Nicorandil may induce colonic ulceration and should be considered in the differential diagnosis of idiopathic colonic ulceration in appropriate patients.

Tocilizumab, a monoclonal antibody against interleukin-6, has been used to treat cytokine release syndrome (CRS) in a subset of patients with severe COVID-19 disease. Acute ulcerative bowel disease has been only rarely documented in patients treated for rheumatological conditions. The gastrointestinal side effects seen when used in the context of COVID-19 are unknown. We present a case of COVID-19 CRS in which acute terminal ileum and perforated caecal ulceration evolved after tocilizumab exposure. We raise awareness of a possible causal relationship between even a single dose of tocilizumab and gut ulceration in patients with COVID-19. Any such drug enteropathy relationship requires watchful monitoring during upcoming trials of tocilizumab in patients with COVID-19.

Nee B Teo clinical research fellow continued over BMJ 2001;323:725-6 725 BMJ VOLUME 323 29 SEPTEMBER 2001 bmj.com 32% (29/91; 22% to 42%) were specialist registrars during their period of higher specialist training. In all, 66% (60/91; 55% to 76%) were in their 30s or older. Surgical research has traditionally incorporated clinical studies into the surgical management of disease and the development and evaluation of surgical techniques. A total of 18% (16/91; 10% to 27%) of fellows were working on purely clinically oriented research, compared with 43% (39/91; 33% to 54%) for laboratory based projects and 38% (35/91; 28% to 49%) for studies comprising both elements.During their research, 77% (70/91; 67% to 85%) of the respondents were required to undertake clinical duties including on-call rotas, outpatient clinics, and minor procedure lists and to assist in theatre, as well as teaching. Their duties varied but were often tied to their funding, for which major grant awarding bodies, hospital trusts, and private industry each provided one third. CommentMost surgical fellows are undertaking research before obtaining their specialist registrar posts and for the sole purpose of career advancement; the research is more commonly laboratory based than clinical. The appropriateness of the timing of the research in a surgeon's career, the reason for doing it, and the nature of the research undertaken is questionable, particularly in view of the current debate on the quality of surgical research.Two thirds of research fellowships are being undertaken before higher specialist training, against the recommendations of the Calman report. Owing to the lack of comparative data from the "pre-Calman" era, we are unable to identify whether or not this represents a continuing trend or a change.Our results reflect the motivation of the fellows in undertaking research. The high percentage of respondents having career advancement as their only aim may be related to the competition involved in obtaining a specialist registrar post, and presumably research enhances their curriculum vitae.We thank all the academic professors of surgery and research fellows who participated in the study, Professor Primrose for the name list of professors in the academic departments, and Mr Jim Paul and Dr Keith Vass for their statistical advice.Contributors: CSS conceived and designed the study and wrote the first draft of the paper. NBT collected the data. All four authors helped to analyse and interpret the data and to revise the paper critically. CSS is the guarantor.Funding: None. Competing interests: None declared. Endpiece A certaintyIn vino veritas-I don't know-but in scribendo veritas-a certainty.

The COVID-19 pandemic has affected surgical education and training significantly. The main impact to surgical residency training is the reduction in number of patients (in caseload and case mix) and the conversion of face-to-face meetings into virtual ones for CME and clinical governance-related events. Assessment of surgical residents by examination (namely the Joint Specialty Fellowship Examination with the College of Surgeons of Hong Kong and the Royal College of Surgeons of Edinburgh) was cancelled at the peak of the pandemic, with resumption after acceptable COVIDcompatible adjustment was made to the format. The migration of CME events into a web-based one has resulted in greater connectivity with more audience. The potential and challenges of virtual format in surgical education include strategy and resources for sustainability; choice of optimal model for effective learning and surgical skills acquisition. In a post-COVID world, the model of blended learning is likely to remain.