The coronavirus pandemic (COVID-19) has altered the undergraduate learning experience for many students across Canada. Medical education is no exception; clinical programs, in-person lectures, and mandatory hands-on activities have been suspended to adhere to social distancing guidelines. As remote teaching becomes the forefront of education, medical curricula have been forced to adapt accordingly in order to fulfill the core competencies of medical training and to provide quality education to medical students. With that in mind, the COVID-19 crisis offers a unique opportunity to evaluate the current “continuity plans” in medical education as they stand. This paper provides the perspective of medical students on how medical education is changing for both pre-clerkship and clerkship students, using their experience at McGill University as an example for the Canadian medical education system. Additionally, we discuss the accommodations put forth by the undergraduate medical education (UGME) office, and reflect on the limitations and sustainable solutions in supporting quality medical education.

Introduction: The COVID-19 pandemic is rapidly evolving with the number of cases exponentially rising. The research scientific community has reacted promptly as evidenced by an outstanding number of COVID-19 related publications. As the number of scientific publications rapidly rises, there is a need to dissect the factors that lead to highly impactful publications. To that end, the present paper summarizes the characteristics of the top 50 cited COVID-19-related publications that emerged early during the pandemic. Methods: A systematic search of the Web of Science, Scopus, and Google Scholar was performed, using keywords related to COVID-19 and SARS-CoV-19. Two independent authors reviewed all the search results, screening for the top 50 cited COVID-19-related articles. Inclusion criteria comprised any publication on COVID-19 or the SARS-CoV-2 virus. Data extracted included the type of study, journal, number of citations, number of authors, country of publication, and study content. Results: As of May 29th, the top 50 cited articles were cited 63849 times during the last 4 months. On average, 14 authors contributed to each publication. Over half of the identified articles were published in only 3 journals. Furthermore, 42% and 26% of the identified articles were retrospective case series and correspondence/viewpoints, respectively, while only 1 article was a randomized controlled trial. In terms of content, almost half (48%) of the identified publications reported clinical/radiological findings while only 7 out of the 50 articles investigated potential treatments. Conclusion: By highlighting the characteristics of the top 50 cited COVID-19-related articles, the authors hope to disseminate information that could assist researchers to identify the important topics, study characteristics, and gaps in the literature.

Background: Adequate control of acute postoperative pain is crucial in breast surgeries, as it is a significant factor in the development of persistent chronic pain. Inadequate postoperative pain control increases length of hospital stays and risk of severe complications. Erector spinae plane block (ESPB) is a novel regional block that has the ability to sufficiently block unilateral multidermatomal sensation from T1 to L3. By reviewing the literature on ESPB, this paper aimed to elucidate its efficacy in breast surgery analgesia and its role in addressing the opioid crisis in North America. Methods: PUBMED, EMBASE, and Cochrane databases were systematically searched for relevant articles according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria included any articles that described ESPB in breast surgery. Exclusion criteria composed of articles that exclusively discussed other kinds of regional blocks. Results: Thirty-two articles including 6 randomized controlled trials were included in this review. ESPB demonstrated superior pain control and less opioid consumption compared with tumescent anesthesia or using no block. However, ESPB showed lower efficacy in pain control compared with pectoral nerve block. Patients experienced less nausea and vomiting and were overall more satisfied with ESPB compared with other pain control modalities. The vast majority of the studies reported the ease of ESPB administration, and only 1 case presented with a complication. Conclusions: ESPB is a promising form of regional anesthesia that can decrease postoperative pain and opioid consumption when used as part of multimodal pain analgesia for patients undergoing breast surgery.

Summary: Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.

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Background: In the absence of an effective vaccine, public health policies are aimed at awareness, and education of the general public in order to contain the quickly spreading COVID-19 pandemic. Most of the recommended precautionary measures are dependent on human behaviors and therefore their effectiveness largely depends on peoples' perception and attitudes toward the disease. This study aimed to assess the level of knowledge, risk perception, and precautionary measures taken in response to COVID-19 in North America. Methods: In this cross-sectional observational study, an online survey targeted to North Americans focused on the public's knowledge of COVID-19, risk perception, and precautionary behaviors taken in response to this pandemic. Descriptive analyses were performed for the whole population and the subgroup analyses contrasted the differences between Americans and Canadians. Results: The cohort comprised 1,264 relatively young participants with an average age of 28.6 ± 9.8 years. The vast majority (>90%) were knowledgeable about COVID-19. Regarding risk perception, about a quarter assumed to be at less risk to contract the disease, and 42.8% considered themselves to be less contagious than others. While the vast majority avoided performing risky behaviors, only a small proportion (13.2%) wore a face mask-which is in line with the public health recommendations of the two countries at the time of data collection. Overall, a larger proportion of Canadian participants (55.8%) were satisfied with the performance of their national public health in response to the current pandemic, compared to their American counterparts (12.2%). Discussion: Data regarding the public's knowledge of COVID-19, risk perception, and behaviors in response to this pandemic is limited. The results of this study highlight that this relatively young and educated sample of North Americans had a high level of knowledge about COVID-19 and a large proportion of them were taking the precautionary measures against this pandemic. However, a significant number of individuals believe to be at less risk of contracting the disease compared to the general population. Educating the public that no one is safe from this disease, could play a role in further limiting risky behaviors and ultimately facilitating disease containment.

Background: Rectus diastasis is a common condition that can result in a protruding abdomen, causing cosmetic and functional disability. Although it is usually repaired during abdominoplasty or herniorrhaphy, there is a lack of consensus with regard to the repair indications and optimal surgical techniques. The goal of this study is to provide an updated review of the surgical techniques used for rectus diastasis repair and their comparative efficacy. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane databases were searched for articles that discussed the surgical management of rectus diastasis and reported on either outcomes, complications, or recurrence rates. Data detailing surgical techniques were extracted, and pooled analyses of complication and recurrence rates were performed, controlling for surgical approach, common variations in technique, and an associated herniorrhaphy. Results: Thirty-seven studies describing 45 techniques were included. An open rectus diastasis repair was performed in 24 of the studies. After controlling for an associated herniorrhaphy, there was no statistically significant difference in surgical complication and recurrence rates between open and laparoscopic approaches (p = 0.165 and p = 0.133, respectively). Although a double-layer suture closure was associated with a significantly lower rate of complications (p = 0.002), no significant difference was found for suture type absorbability. Conclusions: Surgical repair of rectus diastasis is safe and effective through both open and laparoscopic approaches. Although suture type absorbability does not affect complication or recurrence rates, a double-layer suture closure can decrease surgical complications. The pooled analysis of complication and recurrence rates can help improve informed consent and patient education.

Along with the socio-economic burden the COVID-19 pandemic carried, the strain it brought upon our health care system is unparalleled. In an attempt to conserve much needed personal protective equipment (PPE) as well as to free up available hospital beds to accommodate the significant influx of COVID-19 patients, many elective surgical cases were essentially put on hold. Furthermore, to taper the spread of this highly contagious virus and to protect the medical staff, surgical clinics were limited to urgent care that could not be managed through virtual platforms. Surgical trainees, such as residents and fellows, who solemnly rely on clinical and surgical exposure to hone their operative and clinical skills, were evidently left deprived. As the pandemic rapidly progressed, medical staff in the emergency departments and what is now known as the COVID wards and COVID ICUs quickly became overwhelmed and overworked. This new reality required surgical trainees to rapidly redeploy to help meet the rising hospital needs. With no clear end to this pandemic, surgical trainees worry they will not reach the appropriate milestones and acquire the amount of surgical experience required to become competent surgeons. As a result, a rapid solution should be found and applied to remedy this newly created gap in surgical education. The measures we recommend include access to regular webinars from world-renowned experts, increased implementation of surgical simulation, selective redeployment of residents to favor level-appropriate learning opportunities and lastly, the active participation of trainees in telemedicine with an increase in surgical exposure as soon as the restrictions are lifted.