Sussex Medical School Research Articles

Creating a virtual and sustainable global health elective at Brighton and Sussex Medical School (BSMS)

Creating a virtual and sustainable global health elective at Brighton and Sussex Medical School (BSMS)

Qualitative protocol to support detection of the early presentation and diagnosis of mycetoma in Sudan

The neglected tropical disease (NTD) mycetoma is a chronic and progressively destructive infectious disease endemic in Sudan. There is a growing body of scientific research on mycetoma -causes, transmission, treatment, and impact from a clinical and biomedical perspective. However, there is further need for in-depth medical anthropology research on the disease to successfully translate biomedical advances into elimination and control programmes. Given this background the NIHR Global Health Research Unit on NTDs at Brighton and Sussex Medical School is leading multidisciplinary research on skin NTDs, including mycetoma, with a medical anthropology research component exploring how community engagement can lead to earlier presentation of mycetoma in Sudan. This protocol paper sets out the research aims and methods to generate new knowledge on mycetoma in Sudan once the political situation becomes stable and it is safe to carry out global health research once again. We continue to develop appropriate community engagement intervention strategies, while activities like training and capacity strengthening get underway remotely. In what follows we situate this study in the NIHR Research Unit on NTDs and alongside social science research on mycetoma. This study is part of the programme of research conducted by the NIHR Research Unit on NTDs at Brighton and Sussex Medical School (BSMS). Phase I of the Unit was conducted from 2018–2021. Below we detail key findings from Phase I that have informed our more recent work in Phase II (2021)(2022)(2023)(2024)(2025)(2026). It also sits alongside the Social Sciences for Severe Stigmatising Skin Conditions (5-S) Foundation also at BSMS (‘NIHR 5S Foundation -BSMS’ n.d., 5). The 5-S foundation examines the cultural, social, economic, and policy contexts of podoconiosis, mycetoma, and scabies in relation to the dynamics and dimensions of stigma. This study differs from the aims of the 5S Foundation in that it specifically focuses on the role community engagement can have in the early presentation and diagnosis of mycetoma in Sudan.

"My Dead Body": Development, production, and reception of a documentary that publicly displays the dissection of a human donor.

Recently, there has been an emphasis on keeping the study of anatomy using donor material confined to the domain of medical and allied healthcare professionals. Given the abundance of both accurate and inaccurate information online, coupled with a heightened focus on health following the COVID-19 pandemic, one may question whether it is time to review who can access learning anatomy using donors. In 2019, Brighton and Sussex Medical School (BSMS) obtained a Human Tissue Authority Public Display license with the aim of broadening the reach of who could be taught using donor material. In 2020, BSMS received its first full-body donor with consent for public display. Twelve workshops were delivered to student groups who do not normally have the opportunity to learn in the anatomy laboratory. Survey responses (10.9% response rate) highlighted that despite being anxious about seeing inside a deceased body, 95% felt more informed about the body. A documentary "My Dead Body" was filmed, focusing on the rare cancer of the donor Toni Crews. Viewing figures of 1.5 million, and a considerable number of social media comments highlighted the public's interest in the documentary. Thematic analysis of digital and social media content highlighted admiration and gratitude for Toni, the value of education, and that while the documentary was uncomfortable to watch, it had value in reminding viewers of life, their bodies, and their purpose. Fully consented public display can create opportunities to promote health-conscious life choices and improve understanding of the human body.

1706 Introducing geriatrics to medical students through film

Abstract Introduction There is an urgent need to increase the workforce of geriatricians. Geriatrics is not a popular specialty amongst medical students due to limited education and training opportunities in this discipline. Nurturing positive attitudes towards ageing, and early engagement with older people and their social networks could address this challenge. Film can be creatively employed to introduce the lived experience of older generations to medical students. Methods An 8-weeks film-based educational intervention, a student-selected module (SSM) was offered by a clinical-academic geriatrician to 11 first year medical students at Brighton and Sussex Medical School to enable them: to appreciate the diversity of older people, to understand the bio-psycho-social model of ageing, to develop skills in history taking, and present a focused narrative learning from film aesthetics, and to learn how to analyse a life narrative in a non-judgemental, compassionate, and empathic manner. Over 6 weeks, students watched and discussed a selection of short films, and a feature ‘Radiator’ with its director Tom Browne, all films depicted ‘old age’. During the last 2 weeks, students delivered a short presentation on a film they choose and gave feedback on the module. Results In their presentations, students discussed short, feature, and animated films portraying successful ageing, institutionalisation, dementia, and terminal illness. Examples included ‘Ikiru’ (Japan, Akira Kurosawa, 1952), ‘Drving Miss Daisy’ (Bruce Beresford, USA, 1989), ‘Howl’s Moving Castle’ (Hayao Miyazaki, Japan, 2004), ‘Amour’ (Michael Haneke, France, 2012), ‘Echoes’ (Ben Bradbury, UK, 2018), and ‘The Father’ (Florian Zeller, UK, 2020). Students demonstrated insight into the heterogeneity of senior citizens, and the burden experienced by carers of dependent adults. The module, as a platform for interactive learning, was positively perceived by students. Conclusions Conversations with medical students around films portraying ‘old age’ could enhance the possibilities of them choosing ‘Geriatrics’ as a future career.

940 The Metaverse as a Potential Solution for the Delivery of Global Health Education

Abstract Aim We describe a novel approach to the delivery of global health education (GHE) via the utilisation of the Metaverse. In 2015, the Lancet Commission on Global Surgery identified that the global burden of disease amenable to surgical intervention is substantial and growing. Virtual Reality in Medicine and Surgery (VRiMS) is an academic working group based at Brighton and Sussex Medical School (BSMS) devoted to creating technology-based solutions in surgical and medical training and education. Method 10 East African surgeons were selected to attend a 5-day cadaveric dissection course in-person in Brighton, on fully funded scholarships. A parallel conference was also run in Kampala, Uganda and >1000 delegates attended remotely from 61 different countries. A proof of concept of the metaverse was created using the software Spatial. Delegates from the in-person course in Brighton and Kampala used Oculus and PICO headsets in order to access and interact within the metaverse build. Both a quantitative and qualitative approach was implemented for data collection utilising a survey as well semi-structured interviews. Results Feedback was positive and highlighted the interactivity of the platform, the multiple types of content which could be accessed and the level of immersion it provided. The majority of delegates felt that the metaverse could be beneficial in the delivery of medical and surgical education globally. Conclusions The Metaverse could be a novel approach in tackling issues in global health and global surgery and extensive future work related to its validity as an educational resource could be beneficial to trainees worldwide.

917 Building Virtual Reality Into Global Surgical Training: An Innovative Approach Applied in Uganda

Abstract Aim Virtual Reality in Medicine and Surgery (VRiMS) is an academic working group devoted to creating technology-based solutions in post-graduate surgical and medical education. Based at Brighton and Sussex Medical School (BSMS) with funding from Health Education England they use ‘Extended Reality’ including fully immersive Virtual Reality (VR), Augmented Reality (AR) which overlays digital information onto real-time visualisation, and 360-degree video which offers a partially immersive experience. Benefits include reduced costs of delivering education, improving trainees’ experiences, and improving accessibility to surgical opportunities. Method VRiMS utilizes 360-degree video of cadaveric teaching streamed via low-tech cardboard headsets to deliver a novel teaching modality in Low- and Middle-Income Countries (LMICs). Uganda was the first location of a proof-of-concept course over 4 days delivered in 3 modalities: in-person - 10 delegates from East Africa provided scholarships (funded by Saving Faces) to travel to Brighton; 79 delegates attending virtually at a conference centre in Kampala; and over 1000 delegates globally attending remotely from a diversity of nations. Qualitative data was gathered for thematic analysis. Results Feedback was very positive, and barriers identified included requirements of a smart phone and sufficient internet. Ongoing links were developed with other LMIC units, with a recent conference run in Kenya. Conclusions VRiMS aims to ensure scientific validity in the projects being run, and analysis of the courses have given actionable insights into the experiences of surgical trainees both in the UK and in LMICs, showing that Extended Reality has enormous potential to benefit trainees worldwide.

The Royal College of Surgeons of England Damage Control Orthopaedic Trauma Skills course (DCOTS): resuscitative knowledge and confidence in surgical skills are reliably maintained at six months post course.

Since 2012, the Damage Control Orthopaedic Trauma Skills course (DCOTS) has trained more than 250 surgeons in the principles and practice of damage control orthopaedics and early appropriate care. This Royal College of Surgeons of England (RCS England) course takes place at the RCS England Partner cadaver laboratory at Brighton and Sussex Medical School. Trauma is a leading cause of morbidity and mortality in the UK, and the course has tried to pass on the lessons of war and conflict from its military faculty and hard-won lessons of "developed world" trauma from its experienced civilian faculty. Participating surgeons were invited to score their self-reported confidence before attending the DCOTS course, immediately afterwards and again 6 months later. A modified four-point Likert scale was used, with responses from 1 = No Confidence to 4 = Very Confident. Damage control resuscitation principles with damage control surgery showed the greatest retained increase at 6 months - 100% - which is extremely satisfying. Self-reported confidence in pelvic external fixation was initially 93% dropping to 85%, which is also considered good to excellent. For pelvic packing, confidence was 90% at the end of the course, up from 19% precourse. This dropped to 62%, which was still considered good but low for the high standards of the course. This may relate to UK trainees' lack of familiarity with the concept. Three of the main skills taught on the DCOTS are effectively retained at 6 months post course.

A trigger-substrate model of student engagement with learning

BACKGROUND: There is much controversy and disagreement about engagement with learning, in its definition, its causes and its effects. The recent APS book on “Technologies in Biomedical and Life Sciences Education” outlines these controversies. AIM: To develop upon previously proposed engagement models by using trigger and substrate interactions between contributory factors in order to explain how causative factors may have minimal or no effects on learning when required coincident factors are absent. METHOD: Trigger-substrate steps include a longer-lasting, undergirding substrate factor as well as a short-lived trigger factor, which together act as the cause for the outcome. RESULTS: The model that we propose has engagement, effort and use of resources resulting from the triggers of teaching and providing resources, with a substrate of internalized motivation and a sense of belonging. Continuing forward, engagement, effort and use of resources is a trigger for learning and other benefits, and these results require a substrate of strategies and preparedness in the student. Learning can lead to both positive and negative feedback effects via assessment, feedback (from instructors and the institution), and emotions, which can act via metacognition, incentives and social reinforcement, and achievement, identification (of the student with the learning and outcomes), and the educational climate. CONCLUSIONS: Trigger-substrate causality may help to clarify the inconsistencies seen in education results between traditional theories based on teaching and more recent theories that have focused on the learner. The research has been funded by Brighton and Sussex Medical School This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Combatting climate change using education and training in pharmacology and therapeutics.

The climate crisis has implications for the physical and mental health of people worldwide, while, paradoxically, healthcare itself contributes significant greenhouse gas emissions. Healthcare professionals need to be prepared to both mitigate the impacts of climate change and also manage the health effects of the climate crisis. Widespread adoption of sustainable healthcare models is required, with sustainability-driven improvements in clinical pharmacology intrinsically linked to this. Recognizing that education and training are essential steps to equip medical professionals with the knowledge to face the unprecedented challenges that the climate crisis presents, here, with reference to pharmacology and therapeutics, we discuss how the theme of Education for Sustainable Healthcare (ESH) can be integrated into undergraduate and postgraduate teaching programmes and how barriers to successful implementation can be tackled. We support the use of the Principles of Sustainable Clinical Practice as a framework to guide educational interventions and draw upon examples of our own practice at Brighton and Sussex Medical School where ESH has become a core component of medical education in our undergraduate curriculum.

Teaching primary care theory to promote general practice among medical students

Here we describe and reflect upon teaching primary care theory within a fourth-year longitudinal module in general practice at Brighton and Sussex Medical School (2012 to 2021). Primary care theory teaching adopts a ‘hearts and minds’ approach towards promoting general practice. It appeals to students’ ‘hearts’ by highlighting the social justice function of general practice: tackling health inequalities by ensuring patients are treated in the right place, reducing cost and widening access to healthcare. These benefits also point to the place of general practice in promoting environmentally sustainable healthcare. By presenting evidence for the role of general practice in tackling health inequalities, we believe that our teaching also appeals to students' ‘minds’. Both approaches are important in order to counter the ‘hidden curriculum’ in undergraduate medicine which conveys negative messages about general practice.

Effectiveness of an online module: climate-change and sustainability in clinical practice

BackgroundClimate change has significant implications for health, yet healthcare provision itself contributes significant greenhouse gas emission. Medical students need to be prepared to address impacts of the changing environment and fulfil a key role in climate mitigation. Here we evaluate the effectiveness of an online module on climate-change and sustainability in clinical practice designed to achieve learning objectives adapted from previously established sustainable healthcare priority learning outcomes.MethodsA multi-media, online module was developed, and 3rd and 4th year medical students at Brighton and Sussex Medical School were invited to enrol. Students completed pre- and post-module questionnaires consisting of Likert scale and white space answer questions. Quantitative and qualitative analysis of responses was performed.ResultsForty students enrolled and 33 students completed the module (83% completion rate). There was a significant increase in reported understanding of key concepts related to climate change and sustainability in clinical practice (p < 0.001), with proportion of students indicating good or excellent understanding increasing from between 2 – 21% students to between 91 – 97% students. The majority (97%) of students completed the module within 90 min. All students reported the module was relevant to their training. Thematic analysis of white space responses found students commonly reported they wanted access to more resources related to health and healthcare sustainability, as well as further guidance on how to make practical steps towards reducing the environmental impact within a clinical setting.ConclusionThis is the first study to evaluate learner outcomes of an online module in the field of sustainable health and healthcare. Our results suggest that completion of the module was associated with significant improvement in self-assessed knowledge of key concepts in climate health and sustainability. We hope this approach is followed elsewhere to prepare healthcare staff for impacts of climate change and to support improving the environmental sustainability of healthcare delivery.Trial registrationStudy registered with Brighton and Sussex Medical School Research Governance and Ethics Committee (BSMS RGEC). Reference: ER/BSMS3576/8, Date: 4/3/2020.

Commentary: Human orbital cadaveric dissection: A trainee's gateway into surgical oculoplasty.

Acquisition of surgical expertise in the field of ophthalmology requires mastering advanced and precise techniques, which usually is bequeathed upon the novice by their adept seniors. Ophthalmology, being a largely microsurgical arena, demands excellent hand–eye coordination with respect to tissue handling, and thus entails a steeper learning curve. While detailed demonstration of a variety of ocular surgical procedures on animal eyes in order to provide a close simulation has been documented in literature, obtaining orbital and extraocular tissues for the same is far more arduous and may necessitate restructuring of the existing wet lab infrastructure.[1] Pig eyelid models have been utilized for teaching frontalis sling surgery after levator resection and eyelid margin repairs.[2] Sheep cranium has been employed for orbital microsurgical dissection for better understanding of optic nerve and other intra-orbital structures.[3] In a recent review, authors attempted to reproduce the steps of evisceration and implant placement of desired sizes in goats’ eyes for lucid understanding of the anatomy and to aid in the residents’ suturing skills.[1] Human cadaveric dissection, though traditional, provides an opportunity to explore the elusive and inaccessible domains of the surgical field which not only serves as a prudent platform for trainees to create an anatomical mind map of the orbit and its contents, but also makes for an ideal prospect for accomplished surgeons to expand their scope of technical skills.[4] Dissection confers understanding of spatial distribution and surgical tissue planes, offering a sound knowledge of applied anatomy. A study performed at Brighton and Sussex Medical School attempted to test the hypothesis whether there was a significant difference in the educational potential of a dissection-led study of orbital anatomy between participants who were postgraduate ophthalmology trainees and pre-medical school students.[5] It was found that not only was the exercise of a refresher course in anatomy welcomed by the postgraduates but prior expertise in the field enhanced the benefits of dissection-based education. This method was deemed superior because it instigated deep learning, elevated the doctor’s capabilities to draw novel anatomical concepts in relation to pre-existing knowledge of the subject and aided in eliminating the gaps in comprehension which otherwise become apparent even to a trained surgeon only on the operating table. In addition to providing a detailed anatomical blueprint of the orbit, cadaveric simulation has also been noted to improve the self-confidence of ophthalmology residents in executing emergency procedures.[6] Lateral canthotomy and cantholysis for relieving orbital compartment syndrome, temporary tarsorrhaphy for exposure keratopathy, and eyelid laceration repairs were seen to be performed far more assertively by trainees after having rehearsed on human cadavers. The application of cadaveric dissection–led pedagogy is not only limited to functional oculoplastic procedures, but has found its way into the world of esthetic medical education as well. With the exponentially growing market for minimally invasive cosmetic procedures including injectable dermal fillers and botulinum toxin targeting the evolving signs of ageing, a thorough awareness of the facial anatomy and vasculature is of the essence. A novel dissection technique illuminating the lateral orbital anatomy has been devised to mark the periorbital danger zones enabling the trainee to execute safe and confident injectable practices.[7] Such continuing professional development undertakings will develop skilled professionals to navigate through delicate facial anatomy and deliver satisfactory esthetic outcomes. The study by Singh et al. in this journal’s issue highlights the basics of oculoplastic cadaveric dissection, emphasizing on bony anatomy, surface marking, and post-dissection respectful handling of the cadavers.[8] The dissections included a structured protocol beginning from procurement of the human cadaver, soft embalming, holistic theoretical overview of the intended surgical procedure with video assistance followed by demonstration of the actual technique. Oculoplastic surgeries included lid reconstruction, blepharoplasties, ptosis correction, external dacryocystorhinostomy, orbital floor fracture repairs, orbital and optic canal decompression. The protocol also entailed mimicking the operation theatre settings with appropriate surgical site cleansing and draping, utilizing head-mounted loupes or the operating microscope, sterile scrubbing algorithm for the surgeon, and setting of the instrument tray for the procedure. This approach helps students create a mind map which forms a visual memory and is superior to a goal-oriented study for examinations. This mind map translates into deep learning. Additionally, they also place focus on technological advancements in the expanse of cadaveric dissection such as simulation of vasculature with dyed resins, orbital tumors with polyfoam injection, and navigation guidance and three-dimensional printing for accurate localization of surgical landmarks. In conclusion, human cadaveric dissection-led tutelage provides an astute gateway for both novice surgeons and experienced professionals into the land of oculoplastic surgery, encouraging development of surgical confidence and fine tuning of previously acquired skills.

72 Medical Students’ Opinion on Academic Surgery as a Career and Access to Opportunities in Surgical Research

Abstract Introduction The clinical academic training pathway in the United Kingdom is offering an increasing number of surgically themed roles. The understanding of research and available academic opportunities amongst applicants is variable. The aim of this study was to capture the understanding and exposure to clinical academia in surgery amongst UK medical students. Methods: We surveyed 100 medical students prior to them attending the inaugural Academic Surgery Virtual Conference based at Brighton and Sussex Medical school. Participants were sent a google survey via email the day prior to attending the conference to be completed anonymously. Results 52 students completed the pre-conference survey; 55.8% were female, 42.3% male, 1.9% preferred not to disclose gender. Mean ages for females were 21.4 and for males 23.5. An even distribution of students from different year groups responded, from 4 deaneries encompassing different UK medical schools. All participants had an additional degree with a BSc being the most common (n=36, 69.2%). Overall, 61.5% (n=38) of students expressed an interest in an academic surgical career. Only 52.7% (n=30) had previous experience in research, and 36.5% (n=19) knew how to get involved in surgical research. The majority of students had not received any teaching in medical school on academic surgery (n=38, 73.1%). Conclusion This survey has identified that amongst a cohort of medical students interested in academic surgery, few had research experience or knew how to get involved in surgical research. Medical schools should provide earlier education on clinical academic pathways to meet the rising demand for clinical academics in surgery.

Pandemic positives: medical work experience from home

Brighton and Sussex Medical School (BSMS) have developed a sector-leading virtual work experience (VWEX), attracting over 55,000 users world-wide. It serves as a tool for aspiring medical students to gain insight into a career in medicine and explore the roles of a doctor within various specialities. The COVID-19 pandemic has seen interest rise even further. The VWEX was conceived as a resource targeted to applicants to medicine from disadvantaged backgrounds. It is freely accessible, therefore overcoming potential financial challenges that many students from underrepresented backgrounds face, but also in relation to social capital, which can hinder access to professional networks. The programme introduces the NHS and its structure, showcasing six medical specialties through a variety of interactive elements. Participants are encouraged to submit a piece of reflection to complete the course, and no limitations are set on the form that this reflection must take, leading to creative and effective summaries of the insight gained. Whilst the VWEX has been an overwhelming success thus far, there is room for improvements. Some of these key areas include access to more ringfenced specialities, incorporating more interactive elements, and exploration of the numbers gap between registered users and those who complete the course.

Using digital innovation to support anatomy and surgical education during the pandemic

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.

615 Achieving Net Zero Emission by 2050 – The Medical Education Route

IntroductionThere is growing demand to reduce the environmental impact of surgery. Healthcare sustainability has recently become a mandatory GMC learning outcome for undergraduates, but expertise amongst faculty and time within the curriculum are limited. We piloted an E-module that uses surgical case studies to teach these concepts.MethodEvidenced-based multi-media learning principles were used to develop the module. 3rd and 4th year students at Brighton and Sussex Medical School were invited to partake and complete pre- and post-module questionnaires comprising 5-point Likert scales and white-space questions. The primary outcome measures were changes in student-reported understanding of four key concepts:Environmental impact of healthcareInfluence of climate change on health.Principles of sustainable clinical practice.Health co-benefits of climate change mitigation.Results33 students completed the E-module. Questionnaire results indicated a significant increase in understanding of all key concepts (p < 0.001). Students most commonly rated improving sustainability of healthcare as ‘extremely important’. Common themes within white space responses included the importance of preventative medicine and that the module was informative, interactive, user-friendly, and engaging. The majority (81%) strongly agreed that all undergraduates should undertake this module.ConclusionsThis E-module is an effective and COVID-19-safe resource. Adapting this module for postgraduate surgical education should be explored.

234 Remote Surgical Teaching During COVID-19: Early Feedback from Students and Teachers

BackgroundOn the 23rd March 2020 the government issued a nationwide lockdown in response to COVID-19. Using Microsoft Teams software, Brighton and Sussex Medical School transitioned to remote surgical teaching. We discuss the early feedback from students and tutors.MethodAll students (N = 40) and tutors (N = 7) were invited to complete an online feedback survey.ResultsTwenty students responded. Nine preferred remote teaching. The teaching was described as either good (10/20) or excellent (10/20). Small group teaching, lectures and student lead seminar sessions all received positive feedback. Students preferred sessions that were interactive. One hour was optimal (17/20). There was no consensus over class size. 15/20 (75%) would like remote teaching to continue after the pandemic.All tutors responded. There was a preference towards shorter sessions: 45 minutes (2/7) one hour (5/7). Tutors found virtual sessions less interactive (6/7). All tutors would like remote teaching to continue after the pandemic. Three suggested extending teaching to remote surgical ward rounds.Concern was raised by both students and tutors regarding the absence of practical skills.ConclusionsThe value of remote teaching has been highlighted by COVID-19. Our feedback recommends a transition towards blended learning; using the convenience of remote teaching to help augment traditional medical school teaching.

Changing epidemiology and age-specific incidence of cutaneous malignant melanoma in England: An analysis of the national cancer registration data by age, gender and anatomical site, 1981-2018.

BackgroundThe incidence of cutaneous malignant melanoma, which is mostly attributable (86%) to UV radiation exposure, has been steadily increasing over the past four decades in predominantly fair-skinned populations. Although public health campaigns are increasing sun-protective behaviour in England, their effect on melanoma incidence is largely unknown. We conducted a retrospective population-based cohort study to examine whether there have been changes in the epidemiology of melanoma in England during the past four decades.MethodsIndividual level data for patients diagnosed with melanoma in England during 1981–2018 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates were calculated by three age categories (0–34, 35–64, 65+ years), gender and anatomical site during the seven five-year time periods (1981–85 to 2011–15) and the recent three-year period (2016–18). The percentage change in incidence was calculated as change in the average incidence rate from the first (1981–85) to the last time period (2016–18). The Average Annual Percentage Change (AAPC) was estimated using the slope of the linear trend line fitted to the incidence rates by year of diagnosis.FindingsDuring the 38-year period (1981–2018), a total of 265,302 cases of melanoma (45.7% males, 54.3% females) were registered in England. The average annual number of cases increased from 837/year in 1981–85 to 6963/year in 2016–18 in males (+732%), and from 1609/year in 1981–85 to 6952/year in 2016–18 in females (+332%). In the young age-group (0–34 years), the average annual incidence rates initially increased from 1981–85 to 2001–05 and then stabilised during the recent period (2006–18). In the middle age group (35–64 years), the rates increased by +332% (AAPC, 10.4%) in males (from 5.6/100,000 in 1981–85 to 24.2/100,000 in 2016–18) and +185% (AAPC, 5.7%) in females (from 10.2/100,000 in 1981–85 to 29.1/100,000 in 2016–18); and in the old age-group (65+ years) the rates increased by +842% (AAPC, 25.7%) in males (from 9.6/100,000 in 1981–85 to 90.4/100,000 in 2016–18) and +381% (AAPC, 11.2%) in females (from 12.5/100,000 in 1981–85 to 60.1/100,000 in 2016–18). The largest increase in incidence in both males and females was observed for melanoma of the trunk (+817%, AAPC, 24.8% in males and +613%, AAPC, 18.3% in females), followed by melanoma of upper limb (+750%, AAPC, 22.9% in males and 518%, AAPC, 15.5% in females).InterpretationIt appears that the incidence of melanoma among young people in England has stabilised (or levelled off) in recent decades, whereas it continues to increase substantially in older population. These findings suggest that public health campaigns targeted at children/adolescents/parents may be favourably influencing melanoma incidence. The steeper increase in incidence in males is consistent with their relatively greater sun exposure and poor sun-protective behaviour. All the available evidence suggests that the enormous increase in the melanoma of the trunk and upper limb, since the 1980s, is most likely due to increasing trend in intermittent high intensity recreational UV radiation exposure (e.g. sunbathing, holidaying in places with strong sunlight, indoor tanning).FundingThis work was supported by Brighton and Sussex Medical School (BSMS).

Severely stigmatised skin neglected tropical diseases: a protocol for social science engagement.

More than one billion people are affected by neglected tropical diseases (NTDs) and many of these diseases are preventable. While the grouping of these conditions as NTDs has generated vast mapping, mass drug administration and surveillance programmes, there is growing evidence of gaps and weaknesses in purely biomedical approaches, and the need for responses that also recognise the social determinants of health. In order to unpack the social and political determinants of NTDs, it is important to view the problem from a social science perspective. Given this background, the Social Sciences for Severe Stigmatizing Skin Diseases (5S) Foundation has recently been established by the Centre for Global Health Research at Brighton and Sussex Medical School. The broad aim of the 5S Foundation is to incorporate social science perspectives in understanding and addressing the problems around three NTDs, namely, podoconiosis, mycetoma and scabies. This protocol paper sets out the aims and approaches of the 5S Foundation while activities such as research, public engagement, training and capacity building get underway.

An exploration of medical student attitudes towards older persons and frailty during undergraduate training.

Older persons and patients with frailty constitute an ever increasing proportion of hospital patients. Improving student attitudes towards both groups is important in preparing future doctors for this demographic shift. We aimed to investigate medical student attitudes towards older persons and frailty over an entire medical school cohort. All current Brighton and Sussex Medical School students were invited to complete an online questionnaire consisting: (i) the Australian Ageing Semantic Differential (AASD), (ii) the Medical Condition Regard Scale (MCRS) with regards to frailty, (iii) a qualitative question asking participants to record three words regarding both a person over 70years and frailty. 187 students participated (66% female, 25.2% response rate). Participants reported positive attitudes with mean scores of 73.45/114 on the AASD and 52.4/66 on the MCRS. The most positive attitudes towards both older persons and frailty were held by year 1 students, and most negative by year 3 and year 4 students for older persons and frailty, respectively. Examining AASD subgroups, students held negative attitudes towards the instrumentality (function) of older persons (mean score: 17.6/36) with significant variation across year groups (p < 0.05), with the most negative attitudes expressed in year 3. Word clouds of qualitative responses showed that medical students consider the two concepts differently with frailty attracting more negative associations. Generally medical student attitudes were positive towards older persons and frailty. However, these declined when focusing on the functionality, with word cloud analysis of attitudes revealing a dichotomy between the quantitative and qualitative data surrounding frailty.