Background The COVID-19 pandemic and physical distancing have had a significant impact on the conversion of traditional teaching methods to online teaching methods, which although not uncommon in medical schools, has to date only been used for some aspects of the teaching process. Thus, we aimed to measure the effectiveness of e-learning during the COVID-19 pandemic, as well as medical students’ preferences regarding e-learning and classroom teaching, and the possibility of applying it post-pandemic. Methods A cross-sectional online survey of medical students (N = 376) in six medical schools was carried out after their second semester, from August 15 to 20, 2020. Ten parameters were measured for the effectiveness of e-learning based on a 5-point Likert-scale and five parameters were measured for satisfaction. Results e-learning was more or equally effective in four parameters such as assignment submission and meeting individual needs, but less effective in six parameters, including building skills and knowledge, and interaction level. Satisfaction was either high or neutral in all five parameters. Conclusions Our findings have shown that e-learning can assist the teaching process in medical schools in some respects, but cannot be used for the entire teaching process.

Highlights Warfarin rarely causes necrosis, and antiphospholipid syndrome is a rarer cause of skin necrosis. Physicians should consider both conditions in the aetiology of skin necrosis. Management should involve stopping warfarin treatment, administering alternative medications, taking a good history, and performing proper examination, investigation, and wound management with dressings or operation using a multidisciplinary team. Wound management depends on the patient’s medical condition and considers the reconstructive ladder.

Background Plastic surgery is considered one of the most competitive specialties globally. In Saudi Arabia, it was established in 2001 in the central province (Riyadh) and then expanded in 2009 to include more eastern and western provinces. Previous research has identified several factors that impact pursuing a career in plastic surgery.Methods This cross-sectional study was conducted through a five-page, five-section questionnaire distributed among senior medical students and interns using online platforms between August 2021 and January 2022. The overall number of questions was 25, which tackled different aspects, including sociodemographic characteristics (i.e., age and gender); the duration of the elective rotation; supervisor during the elective; encouraging, discouraging, and influencing factors; and the rating of participants’ desire to become a plastic surgeon.Results After elective training, the most common factor that influenced medical students to choose a plastic surgery career was exposure to a variety of cases (favorable to agree: 80.4%), followed by involvement in clinical activities (i.e., rounding, clinics, and case presentations) (favorable to agree: 70.6%). On the contrary, the most common factor discouraging students from choosing a plastic surgery career after elective training was plastic surgery being a competitive specialty for matching (favorable to agree: 62.7%), followed by the intense workload (favorable to agree: 56.9%).Conclusions Medical students were more likely than medical interns to explore a career in plastic surgery. Exposure to a variety of cases, inspiring mentors, and a decent amount of time spent in the operating room were the most influential factors.

Background: Doctors and postgraduate students, especially those in the surgical field, face a highly stressful environment and are exposed to various emotions that have been studied, but the concept of shame-based learning (SBL) is still undergoing investigation, especially in the field of plastic surgery. SBL is a teaching method in which an instructor instills a sense of shame in the student, which may cause depression, anxiety, aggression, and poor job performance, leading to burnout, mental health illness, substance abuse, and suicide. Methods: From March to May 2022, two cross-sectional electronic surveys were conducted for residents and consultants in Saudi Arabia, respectively, which used a validated questionnaire to assess SBL. Results: Among the 70 responses received (29 residents and 41 consultants), 75.9% of the residents and 80.5% of the consultants were shamed. For residents, a wrong answer was the most common trigger for shame (44.8%), and the operating room was the most common place for it (51.7%). Losing self-confidence was the most common result of shaming (37.9%) and (41.4%) dealt with it by keeping it to themselves. Although 27.6% of residents stated that they had no negative effect, 20.7% stated that they were motivated. There are consultants who practice shaming directly or indirectly (65.9%), while some agreed that it is not necessary (80.5%). Conclusions: Although both groups agreed that SBL is unnecessary for the field and will not be practiced in the future, most residents and consultants experienced shame. The negative impact of SBL has several effects on the trainer, the teaching environment, and patient care.

Pethidine is an opioid derivative typically used to treat moderate-to-severe pain. It has a good analgesic effect and is considered safe, although with adverse effects such as nausea, depression, vomiting, respiratory depression, and toxicity. We discuss the case of a 43-year-old female patient who received intravenous pethidine and developed skin necrosis in multiple areas of the body as a complication and how it was managed. This is the first report in the literature discussing skin necrosis after intravenous pethidine.