Surgical Residents as Clerkship Scholars May Improve Student Perception of the Surgery Clerkship.

INTRODUCTION: The surgical clerkship is a formative experience in the medical school curriculum and can leave a lasting impression on students' perception of surgery. Given the historical negative stereotypes of surgeons, the clerkship represents an opportunity to impact students in a meaningful way. METHODS: Our institution developed a program in which research residents can serve as junior clerkship coordinators and educators; working closely with medical students on their surgery clerkship. At the end of their clerkship, students were administered a survey with Likert-scale and free text responses regarding satisfaction with the rotation, lectures, feedback, and value of the clerkship. Student survey results were compared before (2015-2016) and after (2017-2019) the implementation of the scholar program with nonparametric statistical analysis and qualitative text analysis. RESULTS: A total of 413 students responded to the survey with no significant difference in response rate by term (P = 0.88). We found no statistical difference with respect to overall course perception (92.3% versus 91.2%, P = 0.84), but a statistically significant difference was noted for the clarity of the provided written clerkship materials (80.3% versus 91.3%, P = 0.02) and usefulness of the feedback (57.5% versus 78.7%, P = 0.01). Qualitative analysis demonstrated an overall positive shift in perception of the clerkship, improvement in the course materials, and organization. CONCLUSIONS: The scholar program was overall well received by the students with improvements in certain aspects of the clerkship: organization, feedback, and course materials. This program represents a potential strategy to improve certain portions of the medical school clerkship experience.

The outcomes of team-based learning vs small group interactive learning in the obstetrics and gynecology course for undergraduate students.

INTRODUCTION: Team-based learning (TBL) is a well-established active teaching method which has been shown to have pedagogical advantages in some areas such as business education and preclinical disciplines in undergraduate medical education. Increasingly, it has been adapted to clinical disciplines. However, its superiority over conventional learning methods used in clinical years of medical school remains unclear. The aim of this study was to compare TBL with traditional seminars delivered in small group interactive learning (SIL) format in terms of knowledge acquisition and retention, satisfaction and engagement of undergraduate medical students during the 6-week obstetrics and gynecology clerkship. MATERIAL AND METHODS: The study was conducted at Karolinska Institutet, a medical university in Sweden, and had a prospective, crossover design. All fifth-year medical students attending the obstetrics and gynecology clerkship, at four different teaching hospitals in Stockholm (approximately 40 students per site), in the Autumn semester of 2022 were invited to participate. Two seminars (one in obstetrics and one in gynecology) were designed and delivered in two different formats, ie TBL and SIL. The student:teacher ratio was approximately 10:1 in the traditional SIL seminars and 20:1 in the TBL. All TBL seminars were facilitated by a single teacher who had been trained and certified in TBL. Student knowledge acquisition and retention were assessed by final examination scores, and the engagement and satisfaction were assessed by questionnaires. For the TBL seminars, individual and team readiness assurance tests were also performed and evaluated. RESULTS: Of 148 students participating in the classrooms, 132 answered the questionnaires. No statistically significant differences were observed between TBL and SIL methods with regard to student knowledge acquisition and retention, engagement and satisfaction. CONCLUSIONS: We found no differences in student learning outcomes or satisfaction using TBL or SIL methods. However, as TBL had a double the student to teacher ratio as compared with SIL, in settings where teachers are scarce and suitable rooms are available for TBL sessions, the method may be beneficial in reducing faculty workload without compromising students' learning outcomes.

Learning through connections: clinical participation and interpersonal relationships in longitudinal integrated clerkships and traditional block rotations in Taiwan.

BACKGROUND: Longitudinal integrated clerkships (LICs) and traditional block rotations (TBRs) employ different designs that provide various learning experiences for students. In this study, we explored students' clinical participation and interpersonal interactions in LICs and TBRs at 2 metropolitan hospitals in Taiwan. METHODS: In April 2018, we enrolled 15 LIC and 29 TBR students. We conducted a cross-sectional survey which required the students to outline a typical daily schedule during their internal medicine rotations and draw an ecomap of the clinical team members. With the patient in the center as a reference, the size of each circle in an ecomap indicated the importance of the member; the distances and number of connecting lines between two circles represented the relationship and frequency of interaction, respectively, between the corresponding members. We analyzed the results and compared the responses of the LIC and TBR students. RESULTS: The LIC students spent more time on direct patient care and in the outpatient clinic/operation room, whereas the TBR students participated more in educational activities and in observation behind their seniors. In the ecomap analysis, the LIC students had a closer relationship with attending physicians and had better interactions with patients and preceptors than did the TBR students. Conversely, the TBR students felt closer to and interacted more frequently with interns and residents. CONCLUSIONS: The LIC students had more opportunities to care for patients directly and engaged in interactions with patients and attending physicians more frequently than did the TBR students. TRIAL REGISTRATION: Ethical approval for the study was obtained from the Institutional Review Board of Tri-Service General Hospital (TSGHIRB 2-106-05-018).

Test-Only Learning via Virtual Patients to Improve Surgical Illness Scripts of Preclinical Medical Students as a Preparation for Clinical Clerkships: An Experimental Study.

OBJECTIVE: The aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets. METHODS: In this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical. RESULTS: The preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen's d) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students' mean score (75.4 ± 8.9), P > .05. CONCLUSIONS: Test-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships.

Preclinical Immersion Experiences Improve Medical Student Perceptions of Surgery.

INTRODUCTION: Medical students historically receive little to no preclinical exposure to surgery and surgical subspecialties. As a result, by the time they reach their clinical clerkship time, students often have already found interest in other specialties. The goal of this study is to utilize the knowledge to action (KTA) implementation framework to design and refine a clinical immersion experience during the second year of medical school. METHODS: A total of 94 second-year Harvard Medical School students underwent the surgical immersion experience between 2019 and 2022 (the program was postponed in 2020 due to COVID). The development and refinement of the curriculum were nicely modeled by the KTA implementation framework. We identified a gap in medical student preclinical education, adapted a curriculum for preclinical medical students at Massachusetts General Hospital , selected the curriculum components to provide a high-level overview of surgery, monitored the student experience, and evaluated outcomes using the student surveys. Based on the survey results, inductive thematic analysis was utilized to identify prominent positive and negative themes. The feedback was then used to tailor subsequent iterations of the immersion experience. RESULTS: Eighty-eight medical students completed the survey (RR = 93.6%), and 85% rated the immersion experience as "excellent", 11% "very good", 4% "good", and 0% "fair" or "poor". There was no significant difference in ratings between sessions. Several key themes were identified, including changed perceptions, diversity of surgical fields, teamwork, surgery clerkship preparedness, and the need for more preclinical exposure. CONCLUSIONS: Preclinical medical students gave overwhelmingly positive reviews of the surgical immersion experience. A half-day intervention is sufficient to begin changing students' views toward surgery, disproving stereotypes, and even inspiring some to consider a surgical field themselves. In addition, the KTA implementation framework is a useful model for the development and refinement of medical education curricula.

Student Teaching in the Family Medicine Clerkship: Opportunities for Interactive Virtual Learning.

OBJECTIVES: It often is challenging to deliver clerkship didactic sessions in a time-effective and engaging manner for learners. The flipped classroom approach, which fosters independent learning before applying knowledge in group settings, is an evidence-based way to enhance engagement and learning. Electronic learning methodologies were used widely during the coronavirus disease 2019 pandemic to ensure student safety while continuing didactics remotely. Student teaching of didactics delivers key content in innovative ways while also providing students with the opportunity to teach their peers. METHODS: During the Family Medicine clerkship at Florida International University Herbert Wertheim College of Medicine, students deliver an interactive, 15-minute presentation on a core Society of Teachers of Family Medicine National Clerkship Curriculum topic. During the first year of the pandemic (2020), this assignment was transitioned to be conducted remotely via Zoom. For the 2020-2021 academic year, students completed an anonymous, optional, computer-based, postactivity survey to assess their satisfaction with and perceptions of the assignment. RESULTS: The majority (80%) of respondents reported that they enjoyed teaching in the online format. In addition, students reported that this assignment made them feel confident in their teaching abilities, that they learned from their peers, and that teaching helped clarify their understanding of the topic. CONCLUSIONS: Student-led teaching is beneficial to learners because it enhances engagement. It can be easily implemented and help reduce faculty burden for curricular development. In a distributed, community-based clinical model such as ours, electronic learning allows for coordinated teaching efforts across geographical boundaries.

Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists' experiences across continents.

INTRODUCTION: Many health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC. METHODS: The study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed 'Secrets to success'. The session was recorded with the participants' consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified. RESULTS: Thirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed. DISCUSSION: This PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC.

The Effectiveness of Online Experiential Learning in a Psychiatry Clerkship.

OBJECTIVE: The Uniformed Services University of the Health Sciences 5-week psychiatry clerkship educates about 180 students a year at sites around the USA. In 2017, weekly in-person experiential learning sessions were implemented for local students and resulted in improved performance in several end-of-clerkship Objective Structured Clinical Examination (OSCE) skills as compared to distant learners who did not receive these sessions. The difference in performance (~ 10%) highlighted a need to provide comparable training for distant learners. Providing in-person, repeated simulated experiential training at multiple distant sites was not practical, requiring development of a novel online approach. METHODS: Students at all four distant sites over 2 years (n = 180) participated in five weekly synchronous online experiential learning sessions, while local students (n = 180) received five weekly in-person experiential learning sessions. Tele-simulation used the same curriculum, centralized faculty, and standardized patients as the in-person iterations. Overall end-of-clerkship OSCE performance was compared for learners receiving online versus in-person experiential learning for non-inferiority. Specific skills were compared to receiving no experiential learning. RESULTS: Overall OSCE performance was non-inferior for students who received synchronous online as compared to in-person experiential learning. Performance on each skill other than communication improved significantly when comparing students who received online versus no experiential learning (p < 0.05). CONCLUSIONS: The use of weekly online experiential learning to enhance clinical skills is comparable to in-person efforts. Virtual, simulated, synchronous experiential learning provides a feasible and scalable platform for training complex clinical skills to clerkship students, a critical capability given the impact the pandemic has had on clinical training.

A is for advocacy: How introducing student advocacy assessment impacts longitudinal integrated clerkship students and clinical supervisors.

To improve health, physicians are increasingly called to advocate. Yet medical schools have only recently focused on health advocacy skill-building. Limited work to date addresses assessing medical student advocacy on behalf of patients. We describe how students and clinical supervisors (CS) in two urban longitudinal integrated clerkships (LIC) experience patient advocacy and how introducing a new advocacy assessment impacts them. Using a thematic approach, we analyzed transcripts of focus groups during 2018-2019. Seventeen of 24 (71%) students and 15 of 21 (71%) CS participated in the focus groups. We describe how students perceive their advocacy role as they accompany the patient, amplify their voice, and facilitate connection. The rationale for advocacy assessment includes that it (1) adds a novel dimension to the written and verbal assessment, (2) drives student learning, (3) aligns with the institutional goal to promote equity, and (4) impacts CS teaching and clinical practice. Challenges are the ambiguity of expectations, pressure to 'perform,' and a moral overlay to advocacy assessment. Findings demonstrate how educational alliances between students and CS and longitudinal relationships between LIC students and patients offer a constructive opportunity for advocacy assessment. We describe suggestions to hone and expand the reach of advocacy assessment.

Types of clinical reasoning in a summative clerkship oral examination.

INTRODUCTION: Dual-process theory characterizes clinical reasoning (CR) as Type 1 (intuitive) and Type 2 (analytical) thinking. This study examined CR on a summative clinical clerkship structured clinical oral examination (SCOE). METHODS AND SUBJECTS: 511 clinical clerks at the University of Toronto underwent SCOEs. Type 1, Type 2, and Global CR performance were compared to other internal medicine clerkship assessments using descriptive statistics and Spearman correlations. RESULTS: Clinical clerks achieved mean marks >75% on the three clinical reasoning stations, on Type 1 and 2 CR tasks, and the overall SCOE. Performance on the SCOE CR stations correlated with each of the other clerkship assessments: written examination, inpatient, and ambulatory clinic assessments. The correlation of performance between Type 1 and Type 2 clinical reasoning tasks was statistically significant but weak (rs = 0.28). This suggests that defined measures of Type 1 and Type 2 reasoning were indeed assessing distinct constructs. CONCLUSION: Clinical clerks used both Type 1 and Type 2 reasoning with success. This study's characterization of Type 1 and Type 2 CR as separate domains, distinct from existing measures on the SCOE as well as the other clerkship assessments, can suggest a further addition to multimodal clerkship assessment.

How medical students co-regulate their learning in clinical clerkships: a social network study.

BACKGROUND: Self-regulated learning is a key competence to engage in lifelong learning. Research increasingly acknowledges that medical students in clerkships need others to regulate their learning. The concept of "co-regulated learning" captures this act of regulating one's learning by interacting with others. To effectively cultivate such skills in students, we need to increase our understanding of co-regulated learning. This study aimed to identify the purposes for which students in different phases of clinical training engage others in their networks to regulate their learning. METHODS: In this social network study, we administered a questionnaire to 403 medical students during clinical clerkships (65.5% response rate). The questionnaire probed into the composition of students' co-regulatory networks and the purpose for which they engaged others in specified self-regulated learning activities. We calculated the proportion of students that engaged others in their networks for each regulatory activity. Additionally, we conducted ANOVAs to examine whether first-, second-, and third-year students differed in how they used their networks to support self-regulation. RESULTS: Students used others within their co-regulatory networks to support a range of self-regulated learning activities. Whom students engaged, and the purpose of engagement, seemed to shift as students progressed through clinical training. Over time, the proportion of students engaging workplace supervisors to discuss learning goals, learning strategies, self-reflections and self-evaluations increased, whereas the proportion of students engaging peers to discuss learning strategies and how to work on learning goals in the workplace decreased. Of all purposes for which students engaged others measured, discussing self-reflections and self-evaluations were consistently among the ones most frequently mentioned. CONCLUSIONS: Results reinforce the notion that medical students' regulation of learning is grounded in social interactions within co-regulatory networks students construct during clerkships. Findings elucidate the extent to which students enact self-regulatory learning within their co-regulatory networks and how their co-regulatory learning behaviors develop over time. Explicating the relevance of interactions within co-regulatory networks might help students and supervisors to purposefully engage in meaningful co-regulatory interactions. Additionally, co-regulatory interactions may assist students in regulating their learning in clinical workplaces as well as in honing their self-regulated learning skills.

Bridging gaps in oral health education in a medical school in the United States: a pilot study.

BACKGROUND: Oral health is an important component of medical education given its connection to overall health and quality of life; however, oral health is infrequently incorporated into medical school curricula in the United States. The aim of this study was to pilot a novel oral health care clerkship for United States medical students that implemented the Smiles for Life (SFL) curriculum, in-person clinical activities, and pre and post curricula assessments to assess knowledge acquisition, attitude change, and clinical skill development. METHODS: Third year medical students at Albert Einstein College of Medicine, Bronx, New York, volunteered (n = 37) for a clerkship in oral health. Students completed the Smiles For Life National Oral Health Curriculum and participated in three half-day clinical sessions in a hospital-based dental clinic. The participants were evaluated on knowledge acquisition, attitude change, and clinical skill development through a pre and post clerkship assessment in order to assess the efficacy of the intervention. RESULTS: There was a 23.4% increase in oral health knowledge (p < 0.001) following participation in the online modules and clerkship. Additionally, attitudes in the following domains showed improved familiarity and proficiency: causes and prevention of dental caries (78.4%, p < 0.001) and periodontal disease (83.8%, p < 0.001), provision of oral health information to patients (67.6%, p < 0.001), and ability to conduct an oral examination (62.2%, p < 0.001). CONCLUSIONS: Third year medical students who participated in a novel oral health clerkship demonstrated significant increases in basic oral health knowledge and reported increased comfort in providing oral examinations and anticipatory guidance to patients. The results support the feasibility of this approach to incorporating oral health education into a medical school curriculum in the United States.

The influence of surgical and procedural rotations and interest in a surgical discipline on medical students' suturing ability during clerkship.

BACKGROUND: Although suturing is an essential competency for medical students, there has been limited research into the skills acquisition process over the course of medical school curriculum. This study aimed to determine whether suturing ability improved over the course of clerkship and whether an interest in a surgical discipline was associated with improved skill acquisition. METHODS: The suturing ability of third-year medical students at a large Canadian medical school was assessed at the beginning of clerkship (August 2018) as well as before and after their surgery rotation by 2 expert reviewers using a validated, objective scoring system as well as a qualitative assessment, both in person and via blinded video recordings. Students were randomly allocated to 4 groups for their clerkship year by the medical school. RESULTS: Of 133 eligible students, 115 (86.5%) completed the study. Median suturing assessment scores improved significantly after the surgery rotation (214.5 [interquartile range (IQR) 191.1-235.0] v. 238.0 [IQR 223.5-255.0], p = 0.001). Groups that had completed a procedural rotation (emergency medicine, obstetrics and gynecology) between clerkship and starting their surgery rotation had improved scores between these time points (p < 0.05), whereas scores decreased for groups that did not have a procedural rotation between assessments. Regardless of previous rotations, suturing scores were similar between groups after the surgery rotation. The 21 students (18.3%) who were interested in a surgical discipline had higher suturing scores than students who were not interested in surgery at the beginning of clerkship (229.1 [IQR 220.2-253.0] v. 208.0 [IQR 185.0-228.0], p < 0.001) and after the surgery rotation (252.0 [IQR 227.0-268.0] v. 235.8 [IQR 220.5-251.2], p = 0.02). CONCLUSION: Medical students' suturing ability improved during the surgery rotation but was also influenced by other procedural rotations and students' interest in procedure specialties. Skill acquisition by medical students is complex and requires additional investigation.

Case-based intensive veterinary radiology clerkship improves students' radiographic interpretation skills and overall course satisfaction scores.

The variability in diagnostic imaging caseload, increasing class sizes, high hospital workloads, and the progressive departure of veterinary radiologists from academia can lead to inconsistent and reduced teaching opportunities. This one group pretest, posttest study aimed to compare the learning outcomes of students enrolled in two veterinary radiology clerkship models. Our hypothesis was that the learning and satisfaction scores of students in a case-based veterinary radiology clerkship would be higher than those in a clinical veterinary radiology clerkship. During the spring and summer semesters of 2019, students were assigned to a clinical (CRC) or case-based (CBRC) radiology clerkship model, respectively. Prior to starting the clerkship and at the conclusion thereof, all students took identical radiographic interpretation quizzes. Four major areas of learning were assessed: knowledge base (KB), diagnostic test interpretation (DTI), problem prioritization and differential diagnosis (PPDDX), and critical thinking (CrT). A total of 41 of 48 (CRC) and 130 of 151 (CBRC) students enrolled in this study; 15 and 34, respectively, were off-shore students, while the remainder were in-house students. In-house students improved their scores with CRC and CBRC, but achieved better scores in the four areas with CBRC. Off-shore students only improved their scores with CBRC. In both groups, there was a negative effect of CRC on DTI. Course satisfaction score was 3.21 on CRC and 4.38 on CBRC (range 1-5). An intensive, case-based, discussion-focused veterinary radiology clerkship can improve students' radiographic interpretation skills and overall course satisfaction scores.

Medical Student Attitudes and Perceptions on the Relevance of Neuroscience to Psychiatry: a Mixed Methods Study.

OBJECTIVE: Many psychiatry residency programs are actively incorporating neuroscience training into their curricula; however, relatively little scholarship exploring neuroscience and psychiatry integration in undergraduate medical education has been conducted. This study investigated second-year, pre-clerkship medical students' perceptions on the relationship between neuroscience and psychiatry following foundational neuroscience and behavior instruction to identify their views before they enter clerkships. METHODS: A mixed methods design combined qualitative analysis of medical students' essays in response to the prompt: "What is the relationship between neuroscience and psychiatry?" with quantitative analysis of survey responses on a 7-point scale. RESULTS: Ninety-three percent of the class participated in the study (n = 77). Learners rated neuroscience as important for understanding and treating psychiatric disorders, albeit less important for psychiatric compared to neurological disorders. Using applied thematic analysis, the authors identified qualitative themes. Specifically, participants recognized neuroscience as a foundational science for psychiatry, but some emphasized that factors other than neuroscience are needed to explain psychiatric disorders. Some students perceived neuroscience and psychiatry as complementary approaches to understanding the brain and behavior. Others identified a role for neuroscience in reducing the stigma of psychiatric disorders and thereby improving access to psychiatric care. CONCLUSIONS: The quantitative and qualitative findings reinforced each other and provided novel insight to pre-clerkship medical students' views on the relevance of neuroscience for psychiatry. Educating all medical students, not just psychiatry residents, on the neuroscience of psychiatric disorders may better equip the next generation of physicians, regardless of specialty, to care for their patients with psychiatric conditions.

Components of Mid-clerkship Feedback in a Neurology Clerkship and their Impact on Subsequent Student Performance.

Feedback during clinical rotations can be valuable in improving medical student education, but it is unclear what effect such feedback has on subsequent clinical performance and also which feedback topics are the most important in student growth and education. We compared medical student clinical performance before and after mid-clerkship feedback in a Neurology clerkship, with evaluators at the mid-clerkship and at the end blinded to the others' comments. We found that the most important areas holding back student clinical performance were communication, interpersonal interactions, and work ethic rather than textbook knowledge, or the ability to take a history, and do a physical and neurologic examination. Further, students who had concerning comments at the mid-clerkship feedback session usually continued to have the same problems after the feedback (in an admittedly short clerkship). The results suggest that more attention should be given to communication and other interpersonal skills and involvement in the clinical service during feedback sessions and that feedback continue over a much longer period than during a relatively brief Neurology clerkship alone.

The impact of longitudinal integrated clerkships on patient care: a qualitative systematic review.

BACKGROUND: Longitudinal Integrated Clerkships (LIC) are a relatively novel type of clinical placement model within medical education, particularly within the UK. The research on LICs primarily focuses on the impact of the model on students, tutors, communities, and organisations. The impact of LICs on patients has not yet been adequately synthesised. This systematic review aims to fill this gap by examining empirical evidence regarding the impact of LICs on patient care using quality-of-care measures, namely, health process measures and outcome measures. METHODS: A systematic search was conducted in MEDLINE, PsycINFO, Academic Search Premier, Education Research Complete, CINAHL Complete, ERIC, Web of Science, and Scopus. Two reviewers independently conducted the screening process for study selection. Results across studies were analysed and summarised by thematic analysis. RESULTS: The reviewers screened 1632 records. Seven studies met the inclusion criteria following a full-text review, from which four themes were created. Three themes describe health process measures, including: 1) Advocacy within healthcare system, 2) Provision of supplementary and personalised care, and 3) Providing companionship with care. One theme described a health outcome measure: Therapeutic Alliance. CONCLUSION: Current evidence demonstrates an overall beneficial impact of LICs on patient health processes and outcome measures. However, the available evidence is weak and limited. Further research is required to illuminate the true impact of LICs on patient health.

'It was the worst possible timing': the response of UK Longitudinal Integrated Clerkships to Covid-19.

Covid-19 has altered medical education worldwide. Given recent events, UK Longitudinal Integrated Clerkships (LICs), which are relatively new innovations, may have changed in structure and delivery, or may have demonstrated resilience. Collating the responses and experiences of UK institutions may yield transferrable recommendations for institutions wishing to develop sustainable LICs. A mixed-methods survey concerning LIC prevalence, variety, and experiences of responses to Covid-19 was circulated to all 33 UK medical schools through academic networks. 25 survey responses were received, representing 20 institutions. 12 faculty completed follow up semi-structured interviews. 13 LICs were reported: 1 wasn't running during 2020, 5 were running unchanged, and 7 with alterations. 2 additional LICs were planned. Thematic analysis of free-text survey and interview responses revealed that relationships between faculty and institutions were central in facilitating recent adaptations to UK LICs. Given model flexibility, an increased drive to develop LICs was also evident. Barriers to adapting programmes included uncertainty regarding progression of Covid-19 restrictions and issues with secondary care access. Investing in faculty development and support networks could increase LIC sustainability. By highlighting the relative resilience of UK LIC placements during Covid-19, these findings offer important insight for the future delivery of sustainable LICs within, and beyond, the UK.

Necessity is the mother of invention: how the COVID-19 pandemic could change medical student placements for the better.

COVID-19 led to the widespread withdrawal of face-to-face hospital-based clinical placements, with many medical schools switching to online learning. This precipitated concern about potential negative impact on clinical and interprofessional skill acquisition. To overcome this problem, we piloted a 12-week COVID-19 safe face-to-face clinical placement for 16 medical students at the Hospital for Tropical Diseases, London, during the first wave of the COVID-19 pandemic. COVID-19 infection control measures necessitated that students remained in 'social bubbles' for placement duration. This facilitated an apprenticeship-style teaching approach, integrating students into the clinical team for placement duration. Team-based learning was adopted to develop and deliver content. Teaching comprised weekly seminars, experiential ward-based attachments and participation in quality improvement and research projects. The taught content was evaluated through qualitative feedback, reflective practice, and pre-apprenticeship and post-apprenticeship confidence questionnaires across 17 domains. Students' confidence improved in 14 of 17 domains (p<0.05). Reflective practice indicated that students valued the apprenticeship model, preferring the longer clinical attachment to existent shorter, fragmented clinical placements. Students described improved critical thinking, group cohesion, teamwork, self-confidence, self-worth and communication skills. This article describes a framework for the safe and effective delivery of a longer face-to-face apprenticeship-based clinical placement during an infectious disease pandemic. Longer apprenticeship-style attachments have hidden benefits to general professional training, which should be explored by medical schools both during the COVID-19 pandemic and, possibly, for any future clinical placements.

Medical Student and Resident Dermatology Education in Canada During the COVID-19 Pandemic [Formula: see text].

The coronavirus disease 2019 (COVID-19) pandemic and subsequent physical distancing recommendations created major gaps in traditional dermatologic undergraduate and postgraduate medical education delivery. Nevertheless, the educational consequences of various public health restrictions have indirectly set aside the inertia, resistance, and risk averse approach to pedagogical change in medicine. In Canada, rapid collaboration and innovation in dermatologic education has led to novel programs including the implementation of a range of internet-facilitated group learning activities and a dramatic expansion of digital telehealth and virtual care. Going forward, three key issues arising from these developments will need to be addressed: the ongoing assessment of these innovations for efficacy; sustaining the momentum and creativity that has been achieved; and, determining which of these activities are worth maintaining when traditional "tried and true" learning activities can be resumed.