Medical Students’ Attitudes Towards Cardiothoracic Surgery in the United Kingdom: A Cross-Sectional Survey of 1675 Students

Objectives The objectives of this study were the following: (i) assess interest levels in cardiothoracic surgery (CTS) among UK-based medical students, (ii) identify potential motivators and barriers to pursuing CTS training, (iii) explore the influence of gender on interest in CTS in greater depth. Methods Medical students from all year groups across UK medical schools were invited to participate in a cross-sectional, national online survey. Responses were collected from 02/12/2019 to 08/12/2019. Results 1675 medical students from 31 UK medical schools responded, with an estimated 5.3% response rate. Of the respondents, 33.7% respondents reported having exposure to CTS, primarily through their medical school or through extracurricular activities (48.4% and 38.8%, respectively). When assessing interest in CTS, 31.4% were interested in undertaking a career in CTS, with a larger proportion of students expressing interest with no exposure to CTS than those with exposure. However, interest in pursuing CTS decreased with exposure as medical students transitioned from pre-clinical to clinical stages. Additionally, male participants were more interested in seeking a CTS post than their female counterparts (38% vs. 27.6%). The length of training ( p = 0.0009) and competitive nature ( p < 0.0001) of gaining a CTS post were the primary deterring factor for female participants, compared to their male counterparts. Conclusions This study shows the importance of quality of exposure and its impact on students’ interests in pursuing a career in CTS. The negative relationship between exposure and interest in CTS can be associated with the realisation of the challenges that come with pursuing CTS.

Efficacy of Video-Based Forearm Anatomy Model Instruction for a Virtual Education Environment

INTRODUCTION As virtual education becomes more widespread, particularly considering the recent COVID-19 pandemic, studies that assess the impact of online teaching strategies are vital. Current anatomy curriculum at Paul L. Foster School of Medicine consists of self-taught PowerPoint material, clinical vignette-centered team-based learning (dry lab), and prosection-based instruction (wet lab). This study examined the impact of video-based muscle model (VBMM) instruction using a student-designed forearm muscle model on anatomy quiz scores and student perceptions of its effectiveness with regards to learning outcomes. METHODS Students divided into Group 1 (54 students) and Group 2 (53 students) were assessed prior to and following a 3.5-minute video on anterior forearm compartment musculature using the muscle model. Group 1 began by completing a pretest, then received VBMM instruction, and then completed a posttest prior to participating in the standard dry lab and 1 hour wet lab. Group 2 completed the wet lab, then received the pretest, VBMM instruction, and posttest prior to participating in the dry lab. Both groups took an identical five-question quiz covering locations and functions of various anterior forearm muscles each time. RESULTS Mean scores were higher than no formal intervention with exposure to VBMM instruction alone (0.73 points, P = .01), wet lab alone (0.88 points, P = .002), and wet lab plus VBMM instruction (1.35 points, P= <.001). No significant difference in scores was found between instruction with VBMM versus wet lab alone ( P = 1.00), or between either instruction method alone compared to a combination of the two methods ( P = .34, .09). Student survey opinions on the VBMM instruction method were positive. CONCLUSION VBMM instruction is comparable to prosection-based lab with regards to score outcomes and was well received by students as both an independent learning tool and as a supplement to cadaveric lab. When compared to either instruction method alone, the supplementation of VBMM with cadaveric prosection instruction was best. VBMM instruction may be valuable for institutions without access to cadaveric specimens, or those looking to supplement their current anatomy curriculum.

Medical Students’ Attitude Towards Robotic Surgery: A Cross-Sectional Survey

Introduction The robotic surgery and procedures are increasing worldwide. It is unknown whether medical students are well prepared for their future exposure to such technology. Objectives This study aimed to explore the knowledge and attitude of medical students from Saudi Arabia (SA) towards the robotic surgery. Methods We performed a cross-sectional survey of medical students at different colleges of medicine in SA. A web-based self-administered questionnaire using google forms was completed over a 2-month period starting on June 2021. Comparison between those with and without background about robotic surgery was performed. Results A total of 239 medical students from both governmental (46%) and private colleges (54%) responded to the questionnaire. 51.9% were interested in the surgical field and 37.7% considered themselves tech-savvy persons. Only (22.6%) had previous background about robotic surgery mainly from internet. Many (63.2%) showed positive attitude towards robotic surgery and expected that using robots will improve surgical outcomes. 48.5% of the students expected that patients in SA will not accept the robotic surgeries. Some (51.1%) concerned that robots could replace the surgeons and could make them less professional. Many believed that SA should invest and expand the robotic surgeries (69.1%). Students with background in robotic surgery had significantly younger median age (p < 0.030), earlier academic years (p < 0.001), higher GPA (p < 0.025), and more tech-savvy personality (p < 0.000) compared to those without background. Conclusion Most medical students are unaware of robotic surgery, but they have positive attitude with some concerns. Young students who consider themselves tech-savvy persons are in a better position, but they access their knowledge from internet rather than from their medical education. Medical curricula and residency training program should take these findings into consideration for preparing the future surgeons in SA.

Technical Standards from Newly Established Medical Schools: A Review of Disability Inclusive Practices

Introduction Technical standards document US medical school's nonacademic criteria necessary for admission, persistence, and graduation and communicate the school's commitment to disability inclusion and accommodation but are considered one of the largest barriers for students with disabilities. Calls for more inclusive technical standards have increased in recent years, yet the impact of this work on changing technical standards has not been measured. The establishment of 15 new US MD- and DO-granting medical schools between 2017 to 2020 offered a unique opportunity to evaluate differences in the inclusive nature of newly developed technical standards. Method We conducted a document analysis of 15 newly formed medical schools’ technical standards to determine the availability and inclusive nature of the standards as they pertain to students with sensory and mobility disabilities. Technical standards were coded for: ease of obtaining technical standards, the school's stated willingness to provide reasonable accommodations, the origin of responsibility for accommodation request and implementation, and the school's openness to intermediaries or auxiliary aids. Results Of the 15 schools, 73% of the technical standards were not easy to locate online. Few (13%) included language that support disability accommodations. Most (73%) used language that was coded as ‘restrictive’ for students with physical or sensory disabilities. Coding of the newly accredited US MD and DO medical schools suggests that newly created technical standards are more restrictive than those in previous studies. Conclusions Efforts to create more inclusive technical standards have not yet been realized. Newly formed US MD- and DO-granting medical schools may perpetuate historically restrictive technical standards that serve as barriers to applicants with disabilities. Future research should evaluate the role of medical school accrediting bodies to go beyond simply requiring technical standards to ensuring that the standards are readily available and appropriately convey the availability of reasonable accommodations for students with disabilities.

Rapid Mobilization of Medical Student Volunteers to Administer Vaccines During the COVID-19 Pandemic

In December 2020, the first COVID-19 vaccines were approved for emergency use by the U.S. Food and Drug Administration, and vaccination efforts rapidly launched across the country. Concurrently, New York City experienced an increase in COVID-19 hospitalizations. This created an immediate need to inoculate frontline workers in a strained health system that lacked sufficient personnel to meet the demand. In response, New York State permitted medical students with appropriate clinical experience to administer vaccinations. Albert Einstein College of Medicine students rapidly stepped in to administer vaccines and serve as clinic navigators. Student leaders at Einstein collaborated with Montefiore Medical Center to rapidly implement a student vaccination initiative. Medical students underwent virtual and on-site training regarding COVID-19 vaccines and their administration. In January 2021, students began to staff vaccine clinics across the Bronx. By July 2021, 291 out of 830 eligible medical and Medical Scientist Training Program (MSTP) students (35.1%) had volunteered >2400 h. Of the 291 volunteers, 77 (26.5%) worked as vaccinators and administered approximately 2929 COVID-19 vaccines from January to May 2021. We demonstrate success using the concept of Entrustable Professional Activities (EPAs) in the context of training medical students in a specific clinical skill. Our framework resulted in the administration of approximately 2929 COVID-19 vaccines from January to May 2021. The authors believe that this framework can be implemented at peer institutions to alleviate the burden on hospital systems and outpatient clinics vaccinating their communities against COVID-19, or to meet future clinical needs.

Lessons Learned from Clinical and Translational Science Faculty and Student Survey as COVID-19 Pandemic Continues to Shift Education Online

Introduction As the pandemic continues with new variants emerging, faculty and students require support with education's rapid shift to the virtual space. The Mayo Clinic Center for Clinical and Translational Science curriculum team works closely with faculty to support a smooth transition to offering graduate courses in a virtual learning environment. The aim of the present project was to explore faculty and student perceptions of these remote learning strategies to gain an understanding of the innovations required to improve future educational offerings. Methods All faculty and learners involved in nine Clinical and Translational Science courses in spring 2020 were invited to participate in a web-based questionnaire. Quantitative analysis was performed on closed-ended items, including 5-point Likert-scale questions used to assess the range of views. Qualitative free-text responses were independently analyzed for repetitive themes and summarized. Additionally, comparisons of faculty and course evaluations and student grade point averages (GPAs) from the in-person courses and their subsequent virtual course offerings were considered. Results Survey results indicated several positive impacts with moving courses into the virtual environment, including increased accessibility as well as more student-centered education. Learners joining from sites outside of the originating campus were especially grateful for the virtual classroom because they felt newly integrated within classes. Faculty and course evaluations, as well as student GPAs, remained consistent. Conclusion New COVID-19 variants continue to shift education online, and innovative ideas are required to further improve future virtual course offerings. Increased engagement is warranted, both from faculty to incorporate activities designed specifically for a virtual classroom, and from students to increase participation by activating their microphones and webcams. Greater opportunities for global involvement and connectedness arise. Finally, this project advocates for adequate eLearning staffing to support quality online education as the need for pedagogical and technical provision continues.

A Cross-Sectional Study of Undergraduate Teaching of Trauma and Orthopaedics in the UK and the Relationship Between Medical Schools and Interest in Trauma and Orthopaedics as a Career

INTRODUCTION Adequate exposure and teaching of Trauma and Orthopaedics (T&O) to medical students is fundamental in order to obtain sufficient knowledge and sustain their interest in T&O as a career. The primary aim is to assess the exposure and delivery of T&O at all medical schools in the UK. The secondary aim is to determine whether there are any associations between attending a particular medical school and having a strong interest in pursuing a career in T&O. METHODS To explore the primary aim, all 33 UK medical schools were investigated in the study, by means of a questionnaire distributed to medical students. This did not include ‘new’ medical schools, defined as those established from 2014 onwards. To investigate the secondary aim of exploring associations between students’ and alumni's medical schools and their interest in T&O as a career, British Orthopaedic Training Association (BOTA) members were reviewed, using the General Medical Council register to identify the universities from which members had graduated. The authors have made the assumption that membership of BOTA signified an interest in T&O as a career. RESULTS Results were obtained for all 33 medical schools. The mean total teaching time specifically for T&O throughout medical school was 18 days, ranging from 3 to 60 days in total. 118 BOTA members were reviewed. No member of BOTA in the study had attended medical school in Keele, Liverpool, Plymouth or Lancashire. These universities taught below the national average number of days in T&O. DISUCSSION There is a large national variance in the number of compulsory teaching days provided for T&O. The authors advocate medical schools to aim for at least the national average in duration of T&O of 18 days.

Gender Disparities in Symptoms of Depression After Medical School Exams and Student Coping Strategies for Postexam Depression Symptoms

CONTEXT Little research exists to determine if medical students experience symptoms of depression after examinations and if symptoms vary by gender. OBJECTIVES Determine if is there a difference between male and female medical students in the number of symptoms of major depressive disorder (MDD) experienced after exams, as well as which coping strategies are used by students to alleviate depression symptoms. METHODS An anonymous and secure survey was sent via university email to first, second, and third-year medical students after exams for 2 consecutive exam periods. Surveys that were not fully completed were excluded from the analysis. RESULTS A total of 162 out of 550 students completed the survey for a response rate of 30%. Overall, a greater proportion of female students experienced more symptoms of depression compared to males. This was statistically significant for the Diagnostic and Statistical Manual of Mental Disorders 5th Edition symptoms of MDD: depressed mood, anhedonia, changes in sleep, fatigue, and difficulty with concentration after exams compared to their male counterparts. Male first-year medical students experienced higher rates of depression compared to their third-year counterparts. Most students exhibited coping strategies that helped them feel less depressed. The 3 most common coping strategies reported were: reaching out to social support networks, physical activity/exercise, and engaging in hobbies. CONCLUSIONS Both gender and year in a medical school play a role in the number of symptoms of depression experienced after medical school exams. Recognizing that examinations can be a trigger of depressive symptoms in medical students, particularly female and first-year students, has important implications on student mental health. Helping students recognize these symptoms and employ healthy coping strategies may further help alleviate these symptoms. Long-term consequences of experiencing symptoms of depression after recurrent exams in medical school are unknown and require further research.

Development, Implementation, and Initial Participant Feedback of an Online Anatomy and Radiology Contouring Bootcamp in Radiation Oncology

BACKGROUND The Anatomy and Radiology Contouring (ARC) Bootcamp was a face-to-face (F2F) course designed to ensure radiation oncology residents were equipped with the knowledge and skillset to use radiation therapy techniques properly. The ARC Bootcamp was proven to be a useful educational intervention for improving learners’ knowledge of anatomy and radiology and contouring ability. An online version of the course was created to increase accessibility to the ARC Bootcamp and provide a flexible, self-paced learning environment. This study aimed to describe the instructional design model used to create the online offering and report participants’ motivation to enroll in the course and the online ARC Bootcamp's strengths and improvement areas. METHODS The creation of the online course followed the analysis, design, development, implementation, and evaluation (ADDIE) framework. The course was structured in a linear progression of locked modules consisting of radiology and contouring lectures, anatomy labs, and integrated evaluations. RESULTS The online course launched on the platform Teachable in November 2019, and by January 2021, 140 participants had enrolled in the course, with 27 participants completing all course components. The course had broad geographic participation with learners from 19 different countries. Of the participants enrolled, 34% were female, and most were radiation oncology residents (56%), followed by other programs (24%), such as medical physics residents or medical students. The primary motivator for participants to enroll was to improve their subject knowledge/skill (44%). The most common strength identified by participants was the course's quality (41%), and the most common improvement area was to incorporate more course content (41%). CONCLUSIONS The creation of the online ARC Bootcamp using the ADDIE framework was feasible. The course is accessible to diverse geographic regions and programs and provides a flexible learning environment; however, the course completion rate was low. Participants’ feedback regarding their experiences will inform future offerings of the online course.

Building a Shared Mental Model of Competence Across the Continuum: Trainee Perceptions of Subinternships for Residency Preparation

INTRODUCTION Toward a vision of competency-based medical education (CBME) spanning the undergraduate to graduate medical education (GME) continuum, University of Minnesota Medical School (UMMS) developed the Subinternship in Critical Care (SICC) offered across specialties and sites. Explicit course objectives and assessments focus on internship preparedness, emphasizing direct observation of handovers (Core Entrustable Professional Activity, “EPA,” 8) and cross-cover duties (EPA 10). METHODS To evaluate students’ perceptions of the SICC's and other clerkships’ effectiveness toward internship preparedness, all 2016 and 2017 UMMS graduates in GME training ( n = 440) were surveyed regarding skill development and assessment among Core EPAs 1, 4, 6, 8, 9, 10. Analysis included descriptive statistics plus chi-squared and Kappa agreement tests. RESULTS Respondents ( n = 147, response rate 33%) rated the SICC as a rotation during which they gained most competence among EPAs both more (#4, 57% rated important; #8, 75%; #10, 70%) and less explicit (#6, 53%; #9, 69%) per rotation objectives. Assessments of EPA 8 (80% rated important) and 10 (76%) were frequently perceived as important toward residency preparedness. Agreement between importance of EPA development and assessment was moderate (Kappa = 0.40-0.59, all surveyed EPAs). CONCLUSIONS Graduates’ perceptions support the SICC's educational utility and assessments. Based on this and other insight from the SICC, the authors propose implications toward collectively envisioning the continuum of physician competency.