The International Journal of Medical Students

Online ISSN: 2076-6327
Publications
Article
Background: Acute myeloid leukemia (AML) is a malignant disease with significant identified prognostic factors. Therefore our aim was to develop an Assessment Scheme of Prognosis in AML based on prognostic factors. In some counties, such as Romania or other less-highly developed countries, this scheme would be beneficial particularly when cytogenetic testing is unavailable or time-intensive. Methods: We analyzed 119 adult patients with AML during a five year-period from a single-center in Romania. We retrospectively collected and analyzed data with Epi Info and Excel using patient medical records. Results: According to age, the group A1 (<60 years) had a 40 months survival, in contrast with the group B1 (≥60 years) with a survival of 19 months (p=0,0063). The group A2 (secondary AML) survived 15 months, whereas the group B2 (AML de novo) survived 40 months (p=0.0021). Additionally, the group A3 (mild comorbidities) achieved a 40 months survival, the group B3 (moderate comorbidities) survived 19 months, whereas the group C3 (severe comorbidities) survived 7 months (p=0,0059). According to WBC and blast number, the group A4 (high levels) had a 25 months survival, whereas the group B4 (low levels) survived 40 months (p=0,0057). Conclusion: The prognostic factors studied are useful to identify the risk level of AML disease for each patient at diagnosis. We developed an assessment scheme of prognosis with three risk groups according to age, secondary AML, comorbidity, WBC and blasts and cytogenetic examination.
 
Article
We live in an unprecedented time, the covid19 outbreak has paralyzed the world including medical students. They remain in quarantine in the hope that the pandemic will end. The Latin America countries are particularly affected by their lack of resources and the time when medical students return to the universities is lengthening. Meanwhile the use of online platforms to resume the classes and the variety of online courses to complement the learning seems promising and should be more widely disseminated.
 
Article
Many students around the world have been wondering how their life will change since the very first outbreak of Covid-19. In my experience article I have tried to give a flavor of how has the academic world changed in quarantine. Difficulties and opportunities have been analyzed. Questions regarding the validity of e-learning have been posed. In an arduous period as the one we are experiencing, having an idea of what life could be in worst case scenario could be helpful.
 
Article
We were third year medical students preparing for our clinical examinations to take place. What felt like a few moments later, on the 23rd of March 2020 Greater Manchester went into lockdown and we were told to stay home to protect the NHS and prevent the spread of the COVID-19 virus. Like many students across the UK, we seeked a job within the NHS to decrease the demand for staff during the pandemic. We worked on the frontline for an Emergency Community Death Service set up in response to the rapid increase in deaths occurring in the community due to the pandemic. Here we arranged for timely and efficient verification of the deaths alongside handling the legalities of the Medical Certificate of Cause of Death and cremation papers. It was a psychologically challenging, but massively rewarding journey.
 
Article
Background: Since the onset of the COVID-19 pandemic, efforts have been aimed at promoting preventive measures towards curtailing the spread of the SARS-CoV-2 virus. The effectiveness of measures put in place by the government are mostly determined by the Knowledge, Attitude, and Practices (KAP) of the citizenry. We sought to determine the KAP of young Nigerian adults towards preventive strategies against COVID-19. Methods: An online survey was prepared using an 18-question questionnaire to assess the KAP of each participant that satisfied predefined criteria. Data obtained were screened for error and analyzed with SPSS version 23. The level of significance was set at p
 
Article
Background: Quarantine is considered the most effective way to reduce the transmission of an infectious disease. The outbreak of coronavirus disease-19 (COVID-19) in 2020 led to many people being quarantined at various locations. The literature shows that people who undergo quarantine face psychological problems, such as depression, anxiety and stress. The aim of this study was to estimate the prevalence of psychological issues among quarantined people during the COVID-19 pandemic. Methods: This cross-sectional study was conducted in Trivandrum, Kerala, India. Adults aged 18 years and above who underwent quarantine in the area of the Pangappara Medical Health Centre were included. A semi-structured questionnaire and the Depression Anxiety Stress Scale-21 were administered to those who had given their informed consent. Quantitative variables were summarized using mean, standard deviation, and categorical variables with proportions. Significance of association was tested using the chi-square tests. Results: There were 143 participants included in the study. It was found that 23.8% had depressive symptoms, 14% had anxiety symptoms and 16.8% had significant stress. People from the age group of 26-40 years (p = 0.017), people from the higher educated group (p = 0.010) and non-resident Keralites (Keralites who were residing elsewhere and returned to Kerala during the pandemic) (p = 0.041) had the highest prevalence of depressive symptoms. Conclusion: People who undergo quarantine face many psychological issues. The health care system should provide adequate psychosocial support to quarantined people suffering from psychological problems. Health care workers should undergo appropriate training to provide these supports.
 
Article
Medical formation includes the development of several skills including clinical ones. Medical students have to learn how to build a healthy doctor – patient relationship in order to provide the best diagnosis, treatment and quality of attention. COVID-19 provide a new challenge for all students in Mexico to learn skills that traditionally have been learned in person and not through a computer.
 
Article
We’ve all read about the repercussions of pandemics in the past centuries, but COVID-19 is the first one we’ve struggled through! As uncertainty prevails in this unprecedented lockdown, we have deliberated over our perspective of our country’s preparedness and evolving protocols, along with the brunt taken by the academic courses. Nevertheless, there’s always a silver lining to look for, as we escape from our overbearing deadlines!
 
Article
Introduction: The COVID-19 pandemic has been challenging medical professionals and facilities for over a year now. Much of the literature describes pathologic lung changes and complications associated with SARS-CoV-2, with pneumothorax and pneumatoceles not being uncommon. The Case: We describe a case involving a patient that presented to the emergency department with a pneumothorax. Three weeks prior, the patient was hospitalized for 10 days in acute respiratory distress secondary to SARS-CoV-2 pneumonia, which did not require ventilator support. Follow up imaging revealed a 7 cm (AP) x 4.6 cm (transverse) x 2.5 (cc) cm pneumatocele. Conclusion: We speculate that antecedent rupture of an unrecognized pneumatocele likely caused lung collapse leading to the patient’s pneumothorax. This review delves into the etiology of both pneumothoraxes and pneumatoceles along with their relation to SARS-CoV-2 pneumonia.
 
Article
Background: In view of COVID-19 lockdown in India, many colleges started online classes. This study aimed to evaluate the attitudes of, and the factors affecting, medical students attending online classes during lockdown. Methods: We designed an online questionnaire with open-ended, close-ended, and Likert scale questions. Links to the questionnaires were shared with the medical students who have attended at least one online class during the COVID-19 lockdown period. Respondents were 1061 participants from 30 medical colleges from the states of Kerala and Tamil Nadu in India. Results: The majority of students – 94% (955/1016) – used smartphones to attend online classes. ZOOM/ Skype – by 57.1% (580/1016) – and Google platforms – by 54.4% (553/1016) – were commonly used. Learning at leisure – 44.5% (452/1016) – was the top reason why students liked online classes, whereas network problems – 85.8% (872/1016) – was the top reason why students disliked them. Lack of sufficient interaction – 61.1% (621/1016) was another reason why students disliked online learning. More than half the participants – 51.7% (526/1016) – did not want to continue online classes after COVID-19 lockdown. More students – 55% (558/1016) – favored regular classes than online classes. Conclusion: Students in our survey did not seem favorably disposed to online classes. Network problems experienced by students should be addressed. Furthermore, teachers should try to make the classes more interactive and educational institutions should address the problems pointed out by the students in order to make online classes more effective in the future.
 
Article
After the outbreak in December 2019, Coronavirus Disease (COVID-19) has become a global health problem because of its rapid spread throughout the world. To date, there are no effective therapies to treat or prevent COVID-19 infection. Probiotic bacteria are widely used to prevent gastrointestinal infections by modulating intestinal microbiota. Therefore, this literature review focuses on the potential possessed by probiotic bacteria for the prevention of future COVID-19 infections. Information was extracted from PubMed and Google Scholar using the keywords: "COVID-19", "immunomodulator", "inflammation", and "probiotic" and synthesize in a narrative review. The results showed that probiotic bacteria have immunomodulatory activity that can increase immunity against pathogens by regulating the immune system through modulation of intestinal microbiota and interactions with the lymphatic system in the digestive tract. The ability of the immune system regulation by probiotic bacteria has the effect of increasing the body's defense mechanisms against pathogens that infect the respiratory tract. However, further evidence is still needed regarding the effect of probiotic immunomodulators in combating future COVID-19 infections.
 
Article
Background: Infectious respiratory disease in children provides a significant seasonal workload burden to pediatric emergency departments. Studies from the Southern hemisphere during the first wave of coronavirus (COVID-19) had shown a decrease in seasonal pediatric respiratory infections. During the COVID-19 pandemic, predicted drops in infectious disease circulating in children led to redeployment of junior doctors in pediatric services to adult services. Methods: We extracted data on children presenting to a tertiary emergency department with a respiratory illness, comparing winter 2019-2020 (pre-COVID-19) to winter 2020-2021 (post-COVID-19). We compiled demographic and epidemiological data and compared the two groups with regards to number and type of infectious respiratory presentations, admissions, days spent in hospital, and whether intensive or high dependency support was required. Results: We have found a reduction in respiratory disease presentations post-COVID-19 compared to pre-COVID-19. These patients were more likely to be admitted but their stay was reduced, and there was a trend towards a reduction in requirement for intensive or high dependency support during their admission. Conclusion: This work supports the redeployment of junior doctors in pediatric departments to adult departments given increased demand in other areas of medical care at that time. In view of the changing landscape, we suggest the introduction of a flexible staffing format to ensure adequate support to areas with higher demand.
 
Article
The COVID-19 pandemic has strongly affected Brazil in many different aspects, and the country is considered an epicenter of the new disease. With over 5.5 million confirmed cases and 160 thousand deaths by November 2020,1 the country’s healthcare system got oversaturated during the pandemic. Also, since SARS-Cov-2 is a highly transmissible virus, to avoid its spread to the society, many universities canceled in-person classes for indefinite period. For this reason, as a way to deal with both situations, many Brazilian medical students enrolled themselves as volunteers in telemedicine services across the country. Recognized for acting in various sectors of society, volunteering has acquired entrepreneurial characteristics, as it is no longer restricted to assistance and solidarity, and it increasingly occupies spaces for training, education, culture promotion and professionalization.2 In this sense, medical students enrolled in telemedicine may enhance their clinical and communications skills in a period when in-person medical care is not possible to be carried out by many students. Volunteerism is composed by people who perform a social work that reaches areas which the Public Sector is unable to effectively cover.3 The non-governmental organization Médecins Sans Frontières (MSF) announced that Brazil was testing in a very slow rhythm during the pandemic peak in the country, with 7,500 tests per million people, which is around 10 times less than the United States (74,927 per million).4 Thus, during a pandemic scenario in middle-income countries where the lack of available healthcare resources may pose risks to many lives, telemedicine plays an essential role in relieving the country’s overwhelmed health system. Still reported by MSF,4 nearly 100 nurses were dying from the disease per month during the pandemic peak in Brazil, being the fastest rate in the world. So, shown that in-person contact helps spreading the disease, telemedicine can be an interesting tool to avoid new infections, since the attention may be provided without exposing the health professional and the suspected case to one another. Many medical decisions-makings are purely cognitive, and telemedicine can deal with some less severe not life-threatening cases, following-up the patients and referring them to more specialized health facilities if necessary. In a nation of continental dimensions like Brazil, the country’s different regions may face different pandemic phases during the same time. In this regard, since the medical students or volunteer doctors don’t have to leave their houses, telemedicine is also a great strategy that promotes better allocation of health professionals for more distant areas that are facing a worse pandemic phase and have less resources to cope with the health crisis. On this point, more than 15 thousand free telemedicine consultations have already been carried out in 135 different cities across Brazil by the project we are involved in. Nevertheless, it is known that ill-prepared medical students added to the unfamiliarity with the latest guidelines might pose a risk to the country’s public health.5 Also, since telemedicine is a new device for the majority of the students, basal and continued training are essential to offer a high-quality health service. On this matter, during our volunteering experience, materials that guide how to access and deal with the virtual platforms were offered by the project’s staff. In addition, at the weekly meetings, those responsible for training explain in details everything that must be done so that patient care is satisfactory and effective. After a certain period working in the same role, volunteers receive new training in order to be prepared to assume new roles in the project. With this, the experience becomes broader, allowing a comprehensive knowledge of the project's functioning. Despite COVID-19 cases, our telemedicine volunteering experience covers through video calls several medical fields, such as: pediatrics, gynecology and obstetrics, psychiatry, dermatology, oncology, ophthalmology, allergology, cardiology, sports medicine, geriatrics, otorhinolaryngology and other infectious diseases. However, we could notice a high prevalence of psychological assistance needing, specially between the older individuals. The reasons are diverse and often have a deep relation with the current pandemic reality, which consists of social isolation. Since the advent of COVID-19, there has been a significant increase in stress, anxiety and depression rates worldwide,6 and online mental health services were widely implemented in China during the outbreak to alleviate psychological distress,7 showing how important these aids are during pandemic times. We believe that telemedicine volunteering is an extremely positive experience in medical training. As COVID-19 appears that it is still going to be part of our lives in the next year and it might change the way medicine is performed in many different manners, it is important to train medical students in this field so that the new generation of medical doctors is born capable of using technology as an ally to cope with adverse situations.
 
Article
While the COVID-19 virus has infected over 3 million people in the United States of America, Asian Americans face unique unfair treatment due to COVID-19. In America, many anti-Asian incidents have been reported, and the FBI warns of increased hate crimes to Asian Americans due to COVID-19. Americans and high-level politicians use inappropriate names, such as “Chinese Virus,” for the COVID-19 virus, which fuels racism and xenophobia. In this Experience piece, we discuss the harm of referring to the COVID-19 virus based on the geographic location where it was first identified.
 
Article
COVID-19 pandemic has taken over the world. Spreading form its epicenter in a seafood market in Wuhan to more than 200 countries, it has caused alarming situations. The viral infection is caused by an RNA virus called SARS-CoV-2. Its genome resembles the SARS-CoV-1 and MERS-CoV genome. COVID-19 cases were first reported in December 2019 in China; it affects the lungs causing mild to severe respiratory disease. No antiviral drug for the infection has been approved yet, but certain drugs are under consideration including Chloroquine, Hydroxychloroquine and Teicoplanin. The review article will first present the structure of the SARS-CoV-2 and compare it to SARS-CoV-1 and MERS-CoV. The article will then highlight its effect on different organs. Finally, it will highlight the therapeutics which are in consideration and which are being used. The article will provide a good insight into the COVID-19 infection.
 
Article
Normally, the 4th year of medical school in the United States is when students narrow down their clinical experiences to reflect their interests, and prepare for applying to residency programs. The COVID-19 pandemic has made this process difficult, forcing many senior students from the frontlines to the sidelines. Policy changes have forbidden students from attending some in-person rotations and participating in operational procedures. The impact that COVID-19 has had on medical curricula varies between institutions, with many being hindered significantly by the event. However, my institution is using novel approaches to patient care, allowing senior students to help. Senior students are using telecommunication to connect with patients and assist them with their medical questions and needs. They are acting as Transitional Care Providers and Patient Navigation Assistants, allowing them to use their knowledge and skills to help both the patients and the healthcare system. Other students are acting as “COVID-19 case-trackers,” attempting to mitigate the spread of infections. By allowing students to take on these roles during the pandemic, institutions like mine are making this time one of valuable experience and learning. For some senior medical students, the COVID-19 pandemic, with all of its hardships, has become an invaluable learning opportunity and a chance to serve their community.
 
Article
The emerging COVID-19 pandemic has affected most aspects of life all over the world. In addition, it has promoted fear and uncertainty and initiated several ethical challenges. In this brief experience account, I will try to shed the light on the mediocre aspects of our circumstances and assert the protective measures for our wellbeing during current widespread contagion.
 
Article
Five months after the confirmation of the first case of COVID-19 in Kenya, the cases and fatalities due to the disease is still on the rise. The effects of the disease in the developing country have been far-reaching, and closure of all learning institutions has now shifted attention to online learning. However, challenges such as inconsistent access to the internet and electricity have led to inequality in education access. As final-year medical students, online lectures have been a new exciting experience, but it also came with challenges. The halt in clinical medical education has significantly affected the learning and school calendar. Although we are almost done with our journey through medical school, we cannot proceed any further. However, we remain hopeful that a leeway shall be found, and we shall join other healthcare workers in serving our country.
 
Article
Multiple Sclerosis is a chronic inflammatory disease. It is characterized by demyelinating lesions throughout the central nervous system. Patients suffering from multiple sclerosis constitute a vulnerable population to coronavirus disease-2019. This review focuses on the effects of coronavirus disease-2019 on relapse and symptom exacerbation in multiple sclerosis patients and their treatment. It highlights how the blood-brain barrier may be compromised by severe acute respiratory syndrome coronavirus 2, allowing inflammatory mediators and lymphocytes to infiltrate the central nervous system. This may increase the risk of relapse in multiple sclerosis patients. Also, in patients who did not have a prior history of multiple sclerosis, coronavirus disease-2019 has been found to impact multiple sclerosis onset and pathogenesis. However, more comprehensive research is required to fully understand the interplay between multiple sclerosis and coronavirus disease-2019.
 
Article
The COVID-19 pandemic has changed life as we know it. As a senior medical student in London, I offer my perspective on how the virus has affected my education and the potential impact on the education of future medical students. I cover topics including videoconferencing replacing clinical placements, the disadvantages of online learning and an unprecedent shift to online, open book examinations.
 
Article
Background: Leadership training in medical school continues to grow. Little information exists to guide leadership program development. Concurrently, the COVID-19 pandemic provides a real-world crucible of leadership, allowing insight into qualities and characteristics medical students value. We aim to determine what students value in leadership during a pandemic and the implicit framework students use. Methods: We conducted a cross-sectional, qualitative study using a five-item novel survey instrument developed by a consensus group of experts from family medicine, leadership development, medical education, and survey research to elicit student perceptions of effective and ineffective leadership qualities and examples during the COVID-19 pandemic at the University of Michigan Medical School. We used thematic analysis to identify overarching themes to build a model of leadership integrated with existing theory. Results: 162 students participated across all years of medical school. We identified themes of Communication, Other-Orientation, Personal Characteristics, Decisive Action, and Use of Information. These five themes were then built into the model of Pandemic Leadership within the context of complexity leadership theory and collective leadership theory. This model represents qualities and characteristics students value in good leaders during a crisis. Conclusion: This study is unique in its focus on student perceptions of leadership qualities during a real-world laboratory for leadership. We hope that this information, along with the pandemic leadership model, can serve as the first step toward relevant leadership training programs in medical education. Leadership training programs in medical education would likely benefit from grounding in the student values identified by this study.
 
Article
The ongoing pandemic has changed the way medicine is taught and learned. The unexpected challenges of the spread of SARS-CoV-2 worldwide have forced our educators to rethink in a rather narrow window of time the organization of medical education all around the globe. In many countries, clinical clerkships have been cancelled and medical students’ access to university hospitals has been restricted. Lectures have been replaced by online courses and, in many instances, case presentations have replaced classical rotations in the hospital. Although it is not difficult to understand why these measures were put into practice, one is still left wondering: are clinical clerkships dispensable in the training of a future physician? Also, to what extent has the SARS-CoV-2 pandemic affected the work of residents and young researchers? In the current and previous issue of the International Journal of Medical Students, many of these topics are tackled in the Experience articles that we decided to publish with perspectives from countries including Italy,1,2 China/Zimbawe,3 Spain,4 the United States,5- 10 Mexico,11,12 India,13-18 Pakistan,19 Vietnam,20 Saudi Arabia,21 Canada,22,23 Thailand,24 Ecuador,25 Nigeria,26 Democratic Republic of Congo,27,28 Ireland,29,30 the United Kingdom,31,32 South Africa,33 Jamaica,34 and Greece.35,36 Sir William Osler's quote "he who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all" is the theme of the latest issues of the International Journal of Medical Students. As a rhetorical question has arisen in the minds of all students in medicine worldwide: can we actually learn medicine without direct interaction with real patients? When we were younger and progressing through medical school, we sometimes had the delusion that digesting as much medical information as possible could be comparable to the knowledge which we accumulated during our hospital rotations. We were both right and wrong simultaneously. In certain instances, our individual reading enabled us to better grasp a subject and perhaps to establish a correct diagnosis when faced with a patient. However, much of medicine remains an apprenticeship and the day-to-day practicalities of clinical work cannot be effectively taught or learned through the same modalities. The transition from medical student to resident physician is a rather complicated task. One quickly discovers that taking care of a patient does not only require you to establish a correct diagnosis and an appropriate treatment plan, but also that it involves a great deal of time-consuming paperwork: completing medical charts, spending hours in front of the computer or on the phone to request blood tests, scheduling the patient for imaging or verifying whether the medication you prescribed is available in the hospital pharmacy. With the restriction or cessation of clinical rotations, the outgoing classes of 2021 may feel short-changed on the in-between learning from which their predecessors unwittingly benefited. Just a couple of days ago one of the Editors was asked by a colleague in the internal medicine ward to visit a patient with influenza pneumonia (unsurprisingly, flu-like symptoms in the summer can actually reflect a diagnosis of influenza and not necessarily COVID-19). The patient also has new thrombocytopenia and no signs of bleeding. What was the origin of the hematological finding? Could it be secondary to the viral infection? Could it be immune thrombocytopenia? Or does this sudden decrease of the platelet count hide a more severe diagnosis, i.e. cancer?37-42 It is clear that the actual presentations of patients we see every day are far from the "textbook cases" we were versed on during our undergraduate training. Although the cancellation of clinical clerkships was decided in order to prevent the spread of SARS-CoV-2, as well as to reduce the unnecessary use of limited personal protective equipment, we wonder how our future colleagues will adapt to these changes and what will be the sequelae of these decisions. Medical educators are currently struggling between their duty to protect their students from unnecessary harms and their duty to educate the clinicians of tomorrow; to stay at port or to go to sea. Medical academics will require rapid innovative thinking and continued determination to identify potential solutions to address unavoidable training deficiencies which are likely to arise as a result of these difficult times, since the lack of clinical clerkships will impact the education of medical students in a range of foreseeable and unforeseeable manners. In line with this, we believe that it has never been so important to provide a platform to present the unexpected ways in which the lives and training of medical students, residents, senior physicians, members of academia and researchers worldwide have all been affected by the SARS-CoV-2 pandemic.43 In this issue, we are sharing not only the experiences of colleagues from all over the world, but the results of a survey to identify perceptions of how the current lockdowns have affected students’ learning process,44 important reviews on COVID-19,45 including the potential effects of probiotics in the disease,46 and a case report of a patient with gastrointestinal symptoms as the main manifestation.47 This last article kept us wondering about a public health problem that is yet to come if it is proven that the virus can spread in stools, especially for those regions of the world highly affected by disparities and low- and middle-income countries.48 As always, we are also publishing about general medicine topics. You will find original articles about the effects of schoolbags weigh in children,49 prognostic factors for mortality of rocky mountain spotted fever,50 the association of acute liver failure with heat stroke,51 gene variants in major depressive disorder in patients with childhood trauma,52 novel biomarkers in Alzheimer’s disease,53 and the description of artifacts in electrocardiograms due to neurostimulators. Our missions of spreading science does not end with the publication of an issue.43 Systemic racism continues to prevail in the face of the blinding spotlights which have been drawn upon it in the recent months. In an Experience article in this issue, Pak and colleagues explore the origins of SARS-CoV-2 and draw conclusions of the detrimental consequences intended by the use of xenophobic terms,9 which are banned from the International Journal of Medical Students. In these difficult times where science has been put on test by the general public and especially politicians, we close this Editorial with a call for decisions makers to listen to science. No vaccines should be administered without the proper research.55 We cannot go back before the Nuremberg Code (1947). Even governors and people in power should follow ethical principles when dealing with human lives. The Journal remains a global forum for medical trainees of all nations. As such, we will continue to play a central role in promoting accurate and respectful scientific dialogue, in an effort to combat misinformation and xenophobic rhetoric.
 
Article
First described in Wuhan, China, in December 2019, The World Health Organization declared the novel coronavirus disease (COVID-19) a global pandemic on March 11th, 2020. Canada identified its first positive COVID-19 patient on January 25th, 2020. The Canadian government and heath care system immediately started discussing how best to respond to this pandemic. It was hypothesized that potentially positive and confirmed positive COVID-19 patients would present to emergency departments across the country. It has now been over a year since the first positive patient was identified in Canada, and there has yet to be a narrative review that explores how Canadian emergency departments have responded to the novel COVID-19 virus. This narrative review will discuss measures that were taken thus far, including pre-hospital care, the use and implementation of virtual care, the importance of simulation training, protocols regarding patient screening at presentation to the emergency department, the use of personal protective equipment, and lastly rural emergency department response. This narrative review may be beneficial as the COVID-19 pandemic continues, by providing a concise summary of measures that were taken in various emergency departments across Canada to prevent the spread of the virus.
 
Article
The COVID-19 pandemic has affected the world in an unprecedented manner. South Africans waited anxiously for the disease to enter the country. I recount my experience of the first COVID-19 case and the impact it has had on the academic year.
 
Article
The COVID-19 pandemic has provided unprecedented times for people from all walks of life. For the medical student community it is no different. This global health emergency has presented students with circumstances that have required flexibility and constant adaptation with regard to formal medical education. This short commentary draws on personal experience and aims to elucidate the numerous challenges faced by medical students within the context of a low-middle-income country (LMIC) (Pakistan), whilst also highlighting surprising positives that have emerged from an otherwise overwhelming situation.
 
Article
The COVID-19 pandemic has brought forth unprecedented times. Due to this, medical students of all abilities and competencies can play a meaningful part in patient’s treatment. Throughout medical school, teaching is focussed on the overarching clinical care needed – from medication to surgery. However, there are many other aspects of care required for patient’s recovery, such as personal care. Working as a healthcare assistant brings this to the forefront, particularly in an intensive care unit, during a pandemic. This allowed me to experience a different side of medicine and patient care, something I believe all medical students should see.
 
Article
Ecuador is one of the most affected countries of COVID-19 in Latin American. The government invited physicians to become a volunteer to attend call center and practice telemedicine in order to relief an oversaturated health system. Due lack of availability and digital illiteracy the government implement just standard calls. The difficulties that can be faced are secondary to establishing the severity of a patient only with subjective measures and to achieving effective coordination of telemedicine with public health systems. The role played by the doctor during this crisis is fundamental from the educational, preventive and psychological point of view.
 
Article
This paper highlights the experience of graduating medical students or clinical clerks in the Philippines during the COVID-19 Pandemic. For instance, clinical clerks are supposed to be having their actual face-to-face patient encounters in the hospital setting. It is during clinical clerkship, the final year of a four-year medical degree program, that a medical student applies his or her theoretical knowledge into practice. However, due to the pandemic, changes and adjustments were necessary to ensure continuity of learning despite having little to no contact with actual patients. Hence, in this paper various learning strategies and innovations have been presented to provide examples on how Filipino medical students or clinical clerks tried to cope and adapt with the changes in the mode of learning in the medical field.
 
Article
Background: The lockdown due to the COVID-19 pandemic disrupted normal activities including undergraduate medical education in Nigeria, similar to the rest of the world. Nigeria as a low- and middle-income country had peculiar challenges in adjusting to the new norm. This study aimed to assess Nigerian medical student’s perception of the effect of COVID-19 on their learning. Methods: A semi-structured, pre-tested online questionnaire was administered to consenting medical students from thirty-three medical schools in Nigeria. Questions assessed the effect of COVID-19 on study and wellbeing, as well as the perception of interventions from institutions and student organizations to reduce the lockdown consequence on learning. Data was analyzed using (SPSS) version 25. Results: A total of 623 students from 33 institutions participated. All private institutions and 25% of public institutions had commenced online lectures/tutorials, 92% of students in private institutions and 21% in public institutions had attended online lectures/tutorials. Of those who did not attend institution-organized classes, 30.5% were opposed to online lectures, the main reasons stated being internet cost/availability and inefficiency. About 65% of the participants were aware of student-organized online tutorials/seminars. Eighty percent did not feel motivated to study and perceived their personal study to be less effective. Conclusion: Nigerian medical student’s perception of the effect of COVID-19 on their medical education was largely negative. Private institutions fared better in coping with the challenges of the pandemic. Proper planning will be needed to curb the effect of COVID-19 on students’ health and wellbeing.
 
Medical Students in Front of the Monterrey City Hall (side view).
Medical Students in Front of the Monterrey City Hall (rear view).
Article
During February 2021, a protest was organized by Mexican medical students through social media. About 200 interns, social service physicians and physicians protested peacefully in front of the city hall of Monterrey, Nuevo Leon, the capital of Mexico's second largest metropolitan area. Due to the current contingency situation, it was requested to attend with face shield and masks. The reason for the protest was to raise their voice due to the precarious situation where social service physicians are sent to rural areas of the country in which they have all the obligations of workers but without belonging to the working class - lacking the the benefits of this same as a living wage or fair working hours. The protesters were in limbo between student and worker. The protest also demanded justice for the sensitive death of young doctors due to malpractice situations of the Mexican authorities. We believe that a total reform of the social service in medicine is necessary. It is the responsibility of the authorities to cover the rural areas with permanently trained doctors without depending on recently graduated doctors. It is always important to assert our fundamental rights, including the right to protest in a peaceful manner.
 
Article
Discussion Points. • Experience of a surgical trainee to manage COVID-19 patients along with surgical emergencies. • In spite of managing high-risk seropositive cases during non-COVID-19 times with impunity, there is always a sense of apprehension during operation in this critical time. • E-learning is promoted presently with online seminars and webinars on managing COVID-19 and other non-COVID-19 diseases, which is overall a new experience during this critical time. • Every nation and medical university needs to adequately increase the infrastructure to tackle the similar situation and also train their future generation of health care providers more broadly at least to manage critically ill patients during epidemics, irrespective of subspecialties. • The global community should unite to fight against this invisible enemy of humanity.
 
Article
As current medical students, we are in a unique position. Although we possess some medical knowledge, our hometowns may require a medical diploma to provide clinical aid in the fight against COVID-19. However, upon arrival from my medical school in Ireland to my home state of California, multiple community-based opportunities to assist patients were discovered. While medical students provide community care, we can also observe our surroundings, learn from the current situation, and deduce methods of improving patient care and healthcare systems, with hopes of preventing such repercussions if a similar pandemic were to occur in the future. This experience piece aims to express shifts in a medical student’s perspective amidst COVID-19 and explicate potential ways in which the American healthcare system can improve.
 
Article
Neither students nor teachers were prepared for a sudden shift from traditional classroom learning to e-learning without any extensive planning and faculty training. In countries like India, the vast majority of students are underprivileged to access e-learning facilities. To overcome this, special schemes that provide free data daily to attend online classes may be considered. Medical students are also concerned about acquiring practical clinical skills that cannot be provided through e-learning. The drastic reduction in their patient contact time, time spent in wards learning clinical skills, and bedside teaching may have a negative impact on the confidence of medical students with regard to their future career skills. The indefinite extension of their courses is also a concern, as universities have failed to provide appropriate clarity in their communications. Immediate measures need to be instituted so that the efforts of online education may bear fruit. Medical students are a natural reservoir of volunteers and they offer a vast wealth of potential which can be put to use in times of crisis. To harness this potential, medical students should be prepared adequately. The inclusion of “pandemic/crisis specific” content in the medical curriculum may prove to be helpful in tackling these situations in future. This will also help the students to complete their transition from a ‘student’ to a ‘doctor’.
 
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Online education in the pandemic era is a necessity for some and a substitute for others. Like any other form of communication, online education too has its fair share of constraints. Though, it has tried to address the lag of access during the time of pandemic but its universal access is still a matter of deep concern. As the pandemic progresses, so will our dependence on online education which needs to be tailored for students, educators and institutions.
 
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I recount my experience as an intern in the Democratic Republic of Congo during the COVID-19 pandemic. I received a patient who was presumed to have COVID and was isolated. The first test result was a false positive, so I was discharged. Although I was not infected by COVID-19, I was adversely affected by it. The anxiety of waiting for test results and isolation are both mentally challenging. Also, COVID-related stigmatization is a serious complication of the disease. Targeted psychological interventions should prevent all three.
 
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Many students around the world have been wondering how their life will change since the very first outbreak of Covid-19. In my experience article I have tried to give a flavor of how has the academic world changed in quarantine. Difficulties and opportunities have been analyzed. Questions regarding the validity of e-learning have been posed. In an arduous period as the one we are experiencing, having an idea of what life could be in worst case scenario could be helpful.
 
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Background: Access to COVID-19 vaccines was one of the global measures for containing the COVID-19 pandemic. However, it is still not known whether Filipinos accept it. Methods: Cross-sectional study based on a modified version of the community COVID-19 vaccine acceptance survey, disseminated and collected through Google Forms to Filipinos within the Philippines aged 18-65 years old. Multinomial logistic regression analysis was performed to determine the association between the willingness to be vaccinated and sociodemographic characteristics using odds ratios (OR) with 95% confidence intervals (95%CI). Results: Among the 1,011 participants, 79.5% were willing to accept the COVID-19 vaccine. Significant determinants (p<0.05) were age, region of residence, sex, profession, income, religion, practice of alternative medicine, and previous contact with COVID-19 positive individuals. Essential healthcare workers (OR=11.0, 95%CI=1.3-93.5), practiced alternative medicine (OR=2.4, 95%CI=1.3-4.4), with previous contact with a COVID-19 positive person (OR=2.9, 95%CI=1.4-6.0), and females>males (OR=0.6, 95%CI=.3-1.0) were also more likely to accept COVID-19 vaccination. 63.7% preferred Pfizer the most, and 54.4% preferred Sinovac the least. In contrast, married individuals, essential non-healthcare workers and private/self-employed sectors were less likely to accept COVID-19 vaccines. Many individuals who refused to be vaccinated were unsure of its safety (59.70%) and had no trust in vaccines (56.50%). Conclusion: Despite a high prevalence of acceptance of the COVID-19 vaccine in our study, there were significant sociodemographic disproportions in vaccine acceptance. Better policies urging Filipinos to get vaccinated and more effective dissemination of unified information regarding vaccines from verified sources are recommended to boost vaccine confidence in the Philippines.
 
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Background: Online classes have resumed in many colleges amidst the COVID-19 lockdown. Our study aimed to evaluate the opinions of medical teachers who conducted online classes and determine their views on the viability of these classes in a post-COVID-19 era. Methods: We carried out a cross-sectional study using an online survey. Teachers working in medical colleges who conducted online classes during the COVID-19 lockdown were included. Questionnaires were shared in WhatsApp groups of the medical teachers belonging to the states of Kerala and Tamil Nadu, India. Sampling was consecutive and convenient. Results: Respondents were 101 teachers, among which 89 were included in the analysis. The majority of the teachers gave classes after intense preparation. The participants felt that the quality of their work would have been better with enhanced Information Technology (IT) infrastructure. One of the major reasons for favoring online classes was the opportunity it gave them to access the content later (56.2%, n=50). More than half (63%, n=56) of the teachers faced network issues and felt discouraged by the lack of interaction. Thirty-six percent (n=32) of the teachers opined that online classes were very poor compared with regular classes. However, 49.4% (n=44) favored the continuation of online classes after the COVID-19 lockdown. Conclusion: Despite experiencing problems, most participants wanted to continue online classes in the future. The participants felt that the classes were less interactive and educational institutions should improve their IT infrastructure to address the increasing need for online education.
 
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Francisco Javier Bonilla Escobar
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