These are unprecedented times. Although the necessary focus has been to care for patients and communities, theemergenceofsevereacuterespiratorysyndromecoronavirus 2 has disrupted medical education and requires intense and prompt attention from medical educators. The need to prepare future physicians has never been as focused as it is now in the setting of a global emergency. The profound effects of coronavirus disease 2019 (COVID-19) may forever change how future physicians are educated.This pandemic presents practical and logistical challenges and concerns for patient safety, recognizing that students may potentially spread the virus when asymptomatic and may acquire the virus in the course of training. This Viewpoint discusses the current status of medical education, describes how COVID-19 may affect preclerkship and clerkship learning environments, and explores potential implications of COVID-19 for the future of medical education.

Objective Recent studies indicate that many preschoolers meet diagnostic criteria for psychiatric disorders. However, data on the continuity of these diagnoses are limited, particularly from studies examining a broad range of disorders in community samples. Such studies are necessary to elucidate the validity and clinical significance of psychiatric diagnoses in young children. The authors examined the continuity of specific psychiatric disorders in a large community sample of preschoolers from the preschool period (age 3) to the beginning of the school-age period (age 6). Method Eligible families with a 3-year child were recruited from the community through commercial mailing lists. For 462 children, the child’s primary caretaker was interviewed at baseline and again when the child was age 6, using the parent-report Preschool Age Psychiatric Assessment, a comprehensive diagnostic interview. The authors examined the continuity of DSM-IV diagnoses from ages 3 to 6. Results Three-month rates of disorders were relatively stable from age 3 to age 6. Children who met criteria for any diagnosis at age 3 were nearly five times as likely as the others to meet criteria for a diagnosis at age 6. There was significant homotypic continuity from age 3 to age 6 for anxiety, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder, and heterotypic continuity between depression and anxiety, between anxiety and oppositional defiant disorder, and between ADHD and oppositional defiant disorder. Conclusions These results indicate that preschool psychiatric disorders are moderately stable, with rates of disorders and patterns of homotypic and heterotypic continuity similar to those observed in samples of older children.

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Researchers and clinicians have long hypothesized that there are temperamental vulnerabilities to depressive disorders. Despite the fact that individual differences in temperament should be evident in early childhood, most studies have focused on older youth and adults. We hypothesized that if early childhood temperament is a risk factor for depressive disorders, it should be associated with better-established risk markers, such parental depression. Hence, we examined the associations of laboratory-assessed positive emotionality (PE), negative emotionality (NE), and behavioral inhibition (BI) with semi-structured interview-based diagnoses of parental depressive disorders in a community sample of 536 three-year old children. Children with higher levels of NE and BI had higher probabilities of having a depressed parent. However, both main effects were qualified by interactions with child PE. At high and moderate, but not low, levels of child PE, greater NE and BI were associated with higher rates of parental depression. Conversely, at low, but not high and moderate, levels of child NE, low PE was associated with a higher rate of parental depression. Child temperament was not associated with parental anxiety and substance use disorders. These findings indicate that laboratory-assessed temperament in young children is associated with parental depressive disorders, however the relations are complex and it is important to consider interactions between temperament dimensions rather than focusing exclusively on main effects.

Dysthymic disorder has a protracted course and is associated with a high risk of relapse. The nature of chronic depressive episodes varies over time within individuals, indicating that the various manifestations of chronic depression in DSM-IV do not represent distinct disorders. However, the distinction between chronic and nonchronic forms of depression is relatively stable and may provide a useful basis for subtyping in genetic and neurobiological research.