Knowledge, Perceptions and Levels of Utilisation of E-Learning among Medical Students in Nigeria.

BACKGROUND: Globally, electronic learning (e-learning) is being embraced in all spheres, including the field of Medicine, where it has an engrained role in both medical education and practice. OBJECTIVES: The study aimed to assess the knowledge, perception and factors influencing the utilisation of e-learning amongst medical students in Nigeria. METHODS: It was a descriptive, cross-sectional survey. The study involved public and private medical schools across the six geopolitical zones of Nigeria. Five hundred and thirty (530) medical students responded to the online questionnaire (Google forms). Data were analyzed using SPSS version 23.0. RESULTS: The mean age of the participants was 21.5 ± 3.1 years, with 60.8% being females. About three-fifths (59.5%) of the respondents were in public universities, while the remaining were in private universities. Nearly all the respondents (98.1%) were aware of e-learning. The majority believed that e-learning would be useful for lectures and seminars, but not for laboratory demonstrations, clinical demonstrations, and bedside teaching. Class of study (p = 0.002), school ownership (p = 0.034), institutions having e-learning platform (p <0.001); having received e-learning training (p <0.001)) and institution encouraging e-learning for students (p <0.001) were significant predictors of utilization of e-learning. High cost and poor internet connectivity were the most cited disadvantages of e-learning. CONCLUSION: This study showed that e-learning is well known among Nigerian medical students, although some had never utilized it. The high financial costs, poor internet connectivity, and irregular electricity were among the major constraints to the utilization of e-learning.

CONTEXTE: Dans le monde entier, l'apprentissage électronique (elearning) est adopté dans toutes les sphères, y compris dans le domaine de la médecine, où il joue un rôle important dans l'enseignement et la pratique de la médecine. OBJECTIFS: L'étude visait à évaluer la connaissance, la perception et les facteurs influençant l'utilisation de l'apprentissage électronique chez les étudiants en médecine au Nigeria. MÉTHODES: Il s'agissait d'une enquête descriptive et transversale. L'étude a impliqué des écoles de médecine publiques et privées dans les six zones géopolitiques du Nigeria. Cinq cent trente (530) étudiants en médecine ont répondu au questionnaire en ligne (Google forms). Les données ont été analysées à l'aide de SPSS version 23.0. RÉSULTATS: L'âge moyen des participants était de 21,5 ± 3,1 ans,60,8 % étant des femmes. Environ trois cinquièmes (59,5 %) des répondants étaient dans des universités publiques, tandis que les autres étaient dans des universités privées. Presque tous les répondants (98,1 %) connaissaient l'apprentissage en ligne. La majorité d'entre eux pensaient que l'apprentissage en ligne serait utile pour les cours magistraux et les séminaires, mais pas pour les démonstrations en laboratoire, les démonstrations cliniques et l'enseignement au chevet des patients. La classe d'étude (p = 0,002), la propriété de l'école (p= 0,034), les institutions disposant d'une plateforme d'apprentissage électronique (p <0,001), ayant reçu une formation à l'apprentissage électronique (p <0,001)) et les institutions encourageant l'apprentissage électronique pour les étudiants (p <0,001) étaient des prédicteurs significatifs de l'utilisation de l'apprentissage électronique. Le coût élevé et la faible connectivité à internet étaient les inconvénients les plus cités de l'apprentissage en ligne. CONCLUSION: Cette étude a montré que l'apprentissage en ligne est bien connu parmi étudiants en médecine nigérians, même si certains ne l'ont jamais utilisé. Les coûts financiers élevés, la mauvaise connectivité à internet et l'irrégularité de l'électricité sont parmi les principales contraintes à l'utilisation de l'apprentissage en ligne. Mots Clés: Apprentissage en ligne, Connaissances, Étudiants en médecine, Nigeria, Utilisation.

[Personal drug education to learn evidence-based medicine].

A variety of new methods are being tried in education of pharmacology for medical students, to make pharmacology be directly oriented to practical medical treatment. Among them, thinking that the method of "selection of personal drug (P-drug)" is suitable for learning "evidence-based medicine (EBM)", I have been engaged in "P-drug education" in Kyushu university for many years. If doctors carefully select medicines that are indispensable for their medical treatment based on clinical evidence, are made familiar with how to use them, and in principle perform daily medical treatment using only those medicines, EBM can be really practiced. And moreover, it may also lead to the suppression of medical errors and adverse drug reactions. Such essential medicines for an individual doctor are called P-drug. Since 2003, I have adopted "P-drug selection" in the education of pharmacology for upper grade medical students. After more than 15 years of trial and error, I have been able to create an educational model using "P-drug selection" that I think could be easily adopted at any medical school. At this symposium, I talked about the relationship between "P-drug selection" and EBM and demonstrate the "P-drug education" model.

[Practices and challenges of joint education at two medical schools utilizing online pharmacology role-playing].

The pharmacology role-play, in which students impersonate medical personnel and patients to explain illness and drug treatment, is one of the active learning of pharmacology. However, until now, it has been carried out only within one facility, and has not been carried out between different multi-facility facilities with a larger scale. However, the spread of COVID-19 infection in 2020 was a turning point that drastically changed the way of medical school education centered on traditional face-to-face lectures. Above all, remote real-time lessons using Zoom etc. have the advantage that about 300 students can be conducted at multiple facilities without having to gather them in one place at the same time. With the Korona-ka as a strange currency, the infrastructure has been set up to carry out joint education in pharmacological role-playing between different multi-institutions. We are the first in Japan to conduct a pharmacology role-play jointly by Fujita Medical University and Aichi Medical University, so we would like to introduce the contents.

Faculty bridging individual and organizational resilience: results of a qualitative analysis.

BACKGROUND: Medical student burnout and anxiety has received growing attention in the past decade. The culture of competition and assessment has resulted in increasing stress levels amongst medical students, causing a decline in their academic performance and overall mental health. The objective of this qualitative analysis was to characterize recommendations from educational experts to aid students' academic progress. METHODS: At an international meeting in 2019, worksheets were completed by medical educators during a panel discussion. Participants responded to four scenarios representing common challenges medical students face in school (eg. Postponing Step 1, failing clerkships, etc.). For each case, participants addressed what students, faculty and medical schools could do to mitigate the challenge. Inductive thematic analysis was conducted by two authors followed by deductive categorization using an individual-organizational resilience model. RESULTS: Across the four cases, common suggestions made for students, faculty and medical schools were aligned to a resilience model representing the complex interplay between individuals and organizations and the impact on student wellbeing. DISCUSSION: Using suggestions from medical educators from across the US, we were able to identify recommendations for students, faculty, and medical schools to help students succeed in medical school. By applying a model of resilience, faculty serve as a critical bridge to connect students to the medical school administration. Our findings also support a pass/fail curriculum to ease the competition and burden students place on themselves.

Measuring Teaching Efforts in a Medical School Department or Division: A Scoping Review.

PURPOSE: The desire to measure faculty's teaching productivity has led many medical school departments to create academic productivity metrics and evaluation systems to track clinical and/or nonclinical teaching efforts. The authors investigated these metrics and their impact on teaching productivity and quality in the literature. METHODS: The authors performed a scoping review using keywords to query three publication databases. A total of 649 articles were identified. The search strategy resulted in the screening of a total of 496 articles after the removal of duplicate articles, of which 479 were excluded. A total of 17 papers met the criteria. RESULTS: Four of the 17 institutions exclusively measured clinical teaching productivity, and all four reported 11-20% gains in teaching or clinical productivity. Four of the six institutions that tracked only nonclinical teaching productivity shared quantitative data and experienced a variety of gains from measuring teaching productivity that centered on greater participation in teaching. The six institutions that monitored both clinical and nonclinical teaching productivity provided quantitative data. The reported effects ranged from greater learner attendance at teaching events to increases in clinical throughput and teaching hours per faculty member. Five of the 17 institutions tracked quality using qualitative measures, and none of these institutions observed a decrease in teaching quality. CONCLUSIONS: Setting metrics and measurement of teaching seems to have had a generally positive effect on amounts of teaching; however, their impacts on the quality of teaching are less clear. The diversity of metrics reported makes it difficult to generalize the impact of these teaching metrics.

Increasing Inclusion, Diversity, Antiracism, and Equity With a Medical School Curriculum Quality Improvement Project.

ABSTRACT: The students at Mayo Clinic Alix School of Medicine (MCASOM) wrote a call to action to medical school leadership in June 2020. The students requested help in navigating socio-political barriers that affected one another and contributed to healthcare inequities and mistrust. Using the Association of American Medical Colleges (AAMC) tool to assess cultural competence training, our team evaluated the baseline 2017-2018 MCASOM curriculum. There were 254 learning objectives, of which 43 (17%) were related to inclusion, diversity, antiracism, and equity (I-DARE). Mirroring the concerns of the students, the findings identified minimal content about antiracism and inclusion. By applying DMAIC principles for quality and process improvement, we aimed to increase the number of taught learning objectives about I-DARE content for the first-year and second-year medical students by 100%, from 43 to 86 objectives, without adversely affecting student satisfaction and true attendance. To address the underlying causes, we launched a virtual, multisite I-DARE medical school course and doubled the number of I-DARE-taught learning objectives from 43 to 107 (149%), compared with the baseline. The program evaluation review revealed that the students were self-reflective and provided a spectrum of experiences regarding the I-DARE course.

How to: Success factors for the implementation and establishment of the "longitudinal curriculum" on communicative competencies at the Medical Faculty Mannheim.

Communicative competencies are of great importance to the medical profession, hence the teaching of them has been continuously expanded in recent years at many German medical schools. While individual courses on communicative competencies have already been established in the curricula, there remains, in part, a lack of longitudinal anchoring over the entire course of medical study. In 2008 the Medical Faculty Mannheim began implementing a longitudinal curriculum for communicative competencies. This paper outlines the general and phase-specific success factors in this process and gives practical recommendations and tips based on the personal experiences of the authors and the existing literature.

Addressing a Gap in Medical School Training: Identifying and Caring for Human Trafficking Survivors Using Trauma-Informed Care.

Introduction: Human trafficking (HT) is a substantial public health problem, and health care workers are uniquely positioned to help identify and care for survivors. Despite this fact, few medical schools incorporate HT training using trauma-informed care (TIC) principles into their curricula. We developed a training session to educate medical students on recognizing HT red flags and providing TIC to HT survivors. Methods: One hundred twenty-seven fourth-year medical students at Rush Medical College attended a 2-hour session consisting of didactic lectures by expert speakers and participated in a group discussion guided by a clinical vignette. Students completed anonymous pre- and postsession surveys that assessed comfort levels in detecting HT red flags and providing TIC. We used a paired t test to compare pre- and postsession survey responses. Results: Ninety-five pre- and postsession surveys were matched with unique identifiers and used for analysis. The results demonstrated significant improvement in all the metrics assessed. Discussion: This training significantly improved medical students' comfort in identifying and caring for HT survivors, addressing an especially important gap in medical school education. This training can be implemented at other institutions to further improve awareness and efforts in identifying and caring for HT survivors while avoiding retraumatization.

COVID-19, Racial Injustice, and Medical Student Engagement With Global Health: A Single-Institution Survey.

INTRODUCTION: United States medical schools continue to respond to student interest in global health (GH) and the evolution of the field through strengthening related curricula. The COVID-19 pandemic and superimposed racial justice movements exposed chasms in the US healthcare system. We sought to explore the possible relationship between the pandemic, US racial justice movements, and medical student interest in GH to inform future academic offerings that best meet student needs. METHODS: A novel, mixed-methods 30-question Qualtrics survey was disseminated twice (May-August 2021) through email and social media to all current students. Data underwent descriptive and thematic analysis. RESULTS: Twenty students who self-identified as interested in GH responded to the survey. Most (N = 13, 65%) were in preclinical training, and half were women (N = 10, 50%). Five (25%) selected GH definitions with paternalistic undertones, 11 (55%) defined GH as noncontingent on geography, and 12 (60%) said the pandemic and US racial justice movement altered their definitions to include themes of equity and racial justice. Eighteen (90%) became interested in GH before medical school through primarily volunteering (N = 8, 40%). Twelve (60%) students plan to incorporate GH into their careers. CONCLUSIONS: Our survey showed most respondents entered medical school with GH interest. Nearly all endorsed a changed perspective since enrollment, with a paradigm shift toward equity and racial justice. Shifts were potentially accelerated by the global pandemic, which uncovered disparities at home and abroad. These results highlight the importance of faculty and curricula that address global needs and how this might critically impact medical students.

Virtual Reality for Emergency Medicine Training in Medical School: Prospective, Large-Cohort Implementation Study.

BACKGROUND: Virtual reality (VR)-based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. OBJECTIVE: The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. METHODS: The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. RESULTS: A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. CONCLUSIONS: In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine.

Inventory and analysis of literature on the organisation of eight European academic medical centres-A scoping review.

Academic Medical Centres (AMCs) are important organisations for shaping healthcare. The purpose of this scoping review is to understand the scope and type of evidence related to the organisation of European AMCs. We selected the study population intending to obtain a demographic cross-section of European countries: Czech Republic, Germany, Latvia, the Netherlands, Poland, Spain, Sweden and the UK. We focused our search strategy on the relationship between medical schools and AMCs, the organisation of governing bodies, and legal ownership. We searched the bibliographic databases of PubMed and Web of Science (most recent search date 17-06-2022). To enrich the search result, we used Google search engines to conduct targeted searches for relevant websites. Our search strategy yielded 4,672 records for consideration. After screening and reviewing full-text papers, 108 sources were included. Our scoping review provided insight into the scope and type of evidence related to the organisation of European AMCs. Limited literature is available on the organisation of these AMCs. Information from national-level websites complemented the literature and provided a more complete picture of the organisation of European AMCs. We found some meta-level similarities regarding the relationship between universities and AMCs, the role of the dean and the public ownership of the medical school and the AMC. In addition, we found several reasons why a particular organisational and ownership structure was chosen. There is no uniform model for AMC organisations (apart from some meta-level similarities). Based on this study, we cannot explain the diversity in these models. Therefore, further research is needed to explain these variations. For example, by generating a set of hypotheses through in-depth case studies that also focus on the context of AMCs. These hypotheses can then be tested in a larger number of countries.

Accreditation standards items of post-2nd cycle related to the decision of accreditation of medical schools by the Korean Institute of Medical Education and Evaluation.

PURPOSE: The purpose of this study is to analyze the accreditation standards items related to the decision of accreditation of medical schools by the Korea Institute of Medical Education and Evaluation (KIMEE). METHODS: The subjects are medical schools in Korea that have received post-2nd cycle accreditation from the KIMEE between 2012 and 2016. Analyses were conducted for differences in accreditation decisions according to the characteristics of medical schools, sufficient ratios of basic standards items, and correlation between standards items related to accreditation decisions. RESULTS: After examining differences in accreditation decisions by the medical school's characteristics, there were no significant correlations between accreditation standard items and accreditation decisions. Second, according to the number of schools that sufficiently or insufficiently met each standard item, from the total of 97 standard items, 20 (20.6%) were sufficiently fulfilled by all medical schools. Standard item 2-5-2 demonstrated the highest insufficiency ratio. Third, with respect to the standard item that had an effect on accreditation decisions, standard item 1-5-1 showed the highest correlation with the sufficiency rate. CONCLUSION: The validity of accreditation standards items was assured as this study evaluated the post-2nd cycle accreditation standards items regardless of each medical school's characteristics. The accreditation standards items were found to have a meaningful impact on the development of medical schools and qualitative improvement in medical education. The findings are expected to contribute to guaranteeing the validity and reliability of accreditation decisions and raising the quality of accreditation.

Evaluation of the public health clinical rotation in medical school: a qualitative case study design.

Public health clinical rotation in the Faculty of Medicine, Universitas Islam Indonesia, was conducted in Puskesmas (community health center). This study aims to evaluate the public health clinical rotation in Puskesmas, part of the clinical clerkship of the Faculty of Medicine, Universitas Islam Indonesia. Several concerns have been highlighted regarding the implementation of clinical rotations in public health in Puskesmas. A briefing session before placement in the village must be coherent with a guidebook. The placement of students in the village was based on community health issues determined by the Puskesmas supervisor. Priority in the curriculum was given to converting the alertness village (Desa Siaga) into a Program Indonesia Sehat-Pendekatan Keluarga (Healthy Indonesia Program-Family Education) program throughout implementation. Moreover, scheduling after four major clinical programs was difficult, and the writing of reports served as a guide for establishing the correct format. Therefore, the objective of the evaluation was to assess knowledge, skill, and psychomotor, and the burden of assignment in Puskesmas was difficult to accomplish a primary task in the community.

La docencia sobre cronicidad en las facultades de Medicina: una revisión de la situación actual / Teaching about chronicity in medical schools — A review of the current situation

In recent decades, progressive population aging in developed countries has led to a significant increase in the number of people with at least one chronic medical condition. As a result, acquiring knowledge about chronicity in medical school is key for physicians to be able to provide proper management for these patients. However, the presence of chronicity in educational curricula is scarce and highly variable. On the one hand, this work consisted of a review of the educational programs of the main medical schools on each continent with the aim of identifying whether they included chronicity and, on the other, a literature review focused on identifying educational projects in the field of chronicity. The presence of chronicity in most medical schools’ curricula is marginal and only a few universities include specific skills or competences linked to chronicity. In most cases, this topic appears as a global, cross-curricular competence that students are supposed to acquire over the course of their entire education. The literature review retrieved 21 articles on innovative teaching projects on chronicity. Direct contact with chronic patients, most times as “health mentors,” the role of the student as a teacher, and continuous evaluation and feedback from all participants are the main characteristics of the projects analyzed. Some previously published experiences support the usefulness of innovative methodologies for better approaching this capital field in current medical practice. Despite the current situation in which chronic patients consume most healthcare resources, the presence of chronicity in medical schools is marginal. However, a literature review did identify some useful experiences for improving education on chronicity in medical schools. Medical schools should change their academic curricula and redirect them towards providing students all the necessary tools for improving their knowledge on chronicity (AU)

En las últimas décadas, el progresivo envejecimiento de la población en los países desarrollados ha provocado un aumento significativo del número de personas con al menos una enfermedad crónica. Como consecuencia, es fundamental que la formación pregrado en Medicina aporte conocimientos sobre la cronicidad, de forma que los médicos puedan proporcionar un manejo adecuado a estos pacientes. A pesar de ello, la presencia de la cronicidad en los currículos formativos de las facultades de Medicina es escasa y muy variable. Este trabajo consistió, por un lado, en una revisión de los programas formativos de las principales facultades de Medicina de cada continente, con el objetivo de identificar si incluían aspectos relacionados con la cronicidad y, por otro, en una revisión bibliográfica enfocada a identificar proyectos educativos en el campo de la cronicidad. La presencia de la cronicidad en los planes de estudio de la mayoría de las facultades de Medicina es marginal y solo unas pocas universidades incluyen habilidades o competencias específicas vinculadas a este campo. En la mayoría de los casos en los que sí aparece, este tema se refleja como una competencia global y transversal que los estudiantes deben adquirir a lo largo de toda su formación. La revisión bibliográfica identificó 21 artículos sobre proyectos docentes innovadores sobre cronicidad. Las principales características de los proyectos analizados son: el contacto directo con pacientes crónicos, la mayoría de las veces como «mentores de salud», el papel del estudiante como profesor y la evaluación y retroalimentación continuas de todos los participantes. Algunas experiencias previamente publicadas avalan la utilidad de metodologías innovadoras para una mejora en el abordaje de este campo en la práctica médica diaria. A pesar de la situación actual, en la que los pacientes crónicos consumen la mayor parte de los recursos sanitarios, la presencia de la cronicidad en las facultades de Medicina es marginal (AU)

Mid-career graduate practice outcomes of the James Cook University medical school: key insights from the first 20 years.

INTRODUCTION: Previous studies demonstrate early-career James Cook University (JCU) medical graduates are more likely to practise in regional, rural and remote areas than other Australian doctors. This study investigates whether these practice patterns continue into mid-career, identifying key demographic, selection, curriculum and postgraduate training factors associated with rural practice. METHODS: The medical school's graduate tracking database identified 2019 Australian practice location data for 931 graduates across postgraduate years (PGY) 5-14, which were categorised into Modified Monash Model (MMM) rurality classifications. Multinominal logistic regression was undertaken to identify specific demographic, selection process, undergraduate training and postgraduate career variables associated with practice in a regional city (MMM2), large to small rural town (MMM3-5) or remote community (MMM6-7). RESULTS: One-third of mid-career (PGY5-14) graduates were working in regional cities, mostly in North Queensland, with 14% in rural towns and 3% in remote communities. These first 10 cohorts were undertaking careers in general practice (n=300, 33%), as subspecialists (n=217, 24%), rural generalists (n=96, 11%), generalist specialists (n=87, 10%) or hospital non-specialists (n=200, 22%). DISCUSSION: The findings show positive outcomes from the first 10 JCU cohorts for regional Queensland cities, with a significantly higher proportion of mid-career graduates practising regionally compared with the overall Queensland population. The proportion of JCU graduates practising in smaller rural or remote towns is similar to the overall Queensland population. The establishment of the postgraduate JCUGP Training program and the Northern Queensland Regional Training Hubs for building local specialist training pathways should further strengthen medical recruitment and retention across northern Australia.

The Danish-American Research Exchange (DARE): a cross-sectional study of a binational research education program.

BACKGROUND: Most medical educational programs emphasize clinical observation or clinical skill acquisition, fewer focus upon research. The Danish-American Research Exchange (DARE) program, sponsored by the Lundbeck Foundation, is unique in that the medical student initiates biomedical research collaboration between Danish and US medical institutions. To achieve this, Danish medical students (DARE students) conduct binational mentored research projects while based in the United States for 10 months. In addition, DARE students are introduced to interdisciplinary thinking about how to develop ultra-low-cost healthcare interventions through the '$10 Challenge'. METHODS: We conducted a cross-sectional study of DARE alumni over five consecutive years (2015-2020, n = 24). Research metrics included completion of a research project, primary authorship, and co-authorship of publications. The number of publications, prior to and after the DARE program were enumerated. For the first four cohorts, graduation from medical school and acceptance or intention to enter a joint MD-PhD program also were assessed. Two focus groups were conducted using constructivist grounded theory. Discussions were transcribed, redacted, and coded using Dedoose software. RESULTS: DARE Medical students were 31.2 years (range 24-35), the majority were women (67%;16/24). The majority (17/24;71%) completed a first author publication in a peer-reviewed journal with a median of 3.9 per DARE alumnus. DARE alumnus reported increased proficiency in biostatistics, epidemiology, coding and public speaking as well as stronger research qualities in creativity, critical thinking, comfort in approaching scientist in both the US and Denmark (p < 0.001 for all). Qualitative key themes included: increased confidence, a deepening of research inquiry and linkage to a research network. CONCLUSIONS: Preliminarily, this study suggests that medical students can initiate binational collaboration in medicine. Benefits include research productivity, intention to pursue academic medical careers, as well as positive impacts on motivation. This medical student-initiated research model lays the groundwork for using this model across other country pairs to promote binational collaboration.

Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India.

INTRODUCTION: Human-centered design (HCD) refers to a diverse suite of interactive processes that engage end users in the development of a desired outcome. We showcase how 2 global mental health research teams applied HCD to develop mobile health tools, each directed at reducing treatment gaps in underserved populations. CASE STUDY 1: Refugees face higher risks for mental health problems, yet these communities face structural and cultural barriers that reduce access to and use of services. To address these challenges, the Research Program on Children and Adversity at the Boston College School of Social Work, in partnership with resettled refugee communities in the northeastern United States, used codesign methodology to digitally adapt delivery of the Family Strengthening Intervention for Refugees-a program designed to improve mental health and family functioning among resettled families. We describe how codesign methods support the development of more feasible, acceptable, and sustainable interventions. CASE STUDY 2: Sangath, an NGO in India focused on mental health services research, in partnership with Harvard Medical School, designed and evaluated a digital training program for community health workers to deliver an evidence-based, brief psychological treatment for depression as part of primary care in Madhya Pradesh, India. We describe how HCD was applied to program development and discuss our approach to scaling up training and capacity-building to deliver evidence-based treatment for depression in primary care. IMPLICATIONS: HCD involves a variety of techniques that can be flexibly adapted to engage end users in the conceptualization, implementation, scale-up, and sustainment of global mental health interventions. Community solutions generated using HCD offer important benefits for key stakeholders. We encourage widespread adoption of HCD within global mental health policy, research, and practice, especially for addressing mental health disparities with underserved populations.

A Critical Review from the Perspective of 2 Years Thereafter of the Effectiveness of Revolutionary Changes in a Gastroenterology Division at a Medical School Teaching Hospital due to the Coronavirus Disease-2019 Pandemic: Gastrointestinal Physician Clinical Practice and Emotional Stresses, Gastrointestinal Graduate Medical Education, Gastrointestinal Professional Societies, and Pandemic Control.

AIM: Critically review approximately 2 years afterward the effectiveness of revolutionary changes at an academic gastroenterology division from coronavirus disease-2019 (COVID-19) pandemic surge at the metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to >300 infected patients (one-quarter of) in-hospital census in April 2020 and >200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital which had 36 GI clinical faculty who used to perform >23,000 endoscopies annually with a massive plunge in endoscopy volume during the past 2 years; fully accredited GI fellowship since 1973; employs >400 house staff annually since 1995; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: Expert opinion, based on: Hospital GI chief >14 years until September 2019; GI fellowship program director, at several hospitals for>20 years; author of 320 publications in peer-reviewed GI journals; and committee-member Food-and-Drug-Administration-GI-Advisory Committee for >5 years. Original study exempted by Hospital Institutional Review Board (IRB), April 14, 2020. IRB approval is not required for the present study because this opinion is based on previously published data. Advantageous changes: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19. Affiliated medical school changes included: changing "live" to virtual lectures, meetings, and conferences. Initially, virtual meetings usually used telephone conferencing which proved cumbersome until meetings were changed to completely computerized virtual meetings using Microsoft Teams or Google Zoom, which performed superbly. Some clinical electives were canceled for medical students and residents because of the need to prioritize car for COVID-19 infection during the pandemic, and medical students graduated on time despite partly missing electives. Division reorganized by changing "live" GI lectures to virtual lectures; by four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; postponing elective GI endoscopies; and drastically reducing an average number of endoscopies from 100/weekday to a small fraction long-term! GI clinic visits were reduced by half by postponing nonurgent visits, and physical visits were replaced by virtual visits. Economic pandemic impact included a temporary, hospital deficit initially relieved by federal grants and hospital employee terminations. GI program director contacted GI fellows twice weekly to monitor pandemic-induced stress. Applicants for GI fellowship were interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling annual ACGME fellowship survey, ACGME site visits, and national GI conventions changed from physical to virtual. Dubious changes: Temporarily mandated intubation of COVID-19-infected patients for EGD; temporarily exempted GI fellows from endoscopy duties during surge; fired highly respected anesthesiology group employed for 20 years during pandemic leading to anesthesiology shortages, and abruptly firing without warning or cause numerous senior respected faculty who greatly contributed to research, academics, and reputation. CONCLUSION: Profound and pervasive GI divisional changes maximized clinical resources devoted to COVID-19-infected patients and minimized risks of transmitting infection. Academic changes were degraded by massive cost-cutting while offering institutions to about 100 hospital systems and eventually "selling" institutions to Spectrum Health, without faculty input.