Virtual Rounds Research Articles

DOP081 The EXTENT Study (Calculating the LEmann indeX using inTEstiNal ulTrasound): Results from an international expert Delphi consensus

Abstract Background A primary objective in the management of Crohn's disease (CD) is the prevention of bowel tissue damage. The Lémann index (LI) characterizes structural bowel damage based on magnetic resonance enterography (MRE) or computed tomography enterography (CTE) and, for colonic CD, colonoscopy. Intestinal ultrasonography (IUS) provides a non-invasive imaging alternative, though its role in the LI assessment remains unexplored. This study aimed to establish a consensus on parameters and standardized acquisition for scoring small bowel and colonic damage using IUS in accordance with the LI. Methods Thirty international experts in IUS and/or MRE participated in a three-round Delphi process. Participants provided feedback and rated agreement with statements outlining IUS parameters and standardized acquisition in two virtual rounds. During the final in-person round, unresolved items were discussed and voted upon. Statements with at least 80% agreement were accepted. Results Twenty-two statements reached a consensus: 10 defined IUS parameters for stricturing and penetrating lesions for scoring LI-IUS, and 12 addressed optimal IUS cineloop acquisition for centralized review (Table 1). No consensus was reached regarding IUS equivalents for grade 1 stricturing lesions in the small bowel and colon. Conclusion Ultrasonographic equivalents for assessing small bowel and colonic damage in CD were derived to align with the validated LI criteria for MRE/CTE and colonoscopy. These statements mark the first phase of the EXTENT project, supporting the potential use of IUS in clinical practice and disease modification trials as an alternative tool for bowel damage assessment. The lack of consensus on grade 1 stricturing lesions suggests further exploration of IUS parameters is required.

Advancing Telemedicine: Virtual Rounding and Care in an Emergency Department Observation Unit.

Patient overcrowding in emergency departments (ED) impact quality of care by increasing length of stay which often leads to delayed patient dispositions. Emergency Department Observation Units (EDOUs) are protocol driven units staffed by ED providers that can alleviate overcrowding concerns and accommodate patients that require further diagnostics for a final disposition. Virtual rounding on EDOUs can be leveraged to maximize provider shortages and increase access to quality care. We present a case report of a patient who arrived at an ED for abdominal pain and was eventually admitted to an EDOU that practiced virtual rounds. This case report demonstrates the benefits of utilizing a clinical hybrid model that combines telemedicine and observation medicine to achieve quality care while improving ED operational flow.

The effect of "clinical virtual round" on clinical self-efficacy among midwifery students.

One of the methods of clinical education is clinical rounds which makes students more skilled in the comprehensive care of patients. since midwifery students are faced with low-risk and high-risk cases of mothers during the perinatal period, Therefore, it is necessary to pay attention to their clinical self-efficacy. The aim of this study was to determine. The effect of "clinical virtual round" on clinical self-efficacy among midwifery students. The study was experimental with the control group design. The subjects were randomly divided into the intervention (n = 30) and control (n = 30) groups. two groups received clinical virtual round and report back model (respectively). subjects in both groups responded to the 20-item clinical self-efficacy Questionnaire, before and after the intervention. Data were analyzed with paired t-test and t-student by SPSS v 22. The baseline mean ± SD scores for clinical self-efficacy in interventional and control groups were 10.1 ± 1.32, and 10.1 ± 3.05 respectively (P = 0.233). clinical virtual round increased clinical self-efficacy (65.1 ± 1.42) of midwifery students compared with the control group (11.1 ± 1.72) (P = 0.002). According to this study's results, it is recommended that clinical virtual rounds can be increasing clinical self-efficacy among midwifery students.

COVID-19 Rounds": An Inquiry-Based Distance Learning Tool for Medical Students Under Lockdown: A Cross-Sectional Study.

The coronavirus disease 2019 (COVID-19) pandemic presented significant challenges to both clinical practice and the delivery of medical education. Educators and learners implemented novel techniques including distance learning and virtual rounds while trying to stay updated with the surge of information regarding COVID-19 epidemiology, pathogenesis, and treatment. Hence, we designed and implemented a technology enhanced course "COVID-19 Rounds" to educate students about the rapidly evolving pandemic. The objectives of this study are first, to describe a technologically-enhanced course "COVID-19 Rounds" and second, to evaluate the following: a) student satisfaction and program usefulness in achieving pre-set objectives, b) perceived improvement in literacy regarding the pandemic, and c) the impact of student engagement by designing infographics and initiating COVID-19 related research projects. This is a cross-sectional study measuring the impact of the implementation of the "COVID-19 Rounds" on-line course. This program included virtual clinical experiences with physicians on actual rounds in the hospitals and COVID-19 wards, weekly updates on evolving data and new research, and engagement with student-led projects. The study population included 47 fourth-year medical students at the Mohamed Bin Rashid University of Medicine and Health Sciences (MBRU) in Dubai, United Arab Emirates who attended the course. We designed and administered a 47-item survey to assess student satisfaction, program usefulness, impact on knowledge, and student engagement. Data was collected at the end of program delivery via Microsoft forms. A total of 38 out of 47 (81%) fourth-year medical students participated in the study. Final course evaluation revealed an overall high satisfaction rate, with a mean rating of 3.9 (SD 0.94) on the 5-point Likert Scale. Most students were satisfied with course format (27/38; 71%), organization (31/38; 82%) and learning experience (28/38; 74%) that the course offered. The course was particularly useful in offering evidence-based talks about aspects of the pandemic (34/38; 90%), providing weekly updates of emerging evidence (32/38; 84%), enhancing understanding of the challenges of the pandemic (34/38; 90%). Satisfaction with distance learning was moderate (23/37; 62%), and a minority of students would have preferred an in-person version of the course (10/37; 27%). Student engagement in the course was high. All students participated in small group presentations of "infographics" of pandemic related topics. Perceived advantages included conciseness and visual appeal; disadvantages included lack of detail, time consuming requiring design experience. After the course ended 27 students initiated research projects. This resulted in 6 abstracts presented at local meetings and 8 scientific papers published or submitted for publication. This inquiry-based adaptive approach to educate medical students about updates in COVID-19 via virtual learning was successful in achieving objectives and encouraging engagement in research. However, shortcomings of the course related to lack of in-person teaching and clinical activities were also highlighted.

Feasibility and Acceptability of Virtual Rounds on an Academic Inpatient Pediatric Unit.

Virtual rounds enable remote participation in bedside clinical encounters. Their effects on education remain poorly characterized and limited by lack of foundational evidence establishing that this approach is welcomed among learners and educators. We assessed technical feasibility and acceptability of incorporating video conferencing into daily work rounds of pediatric residents and attending physicians. We conducted a cross-sectional survey-based study of attending observers and pediatric residents participating in rounds both at the bedside and via video teleconferencing from September to December 2020. Participant experiences were assessed and summarized using parametric Likert-type questions regarding technical issues, efficiency, educational experience, and engagement. Associations between technical aspects and individual perceptions of virtual rounds and self-reported engagement were also measured. Of 75 encounters, 29% experienced technical issues, 45% of which were attributable to a low-quality tablet stand. Negative impacts of virtual rounding on efficiency were reported in 6% of responses. Virtual participants were engaged (70%) and reported educational value for 65% of encounters. Comfort with virtually asking questions (odds ratio 3.3; 95% confidence interval 2.0-5.7) and performing clinical tasks for other patients (odds ratio 0.42; 95% confidence interval 0.2-0.9) were associated with engagement (P <.05). Virtual participation in rounds was technically feasible and maintained educational value and engagement for residents in the majority of encounters, without sacrificing efficiency. Even as restrictions from the coronavirus disease 2019 pandemic are lifted, this rounding model has many important applications, including increasing educational opportunities for remote learners and making multidisciplinary rounds more accessible.

Linking measures to mechanisms of action: An expert opinion study.

This study sought to integrate the NIH Science of Behaviour Change (SOBC) measures repository comprising measures of putative mechanisms with mechanisms of action (MoA) identified by the Human Behaviour-Change Project (HBCP). Participants were 30 international experts recruited from professional networks and societies. In three anonymous virtual rounds, experts established consensus on hypothesized links between 26 MoAs and 44 self-report measures. In Round 1, experts completed a survey rating agreement with 84 pre-identified measure-MoA links and suggested new links. In Round 2, experts discussed 10 links in an online forum, including pre-identified links with <50% agreement and new links suggested by 20-50% of experts. In Round 3, experts completed a survey rating all links eligible for discussion in Round 2. Twenty-seven experts completed Round 1, 23 completed Round 2 and 18 completed Round 3. In Round 1, 82 of 84 pre-identified links reached >50% agreement and 14 new links were suggested by >50% of experts. In Round 2, experts discussed measure-MoA links and measurement quality. In Round 3, 71 of 96 links reached ≥50% agreement. A total of 167 links reached >50% expert agreement, 33 of which reached ≥90% agreement. By identifying putative mechanisms (HBCP) for the 44 self-report measures (SOBC), this study advances the cumulation of scientific results and interoperability of resources to facilitate process research.

Evaluation of family and staff experiences with virtual rounding and bedside presence in a tertiary neonatal intensive care unit during the COVID-19 pandemic

Introduction The COVID-19 pandemic-related visitation restrictions started in March 2020 in Alberta, Canada. In the Neonatal Intensive Care Unit, we implemented a Virtual Communications initiative to allow parents to continue to be present with their infants, attend daily rounds, and communicate with the medical team. The purpose of this survey study was to describe our approach and evaluate the experience for families and staff. Methods The study surveys consisted of 13–18 questions directed toward understanding staff and family experience with the process and emotional impact using Likert scale and open-ended questions. The study team reviewed results and implemented changes in real time. Analysis was mixed quantitative and qualitative design, with descriptive data organized into themes. Results Twenty-six surveys were completed by 16 staff (62%) and 10 parents (38%). About 50% to 100% of respondents agreed or strongly agreed with statements addressing the quality and value of the virtual sessions. Staff identified challenges with slow devices and need for awareness and education. Both staff and parents expressed gratitude for the initiative and an overall positive experience. Discussion Offering Virtual Rounds and Bedside Presence in the Neonatal Intensive Care Unit is a well-received and feasible alternative to in-person presence that allows parents to stay involved and connected to their infants. Families have a better understanding of their babies’ clinical status and plans with an overall positive experience.

Teledermatology for medical education in the COVID-19 pandemic context: A systematic review

Teledermatology for medical education in the COVID-19 pandemic context: A systematic review

Tele-critical health care: Lessons learned from the pandemic

The approach of remotely managing critically ill patients via an off-site command center was implemented since decades. However, SARS COV-2 pandemic lockdown triggered an urgent need for more innovations to ensure the continuity of intensive care units services when self-isolation was needed to prevent and reduce infection rates. Hence, implementing tele-intensive care units (tele-ICU) became a must and seems to be the future system cornerstone. The Society of Critical Care Medicine's Tele-ICU committee has recently described various models of tele-critical care (TCC) and its current adapted applications [1]. The ability to regionalize advanced critical care support such as nonconventional mechanical ventilation modes, extracorporeal membrane oxygenation, and other complex needs may be simplified with telemedicine [2]. Experienced intensivists can provide a real-time support to the local teams and participate to the decision making while performing virtual rounds using high-definition audio/visual (A/V) equipment. Moreover, TCC may enhance the intervention quality for emergency situations such as advanced cardiac life support. The immediate delivery of an intensivist to the room via A/V technology may save time and promptly initiate life-saving procedures. Instead of “all hands-on deck” approach, code leadership by a tele-ICU intensivist may allow to reduce the number of the on-site responding staff. The benefit was objective in several scenarios during the pandemic era and enabled a full compliance with the social distancing requirements [3]. The COVID Caregiver Cockpit is an approved connected health care solution which is compliant with the FDA classification for Mobile Medical Devices. It offers various enhanced features that allow remote patient monitoring, and secure inpatient ward staff communications. COVID Caregiver Cockpit might be an example of the great flexibility and adaptability of TCC solutions with unexpected emergencies [4]. The cost of Tele-ICU varies depending on the setting, hardware, software, training, and compatibility issues with other health systems. Cost was usually considered as limiting factor for the implementation of eHealth solutions. However, the return on investment (ROI) for an implemented Tele-ICU seems to be satisfactory especially in case of shortage in bedside board-certified intensivists [5]. Physician acceptance of TCC technologies was not optimal at the beginning of the experience. However, the urgent need during the pandemic has permitted to prove the TCC efficacy and increased its acceptability. Based on this objective benefit of TCC, several savant and scientific societies recommended the integration of telemedicine consultations into routine clinical care [6]. Recent reviews of the literature provided several examples of successfully implemented telehealth services. A framework of patient-centered telehealth models implementation should be introduced in all clinical practice settings [7,8].

Broadening learning communities during COVID-19: developing a curricular framework for telemedicine education in neurology

BackgroundIn response to the cancellation of clinical clerkships due to COVID-19, the Johns Hopkins (JH) Neurology Education Team developed a virtual elective to enhance medical students’ clinical telemedicine skills and foster community between academic institutions.MethodsThis two-week clinical elective, entitled “Virtual Patient Rounds in Neurology,” was administered once in April 2020 and once in May 2020. The curriculum included attending/fellow-led Virtual Rounds, Student Presentations, and Asynchronous Educational Activities. We also developed a new lecture series entitled JHNeuroChats, which consisted of live synchronous lectures presented by JH faculty and Virtual Visiting Professors. Trainees and faculty from outside institutions were invited to participate in the JHNeuroChats. Students and faculty completed pre- and post-elective surveys to assess the educational impact of the elective. Student’s t-tests were used to compare scores between pre- and post-elective surveys.ResultsSeven JH medical students enrolled in each iteration of the elective, and an additional 337 trainees and faculty, representing 14 different countries, registered for the JHNeuroChats. We hosted 48 unique JHNeuroChats, 32 (66.7%) of which were led by invited Virtual Visiting Professors. At the end of the elective, students reported increased confidence in virtually obtaining a history (P < 0.0001) and performing a telehealth neurological physical exam (P < 0.0001), compared to the start of the course. In addition, faculty members reported increased confidence in teaching clinical medicine virtually, although these findings were not statistically significant (P = 0.15).ConclusionsDespite the constraints imposed by COVID-19, this virtual Neurology elective increased medical students’ confidence in certain telemedicine skills and successfully broadened our learning community to encompass learners from around the world. As virtual medical education becomes more prevalent, it is important that we are intentional in creating opportunities for shared learning across institutions. We believe that this elective can serve as a model for these future educational collaborations.

Evolution of a Bidirectional Pediatric Critical Care Educational Partnership in a Resource-Limited Setting.

Introduction: Children in resource-limited settings are disproportionately affected by common childhood illnesses, resulting in high rates of mortality. A major barrier to improving child health in such regions is limited pediatric-specific training, particularly in the care of children with critical illness. While global health rotations for trainees from North America and Europe have become commonplace, residency and fellowship programs struggle to ensure that these rotations are mutually beneficial and do not place an undue burden on host countries. We created a bidirectional, multimodal educational program between trainees in Manila, Philippines, and Baltimore, Maryland, United States, to improve the longitudinal educational experience for all participants.Program Components: Based on stakeholder input and a needs assessment, we established a global health training program in which pediatricians from the Philippines traveled to the United States for observerships, and pediatric residents from a tertiary care center in Baltimore traveled to Manila. Additionally, we created and implemented a contextualized simulation-based shock curriculum for pediatric trainees in Manila that can be disseminated locally. This bidirectional program was adapted to include telemedicine and regularly scheduled “virtual rounds” and educational case conferences during the COVID-19 pandemic. Providers from the two institutions have collaborated on educational and clinical research projects, offering opportunities for resource sharing, bidirectional professional development, and institutional improvements.Conclusion: Although creating a mutually beneficial global health partnership requires careful planning and investment over time, establishment of a successful bidirectional educational and professional development program in a limited-resource setting is feasible and benefits learners in both countries.

Virtual Rounding in Stroke Care and Neurology Education During the COVID-19 Pandemic - A Residency Program Survey

Background and PurposeDuring the coronavirus disease 2019 (COVID-19) pandemic, we instituted virtual inpatient stroke rounds and acute stroke evaluations via telemedicine in the emergency department. We sought to explore trainees’ and experienced providers’ views on stroke care and education. MethodsThe implementation and the survey took place at a single academic comprehensive stroke center in northeast Ohio in the United States. “Virtual rounding” consisted of patient presentation and discussion in the morning in on-line virtual team format followed by in-person patient rounds in small groups. Acute stroke evaluations in the emergency department included direct in-person evaluation by neurology residents with supervision over telemedicine.The neurology residents, stroke fellows, stroke nurse practitioners, and stroke staff physicians were surveyed 2 months after implementation. Quantitative data was analyzed using descriptive statistical analysis, written responses in comment sections were analyzed using content analysis. ResultsThirty-two of 42 (73%) surveys were completed. Nine (45%) residents and 5 (42%) experienced providers responded that virtual rounds did not compromise learning and education on stroke service. Fifteen (75%) residents and all experienced providers agreed that virtual rounds protected caregivers from exposure to the virus. While more than a third of residents (37%) did not feel comfortable utilizing telemedicine in ED, the majority of experienced providers (89%) were at ease with it. A total of 58% of residents and 67% of experienced providers felt that they were spending less time at the bedside, and 42% of residents and 58% of experienced providers felt less connected to patients during the pandemic. ConclusionMajority of neurology residents' experience was not positive utilising telemedicine as compared to other staff providers. This is likely attributed to lack of prior exposure and unpreparedness. Incorporation of telemedicine curricula in medical school and residency training could prepare the next generation physicians to effectively use these technologies and meet the growing need for telehealth services for current and future pandemics.

Compelled dichotomy of the cardiology training during COVID-19 time: green flag to the distant technologies

Abstract Background The COVID-19 pandemic has dramatically influenced healthcare systems as well as the training environment worldwide. Numerous concerns have been raised about the disruption of cardiology training due to the social and physical distancing. We aimed to characterize the changes made in cardiology training in response to the COVID-19 pandemic and the personal perception of the new educational realities amongst first-year residents of the university clinic of the national medical research centre. Methods The institutional educational program underwent urgent and significant adaptation. Functions of the e-learning platform were extended in the purpose of the accumulation of the recorded lectures, online discussions, meetings, case-based clinical scenarios, virtual simulations, and regular virtual clinical rounds 2 times per week. Using an online 7-items survey, we analyzed the practical experience of 33 clinical cardiology trainees who worked within “red” and “green” zones and their personal perception of the distance educational technologies. Results At the peak of the pandemic outbreak, 40.6% of the residents have transferred into facilities restructured for COVID-19 patients for a median of 3 (1; 4) months. According to the responses they did not experience changes in the direct supervision time by their trainers and have achieved a higher level of independence in the procedural activity (arterial and central venous catheterization, CPR, performing intubation and invasive ventilation), decision making (such as prescription of anticoagulants and antibiotics, treatment of comorbid conditions), interpretation of the laboratory (acid-base balance, markers of myocardial, kidney and liver damage) and instrumental findings (ECG, echocardiography, coronary tomography). Despite the challenges, 75% of the trainees positively assessed their training in infectious settings. Due to the accidental contacts with COVID-19 patients and the associated need for 14-days quarantine residents who remained in the “green” zone experienced a reduction in direct supervision time from 57 to 17 hours per week (−70%) and were lack of procedural skills improvement. However, using the wide range of the educational resources provided in demand resulted in an increase in their learning time (plus 8 hours per week) with improvement in cardiology knowledge. Positive feedback was received from 85% of these residents with mention of the improvement of self-management. Conclusions Despite worldwide adoption of the educational program to the distant learning cardiology residents can experience different educational scenarios in the different setting due to COVID-19 cases surge. Combination of direct supervision, teaching remotely with staff support, case-based discussions, wider use of simulation, telemedicine, and social media engagement are urgently needed for adaptation of the educational programs in order to reduce the continuing shortage of specialists. Funding Acknowledgement Type of funding sources: None.

Adapting clinical experiences during a pandemic: One college of nursing's approach.

Graduate level nursing programs are having increasing difficulty obtaining clinical sites for their students. Nurse practitioner (NP) students need a minimum of 500 direct care hours in addition to indirect hours. Simulation experiences may not be used as direct patient care hours for NP students, but telehealth experiences may be used if the focus is on obtaining similar competencies to what would be acquired with face-to-face patient experiences. One college of nursing adapted several opportunities for NP students to acquire indirect clinical experiences and specific NP competencies during the coronavirus (COVID-19) pandemic. Several different clinically focused teaching methodologies were planned and implemented. These varied by NP specialty track and included complex case analyses, virtual (Zoom) rounds, well-child cases, and objective structured clinical examinations. These adapted clinical experiences are effective methods of helping students acquire clinical competencies and skills; however, they bring their own challenges. Post-COVID may be a time of new beginnings, moving nursing education forward on finding new and better ways to ensure that students acquire clinical competencies. What the new normal will be for nursing education is yet to be determined, but nursing education will likely never return to where we were before the pandemic.

Pediatric Intensive Care Hybrid-Style Clinical Round During COVID-19 Pandemic: A Pilot Study.

Objectives: With the evolving COVID-19 pandemic and the emphasis on social distancing to decrease the spread of SARS-CoV-2 among healthcare workers (HCWs), our pediatric intensive care unit (PICU) piloted the integration of Zoom meetings into clinical rounds. We aimed to explore the feasibility of these hybrid virtual and physical clinical rounds for PICU patients.Design: Mixed quantitative and qualitative deductive thematic content analysis of narrative responses.Setting: PICU, single tertiary-care academic center.Participants: Multidisciplinary PICU HCWs.Interventions: Integration of Zoom meeting into clinical daily PICU rounds.Measurements: For the quantitative part, we gathered the details of daily PICU hybrid rounds in terms of times, number of HCWs, and type of files shared through Zoom. For the qualitative part, open-ended questions were used.Main Results: The physical round took statistically significantly less time (34.68 ± 14.842 min) as compared with the Zoom round (72.45 ± 22.59 min), p < 0.001. The most shared component in the virtual round was chest X-rays (93.5%). Thirty-one HCWs participated in focus group discussions and were included in the analysis. Some of the HCWs' perceived advantages of the hybrid rounds were enabling multidisciplinary discussions, fewer round interruptions, and practicality of virtual discussions. The perceived challenges were the difficulty of the bedside nurse attending the virtual round, decreased teaching opportunities for the trainees, and decreased interactions among the team members, especially if video streaming was not utilized.Conclusions: Multidisciplinary hybrid virtual and physical clinical rounds in the PICU were perceived as feasible by HCWs. The virtual rounds decreased the physical contact between the HCWs, which could decrease the possibility of SARS-CoV-2 spread among the treating team. Still, several components of the hybrid round should be optimized to facilitate the virtual team-members' interactions and enhance the teaching experience.

Impact of first and second shift tele‐critical care pharmacy services and virtual rounds on interventions at Atrium Health Lincoln

AbstractBackgroundIn 2015, Atrium Health (AH) established second shift pharmacy services in the tele‐critical care (TCC) setting to optimize medication therapy and serve as a drug information resource to facilities across the health care system. TCC pharmacy services expanded to the first shift in July 2017. In September 2017, the first shift pharmacist began participating in virtual multidisciplinary rounds 1 day per week, which increased to 3 days per week in October 2019 at AH Lincoln, a community hospital with a 10‐bed intensive care unit (ICU).MethodsThis was a nonrandomized retrospective cohort study of adult ICU patients at AH Lincoln across two different time periods. The primary outcome was the number and type of pharmacy interventions made on rounding day(s) vs nonrounding days and first vs second shifts. Data are reported using descriptive statistics.ResultsDuring time period 1, a total of 1174 patients were admitted to the ICU for a total of 2115 patient days, with an average length of stay (LOS) of 1.8 days (SD ± 1.8 days). During time period 2, a total of 812 patients were admitted to the ICU for a total of 1775 patient days with an average LOS of 2.2 days (SD ± 2.7 days). During time period 1, a total of 753 interventions (297 on first shift and 456 on second shift) were performed as compared to time period 2, which had 1276 interventions (816 on first shift and 460 on second shift). For both time periods, the most common intervention on the first shift was medication management (45%) vs glycemic control (36%) on the second shift.ConclusionsThe addition of TCC pharmacy services to AH Lincoln has resulted in a positive impact on medication management, with the largest impact demonstrated through virtual rounding by the first shift TCC pharmacist.

Survey of the Impact of COVID-19 on Pediatric Orthopaedic Surgeons Globally.

The coronavirus disease 2019 (COVID-19) pandemic required rapid, global health care shifts to prioritize urgent or pandemic-related care and minimize transmission. Little is known about impacts on pediatric orthopaedic surgeons during this time. We aimed to investigate COVID-19-related changes in practice, training, and research among pediatric orthopaedic surgeons globally. An online survey was administered to orthopaedic surgeons with interest in pediatrics in April 2020 and a follow-up was administered in February 2021. The surveys captured demographics and surgeons' self-reported experiences during the pandemic. Participants were recruited from web media and available email lists of orthopaedic societies over a 2-month period. Descriptive statistics were used to analyze results, stratified by the severity of local COVID-19-related measures. A total of 460 responses from 45 countries were collected for initial survey. Of these, 358 (78.5%) respondents reported lockdown measures in their region at time of survey. Most (n=337, 94.4%) reported pausing all elective procedures. Surgeons reported a reduction in the average number of surgeries per week, from 6.89 (SD=4.61) prepandemic to 1.25 (SD=2.26) at time of survey (mean difference=5.64; 95% confidence interval=5.19, 6.10). Average number of elective outpatient appointments per week decreased from 67.89 (SD=45.78) prepandemic to 11.79 (SD=15.83) at time of survey (mean difference=56.10, 95% confidence interval=5.61, 60.58). In total, 177 (39.4%) surgeons reported using virtual modes of outpatient appointments for the first time. Of 290 surgeons with trainees, 223 (84.5%) reported implementation of systems to continue training such as webinars or virtual rounds. Of 192 respondents with research, 149 (82.8%) reported continuing research activities during the pandemic with most reporting either cessation (n=75, 64.15%), or reduction (n=25, 29.9%) in participant recruitment. A total of 111 responses from 28 countries were collected during follow-up. Surgeons described policy and circumstantial changes that facilitated resumption of clinical work. The COVID-19 pandemic and its related counter measures have had significant impacts on pediatric orthopaedic practice and increased uptake of technology to provide care continuity. Rigorous epidemiological studies are needed to assess impacts of delayed and virtual care on patient outcomes.

The COVID-19 pandemic as a catalyst for medical education innovation: A learner's perspective.

The COVID‐19 pandemic has been transformative for healthcare and medical education. Physician trainees and the education system that serves them adapted quickly so that trainees could finish the academic year on time and advance to the next phase of training without compromising clinical competency or public safety. Systemic changes have had the most significant impact on telemedicine training, virtual learning, secure testing, and the interview process for residency and fellowship training positions. Trainees are now getting regular, supervised practice experience with telemedicine. Some secure testing is being done remotely, without jeopardizing examination test items or trainee assessment. Attending physicians are experimenting with novel ways to engage learners with video for virtual rounds to keep the rounding team safe. Finally, the interview process for medical school, residency, and fellowship programs, which has traditionally been an expensive and travel‐laden process, has been made completely virtual for the first time ever. These changes have disadvantages, including a lack of social connection, potential distraction when learning remotely, and limited contact with a potential training program when interviewing by video. This perspective paper, written by a senior internal medicine resident, details his firsthand experience with these changes during the pandemic. It also looks forward to how the current changes will likely change medical education permanently and for the better.

Disruption of Patient and Family Centered Care Through the COVID-19 Pandemic

Disruption of Patient and Family Centered Care Through the COVID-19 Pandemic

Changes to Pediatric Gastroenterology Practice During the COVID-19 Pandemic and Lessons Learned: An International Survey of Division and Group Heads

Changes to Pediatric Gastroenterology Practice During the COVID-19 Pandemic and Lessons Learned: An International Survey of Division and Group Heads