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      Continuing medical education during a pandemic: an academic institution’s experience

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          Abstract

          The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution’s experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year’s end.

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          Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period

          It is urgent to understand the future of severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) transmission. We used estimates of seasonality, immunity, and cross-immunity for betacoronaviruses OC43 and HKU1 from time series data from the USA to inform a model of SARS-CoV-2 transmission. We projected that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave. Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022. Additional interventions, including expanded critical care capacity and an effective therapeutic, would improve the success of intermittent distancing and hasten the acquisition of herd immunity. Longitudinal serological studies are urgently needed to determine the extent and duration of immunity to SARS-CoV-2. Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024.
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            Can we contain the COVID-19 outbreak with the same measures as for SARS?

            Summary The severe acute respiratory syndrome (SARS) outbreak in 2003 resulted in more than 8000 cases and 800 deaths. SARS was eventually contained by means of syndromic surveillance, prompt isolation of patients, strict enforcement of quarantine of all contacts, and in some areas top-down enforcement of community quarantine. By interrupting all human-to-human transmission, SARS was effectively eradicated. By contrast, by Feb 28, 2020, within a matter of 2 months since the beginning of the outbreak of coronavirus disease 2019 (COVID-19), more than 82 000 confirmed cases of COVID-19 have been reported with more than 2800 deaths. Although there are striking similarities between SARS and COVID-19, the differences in the virus characteristics will ultimately determine whether the same measures for SARS will also be successful for COVID-19. COVID-19 differs from SARS in terms of infectious period, transmissibility, clinical severity, and extent of community spread. Even if traditional public health measures are not able to fully contain the outbreak of COVID-19, they will still be effective in reducing peak incidence and global deaths. Exportations to other countries need not result in rapid large-scale outbreaks, if countries have the political will to rapidly implement countermeasures.
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              SARS and its effect on medical education in Hong Kong

              N Patil, Y Yan (2003)
              SARS has disappeared and its scars are healing, but the fear of a winter return remains. We can only hope that, by the time this article is published in December, SARS will have gone for good and that no other ‘super‐spreader’ visits Hong Kong. SARS affected medical education in Hong Kong physically – yes, physically – when 17 medical students at the Faculty of Medicine at the Chinese University of Hong Kong came down with the virus after a visit to a ward with an index patient who was not known to be suffering from SARS at the time. Students at the Faculty of Medicine of the University of Hong Kong were lucky to escape the disease but had to go through the same anxieties and agony as their counterparts across the harbour. 1 (Hong Kong has 2 medical schools; one on Hong Kong Island and the other in New Territories). Both schools had to implement contingency plans quickly in order to maintain continuity in medical education. The authorities soon became aware of the catastrophe that was to endanger Hong Kong At noon on 18 March 2003, the suspension of clinical teaching was ordered. The authorities soon became aware of the catastrophe that was to endanger Hong Kong, and on 28 March 2003, they announced the suspension of all teaching activities in primary and secondary schools, followed by the closure of the universities. This was the beginning of what seemed to be an entry into the unknown. The final MBBS examination was completed just before SARS took its hold. However, dates for other examinations could not be confirmed. Four plans – A, B, C and D – were put in place in case the situation dragged on indefinitely. ‘Make good use of the time to do revision,’ was the advice given to students. Fortunately, we didn't have to go beyond plan A. The outbreak of SARS provided an opportunity to introduce and integrate information technology further into the teaching and problem‐based learning (PBL) methodologies at our medical school. As gathering large numbers of students in a lecture hall was considered to be a high risk activity, PowerPoint files containing the lecturer's voice were made available on the faculty website. These proved successful as students did not have to rush to attend their 08.00 hours whole‐class sessions and they could re‐visit the lecture as many times as they wished. For students, falling asleep or daydreaming in class were no longer considered problems! A plan for holding PBL tutorials through chat rooms on the web did not need to be put into action as SARS declined. All of this, although helpful, was, of course, a far cry from face‐to‐face interaction between students and tutors. Although students were given a break from formal teaching on the wards in order to avoid direct patient contact, they were keen to play their part in the fight against SARS. In April, over 200 medical and nursing students came together to launch a public health information campaign at mass transit railway stations in support of the massive efforts of various other organisations in Hong Kong. The ‘astronauts’ became an instant hit and were a major attraction around the hospital On 5 May 2003, when reports of new cases had ceased and SARS was considered to be under control, the students − who had stayed away from all wards for more than a month − were at last allowed to visit nominated wards and patients, wearing personal protection equipment. ‘Wear mask, wash hands and control SARS’ was a slogan most frequently used to remind everyone visiting or working in hospitals. In practice, however, what it meant for medical students was that they should: ‘Wash hands, wear gown, put on cap, mask and eye‐shield and look like an astronaut to control SARS’. These ‘astronauts’ were an instant hit and were a major attraction around the hospital, particularly with the patients, who were more than happy to talk to such extremely well protected medicos. A solution was worked out whereby the vivas were conducted by telephone conference The Year 3 MBBS summative examination was postponed and students gave up their 2‐week summer vacation to return for examinations. Due to a prior engagement in Europe, the external examiner could not attend the examinations during the week of the reassigned examination. There was no difficulty in sending him random samples of written papers and MCQ/EMQs and scores of marks for evaluation. However, regulations require that an external examiner must participate in distinction vivas. A solution was worked out whereby the vivas were conducted by telephone conference. A connection was made to a hotel room in France where external examiner Professor Ronald Harden, from Dundee, was staying at the time. Because there were 8 candidates, and the possibility of telephone line interruption could not be ruled out, the first part of the viva was conducted by Prof Harden with candidates responding to his questions in front of 3 internal examiners. All went well for this part. However, a short time into the second part, while Prof Harden was listening to other examiners' questions and the candidates' answers, the line from France appeared to go completely silent. One of the internal examiners gently remarked, ‘I think the line has gone. Perhaps Professor Harden got bored and hung up, or has gone somewhere else.’ Ron Harden's response came back instantly, ‘No, I am still here and can hear everything loud and clear.’ (Moral: Take care; silent telephones also have ears!). This was one of the few lighter moments during the scourge of SARS. In their commitment to duty and care four doctors succumbed to the virus and sacrificed their lives All health care professionals countered the terror and challenge of SARS with immense dedication and commitment. There are tales of triumph and stories of sorrow. Scientists at the Faculty of Medicine, University of Hong Kong were first to identify the Coronavirus as the cause of SARS. In their commitment to duty and care, 4 doctors succumbed to the virus and sacrificed their lives. A medical student wrote: ‘I learned the true meaning of duty, dignity, discipline and dedication.’ An intern who recovered from SARS expressed his sentiments thus: ‘Having survived an illness with an unpredictable outcome … my approach to patients’ needs has been radically altered … What may appear to be minor to us as doctors might be a major event for the patient. They will have my understanding and sympathy – always.' We wish you all a happy and safe Christmas and a peaceful New Year.
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                Author and article information

                Contributors
                Journal
                Postgrad Med J
                Postgrad Med J
                pmj
                Postgraduate Medical Journal
                Oxford University Press
                0032-5473
                1469-0756
                July 2020
                13 May 2020
                13 May 2020
                : 96
                : 1137
                : 384-386
                Affiliations
                Department of Obstetrics and Gynaecology, National University Hospital , Singapore
                Department of Cardiology, National University Heart Centre , Singapore
                Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
                Department of Anaesthesia, National University Hospital , Singapore
                Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
                Emergency Medicine Department, National University Hospital , Singapore
                Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
                Author notes
                Correspondence to Dr Abhiram Kanneganti, Department of Obstetrics and Gynaecology, National University Hospital, Singapore 119074, Singapore; abhiram_kanneganti@ 123456nuhs.edu.sg
                Author information
                https://orcid.org/0000-0002-5559-4534
                https://orcid.org/0000-0001-9175-7479
                Article
                postgradmedj-2020-137840
                10.1136/postgradmedj-2020-137840
                10016839
                32404498
                14f3687f-58c5-4b9d-96a4-d1fea8a131d5
                © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by/4.0/), which permits non-commercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 07 April 2020
                : 11 April 2020
                Page count
                Pages: 3
                Categories
                Education and Learning
                AcademicSubjects/MED00160
                AcademicSubjects/MED00790
                AcademicSubjects/MED00530

                Medicine
                audit,telemedicine,education & training (see medical education & training),health policy,medical education & training

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