Common Health Issues Encountered by Ultraendurance Ocean Rowers.

INTRODUCTION: Ocean rowing is an extreme ultraendurance sport in which athletes push themselves to their mental and physical limits while rowing across an ocean. Limited academic attention has meant health issues facing this population are poorly understood. This report provides a descriptive analysis of the injuries and illnesses encountered by ocean rowers at sea and suggests potential preventative measures. METHODS: Retrospective self-reported data were collected from ocean rowers via an online 29-question survey, classified by medical system, and totaled to produce a report of the most frequently encountered symptoms. RESULTS: Seventy-one ocean rowers, accounting for 86 ocean rowing attempts, completed the survey. Dermatologic symptoms formed 52% (n=169) of all reported issues, followed by musculoskeletal injuries (14%; n=45), mental health symptoms (11%; n=36), gastrointestinal symptoms (5%; n=16), and neurologic symptoms (2%). Gluteal pressure sores were the most common dermatologic symptoms (24%; n=40), hallucinations the most common mental health symptoms (69%; n=25), hand and finger issues the most reported musculoskeletal problems (36%; n=16); vomiting (38%) and headaches (50%) were the most common gastrointestinal and neurologic issues, respectively. Seasickness was reported in 42% of expeditions (n=33). CONCLUSIONS: This report presents the physiological, mental, and medical challenges facing ocean rowers. Dermatologic and musculoskeletal issues were most common and varied greatly in severity. Over 90% of reported infections occurred as a dermatologic complaint, demonstrating the importance of preventative measures such as hygiene and wound care. Continued work with a larger population is required to further understand the physiological stress and medical complaints associated with transoceanic rowing.

Implementing Wilderness Medicine Training for Undergraduate Medical Students in the UK.

The UK General Medical Councils' approved curricula share only 3 topics with the Fellowship in the Academy of Wilderness Medicine core curriculum, suggesting an underrepresentation of wilderness medicine (WM) in medical education. We developed a 5-mo course to address the gaps between these curricula to run in parallel with the conventional curriculum. Our 71-h course is composed of lectures and practical exercises. We set out to evaluate the effectiveness of this concept and assess its suitability for use by other institutions. The course was undertaken by 18 medicine and healthcare undergraduates. Semiquantitative evaluation of the course was done using participants' self-reported WM knowledge and interest before and after the course using a Likert scale. Participants were further assessed with a WM objective structured clinical examination. Before the course, students had a lower understanding of WM (2.8/5.0) and were not confident in prehospital medicine (2.5/5.0). After the course, knowledge and confidence increased in all teaching categories, with a mean gain of 1.4/5.0 (P<0.05). Students demonstrated competence in a range of WM categories by completing the WM objective structured clinical examination, with a pass rate of 82%. Providing students with a WM course is effective in introducing components of the Fellowship in the Academy of Wilderness Medicine curriculum and inspiring future engagement in the field. We have developed a framework for successful implementation of WM teaching and shown that the concept may be used in other undergraduate settings.

Development of hidden curriculum skills in a COVID-19 vaccination centre.

BACKGROUND: During the COVID-19 pandemic, many medical students were deployed as vaccinators. This study set out to capture the lived experience of students at a London-based mass vaccination site, understand what they learned, how this learning compared to their experience of usual medical education and how any identified benefits might be leveraged in a post-pandemic context. METHODS: Student vaccinators (n = 8) were recruited from the vaccine clinic workforce and invited to complete semi-structured interviews about their experiences. Thematic analysis was conducted on interview transcripts to identify significant concepts, which were interpreted in the context of available literature. FINDINGS: Participants' experiences aligned broadly with the undergraduate curriculum. However, many also identified hidden curriculum areas developed through their work as vaccinators, including professionalism, self-regulating learning and ethical decision-making. DISCUSSION: The need for adequate support, whilst promoting autonomy, was highlighted as vital in supporting professional identity formation within a community of practice, benchmarking clinical knowledge and performance, and in support of student wellbeing, in the face of challenging real-world clinical encounters. CONCLUSION: Increased entrustment of clinical activity could be implemented in primary and secondary care settings to reproduce the benefits experienced by student vaccinators in front-line roles during the COVID-19 pandemic. Further work might consider how to maximise these benefits and increase inclusion and participation.

Common health issues and advised treatments reported in an ultraendurance ocean rowing race.

OBJECTIVES: Ocean rowing is an extreme ultraendurance sport where individuals row unsupported across an ocean. This can mean months at sea in unpredictable and inhospitable conditions. The extreme physical and mental demands associated mean medical issues are common yet under researched, impacting the medical assistance provided. METHODS: The Talisker Whisky Atlantic Challenge provides a framework with safety protocols to create safer environments for athletes to attempt transatlantic crossings. Race logs, which record communication between rowers and safety teams, were anonymised and examined to create cumulative totals of medical issues requiring help and an incident timeline. RESULTS: Duty officers were notified of 65 medical complaints, 32% (n=21) requiring race doctors. Dermatological conditions were most common, accounting for 32% of complaints (n=21) and affecting 24% of rowers. Pressure sores and infections represented 43% and 38% of dermatological complaints respectively. Musculoskeletal injuries equalled 18% (n=12) of complaints, affecting 20% of rowers. Most cases were reported in weeks one and three, with 37% (n=24) of issues and 90% (n=10) of seasickness cases in week one. Hygiene and antibiotics were frequently advised management options. CONCLUSION: Conditions requiring race doctor input represent the most severe cases with the potential to deteriorate. Managing dermatological and musculoskeletal issues is vital throughout the race, while seasickness prophylaxis and education is essential in initial race stages. Infections are cause for concern, with gluteal pressure sores a potential route for secondary infections. Further research is required before evidence-based guidelines for management of health issues in ocean rowers can be introduced.

A quantitative study of letters to the editor by medical students in medical education journals.

Letters to the Editor offer ways for readers to engage with authors' publications. Letters are the shortest manuscript for medical students to publish and medical-education journals are best suited. The UK Foundation Programme rewards medical students achieving PubMed ID publications and we hypothesise that this is a main motivation for medical students to submit Letters to the Editor. A review of 15 medical-education journals with an impact factor was conducted to identify numbers and percentages of Letters to the Editor by medical students between July 2018 and June 2020. Affiliation of medical students was collected. Our results show over two years, 299 letters were published by medical students equating to 45.9% of total letters. There was a 60% overall increase in letters by medical students published in the first 12 months compared to second 12 months. During this period overall numbers of letters published increased by 27%. 86% of the letters published by medical students over the two-year period were from UK medical schools. Five schools accounted for 60.5% of these letters. The three medical schools with highest numbers of letters published were King's College London, Imperial College London and University of Oxford for both 2018/19 and 2019/20. The increase in letters published overall with greater numbers published by students, may indicate greater awareness of Letters to the Editor as means of dissemination amongst medical students. UK medical schools published large numbers of letters, perhaps reflecting increasing importance to students of publications due to impacting on subsequent jobs. Results from our quantitative research revealing: large numbers of letters by medical students, increase in letters published from 2018/19 to 2019/20 and overrepresentation of UK medical students supports the hypothesis that medical students are publishing letters to achieve PubMed IDs. Further qualitative research is required to test our hypothesis.

The medical response to the Boston Marathon bombings: an analysis of social media commentary and professional opinion.

OBJECTIVES: To explore the differences in perception of the medical response to the victims of the 2013 Boston Marathon bombings between laypeople and healthcare professionals. METHODS: Commentary accessible and available on Internet discussion websites by non-medically trained persons and in the academic literature by healthcare professionals was analysed qualitatively. RESULTS: Major themes were found relating to both the pre-hospital and hospital-based phases of the medical response to the disaster. Laypeople focused more on pre-hospital care and the actions of specific bystanders, while healthcare professionals focused on hospital care, the importance of a disaster plan, and frequent training for the success of the response. CONCLUSION: Laypeople and healthcare professionals have positive but differing perceptions of the medical response to the victims of the bombings. This may have implications for future funding and implementation of disaster preparedness.