To date (17 November 2021), there has been more than 254 million confirmed cases of COVID‐19, and more than 5 million death globally (World Health Organization. https://covid19.who.int/). The virus ...causing COVID‐19 is called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2). SARS‐CoV‐2 infects host cells by the binding of its spike protein to the cellular surface protein angiotensin‐converting enzyme 2 (ACE2). The predicted 29 amino acid residues of ACE2 that interact with SARS‐CoV‐2 spike protein receptor binding domain (RBD) vary between human ACE2 and mouse or rat ACE2. Therefore, wildtype mice and rats show lower SARS‐CoV‐2 infection rate and mild symptoms compared to what is seen in humans. Small animal models that recapitulate human COVID‐19 disease are urgently needed for better understanding the transmission and therapeutic measurement. Currently, scientists use either mouse‐adapted SAS‐CoV‐2 (SAS‐CoV‐2 MA) models or random transgenic mouse models that artificially express human ACE2 under the control of cytokeratin 18 promoter or a constitutive promoter. SAS‐CoV‐2 MA may not completely reflect all aspects of the original human‐tropic SAS‐CoV‐2 and the current transgenic human ACE2 mouse models typically have high mortality rate caused by neuroinvasion and encephalitis due to very high human ACE2 expression. To overcome these limitations, we have developed humanized ACE2 mouse and rat models using CRISPR‐Cas9. Specifically, we inserted a ~3kb human ACE2 cDNA cassette into the mouse and rat Ace2 gene loci to ensure that human ACE2 expression is under the control of rodent Ace2 promoter and regulatory elements, while simultaneously disabling the rodent Ace2 gene. To accomplish this, CRISPR gRNAs targeting close to the translation initiation site of Ace2 were screened in cultured mouse and rat cells. Then CRISPR/Cas9 complex and donor DNA were subsequently microinjected into one‐cell stage embryos which were subsequently implanted into pseudo pregnant females. Resulting pups were screened for correct knockin by junction PCR and insert PCR, and the PCR products were Sanger sequenced. Targeted Locus Amplification (TLA) further confirmed the integration sites and transgene sequence. RT‐qPCR and Western blot analysis data showed that, in our models, human ACE2 is expressed in tissues expressing endogenous Ace2 (such as lung, kidney, and GI tract), while rodent endogenous Ace2 is absent from these tissues. Further breeding data indicated that both hemizygous and homozygous humanized ACE2 animals appear to be normal and fertile. Most importantly, animals displayed symptoms after infection with SARS‐CoV‐2. In summary, these data suggest that our humanized ACE2 models can be valuable for COVID‐19 research.
Introduction
The traditional method of teaching anatomy has been through live in person lectures and dissection labs as well as textbooks and other course materials. However, during the COVID‐19 ...pandemic, these resources were no longer available due to health and safety protocols. With the advancement of technology, it was possible to create anatomy walkthrough videos for the students to supplement the traditional methods of teaching anatomy.
Goal
To investigate the effectiveness of a video based guide to learning gross anatomy of the boney pelvis and the viscera.
Methods
Two videos were created covering the boney pelvis and the viscera for the first and second year medical students. The videos were presented by an anatomy professor and filmed and edited by Medical Students. The video covers the curriculum outline, labels relevant parts of the anatomy, and provides extra information relating to form and function. The videos included a quiz at the end for students to test their knowledge. The videos were made available online on Youtube to an international audience, along with a feedback survey.
Results
Feedback was collected on the boney pelvis and the viscera videos. The respondents watched the videos for the purpose of preparing for anatomy labs and dissections, preparing for anatomy lectures and preparing for examinations. The majority of respondents agreed or strongly agreed that the videos presented assisted them in fulfilling their indicated purpose (89.1%), that a combination of video and written materials should be used for effective learning of anatomy (95.7%), and that they would like to see videos for other anatomical regions (95.7%).
Conclusion
In summary, digital media in the form of video‐based anatomy guides may be useful in instances when in person teaching is not possible and may be a useful tool to be incorporated into the educational curriculum in combination with traditional teaching methods. Future goals include implementing student feedback and reaching a broader audience.
INTRODUCTION
Schools of higher education across the US closed all operations and in‐person classes during the COVID ‐19 pandemic, significantly affecting laboratory‐based anatomy dissection courses ...and the anatomical gift programs (AGP) that support them. The purpose of this study was to investigate how the COVID‐19 pandemic affected AGP operations in the US. The researchers hypothesized that programs would modify donation acceptance criteria and that anatomy education demands for donors would be reduced during the first year of the pandemic.
METHODS/ RESULTS
The researchers sent a Qualtrics survey to 135 AGP directors with a response rate of 28% (n=38). Respondents were from 26 states and included 28 AGPs operating for 25 years or longer and ten programs operational for 15 years or less. Six AGP’s (16%) stopped accepting donors for varying lengths of time secondary to the COVID‐19 pandemic during its first year, while 32 programs (84%) continued operations. Of the programs that remained operational, 81% (n=26) made modifications to donor acceptance policies, while 19% (n=6) maintained existing acceptance policies. Schools that made policy modifications for donor acceptance criteria reported changes, including heightened screening for symptoms of COVID‐19 at the time of donor registration and upon death and requiring a negative COVID test for the anatomical donor near the time of death. In addition, COVID‐19 infection was added to the existing list of disqualifying conditions for many programs. Some sites excluded donors from large group facilities (hospitals, long‐term care), and some declined any donors with respiratory infections at the time of death. Several programs (13%) stopped accepting those donors who were not registered with their AGP prior to the onset of the COVID pandemic.
During COVID‐19, the demand for donors in anatomy education decreased significantly (p<0.05). Reasons for the reduced donor demand as reported by respondents included school closings and adjusted (smaller, shorter in time) laboratory sessions. These actions were taken because of concern for student/staff safety, reduced availability of appropriate personal protective equipment, and safety‐related student/faculty spacing needs.
CONCLUSION
Most AGPs were operational during COVID‐19 and able to maintain donor needs for anatomy education. Further research is warranted into the long‐term effects on AGPs as the pandemic persists.
The COVID‐19 pandemic has had a detrimental impact on healthcare education. With restricted access to traditional teaching aids such as the cadaver, educators had to adapt their teaching practise to ...minimise disruptions to students’ educational process. However, cadaveric dissection is highly regarded as a key component of anatomical and surgical education. This was particularly challenging when teaching was purely online due to pandemic restrictions. To accommodate the shift to online delivery only, the Anatomy Department at Brighton and Sussex Medical School (BSMS) adopted a variety of synchronous and asynchronous teaching methods. As part of this strategy, the department extended its provision of anatomy teaching by live streaming cadaver dissections to first year medical students (n=220). BSMS was the first UK medical school to use this innovative digital tool. A Virtual Reality in Medicine and Surgery (VRiMS) course was also developed to provide training to surgeons worldwide. This work explores the place of cadaver‐based education in a true blended learning provision.
Cadaver dissections were live streamed from the dissection room using operating theatre lights and a 4K camera via Microsoft Teams. These sessions were also interactive in nature, allowing students to ask questions throughout the dissection. Student feedback was collected through module and end of year evaluations. The VRiMS course provided a platform to demonstrate surgical procedures on cadavers using live streaming with virtual reality or 360 cameras. Surgeons were able to choose multiple camera angle perspectives through virtual reality headsets. Course participation data was used to determine the useability of this novel method of teaching and training.
Module evaluation showed that the overall quality of delivery for anatomy practical sessions was rated as good and very good by 86% of the cohort. Moreover, 93% of students found the material to be just right. In the end of year evaluation, students have indicated that live streamed dissection sessions were one of their favourite aspects and has had a positive impact on their time at BSMS. In total, 1354 participants from around the world have watched 923 hours of live broadcasted content across four VRiMS courses to date. The course has seen a 52% increase in participation rate since its launch.
The evaluation findings suggest that a hybrid learning approach with the use of live streaming for anatomical education has had a positive outcome on student satisfaction. Furthermore, VRiMS course participation data indicates that virtual reality has a promising future in surgical training. Live streaming and virtual reality have proved successful in bringing the dissection room to medical students and surgical trainees during unprecedented circumstances. This approach has the potential to prevent the complete loss of interactive cadaver‐based education and a probable solution to cadaver scarcity.
Purpose
First‐year medical students (M1s) at the Icahn School of Medicine at Mount Sinai begin their year with Structures course, which opens their medical education, covering gross anatomy, ...embryology, and histology. Second‐year medical students (M2s) serve as teaching assistants (TAs) for this course and their responsibilities include leading comprehensive review sessions prior to each set of exams. Historically, such reviews have taken place in small‐group classrooms, with groups of 10‐18 M1s rotating through a series of rooms, each hosting a rapid‐fire review of a specific topic, conducted by several TAs. In 2020, the virtual setting imposed by COVID‐19 restrictions demanded creativity to rethink the format of these review sessions, leading to the implementation of a large‐group, interactive format, with all M1s in the same remote video session, covering material at a slower pace. We here examine the effectiveness of this large‐group, interactive format. Methods: The first two review sessions of Structures 2020 mimicked the traditional style, with groups of M1s rotating through a series of 20‐minute Zoom sessions led by M2s TAs. For the last two review sessions, all students remained in one 3‐hour Zoom session, and TAs covered certain material at certain times, with more or less time allotted depending on the difficulty and amount of material. TAs also incorporated more interactivity with real time quizzes on high‐yield topics and direct practical questions through the review. We surveyed M1s regarding which format they preferred and also solicited qualitative feedback from M1s and TAs throughout Structures. Results: 55% of M1s preferred the large‐group format, with 23% preferring the traditional format and 23% expressing no preference. Many TAs also expressed preferences for the large‐group format. Qualitative feedback from M1s indicated that they appreciated the interactivity with quizzes and practical questions. Conclusion: In the remote environment, most students preferred a large‐group, interactive format over the small‐group rotation format. Main advantages observed were: 1) time flexibility: complex components of the session addressing challenging topics were covered more extensively and in‐depth; 2) In the large group, all M1s experience the session equally, including the answers to all questions from their classmates. Such interactivity is not compatible with the small group format and can be challenging in its compressed timeframe. 3) optimization of M2 TAs workforce: in the large session TAs are assigned with a section of the review and lead the review of their only once, for a short period of time, while in the small group format, TAs are required to repeat the review of their topic multiple times. The effectiveness of this format may have implications once in‐person instruction resumes; for example, review sessions could be conducted in a lecture hall, in an in‐person setting, or virtually, in a hybrid learning system, to facilitate the advantages of the large‐group interactive format.
Introduction
The best way to teach human gross anatomy to medical students has often been debated, although recent studies emphasize on the benefits of dissection‐based courses (DOI ...10.1002/ase.1859). Prosection and model‐based courses, online and virtual reality approaches have been introduced over time, due to reduction in teaching time, and due to economic reasons with decreasing budget. In 2020, we were challenged by the pandemic of SARS‐CoV‐2 and corresponding COVID‐19 public health measures. We had to change and adapt several times anatomy teaching and learning over the two semesters for the cohort of 112 first/second year undergraduate medical students. With the experience of this student cohort with various anatomy learning approaches, we wanted to know what anatomy teaching method was best perceived by the students.
Methods
112 medical students were asked about their learning experience with various anatomy teaching approaches for 2020, including 1) dissection‐based learning, 2) prosections and models‐based demonstrations, 3) structured self‐directed learning using written instructions and corresponding anatomical material, 4) structured self‐directed learning using online instructions via Moodle and an online anatomy program (https://e‐learn.anatomy.uzh.ch/Anatomy/Anatomy.html; German version). All students agreed to participate in the study. The questionnaire was administered by https://www.surveymonkey.com and done anonymously. To date 66/112 (59%) students replied.
Results
The majority of the students (92%) preferred the dissection course as their main anatomy learning method, 80% of students were happy with a demonstration course using prosections and anatomical models. Only a minority liked to have structured self‐directed learning with either anatomical specimens and models (42%) or with online material (36%). Rather few students preferred learning with an online course (18%) or through unstructured self‐directed learning using their own resources (12%). For the dissection course the students appreciated the 3 dimensional aspect (92%), the real size appearance of the structures (90%), the active explorative approach (81%), the topographical relationship of the structures (81%) and anatomical variability (72%). During complete lock‐down of the COVID‐19 measures when the students had to stay isolated at home for several weeks, the majority of students thought that the offered online structured self‐directed course was most adequate under those circumstances (55%), but would otherwise not be the preferred replacement of a dissection course (55%).
Conclusion
Evaluation of student experience with a variety of anatomy learning methods clearly indicate that a structured dissection‐based course with additional anatomical demonstration would be preferred by the majority of our students. Online material would be beneficial as additional learning support. However, the majority of students agreed that, under strict COVID‐19 stay‐at‐home measures, the structured self‐directed online course was the best way to learn anatomy. When going back to normal, we will offer the newly developed online material for guided self‐directed learning, in addition to the established dissection course.
The global pandemic of coronavirus disease has significantly impacted medical education, including removing trainees from clinical environments, transitioning didactic sessions to virtual platforms, ...and necessitating creative solutions to provide interactive learning opportunities in a virtual, socially distant setting. Human gross anatomy education, with its emphasis on hands‐on, team‐based, active learning by body donor dissection, has been particularly impacted by these transitions. Dissection is considered the best practice for learning gross anatomy and has been shown to enhance learning over non‐dissection‐based methods.
At the Medical College of Wisconsin, team‐based, body donor dissections are the basis for the Clinical Human Anatomy course. However, the pandemic necessitated changes to the format of laboratory activities. For the 2020‐2021 academic year, students either completed anatomy labs in‐person in a socially distant environment or virtually. This provided an opportunity to directly compare the effect of different laboratory instructional modalities on student performance within a single course.
All first‐year medical students were enrolled in the same Clinical Human Anatomy course, attended identical didactic sessions, and were assessed by identical examinations that included lecture‐based questions as well as laboratory image‐based questions. As the semester progressed and coronavirus disease case numbers rose, students were offered two options for completing laboratory instruction: (1) continue dissections in socially distant pairs or (2) transition to a virtual lab format. The virtual lab format included a self‐directed module which guided students through the dissections they would have done in person. Each module consisted of a PowerPoint presentation that incorporated interactive software (3D4Medical Complete Anatomy) and dissection images. The self‐directed modules were followed by interactive Zoom sessions, wherein faculty reviewed a prosection and posed clinically relevant questions to the meeting attendees. Students who opted for the virtual lab format were able to review dissections in‐person on their own time or with a tutor. Likewise, students who opted to continue dissection had access to the virtual modules and recordings of the Zoom sessions.
Comparison between students completing labs virtually or in‐person showed no difference in aggregate performance on examinations. This study examined medical knowledge and did not investigate other competencies impacted by lab activities (teamwork, dealing with death, and the “first patient” experience). We consider hands‐on dissection to be the gold‐standard format for learning gross anatomy, but this study showed by direct comparison in a single course, that multiple laboratory formats can yield equivalent understanding of the complex structure of the body.
Human anatomy is complex and best understood through hands‐on dissection in the laboratory. Faced with the daunting task of adapting to the constraints brought on by the pandemic, a team of current ...and past course directors, while under extreme and fluid circumstances, designed systems to allow for a dissection based, in‐person curriculum for large student groups (220 medical and 105 dental) while maintaining a safe environment. Through immeasurable hours of deliberations, numerous unique and novel changes were instituted. Tank teams of students (6 medical & 4 dental) were assigned to rotating pairs of dissection or review teams. A complex plan of staggered student entry into and exit from the laboratory, provided for distancing. 3D printed face shields, designed and assembled in house, were provided to faculty; additional face shields were provided to students. An intricate rotating peer‐teaching component was incorporated to hand off the dissection between groups and to allow for study of anatomical variations. In‐person lectures were converted to virtual platforms using both synchronous and asynchronous formats. Medical tank teams met virtually to review and report on their dissection. A strict protocol was designed for in‐person self‐study. Students have embraced these designs and safety protocols and continue to perform extremely well. Student success, as measured by exam performance, is comparable to previous years. While several students required absences out of an abundance of caution, none of the students tested positive due to contact during the actual lab time. Three students reported testing positive for COVID‐19 following the Thanksgiving break. This time‐intensive endeavor required creativity, commitment, and leadership, and has had several novel benefits to include improved student to faculty ratio, more time for self‐study, and the additional responsibility and accountability for tank‐mates to act as both learners and teachers.
COVID‐19 Causing Burnout Among Medical Students Jezzini‐Martinez, Sofía; Quiroga‐Garza, Alejandro; Jacobo‐Baca, Guillermo ...
The FASEB journal,
20/May , Letnik:
35, Številka:
S1
Journal Article
Recenzirano
Odprti dostop
Introduction
Emotional exhaustion, excessive depersonalization, and reduced personal achievement define the burnout syndrome. The academic workload on students can cause exhaustion, similar to that ...of a worker. The Maslach Burnout Inventory‐ Student Survey (MBI‐SS) was designed to reflect student burnout by evaluation of emotional exhaustion, cynicism, and academic efficacy. It has been reported that at least half of the students will suffer burnout at some point in their medical studies. Burnout evaluation has been focused on physicians or those working in hospitals attending coronavirus patients. The psychological burden and pressures on students due to the closure of facilities and schools around the world has not been thoroughly evaluated. The objective was to evaluate the prevalence of burnout in medical students during the COVID‐19 pandemic.
Materials and Methods
A cross‐sectional, prospective, and descriptive study was performed. The MBI‐SS was applied during the spring semester to all anatomy students of one of the largest medical schools in Mexico. The study was previously reviewed and approved by the Ethics and Research Committees to be answered anonymously and voluntarily. Results were classified as low, moderate, or high in emotional exhaustion, cynicism, and academic effectiveness.
Results
A total of 154 students participated in the survey, with a mean age of 18.9 years, 60.4% (n = 93) were women. Based on the MBI‐SS definition, 14.9% (n = 23) were identified with symptoms of burnout. There was also a high prevalence of emotional exhaustion (53.9% n = 83), cynicism (16.9% n = 26), and low academic effectiveness (34.4% n = 53). Men were statistically more prevalent towards lower academic effectiveness (p = 0.037) and increased cynicism (p = 0.003), as well as a higher incidence of burnout (26.6% vs 7.5%, p = 0.001).
Conclusions
Burnout prevalence among medical students has been reported as high as 46% during the pandemic, however different types of surveys have been used. A previous study using the same survey reported a prevalence of 5.2% for moderate burnout syndrome, in a similar population which could indicate the COVID‐19 pandemic as an influencing factor. Universities need to consider the psychological effects of the pandemic on students, and provide guidance of support alternatives to improve mental health, due to the impact this syndrome may cause on the quality of life.
Hypothesis
Incorporating 3D Anatomy Platforms with prosected cadavers improves understanding of gastrointestinal and genitourinary anatomy and pathology compared to only using only prosected ...cadavers.
Introduction
When considering anatomy in medical school, one challenge facing medical education is integrating preclinical anatomy knowledge with the procedural experiences and pathology encounters of clerkship years.1,2 COVID‐19 has further exacerbated this challenge by forcing medical school institutions to maintain social‐distancing through reshaping their approach to teaching anatomy. The most notable changes include limiting on‐site anatomy laboratory experiences and increasing virtual didactic anatomy sessions. By integrating a virtual 3D anatomy platform into a prosection driven lab curriculum, the possible quality impacts to anatomy medical education may be lessened and even improved.3‐9
Materials and Methods
First‐year medical students at HWCOM (CO 2024) participated. Groups of 4‐10 students rotated through six 20‐minute stations. Two of the six 20‐minute stations were facilitated by a fourth year medical teaching assistant (TA). In each station led by the TA, the TA utilized a didactic teaching model to teach select gastrointestinal and genitourinary anatomy and pathology topics using a prosected cadaver and prosected 3D virtual anatomy models on the Complete Anatomy application. The first ten to fifteen minutes of teaching involved using the prosected cadaver and the final five to ten minutes involved the 3D virtual prosected models. The 3D virtual prosected models were used to further explain anatomical features or pathologies identified on the cadaver. Prior to or after the station was completed, students rotated at the four 20‐minute self‐learning stations that contained plastinated models, plastic models, or wet organ specimens of gastrointestinal anatomy. At these stations, students completed a worksheet based on the lab objectives for gastrointestinal and genitourinary anatomy. A five‐question end‐of‐course survey (5‐point Likert Scale) will be administered to all first‐year medical students who participated in the wet lab session.
Results
We expect the results of our end‐of‐course survey to support our hypothesis that the integrated didactic anatomy teaching model would improve first year medical students’ understanding of the course material. Additionally, we expect the students to recommend incorporating the Complete Anatomy app with the prosected models for the first‐year anatomy lab curriculum. Final data analysis of the variables will be completed after obtaining IRB exemption.
Conclusion and Significance/Implication
Despite the limitations to human anatomy medical education due to the COVID pandemic, we believe this novel integrated virtual 3D and cadaver prosection approach to the traditional anatomy curriculum will not only lessen the impacts to quality but also improve the baseline quality of anatomy medical education, become a permanent inclusion within our institution's curriculum, and serve as a model for novel approaches to first‐year anatomy curriculum.
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