-19 Pandemic

Introduction Due to the Covid-19 social distancing restrictions, in March 2020, Weill Cornell Medicine-Qatar decided to replace students’ clinical instruction with novel online electives. Hence, we implemented an innovative online and remote pathology curriculum, anchored on virtual microscopy and Zoom videoconferencing: ideal tools to support online teaching. Objective To assess a new curriculum implementation at Weill Cornell Medicine-Qatar. Materials and Methods This for-credit, 2-week elective included 6 synchronous Zoom sessions where complex clinicopathological cases were discussed in small groups. We used open access digital microscopy slides from the University of Leeds’ Virtual Pathology Library (http://www.virtualpathology.leeds.ac.uk/slides/library/). Students independently prepared for these sessions by reviewing cases, slides, readings, and questions in advance (asynchronous self-directed learning anchored on a flipped classroom model), and wrote a final review of a case. An assessment and feedback were given to each student. Results Four elective iterations were offered to a total of 29 students, with learners and faculty spread over 4 countries. During the Zoom sessions, students controlled the digital slides and offered their own diagnoses, followed by group discussions to strengthen autonomy and confidence. We surveyed learners about the elective’s performance (program evaluation). Students conveyed high levels of satisfaction about the elective’s overall quality, their pathology learning and online interactions, with minimal challenges related to the remote nature of the course. Discussion and Conclusions Technological innovations mitigate sudden disruptions in medical education. A remote curriculum allows instruction at any distance, at any time, from anywhere, enhancing educational exchanges, flexibility and globalization in medical education.

CLINICAL MANAGEMENT OF PATIENTS WITH COVID-19. “LIVE” CLINICAL INSTRUCTION (2021)

SUMMARY. In response to the challenges posed by the coronavirus (COVID-19) pandemic, Ukraine has undergone the necessary legislative changes, harmonized with international approaches, which in turn have led to significant changes in health care practices. The Law of Ukraine “On Amendments to Some Legislative Acts of Ukraine on Provision of Treatment of Coronavirus Disease (COVID-19)” № 539-IX, the Order of the Ministry of Health “On Approval of the Procedure for Prescribing and Using Medicines for the Treatment of Coronavirus Disease (COVID-19)” of 30.06.2020 № 1482, registered in the Ministry of Justice of Ukraine on July 08, 2020 for № 641/34924, establish the conditions of use of registered medicines according to the indications not specified in the instructions for medical use (off label), and unregistered medicines, recommended by the relevant official bodies outside Ukraine for the treatment of COVID-19. In pursuance of legislative acts, the Standard of Emergency Care “Coronavirus Disease (COVID-19)”, the Standards of Medical Care “Coronavirus Disease (COVID-19)”, the Standard of Pharmaceutical Care “Coronavirus Disease (COVID-19)”, the Protocol “Provision of medical care for the treatment of coronavirus disease (COVID-19)” were developed, approved and updated in accordance with the established procedure. At the same time, in order to assist the doctor and the patient in making a rational decision in different clinical situations, a clinical guideline “CLINICAL MANAGEMENT OF PATIENTS WITH COVID-19. “LIVE” CLINICAL INSTRUCTION” was developed – a document containing systematic provisions on medical and medico-social assistance, developed using the methodology of evidence-based medicine on the basis of reliability and proof confirmation. The basis of this clinical guideline is the WHO guideline “Clinical management of COVID-19: interim guidance” (27.05.2020), supplemented by the provisions of other WHO documents, as well as clinical guidelines of Great Britain, Belgium, USA and Australia. This guideline, as a living guideline, is a WHO innovation driven by the urgent need for global collaboration to provide reliable data and guidance emerging in the world as the result of numerous randomized clinical trials on COVID-19. The clinical guideline reflects the sequence of evidence on COVID-19 treatment in the world during a pandemic, on the basis of which the treatment strategy depending on the stage of the disease was formed and the decisions to include and exclude drugs in the protocol for COVID-19 treatment were justified, and will be further updated.

A mixed-methods assessment of the transition to a dedicated educational unit: nursing students’ perceptions and achievements

Background In 2019, our nursing school shifted clinical instruction from the traditional model to the Dedicated Educational Unit (DEU). Objectives To evaluate the DEU learning atmosphere, instruction quality, clinical instructor’s performance and students’ grades. Methods A sample of 45 nursing students completed the CLES-T; 10 of them participated in a focus group. Students’ grades in the DEU and traditional models were compared. Results Students (77.6%) ranked the DEU outcomes as “good”-“excellent;” “nursing care on the unit” and the “clinical faculty’s ability to integrate theory and practice” were the highest and lowest ranked categories, respectively. The focus group revealed dichotomous opinions regarding the unit atmosphere and the professional performance of the nurse manager and staff. Students in the DEU framework attained higher grades than did their counterparts. Conclusions Clinical instructors need specific training; the clinical staff and nurse managers should be informed about the unit atmosphere’s impact on students’ future professional decisions.

Survey Analysis to Determine the Impact of Evidence Informed Practice Education upon Faculty Clinical Instruction and East Asian Medicine Student’s Skills, Knowledge, Attitudes and Behaviors

BackgroundBetween 2013-2018 Pacific College of Health and Science (formerly Pacific College of Oriental Medicine) trained faculty and developed curriculum in evidence informed practice (EIP), with support from a grant from the National Institutes of Health (NIH). A three-credit (45 hour) Foundations of EIP course, and online EIP learning modules (developed as part of a previous NIH R25 award), were used for faculty and student training. In addition, EIP was incorporated into 73% of the East Asian medicine degree program. Clinical integration of EIP in the College clinic was enhanced by improving access to reference sources, including additional EIP-related questions to the patient intake forms, requiring the use of a patient-centered outcome instrument, and assessing student’s clinical EIP competencies. MethodsMaster’s degree student’s EIP skills, knowledge, attitudes and behaviors were assessed before and after taking the Foundations of EIP course using a 17-question paper-based survey with an additional open-ended comments section. The survey was administered in 29 courses across all three Pacific College campuses. Clinical faculty EIP instruction was evaluated on the New York City campus using a paper-based survey before and after changes were made to enhance the clinical integration of EIP. ResultsA total of 1181 completed EIP-course surveys consisting of 657 pre-EIP course surveys and 524 post-EIP course surveys were analyzed. There was a statistically significant improvement in student’s EIP skills, knowledge and behaviors after completing the EIP course. Students’ perception of the importance of EIP was high before and after the EIP course. Little change in Faculty’s EIP-related clinical instruction was evident following the EIP-related changes that were made to the Clinic. Conclusion Students’ self-assessed EIP skills, knowledge and behaviors improved after EIP training. Different approaches may be required to improve implementation of EIP in clinical settings.