ObjectivesTo investigate perceptions of medical students on the role of online teaching in facilitating medical education during the COVID-19 pandemic.DesignCross-sectional, online national survey.SettingResponses collected online from 4th May 2020 to 11th May 2020 across 40 UK medical schools.ParticipantsMedical students across all years from UK-registered medical schools.Main outcome measuresThe uses, experiences, perceived benefits and barriers of online teaching during the COVID-19 pandemic.Results2721 medical students across 39 medical schools responded. Medical schools adapted to the pandemic in different ways. The changes included the development of new distance-learning platforms on which content was released, remote delivery of lectures using platforms and the use of question banks and other online active recall resources. A significant difference was found between time spent on online platforms before and during COVID-19, with 7.35% students before versus 23.56% students during the pandemic spending >15 hours per week (p<0.05). The greatest perceived benefits of online teaching platforms included their flexibility. Whereas the commonly perceived barriers to using online teaching platforms included family distraction (26.76%) and poor internet connection (21.53%).ConclusionsOnline teaching has enabled the continuation of medical education during these unprecedented times. Moving forward from this pandemic, in order to maximise the benefits of both face-to-face and online teaching and to improve the efficacy of medical education in the future, we suggest medical schools resort to teaching formats such as team-based/problem-based learning. This uses online teaching platforms allowing students to digest information in their own time but also allows students to then constructively discuss this material with peers. It has also been shown to be effective in terms of achieving learning outcomes. Beyond COVID-19, we anticipate further incorporation of online teaching methods within traditional medical education. This may accompany the observed shift in medical practice towards virtual consultations.

Background Positive shunt response (SR) remains the gold standard for diagnosing idiopathic normal pressure hydrocephalus (iNPH). However, multiple pathologies mimic iNPH symptoms, making it difficult to select patients who will respond to shunt surgery. Although presenting features, extended lumbar drainage (ELD), infusion test (IT), intracranial pressure monitoring (ICPM), and tap test (TT) have been used to predict SR, uncertainty remains over which diagnostic test to choose. Objective To conduct a systematic review and meta-analysis to identify clinical predictors of shunt responsiveness, evaluate their diagnostic effectiveness, and recommend the most effective diagnostic tests. Methods Embase, MEDLINE, Scopus, PubMed, Google Scholar, and JSTOR were searched for original studies investigating clinical predictors of SR in iNPH patients. Included studies were assessed using the QUADAS-2 tool, and eligible studies were evaluated using univariate and bivariate meta-analyses. Results Thirty-five studies were included. Nine studies discussed the diagnostic use of presenting clinical features, 8 studies ELD, 8 studies IT, 11 studies ICPM, and 6 studies TT. A meta-analysis of 21 eligible studies was conducted for TT, ELD, IT, and ICPM. ICPM yielded the highest diagnostic effectiveness, with diagnostic odds ratio (DOR) = 50.9 and area under curve (AUC) = 0.836. ELD yielded DOR = 27.70 and AUC = 0.753, IT had DOR = 5.70 and AUC = 0.729, and TT scored DOR = 3.86 and AUC = 0.711. Conclusion Intraparenchymal ICPM is statistically the most effective diagnostic test, followed by ELD, IT, and lastly TT. Due to the higher accessibility of TT and IT, they are recommended to be used first line, using a timed-up-and-go improvement ≥ 5.6 s or a Rout cut-off range between 13 and 16 mmHg, respectively. Patients who test negative should ideally be followed up with ICPM, using mean ICP wave amplitude $$\ge$$ ≥ 4 mmHg, or 1- to 4-day ELD with an MMSE cut-off improvement $$\ge$$ ≥ 3. Future research must use standardized methodologies for each diagnostic test and uniform criteria for SR to allow better comparison.

Objectives The objectives of this study were the following: (i) assess interest levels in cardiothoracic surgery (CTS) among UK-based medical students, (ii) identify potential motivators and barriers to pursuing CTS training, (iii) explore the influence of gender on interest in CTS in greater depth. Methods Medical students from all year groups across UK medical schools were invited to participate in a cross-sectional, national online survey. Responses were collected from 02/12/2019 to 08/12/2019. Results 1675 medical students from 31 UK medical schools responded, with an estimated 5.3% response rate. Of the respondents, 33.7% respondents reported having exposure to CTS, primarily through their medical school or through extracurricular activities (48.4% and 38.8%, respectively). When assessing interest in CTS, 31.4% were interested in undertaking a career in CTS, with a larger proportion of students expressing interest with no exposure to CTS than those with exposure. However, interest in pursuing CTS decreased with exposure as medical students transitioned from pre-clinical to clinical stages. Additionally, male participants were more interested in seeking a CTS post than their female counterparts (38% vs. 27.6%). The length of training ( p = 0.0009) and competitive nature ( p < 0.0001) of gaining a CTS post were the primary deterring factor for female participants, compared to their male counterparts. Conclusions This study shows the importance of quality of exposure and its impact on students’ interests in pursuing a career in CTS. The negative relationship between exposure and interest in CTS can be associated with the realisation of the challenges that come with pursuing CTS.

Background: The choice of antithrombotic therapy, anticoagulants or antiplatelets, after prosthetic heart valve replacement or repair, remains a disputed topic in the literature. Antithrombotic therapies are used after heart valve intervention to reduce the rates of thromboembolic events, therefore improving patient outcomes. Different interventions may require different therapeutic regimens to achieve the most efficacious clinical outcome for patients. Methods and Discussion: This review aims to summarize and critique the available literature concerning therapeutic agents used for bioprosthetic and mechanical valves as well as for valve repair, so as to assist clinicians and researchers in making decisions with regard to their patients and research endeavors.

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Aim Cardiothoracic surgery (CTS) is a rapidly evolving specialty requiring the recruitment of talented graduates. This study aims to explore perceptions and exposure of medical students nationally, to CTS. Method Medical students currently in the clinical years of their study were invited to complete an online questionnaire exploring their perceptions of CTS. The questionnaire evaluated students’ personal speciality interest, interest in pursuing CTS as a career, exposure to CTS throughout medical school and using a 5-point likert-scale. Results A total of 917 students were surveyed across 30 different medical schools, of these 378 (41.2%) had exposure to CTS either through their medical school or via extra-curricular activities. 526 (57.3%) were considering CTS as a career choice, 76 (8.3%) were considering it as their top choice of which 9 (11.8%) were final years. Overall, 16.9% (76) of medical students in their penultimate and final years are considering a career in CTS, 39.5% of whom were undecided as to which subspeciality with cardiac surgery being the most popular choice after this. The length of training and the high competition for places were the most deterring factors for medical students while the skilful nature of the surgery and its impact on patients’ lives were attracting factors to CTS. Conclusions Despite many students recognizing CTS as a highly impactful and stimulating field this is not reflected by the number of students wanting to undertake a career pathway within CTS. Very few students have dedicated CTS placements which may be a factor in lack of interest.

Aim Accurate, informative, and consistent documentation in the postoperative period is an essential aspect enabling effective and safe communication between healthcare professionals. Limited documentation can increase the risk of errors and suboptimal care. The Royal College of Surgeons (RCS) identified 18 criteria for operation note documentation for ‘Good Surgical Practice’, enabling continuity of care. Currently, the structure and information documented in a tertiary neurosurgical department varied. The aim of this quality improvement project was to improve the documentation in the department using a proposed proforma. Method A proforma was identified using the RCS guidelines and distributed via email. Operation notes of all patients undergoing neurosurgical procedures were compared against RCS guidelines from November 1st – November 30th, 2020, pre-proforma introduction. Operation notes were then re-audited from July 1st – July 31st post-proforma introduction. Results 66 operations were identified in the pre-proforma group, and 49 in the post-proforma group. Date, time, details of tissue alteration, operative findings, incision, prosthesis identification, antibiotic use and signature were well documented in both pre and post proforma introduction (&gt;90%). In the reaudited group there was an improvement in documentation of anaesthetist (37 vs 24%), complications (78 vs 35%), extra procedures (18 vs 2%), blood loss (22 vs 12%), and a small decrease in the documentation of DVT prophylaxis (59 vs 53%). Conclusions A structured proforma is useful for enhancing communication in the post-operative period. We aim to create a standardised template in the trust's note-taking system to standardise the documentation process and provide further training on the importance of documentation.

Amrit Sachar, Aida Abdelwahed, Lana Al-Nusair and Edagul Ulucay explore the relationship between patients' actual cognitive function and staff perception of it