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      Medical education in times of COVID-19: survey on teachers' perspectives from a German medical faculty Translated title: Die medizinische Ausbildung in Zeiten von COVID-19: Eine Umfrage über die Perspektiven von Dozierenden einer deutschen medizinischen Fakultät

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          Abstract

          Background: Clinicians in their role as teachers and medical faculties were struggling to address the medical students’ needs regarding their medical education in times of COVID-19. They were especially confronted with several challenges regarding what medical training should look like and how to transfer medical training to integrate relevant skills like interpersonal or practical competencies. This study aimed to investigate the teachers’ perspectives on medical education and COVID-19 in general, including their distress level.

          Methods: This quantitative questionnaire study was distributed online among responsible lecturers of medical training at the Medical Faculty of Tuebingen. Teachers answered questions about the medical training, COVID-19 in general (on a seven point- Likert scale from “not at all” to “completely”) and their mental well-being (STAI). Descriptive data analysis and t-tests were performed.

          Results: The teachers reported being significantly (p<.01) more distressed regarding the medical training ( M=4.63, SD=1.24) in comparison to their private lives ( M=3.58, SD=1.38) or the clinical context ( M=3.33, SD=1.95). They also felt significantly less informed about the medical training in times of COVID-19 (p<.001). They wished for more support and information from their medical faculty. When teachers were asked which teaching should be implemented in future, they reported the most the online lectures (87.5%), followed by collaborative working (75.5%), live broadcast (62.5%) and online chats (58.3%). Teachers also saw the current situation of COVID-19 as a chance for a digital transformation of the medical education ( M=5.92, SD=0.95).

          Discussion: Teachers of the Medical Faculty of Tuebingen saw online-based teaching formats as a chance to meet the medical students’ needs regarding the medical education. Video-based formats like online lecturers and online chats with teachers might play a relevant role in order to impart knowledge. Furthermore, medical students should also be taught in digital formats like telehealth, including patient-physician distance interactions.

          Zusammenfassung

          Hintergrund: Dozierende Klinikärzte/-ärztinnen und medizinische Fakultäten hatten es schwer, den medizinischen Ausbildungsbedürfnissen der Medizinstudierenden in Zeiten von COVID-19 gerecht zu werden. Insbesondere waren sie vor die Herausforderung gestellt, wie die medizinische Ausbildung unter den gegebenen Bedingungen aussehen könnte und wie sich die Vermittlung maßgeblicher zwischenmenschlicher oder praktischer Fähigkeiten integrieren ließe. Diese Studie hatte zum Ziel, die Perspektiven der Dozierenden hinsichtlich der medizinischen Ausbildung und COVID-19 im Allgemeinen zu untersuchen, einschließlich ihres eigenen Stresslevels.

          Methoden: Die Fragebögen dieser quantitativen Erhebung wurden den Dozierenden der Medizinischen Fakultät Tübingen online zur Verfügung gestellt. Die Dozierenden beantworteten Fragen zur medizinischen Ausbildung, zu COVID-19 im Allgemeinen (anhand einer 7-stufigen Likert-Skala von "überhaupt nicht" bis "sehr") und zu ihrem psychischen Wohlergehen (STAI). Es wurden deskriptive Datenanalysen und and t-Tests durchgeführt.

          Ergebnisse: Die Dozierenden gaben an, dass sie sich in ihrer medizinischen Lehrtätigkeit signifikant mehr (p<0,01) belastet fühlten ( M=4,63, SD=1,24) als in ihrem Privatleben ( M=3,58, SD=1,38) oder ihrer klinischen Tätigkeit ( M=3,33, SD=1,95). Ferner fühlten sie sich hinsichtlich ihrer Lehraufgabe unter COVID-19-Bedingungen signifikant weniger informiert (p<0,001). Sie wünschten sich mehr Unterstützung und Informationen von ihrer medizinischen Fakultät. Auf die Frage, welche Lehrformen in Zukunft implementiert werden sollten, gaben die Dozierenden überwiegend Online-Vorlesungen an (87,5%), gefolgt von kollaborativem Arbeiten (75,5%), Live-Übertragungen (62,5%) und Online-Chats (58,3%). Die Dozierenden sahen die aktuelle Situation mit COVID-19 auch als Chance für eine digitale Transformation der medizinischen Ausbildung an ( M=5,92, SD=0,95).

          Diskussion: Dozierende der Medizinischen Fakultät Tübingen sahen Online-Lehrformate als Chance an, um den Bedürfnissen der Medizinstudierenden in ihrer medizinischen Ausbildung gerecht zu werden. Videobasierte Formate wie Online-Vorlesungen und Online-Chats mit Dozierenden könnten bei der Wissensvermittlung eine wichtige Rolle spielen. Darüber hinaus sollten Medizinstudierende auch in digitalen Formaten wie der Telemedizin ausgebildet werden, einschließlich der Fern-Interaktion zwischen Arzt/Ärztin und Patient/-in.

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          COVID-19 and medical education

          The coronavirus disease 2019 (COVID-19) outbreak has rapidly transitioned into a worldwide pandemic. This development has had serious implications for public institutions and raises particular questions for medical schools. Frequent rotations between departments and hospitals make medical students potential vectors for COVID-19. Equally, as trainee doctors we stand to learn a tremendous amount and can contribute to the care of patients. More immediate concerns among medical students centre on the impact of COVID-19 on medical education. A substantial number of medical students are in the process of preparing for or undertaking assessments that require clinical exposure. The effect of COVID-19 on medical education could therefore be considerable. Several teaching hospitals in the UK have reported cases of COVID-19, with some hospitals suspending medical and observership students from attending clinical attachments. This suspension might extend to more hospitals as the COVID-19 pandemic continues to develop, which could lead to clinical medical students receiving reduced exposure in specific specialties, causing a detrimental effect to exam performance and competency as foundation year 1 doctors. The situation is more complex for some final year medical students who are in the process of sitting their final assessments. Some medical schools have reduced clinical exposure in the weeks coming up to their final exams to reduce the risk of contracting the virus. Many electives could also be cancelled because of the global prevalence of COVID-19. This situation would not only cause financial losses for students, but also lead to a missed opportunity of working in a health-care system outside of the UK. At this stage, it is difficult to predict what will happen, and most medical schools are following advice from Public Health England to determine how to proceed. Despite widespread panic and uncertainty, the medical community must ask itself what history has taught us about medical education during pandemics. To answer this question, we reflect on the effects of severe acute respiratory syndrome (SARS) on medical education in China at the turn of the century. 1 Some Chinese medical schools officially cancelled formal teaching on wards and their exams were delayed, hindering the education of medical students in the face of the newly emerging epidemic. 1 Similarly, in Canada, the impact of the SARS restrictions led to the cessation of clinical clerkships and electives for students for up to 6 weeks. 2 The Canadian national residency match felt the effect of these limitations, particularly because electives are one of the most crucial factors determining allocation. 1 Despite the challenges posed by the SARS epidemic, several resourceful initiatives were implemented, leading to progress in medical education. In one Chinese medical school, online problem-based learning techniques were implemented to complete the curricula; these methods proved incredibly popular, to the extent that they were applied in subsequent years. These impressive feats illuminate how even in times of distress, solace can always be found. We are waiting to see what ingenuities for medical education will emerge in the face of the COVID-19 pandemic. This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on March 27, 2020.
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            The Impact of COVID-19 on Medical Education

            In the wake of the novel coronavirus (COVID-19) pandemic, it is abundantly clear to all the necessity of studying the pathology and widespread health consequences associated with the virus. However, what is much less clear is the impact of COVID-19 on medical education. Already, faculty and medical students are grappling with the changes that have been made and attempting to consolidate these with their plan of career development. Changes that may seem relatively minor in comparison to the global pandemic have the potential to be drastic turning points in the career progression of many. As not much is known regarding the long-lasting impact of COVID-19 on medical education, it is therefore also necessary to record and study the full impact of the changes being made. The path to entering a successful residency has been predictable for the last few years - do well on Step 1, give conference presentations, go the extra mile in clerkships and shadowing opportunities, and have meaningful non-academic extracurricular activities - all of which designed to best demonstrate a student's knowledge, persistence, collaborative spirit, and dedication to medicine. This trajectory has been changed with COVID-19 disrupting routines in hospitals, medical schools and beyond. The replacement of in-person classes with online equivalents is an obvious necessity at this time but creates a loss of collaborative experiences that has the potential to be a significant detriment to education. Likewise, the cancellation of clerkships, which are necessary for both skill acquisition as well as for relationship building, is a serious issue which students and medical schools must now resolve. Many medical students have also lost the opportunity for personal development through conference presentations. These presentations play a large role in distinguishing applicants during the residency application process, and therefore these lost opportunities have the potential to be a serious detriment to medical students’ career trajectory. While implementing technology to help resolve these issues is a unique way to help students to develop these skills, it is now necessary for medical students to demonstrate the same set of skills which they would have previously in a completely new and innovative manner. Persistence and adaptability during this time of challenge are attributes that medical students can demonstrate more readily. While every student has a personal story of how COVID-19 has impacted their education, there is no question that the impacts of COVID-19 will be felt on an extensive level. The panic in the community is palpable, and many are confused by how to proceed in the wake of COVID-19. This is no different for medical students and faculty and the questions that arise regarding medical education and their future careers.
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              The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients.

              In geriatric psychiatry assessment scales are often used in clinical praxis in the diagnostic work-up of mental disorders. To assess whether the state part of the STAI is useful as a case-finding instrument of mental disorders. Data came from 70 non demented geriatric in-patients in stable clinical condition. Mean age was 83.3 years (range 64-96), and 74.3% were women. The 20-item STAI state instrument was used to measure current anxiety symptoms. Without knowledge of the score on STAI state a psychiatrist examined all patients and set diagnosis according to DSM-IV-TR criteria, but hierarchical rules were not used. Sensitivity, specificity, Likelihood ratio and accuracy were calculated for different cut-points of the mean sumscore on the STAI state. 15.7% of the participants suffered from a mental disorder: GAD = 1, mixed anxiety-depression = 5, depression = 1, dysthymic = 1, adjustment disorder (mixed anxiety-depression) = 1, and personality disorder = 1. The mean STAI sumscore in this group was 56.3 compared with 39.2 in the 59 patients without any psychiatric diagnosis. The optimal cut-off score on the STAI mean sumscore corresponding to the highest accuracy of 0.87 was 55/54 with sensitivity 0.82, specificity 0.88, and LR + 6.8. The STAI state scale is a useful instrument for detecting a variety of mental disorders in older people. Further studies should be carried out in different populations. Copyright 2005 John Wiley & Sons, Ltd.
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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                15 June 2021
                2021
                : 38
                : 5
                : Doc93
                Affiliations
                [1 ]University Hospital Tuebingen, Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany
                [2 ]Eberhard-Karls University of Tuebingen, Faculty of Medicine, Tuebingen, Germany
                Author notes
                *To whom correspondence should be addressed: Teresa Loda, University Hospital Tuebingen, Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, Osianderstr. 5, D-72076 Tuebingen, Germany, Phone: +49 (0)7071/29-86719, Fax: +49 (0)7071/29-4382, E-mail: Teresa.loda@ 123456med.uni-tuebingen.de
                Article
                zma001489 Doc93 urn:nbn:de:0183-zma0014899
                10.3205/zma001489
                8256125
                34286073
                3512ea1e-6f6b-4b5d-9b8c-aab8c0b57d3b
                Copyright © 2021 Herrmann-Werner et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

                History
                : 16 September 2020
                : 31 March 2021
                : 08 March 2021
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                medical education,covid-19,teacher,mental well-being,digitalization

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