APPENDIX 1: Search StrategyPubMed (covid-19[tw] OR COVID19 [tw] OR OR OR OR severe acute respiratory syndrome coronavirus 2[nm] OR severe acute respiratory syndrome coronavirus 2[tw] OR 2019-nCoV[tw] OR 2019nCoV[tw] OR coronavirus[tw] OR coronavirus[mh] OR pandemic[tw]) AND ("Internship and Residency"[Mesh] OR "Students, Medical"[Mesh] OR "Education, Medical"[Mesh] OR "Schools, Medical"[Mesh] OR Intern[tiab] OR interns[tiab] OR "House officer"[tw] OR "house officers"[tw] OR Resident[ti] OR residents[ti] OR residency[ti] OR "medical education"[tw] OR fellow[tiab] OR fellows[tiab] OR "junior doctor"[tw] OR "junior doctors"[tw] OR "postgraduate"[tw] OR postgraduate[tw] OR "foundation year"[tw] OR "foundation program"[tw] OR "medical student"[tw] OR "medical students"[tw] OR "Curriculum"[mesh] OR curricul*[tiab] OR "medical school"[tw] OR "medical schools"[tw] OR "medical training"[tw] OR "undergraduate"[tw] OR "graduate"[tw] OR Learn*[tw] OR training[tw] OR trainer[tw] OR trainee*[tw] OR instructor*[tw] OR instructional[tw] OR educat*[tw] OR classroom*[tw] OR simulat*[tw] OR virtual[tw] OR ZOOM[tw]) AND ("2020/05/01"[Date -Publication] : "3000"[Date -Publication])

Background: The novel coronavirus disease was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplacebased clinical learning in response to the pandemic. The objectives were to synthesise what adaptations/innovation were implemented (description), their impact (justification), and 'how' and 'why' these were selected (explanation and rationale). Methods: The authors systematically searched four online databases up to December 21, 2020. Two authors independently screened titles, abstracts and full-texts, performed data extraction, and assessed the risk of bias. Our findings are reported in alignment with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance. Results: Fifty-five articles were included. Most were from North America (n ¼ 40), and nearly 70% focused on undergraduate medical education (UGME). Key developments were rapid shifts from workplace-based learning to virtual spaces, including online electives, telesimulation, telehealth, radiology, and pathology image repositories, live-streaming or pre-recorded videos of surgical procedures, stepping up of medical students to support clinical services, remote adaptations for clinical visits, multidisciplinary team meetings and ward rounds. Challenges included lack of personal interactions, lack of standardised telemedicine curricula and need for faculty time, technical resources, and devices. Assessment of risk of bias revealed poor reporting of underpinning theory, resources, setting, educational methods, and content. Conclusions: This review highlights the response of medical educators in deploying adaptations and innovations. Whilst few are new, the complexity, concomitant use of multiple methods and the specific pragmatic choices of educators offers useful insight to clinical teachers who wish to deploy such methods within their own practice. Future works that offer more specific details to allow replication and understanding of conceptual underpinnings are likely to justify an update to this review.

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Background: The COVID-19 pandemic caused graduate medical education (GME) programs to pivot to virtual interviews (VIs) for recruitment and selection. This systematic review synthesizes the rapidly expanding evidence base on VIs, providing insights into preferred formats, strengths, and weaknesses. Methods: PubMed/MEDLINE, Scopus, ERIC, PsycINFO, MedEdPublish, and Google Scholar were searched from 1 January 2012 to 21 February 2022. Two authors independently screened titles, abstracts, full texts, performed data extraction, and assessed risk of bias using the Medical Education Research Quality Instrument. Findings were reported according to Best Evidence in Medical Education guidance. Results: One hundred ten studies were included. The majority (97%) were from North America. Fourteen were conducted before COVID-19 and 96 during the pandemic. Studies involved both medical students applying to residencies (61%) and residents applying to fellowships (39%). Surgical specialties were more represented than other specialties. Applicants preferred VI days that lasted 4-6 h, with three to five individual interviews (15-20 min each), with virtual tours and opportunities to connect with current faculty and trainees. Satisfaction with VIs was high, though both applicants and programs found VIs inferior to in-person interviews for assessing 'fit.' Confidence in ranking applicants and programs was decreased. Stakeholders universally noted significant cost and time savings with VIs, as well as equity gains and reduced carbon footprint due to eliminating travel. Conclusions: The use of VIs for GME recruitment and selection has accelerated rapidly. The findings of this review offer early insights that can guide future practice, policy, and research.

AimsThe levels of abstraction, vast vocabulary and high cognitive load present significant challenges in undergraduate histopathology education. Self-determination theory describes three psychological needs which promote intrinsic motivation. This paper describes, evaluates and justifies a remotely conducted, post-COVID-19 histopathology placement designed to foster intrinsic motivation.Methods90 fourth-year medical students took part in combined synchronous and asynchronous remote placements integrating virtual microscopy into complete patient narratives through Google Classroom, culminating in remote, simulated multidisciplinary team meeting sessions allowing participants to vote on ‘red flag’ signs and symptoms, investigations, histological diagnoses, staging and management of simulated virtual patients. The placement was designed to foster autonomy, competence and relatedness, generating authenticity, transdisciplinary integration and clinical relevance. A postpositivistic evaluation was undertaken with a validated preplacement and postplacement questionnaire capturing quantitative and qualitative data.ResultsThere was a significant (p<0.001) improvement in interest, confidence and competence in histopathology. Clinical integration and relevance, access to interactive resources and collaborative learning promoted engagement and sustainability post-COVID-19. Barriers to online engagement included participant lack of confidence and self-awareness in front of peers.ConclusionsFostering autonomy, competence and relatedness in post-COVID-19, remote educational designs can promote intrinsic motivation and authentic educational experiences. Ensuring transdisciplinary clinical integration, the appropriate use of novel technology and a focus on patient narratives can underpin the relevance of undergraduate histopathology education. The presentation of normal and diseased tissue in this way can serve as an important mode for the acquisition and application of clinically relevant knowledge expected of graduates.

IMPORTANCE Breslow thickness is a 1-dimensional surrogate prognostic feature for tumor size, yet tissue sections have 2 dimensions. Therefore, a 2-dimensional feature, calculated tumor area (CTA), was devised. OBJECTIVE To determine CTA precision and prognostic value.

Background Covid-19 has had a seismic impact on medical training, in ways that are continually being realised. In response to the call to establish a ‘new normal’, we performed a detailed evaluation and thematic analysis of recent trainee experiences, which identifies the priorities for developing an innovative training framework that is adaptable during the peaks and troughs of a pandemic. Methods A 14-item survey was sent to junior doctors at a large teaching hospital. Data was analysed using a grounded theory framework and cycles of open and axial coding allowed for identification of emergent themes. Explanatory models were developed using inductive analysis to postulate thematic relationships. Results 137 junior doctors responded to the survey. Respondents across all grades reported benefits to themselves, clinical teams and the profession. A notable benefit to junior trainees was the greater consultant support, fostering a more supportive work environment. Respondents also identified several challenges to working practice, including the availability of suitable PPE, burnout and the general pressures on physical and mental wellbeing. Discussion Trainees’ perceived value was inferred typically from how ‘busy’ they were, possibly as postgraduate training is largely competence based. Educational bodies should attempt to highlight the equal value of non-technical skills, such as mentorship and problem-solving for a rounded curriculum. Trainees highlighted the inequity of opportunities due to sometimes inappropriate redeployment, suggesting that educational bodies should strive to develop personalised training programmes. Covid-19 has shown that a sense of personal physical and psychological safety to be of paramount importance to trainees.

Background The first UK wave of COVID-19 led to the temporary suspension of medical school placements. Medical students were offered paid employment through a COVID Responder Scheme (CRS). We aimed to qualitatively assess the experience of those who participated in this scheme in comparison to traditional clinical attachments. Summary of work A bespoke questionnaire was designed to explore key themes identified through theme selection, literature review and consensus. Following piloting and validation, the questionnaire was circulated to students recruited to the CRS. A grounded theory analytic framework was used to analyse data. A modified-Delphi consensus process was used to reach a consensus on ‘what makes you feel most valued as a medical student’. Summary of results 36 students (46.2% response rate) responded. 86.1% of respondents felt their contribution was worthwhile. 65% reported being significantly more integrated into a team than in their university attachments. Concerns prior to starting CRS work included availability of PPE and the ability to contribute effectively, but refreshingly these concerns did not present as challenges. The steep learning curve of experiential learning alongside virtual teaching commitments proved difficult to juggle when facing physical, mental and emotional fatigue from long hours working busy clinical shifts. Respondents cited the educational benefit of the CRS throughout the survey. Recognition and commendation were highly effective in providing a sense of value ahead of renumeration. 44.4% of respondents were concerned about their future training and a reduction in clinical exposure. Discussion The majority of respondents reported CRS work as worthwhile, with reasons including increased responsibility for patient care and a sense of contribution to the clinical team. This in turn led to autonomous practice and task accountability, which further integrated them into the team and developed their clinical confidence. A student’s sense of value was strongly linked to being identified in emotional responses from colleagues and patients ahead of financial renumeration, suggesting scope for improvement within unpaid attachments / rotations. Conclusion There is an opportunity to take value from the COVID-19 medical student experience to improve undergraduate medical education through and beyond the pandemic.