The Impact of COVID-19 lockdown on Indian medical undergraduate students

Background and Aims: With the implementation of the COVID-19 lockdown, conventional teaching had to be replaced with online teaching, to ensure the continuity of medical education. This has impacted the clinical training of medical undergraduates. We aimed to explore their perceptions and differences before and during the COVID-19 lockdown. Methods: A cross-sectional online survey using a self-administered, retrospective pre-post questionnaire, was conducted among students from pre-final and final year between December 2020 and March 2021. Agreement scores with 15-items about the various domains of clinical training were recorded. Open-ended question was asked to know about the reasons for the students’ preferences. Chi-square test and Wilcoxon signed rank test were used to compare the proportion and medians respectively. Results: We received 1000 responses from students of 191 medical colleges {Median (IQR): 6 (2,10) per college}. Most (81.6%) opined that their experience with clinical training was better before COVID-19 lockdown, irrespective of the mode of teaching in clinical skills (P<0.001). In addition, despite being more comfortable, focused, and interactive, online clinical training could not offer interaction with patients, residents and colleagues. Students who had gone through in-person training during lockdown period also perceived disadvantages like limited exposure to patients, limited time for faculty to teach, and less time for clinical practice. Conclusion: The learning experiences of clinical training during COVID-19 lockdown were perceived as inferior than that before lockdown by the medical undergraduate students, irrespective of the mode of clinical training.

Omicron and the future of the Pandemic

The advent of the Omicron variant

Haematuria readmission rates in DOAC patients undergoing TURP/TURBTs and urinary tract biopsies – is there any need for a bridging plan?

Aim - The purpose of our quality improvement project was to reduce readmission rates for haematuria in patients on direct oral anticoagulants (DOACs) who had undergone a urinary tract biopsy or resection. Methods - For each cycle we used operating lists, pre-assessment clerking and departmental inpatient lists to identify the proportion of patients on DOACs readmitted post-operatively within 1 month from date of surgery. Cycle 1 was completed over a six-month period. We then discussed these results with a Haematologist, who advised a bridging plan with low-molecular weight heparin to mitigate the risk. Following implementation of the bridging plan, we then completed the second cycle over a three-month period. Results - The first cycle showed that 37.5% (n=16) of all patients on DOACs who had undergone one of these procedures were readmitted with significant haematuria. After implementation of the bridging plan with Low molecular weight heparin, the second cycle showed a reduced readmission rate of 33.3% (n=9), despite a higher percentage of patients on a DOAC in this cycle. Discussion - There was no uniform practice or protocol for restarting DOACs in our hospital. After completion of this project, a uniform protocol has been established. Recommendations included: (1) rediscuss with a Haematologist whether further measures were needed; present our data at a regional meeting to survey protocol and practices in neighbouring hospitals. Limitations included: a small sample size; non-uniform duration of data collection per cycle; reduction of elective operative lists due to COVID-19.

Alexithymia and Empathy in a Non-Clinical Population: How do they Correlate?

Alexithymia and empathy are functional concepts surrounding human emotions.This study aimed to estimate the association between alexithymia and empathy within a neurotypical population. The study was a cross sectional survey conducted within a non-clinical population of medical students at a University in England using voluntary sampling to complete the Toronto Alexithymia Scale (TAS), Basic Empathy Scale (BES), General Health Questionnaire- 12. Alexithymia and empathy scores did not show a statistically significant correlation. There was a statistically significant negative correlation between total alexithymia and cognitive empathy scores (correlation co-efficient was -0.184, p value was 0.013). Men and women differed significantly on empathy scores with women showing significantly higher empathy. The relationship between the understanding of one’s own emotions and the interpretation of others’ emotions are different functions with a more complex interaction than a simple linear correlation. Future research should focus on further exploring the differences between cognitive and affective empathy.

Equality & Diversity Perspectives for the Proficiency in English Assessment for IMGs

The story of a West Midlands General Practitioner who faced the fearsome prospect of deportation and severance from her young family due to expiry of her English proficiency test after 2 years- highlights the lack of consultation, awareness, empathy and dignity that is perceived by international medical graduates in the UK. What is most alarming is that evidence of working as a GP in the UK for 8 years, communicating with patients and colleagues in English - and passing all the standardised professional examinations set by the medical royal colleges was not considered sufficient for her to be assessed to have the minimum requirements for her permit/ leave to remain to be renewed. The mental anguish and stress that a frontline GP has to face is totally avoidable. The NHS, GMC and Department of Health and Social Care need to have robust consultation with the Home Office department on making the rules sensitive and meaningful and applied with awareness, understanding and compassion that is critical for the wellbeing of the healthcare workforce- and the benefit of our patients.

Research & Innovation Abstracts

Oral and Poster Presentations at the BAPIO Silver Jubilee Annual Conference 2021 Birmingham, UK 22-24 Oct 21

A Novel Minimally Invasive Retro Rectus Repair of Ventral Hernia

Background Ventral hernia repair is one of the common general surgical procedures. A novel eTEP technique has been developed where in a mesh is placed in retro muscular plane through minimally invasive approach. There is scarcity of data on its effectiveness as compared to conventional Laparoscopic IPOM hernioplasty. Aims and Objectives We aim to introduce our innovative Kumar-Subhash’s modified 3 port eTEP technique for ventral hernia repair and compare its clinical effectiveness with conventional IPOM repair. Methods A prospective comparative study was undertaken at Devagiri Hospital, Bangalore, India from January 2017 to December 2019. 30 patients were included in the study (12 in eTEP group and 18 in IPOM group) based on predefined inclusion and exclusion criteria. Patients were followed up to 30 days post-operatively. The outcomes were compared with respect to postoperative pain, length of hospital stay and early postoperative complications. Results Baseline characteristics and presenting complaints were comparable for both the groups. The mean pain score on POD 1 in eTEP group was 3, and 1 on POD 7 as compared to 7 and 3 in IPOM group on POD1 and 7 respectively, which was statistically significant. Patients in eTEP group had a shorter length of hospital stay (LOS). None of the patients had any complications related to the novel technique. Conclusions Kumar-Subhash’s modified 3 port eTEP technique is a novel and easy approach for laparoscopic repair of ventral hernia with significantly less post-operative pain and LOS with an additional cosmetic advantage for patients.

Optimum Sleep is Important for Reducing the Risk of Cardiovascular Mortality & Morbidity

Cardiovascular disease (CVD) is the leading cause of death worldwide. Humans spend up to a third of their life asleep, yet sleep problems are common in society [1]. Sleep disorders, such as insomnia and obstructive sleep apnoea, not only affect optimal functioning and productivity but have long term impacts on health. Over the last two decades, emerging research has linked sleep duration, quality and sleep disorders with CVD, metabolic syndrome and obesity. This essay will explore the role of sleep in maintaining a healthy heart, and how strategies to improve sleep can reduce CVD risk.

Key Factors Fuelling India's Second COVID Surge

Having declared in autumn of 2020, that India had defeated Coronavirus, the steep rise of cases in April-May 2021, caught the authorities unawares. The health care infrastructure was rapidly overwhelmed at every level and equally in the national capital, large and small cities and the vast rural populace. The human catastrophe that was unfolding in front of the digitally connected world was heart-breaking. The natural ingredients of a battered economy (-23.9% GDP), a large populace (1.34 billion), poor public health, a chronic epidemic of diseases such as tuberculosis, diabetes, hypertension or kidney disease, chronic underfunding of healthcare infrastructure (1.8% of GDP), deficiency of healthcare workforce (estimated deficit of 600,000 doctors and 2 million nurses) and disjointed, disordered leadership combined with an incoherent, incohesive healthcare policy led to the disaster. After relative stabilisation from the first few weeks of the impact of colossal lack of hospital beds, oxygen, supported ventilation, life-saving drugs, safe and dignified disposal of the dead, and any form of coordinated disaster response, there is now the new epidemic of the black fungus. This editorial explores the emergence of this new health challenge for India and issues a call to rally.

Drug resistance In Mycobacterium Tuberculosis

The COVID-19 pandemic has also had a significant impact on the detection and management of infectious diseases worldwide. As the healthcare resources struggle to deal with the pandemic, there is widespread fear that there will be a rise in other infections and non-communicable diseases. Mycobacterium Tuberculosis remains one of the highest cause of mortality and morbidity in the world with 10 million new cases, 1.4 million deaths and nearly half a million cases of drug-resistant TB, in 2019. The need of the hour is to prevent the rise of drug resistance in TB. The rise in drug resistance can be mainly attributed to failure to adhere to treatment regimens. Recent studies show that the exposure of bacteria to sublethal levels of bacterial antibiotics, promotes cellular mutations, leading to increased mutations promoting drug resistance. Because of the problems associated with the detection and treatment of drug-resistant tuberculosis, it is of paramount importance that we aim to implement stringent measures of primary and secondary prevention against cases of drug-sensitive tuberculosis to prevent the rise of drug resistance. It is important to highlight the importance of DOTS while talking about measures of primary and secondary prevention. The involvement of the multidisciplinary health team and auxiliary health workers to monitor the treatment of affected patients cannot be stressed enough, since this is the most simple and effective way to prevent treatment failure. Furthermore, the cost of treatment of MDR-TB remains out of reach of the middle and lower middle-income strata of society. It is the need of the hour to lower the cost of drugs as well as provide easy and affordable access to rapid investigations to detect drug resistance