Inequalities in health have existed for many decades and have led to unjust consequences in morbidity and mortality. These have become even more apparent during the COVID-19 pandemic with individuals from black and minority ethnic groups, poorer socioeconomic backgrounds, urban and rurally deprived locations, and vulnerable groups of society suffering the full force of its effects. This review is highlighting the current disparities that exist within different societies, that subsequently demonstrate COVID-19, does in fact, discriminate against disadvantaged individuals. Also explored in detail are the measures that can and should be taken to improve equality and provide equitable distribution of healthcare resources amongst underprivileged communities.

Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonatal period. Indications for palliation include prematurity, complex anatomy, small pulmonary artery size, and comorbidities. Given that outcomes after right ventricular outflow tract stent palliation are particularly promising – there is low mortality and morbidity, and consistently increased oxygen saturations and increased pulmonary artery z-scores – it is now considered the first-line palliative option. Disadvantages of right ventricular outflow tract stenting include increased cardiopulmonary bypass time at later repair and the stent preventing pulmonary valve preservation. However, neonatal surgical repair is associated with increased short-term complications and hospital length of stay compared to staged repair. Both staged repair and primary repair appear to have similar long-term mortality and morbidity, but more evidence is needed assessing long-term outcomes for right ventricular outflow tract stent palliation patients.

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We read with great interest the article published by AlSaif et al 1 investigating the relationship between the willingness of final-year medical students to participate in the response towards COVID-19, and their perceived clinical competence. The pandemic has resulted in significant staff shortages requiring the help of volunteers to compensate for professionals lost to the outbreak. 2 Therefore, this article comes at a critical time to allow for a better understanding of the influences that would impact final-year medical students' willingness to contribute to the response. Although the authors have attempted to correlate perceived clinical competence and willingness to volunteer during the pandemic, the questionnaire used address general competencies, rather than ones that are relevant to the COVID-19 response. These general competencies encompass a wide array of skills that are not necessarily needed, or expected, from a volunteering student. For example, the authors ask about the perceived competence in "essential clinical procedures" which can vary from complex intubation to simple venepuncture. As medical students, we would expect the questionnaire to include specific tasks required, eg performing nasopharyngeal swabs, to successfully judge our competence. The questionnaire also includes skills that are unlikely to be needed, such as "select and apply the most appropriate and cost-effective diagnostic procedures" which would generally be expected from senior doctors rather than the students. The general nature of the questions has therefore likely influenced the results of the study, providing an inaccurate reflection about the true willingness of students to help during large-scale outbreaks. Various studies such as that of Miller et al 3 demonstrate that volunteering students were asked to perform simpler tasks, and often non-COVID-19 related, such as routine outpatient clinical care, hosting PPE drives and calling patients with lab results. These tasks although play a critical role in patients' outcomes and ease the stress of healthcare systems, they do not require extensive expertise, nor do they pose a high risk of COVID-19 transmission. Therefore, it would be more appropriate for the questionnaires to include such tasks when assessing for willingness.

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Introduction Alongside declining ST3 applications, cardiothoracic surgery (CTS) is underrepresented in the medical curriculum with 90% of medical students reporting no exposure to the specialty in medical school placements. This may result in clinicians having difficulties recognising emergency presentations, with subsequent referrals made inappropriately. Method A simulation course involving teaching around common CTS conditions and procedures was delivered by CTS trainees to undergraduate medical students (n = 50). This involved both theory and high-fidelity simulations of coronary anastomoses using cardiac surgical equipment on porcine hearts and ureters. Delegates were given pre and post-test questionnaires, and another at six-weeks to test knowledge retention. Results were statistically analysed using paired and independent sample t-tests. Results Delegates demonstrated significant improvements in post-test knowledge of 56% (p<0.01), and sustained improvement of 51% (p<0.01) six-weeks later compared to baseline. 64% of delegates reported an increased interest in pursuing CTS as a career; 40% reported improved confidence performing a coronary anastomosis. Conclusions Immediate and long-term knowledge retention of key CTS concepts and ability to assess common CTS pathological scenarios were demonstrated in this study. CTS simulation therefore represents an effective mechanism by which key concepts can be taught to undergraduate medical students, whilst enhancing interest in pursuing CTS as a career. As an educational adjunct, simulation can help bridge the gap between taught theory and applied practice, with the potential to empower future doctors to make more informed referrals and management decisions.

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