key: cord-1016096-so3ae5b4
authors: Park, Hyunmi; Shim, Sunhee; Lee, Young-Mee
title: A Scoping Review on adaptations of clinical education for medical students during COVID-19
date: 2021-09-09
journal: Prim Care Diabetes
DOI: 10.1016/j.pcd.2021.09.004
sha: f2b3dc16a00149a35794f7cb51b72422e8cebe16
doc_id: 1016096
cord_uid: so3ae5b4

Rapid advances in clinical education in response to the COVID-19 pandemic are taking place globally. This scoping review updated the educational strategies which could be applied by clinical educators in their practice to effectively maintain clinical attachment programs for medical students amidst public health crises. Almost all elements of clinical teaching were deliverable, whether it was online, onsite, virtual or blended, their educational effectiveness should be further examined. Increase in the number of telemedicine related publications were remarkable, and they could serve as a scalable model for future educational programs to be incorporated into the medical student curricula.

Despite the profound effects from the COVID-19 pandemic, the medical community has fought to maintain high-quality education by flinging open the doors of technology into teaching and patient care [1] . Recent publications include reviews encompassing the rapid advances in medical education in response to the current pandemic and provided easily accessible summaries to grateful readers [1, 2] .

Previous systematic or scoping reviews up to September 2020 on medical educational responses to COVID-19 have highlighted areas of relative strength, but also parts in need of further development and research such as telemedicine. A rapid systematic review by Gordon et al. [1] suggested that the range of options deployed offered good guidance for the medical education community despite J o u r n a l P r e -p r o o f 3 outcome data mostly being Kirkpatrick's level 1. Daniel et al.'s [2] scoping review identified publications in telehealth, student admission, and faculty development to teach in remote settings to be areas in urgent need of further research.

Previous reviews dealt with medical education across the continuum, therefore detailed programs focusing on clinical teaching in undergraduate medical students, when direct patient contact limited due to the COVID-19, have been somewhat lacking. Especially, as clinical teaching is known to be effectively taught and learned through workplace based experiences, concerns exist amongst teachers [3] and students [4] The purpose of this scoping review was to summarize the extent and details of clinical teaching adaptation for medical students in response to COVID-19 up to March 2021, which could be readily and easily used by clinicians in both primary care settings and hospitals. due to COVID-19? (2) what further advancements in educational developments or research have been suggested as areas of improvement since the previous reviews?

Our scoping review included peer-reviewed publications including primary literature, review editorial, commentary/opinion pieces, but did not include grey literature, and conference proceedings. PubMed, Embase, Scopus, Web of Science (including ESCI) and ERIC were searched with keywords in the title and/or abstract and subject headings (eg, MeSH, EMTREE) as appropriate.

To select studies for inclusion, we used an iterative approach. Two authors (HP and SHS) independently reviewed the titles and/or abstracts of all the articles against an initial set of inclusion and exclusion criteria. Articles without abstracts underwent full-text screening to assess suitability.

The two authors met 5 times. On the first meeting the authors worked to create a shared understanding of the criteria, and on the following meetings the selected citations were compared and discussed for any discrepancies. Any coding disagreements were facilitated by author YML.

Inter-rater reliability was calculated using Cohen's Kappa.

Published articles on: (1) research or description on clinical teaching programs developed by medical schools, affiliated hospitals or primary care practices; (2) for undergraduate medical students; (3) brought by COVID-19 (4) from 1 st March 2020 to 1 st March 2021; (5) published in the English language; (6) listed in the MEDLINE and EMBASE databases including case reports, case studies, case control studies, cohort studies and randomized control trials, letters to the editor, commentaries, editorials, perspectives, and any potential reviews or meta-analyses. (7) any type of study were included such as quantitative, qualitative, and mixed method studies.

J o u r n a l P r e -p r o o f 5 Articles focusing on (1) postgraduate medicine (e.g. resident, fellow), or (2) other health care professionals bar medical students (e.g. nursing, physio, dentist); (3) on educational theories/concepts or general opinions without actual implementation or adaptations in clinical teaching and; (4) non-clinical education (e.g. anatomy, basic sciences) were excluded.

Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Metaanalysis Protocols [6] [7] . Both the PRISMA-ScR checklist and the protocol for scoping review can be found in the appendix section. All three authors independently reviewed and extracted data from all the included articles and any discrepancy was resolved by iterative discussions. YML served to discuss any coding disagreement and as a tiebreaker.

Authors developed a coding sheet in the protocol (appendix 3). The abstracted data was analysed in quantitative and thematic content analysis. Frequency was calculated for: (1) overall characteristics including publication year, curricular phase, institutional setting, educational platform, type of publication, country of papers, medical specialities; (2) papers that reported educational outcomes were classified by Kirkpatrick level. Content analysis was performed in the following categories: (1) telemedicine; (2) online clinical education by curricular phase, patient type, types of clinical skills/procedures, clinical case scenarios discussion; (3) onsite clinical education. Microsoft Excel and SPSS v25 were used for data management and analysis.

Database searching yielded 1369 records and 11 extra from manual searching. Removing duplicates resulted in 759 articles. After title and abstract screening, 615 records were excluded. 144 underwent J o u r n a l P r e -p r o o f full text screening and 87 were excluded. Inter-rater reliability at the screening phase was 0.899 suggesting excellent consistency. Figure 1 shows the PRISMA flow diagram for article identification. 

Adding to previous reviews, we found reports using telemedicine to overcome the challenges in clinical education amidst the pandemic disruption (table 2). 17 papers [8, 9, [18] [19] [20] [21] [22] [23] [24] [10] [11] [12] [13] [14] [15] [16] [17] described the use of telemedicine as an educational tool mostly for clerkship rotations but three also included pre-clinical year students. Whilst telemedicine was mainly implemented in university hospitals, six programs were also executed in the community. Through the telehealth platform, diverse clinical competencies including history taking, communication skills, information management and diagnostic skills were taught, whilst education on physical examination and clinical procedures were scarce. In addition, professionalism was also learned through patient encounters over telemedicine platforms (figure 5). Practice guidelines [11, 12, 20, 22] and training for faculty and students were J o u r n a l P r e -p r o o f 7 provided [10, 14, 16, 18, 20, 22, 24] prior to encountering patients over the telehealth platform. Inadvance informed consent from the patients were obtained and screening took place to ensure patients had the appropriate virtual interfaces [18, 19, 21] .

At an ophthalmology telemedicine clinic, third and fourth-year students took histories, performed focused ophthalmic examinations, presented the findings to the faculty, and received 5-minute feedback sessions [10] . Pellegrini et al. [9] described teaching of fourth-year medical students during their otolaryngology telemedicine outpatient clinics. Rupley et al. [11] implemented three obstetric projects where students provided: 1) public health and access information to vulnerable patients; 2) telehealth outreach to antepartum and post-partum patients scheduled for telehealth visits; and 3) post-partum outreach interdisciplinary efforts. Family medicine departments used telemedicine for communication skills education [16] ; scripts and disease templates used in telemedicine were shared amongst students to widen their clinical knowledge [17] ; and prior training in EMR (Electronic Medical Records) allowed students to contribute to telemedicine documentation of consented patients visits [18] . Ho et al. [14] developed a pilot project integrating medical students into tele-ICU patient care using a 2-way video conferencing platform.

Telemedicine was also used for clinical teaching in the community health care setting. Carson et al. [20] staffed medical students in multicounty telehealth COVID-19 hotlines letting them assist the underserved rural population conducting audio-only exams, screening and triaging patients. Cain et al. [19] reported family medicine clerkship students reviewing and documenting on EMR charts later reviewed by the attending. Similar pilot programs were reported by family medicine telehealth clinics at the Medical University of South Carolina [21] . A unique program led by Stanford University's students, called Cardinal Free Clinics, opened immediately after the onset of the pandemic, and changed to a telehealth clinic model when in-person patient clinics were forced to close due to university COVID-19 policies [22] . In the UK, Darnton et al. [23] used telemedicine for teaching pre-clinical medical student in the community. 35 second year students were spread across J o u r n a l P r e -p r o o f nine primary care organisations and participated in real-life telemedicine consultations. Final year medical students from Kings College London [24] reported their insights on participating in virtual general practice clinics amidst the pandemic and how their practices as incoming junior doctors would continue.

Some studies reported online delivery of clinical education for preclinical students [23, [25] [26] [27] [28] . Knie et al. [27] implemented communication skills by interviewing simulated patients over Zoom, resulting in higher satisfaction levels than role-playing among themselves. Elengickal et al. [26] reported online critical community-based projects through an interdisciplinary approach and Shah et al. [28] described maximizing active and collaborative learning over online platforms.

Four medical schools described clinical educational programs across all curricular stages, including pre-clinical and clinical phase students [20, [29] [30] [31] . A half century old course in Germany on ethics and professionalism involving real patients was successfully digitalised [30] and diagnostic reasoning and diagnosis training were delivered to medical students via an artificial intelligence-based virtual patient simulator developed by a medical school in Italy [29] .

Most papers with real patient involvement were in the realms of outpatient telemedicine, but Pennell et al. [32] described live-streaming inpatient ward rounds as a clerkship educational tool. Medical students were engaged securely via mobile phone to participate in the ward round, including discussion before and after a patient visit. Sukumar et al. shared internal medicine clerkship experiences at a university hospital [33] in three steps; students pre-rounded an assigned hospitalised patient by remotely accessing their electronic health records, then calling into hospital rounds virtually, followed by oral presentation to their small group of instructors and fellow students. Kopp J o u r n a l P r e -p r o o f et al. [34] provided third-year medical students an opportunity to join inpatient medicine e-Consult teams which included COVID-19 patients. The orthopaedic department at the Chinese University of Hong Kong [35] set up a live-feed camera that allowed students to interact with consented patients in the online clinic and an attending physician demonstrated physical examinations techniques.

To compensate restricted real patient physical examination, tutors played the role of standardised patients and taught via video conferencing [13] . Schleicher et al. [36] taught musculoskeletal and neurological system examinations using models as well as demonstrating physical examinations on a second tutor via live video link. Student demonstration also took place in reverse with live feedback.

In Jiang et al.'s [37] program, instructors played children's parents' roles and the students were able to take histories and propose necessary physical examinations via video link. Torres et al. [38] reported online clinical skills education by 'borrowing' the hand of a technician during medical simulation over zoom, where students guided the technician through a clinical examination on a fully articulating patient simulator. In a surgical skills study in Hong Kong, a synthetic skin and suture set was sent to each final year student, and 30 students per group joined an interactive tutorial. The students' hands-on practice was monitored and assessed by the surgical tutor online [39] .

Final year Italian students [40] underwent virtual reality online platform training with simulated clinical scenarios. Body Interact TM is one of the increasing virtual patient platforms that allows students to interact with virtual patients, to collect histories, perform physical examinations, request and view vital signs and laboratory images, administer medications and decide on interventions.

Sixteen papers from an array of countries described the use of online clinical case scenarios to remedy the disruption in clinical clerkships for clinical year students [41, 42, [51] [52] [53] [54] [55] [56] [43] [44] [45] [46] [47] [48] [49] [50] . The University of Bergen's radiology department [41] allowed fifth-year students to download the J o u r n a l P r e -p r o o f multiplatform image viewer on their personal computers and taught online practical skills on how to read and interpret CT examinations.

Online case discussions at a university hospital [51] was performed by students and residents together: third-year students produced a preliminary list of differential diagnoses; fourth-year students helped arrive their junior to the correct answer; and surgical residents provided examples of real-life experiences and evidence-based best practices to contextualize and enrich the patient

presentations. An otolaryngology department [53] provided students online cases in response to the markedly reduced outpatient and surgical volume due to COVID-19. Not only video media, but auscultation of cardiac murmurs were incorporated into an interactive case-based online course [50] .

To prevent disengagement during online clinical case discussions, Zottmann et al. [55] formally trained selective students in didactics of higher education encouraging fellow students during virtual teachings. At a general practice program, rural family physician preceptors led online education sessions on rural hospice and end-of-life care, obstetrical services and maternity care, approaches to opioid use disorder and medication-assisted treatment, and COVID-19 rural disaster preparedness and response [42] .

Whilst onsite modified clinical clerkships continued in parts of the world [57] [58] [59] [60] [61] , in others it was combined with online teaching [28, 62, 63] . Thomas von Lengerke et al. [64] described communication skills teaching for preclinical students using simulated patients in a classroom setting under social distancing and infection control guidelines. Lee YM et al. [60] reported a modified paediatric clerkship in response to reduced patient volume and parents' reluctancy to be seen by medical students. The University College London infectious diseases team [61] trialled an 8-week 'COVID-19 apprenticeship' for the graduating students to work as Doctors' Assistants or Healthcare support worker assistants. The Doctors' Assistant program was also positively reported by Lavender et J o u r n a l P r e -p r o o f al. [59] and Cowley and White [57] who reported the assistantships to form part of the mandatory medical school as successfully piloted in the UK.

Authors of this scoping review aimed to provide practical information to help teachers effectively maintain clinical attachment programs for medical students when patient contact or clinical attachment become restricted due to public health crises. Our research has amalgamated knowledge on assorted online and onsite methods of clinical teaching over various delivery platforms adding to the body of evidence from previous reviews [1, 2] .

COVID-19 has been the spark that accelerated the implementation of already existing technology in medicine. Students being excluded from the clinical space led to many novel ideas from clinical teachers who used the available technology to facilitate real patient contact in the ward or outpatient setting [29, 38, 58, [60] [61] [62] 65] . Even without real patients, the passion of clinical teachers has led them to become simulated patient themselves [36, 37] and taught using clinical case scenarios allowing access to real patient imaging and EMR [18, 19] . Albeit fewer in number, there were attempts at teaching clinical skills such as suturing, demonstrating that with advance preparations, basic technology and willingness, such education was possible over online platforms.

We identified telemedicine as an area of additional publication from previous reviews. Despite the exponential growth in telemedicine in the last decade, its enactment has been lukewarm until social distancing rules created the opportunity for its expansion in medical student education [13] . Iancu et al. [13] highlighted telemedicine education as an important aspect of future medical student training, especially in augmenting traditional in-person clinical experiences. Telemedicine engaged students and patients in diverse clinical settings providing a platform to teach wide range of clinical skills including clinical reasoning, professionalism, and communication skills during a pandemic [14, 19] J o u r n a l P r e -p r o o f with high satisfaction levels [14, 33] . The publications reporting clinical teaching via telemedicine during the COVID-19 could serve as a scalable model for future educational programs to be incorporated into the medical student curricula [21] and expanded into outreach programs, especially in underserved rural communities [19] .

Although the papers showed that most clinical competencies could be learned online or in the virtual setting, concerns as per their effectiveness on clinical skills learning are abound. There is also a need for further outcome data collection in regards to the benefits or adverse effects of the new approaches in clinical teaching as our review has shown that reported educational outcomes stagnated at Kirkpatrick level 1 assessing only participants' reactions or satisfaction to the educational programs.

Our scoping review confined peer reviewed published papers in English, but grey literatures, conference proceedings were not included. These restrictions may affect the whole picture of mapping clinical teaching adaptations for medical students due to COVID-19, despite the widespread educational developments attempted to counteract the pandemic disruption across the globe.

Evidence for substituting or effectively teaching physical examination online or virtual platforms could not be identified.

Our analysis included papers up to March 2021 filling the gap in the literature and updating previous published reviews with the focus on clinical teaching for medical students. We have especially updated clinical educational developments in telemedicine, an area highlighted in a previous scoping review to be in urgent need for further research and development.

The new educational developments brought by the pandemic are still fraught with challenges and there is still lack of evidence in their educational effectiveness. However, this scoping review updated the educational strategies which could be applied by clinical educators in their practice to effectively maintain clinical attachment programs for medical students amidst public health crises. In particular, the increase in telemedicine related publications were remarkable, which may serve as a scalable model for future educational programs to be incorporated into the medical student curricula.

Please check the following as appropriate: 

Patients screened in advance, consented and ensured appropriate virtual interfaces in place. Students able to document the visit in patients' EMR and attested by attending. 

Title 1 Identify the report as a scoping review. 1 ABSTRACT

Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.

Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach.

2

Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives. Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number.

3

Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale.

Information sources 7

Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed.

Search 8

Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated.

Selection of sources of evidence 9

State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review. 4

Data charting process 10

Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.

List and define all variables for which data were sought and any assumptions and simplifications made. 5

Critical appraisal of individual sources of evidence

If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate).

Synthesis of results 13 Describe the methods of handling and summarizing the data that were charted. 5

Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.

Characteristics of sources of evidence 15 For each source of evidence, present characteristics for which data were charted and provide the citations. 5

Critical appraisal within sources of evidence 16 If done, present data on critical appraisal of included sources of evidence (see item 12).

Results of individual sources of evidence

For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives.

Synthesis of results 18 Summarize and/or present the charting results as they relate to the review questions and objectives.

Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.

Limitations 20

Discuss the limitations of the scoping review process. 12

Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps. Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review. The review process will consist of two levels of screening: (1) a title and abstract review and (2) fulltext review. For the first level of screening, two investigators will independently screen the title and abstract of all retrieved citations for inclusion against a set of minimum inclusion criteria. Any articles that are deemed relevant by either or both of the reviewers will be included in the full-text review. In the second step, the two investigators will then each independently assess the full-text articles to determine if they meet the inclusion/exclusion criteria. To determine inter-rater agreement,

Cohen's κ statistic will be calculated at both the title and abstract review stage and at the full article review stage. Any discordant full-text articles will be reviewed a second time and further disagreements about study eligibility at the full-text review stage will be resolved through discussion with a third investigator until full consensus is obtained. Relevant studies will be included if they describe the concept of Medical Education during COVID-19.

Studies included can be on any of (a) development; (b) implementation; (c) evaluation; or (d) comparative validation of medical education interventions. Any type of study design (eg, randomised control trials, case-control study, prospective or retrospective cohort study, quasi-experimental, qualitative) will be included. Studies will be excluded if they do not describe an intervention but is a personal opinion only.

Study characteristics to be extracted will include, but not be limited to: J o u r n a l P r e -p r o o f each reviewer's independent abstracted data will be compared and any discrepancies will be further discussed to ensure consistency between the reviewers. The data will be compiled in a single literature review software program, Mendeley, and then downloaded into a single excel spreadsheet in Microsoft Excel software for validation and coding.

Since a scoping review can be used to map the concepts underpinning a research area and the main sources and types of evidence available, the aggregated findings provide an overview of the research rather than an assessment of the quality of individual studies. 

Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No

An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64

COVID-19 and medical education

Medical Student Concerns Relating to Neurosurgery Education During COVID-19

Scoping studies: Towards a methodological framework

Guidance for conducting systematic scoping reviews

Medical Student Participation in Otolaryngology Telemedicine Clinic During COVID-19: A Hidden Opportunity

Ophthalmology Education in COVID-19: A Remote Elective for Medical Students

Mobilization of health professions students during the COVID-19 pandemic

Student Perspectives on Remote Medical Education in Clinical Core Clerkships During the COVID-19 Pandemic

Twelve tips for the integration of medical students into telemedicine visits

Developing the eMedical Student (eMS)-A Pilot Project Integrating Medical Students into the Tele-ICU during the COVID-19 Pandemic and beyond

Teaching Telepalliative Care: An Elective Rotation for Medical Students during the COVID-19 Pandemic

Transforming a clerkship with telemedicine

Building a Successful, Socially-Distanced Family Medicine Clerkship in the COVID Crisis

An outpatient telehealth elective for displaced clinical learners during the COVID-19 pandemic

Telemedicine implementation in family medicine: Undergraduate clerkship during COVID-19 pandemic

Student Hotline Improves Remote Clinical Skills and Access to Rural Care

The COVID-19 Pandemic as an Opportunity for Operational Innovation at 2 Student-Run Free Clinics

Medical students consulting from home: A qualitative evaluation of a tool for maintaining student exposure to patients during lockdown

Integration of Technology in Medical Education on Primary Care During the COVID-19 Pandemic: Students' Viewpoint

I Have a Cough": An Interactive Virtual Respiratory Case-Based Module

Adapting Education at the Medical College of Georgia at Augusta University in Response to the COVID-19 Pandemic: the Pandemic Medicine Elective

To zoom or not to zoom -the training of communicative competencies in times of Covid 19 at Witten/Herdecke University illustrated by the example of "sharing information

Beginning a new medical school curriculum amidst a global pandemic

A natural language processing-based virtual patient simulator and intelligent tutoring system for the clinical diagnostic process: Simulator development and case study

Learning in peer teaching of patient relations and communication skills at the "Anamnesegruppen" munich -proof-of-concept and lessons learned

Telephone-based communication training in the era of COVID-19

Live-streamed ward rounds: a tool for clinical teaching during the COVID-19 pandemic

Designing and Implementing a Novel Virtual Rounds Curriculum for Medical Students' Internal Medicine Clerkship During the COVID-19 Pandemic

Medical student remote eConsult participation during the COVID-19 pandemic

Impact of COVID-19 on medical education and resident burnout in a postgraduate programme

Training of physical examination techniques in video conferences

Twelve tips for teaching medical students online under COVID-19

Transition to online is possible: Solution for simulation-based teaching during the COVID-19 pandemic

Distant surgical teaching during COVID-19 -A pilot study on final year medical students

Pregraduation medical training including virtual reality during COVID-19 pandemic: a report on students' perception

An Open Source Solution for "Hands-on" teaching of PET/CT to Medical Students under the COVID-19 Pandemic

Transforming Rural Family Medicine Curriculum From Experiential to Virtual: A Response to COVID-19 Limitations

Learning new ways of teaching and assessment: the impact of

COVID-19 on undergraduate dermatology education

The prevalence of depressive symptoms, anxiety symptoms and sleep disturbance in higher education students during the COVID-19 pandemic: A systematic review and metaanalysis

Pilot virtual clerkship curriculum during a pandemic: podcasts, peers, and problem-solving

An Online Dermatology Teaching Module for Undergraduate Medical Students amidst the COVID-19 Pandemic: An Experience and Suggestions for the Future

The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students' perspectives

Efficacy of vascular virtual medical student education during the coronavirus disease 2019 pandemic

Teachings for dermatological teaching

Virtual auscultation course for medical students via video chat in times of covid-19

Surgery Clerkship Curriculum Changes at an Academic Institution during the COVID-19 Pandemic

Designing virtual patient based self-study quizzes covering learning goals in clinical diagnostic sciences for undergraduate medical students -the radiology example

A Model for Undergraduate Medical Student Education in Otolaryngology During the Post-COVID-19 Era, Otolaryngol. -Head Neck Surg

Facing COVID-19, jumping from inperson training to virtual learning: A reviewoneducational and clinical activities in a neurology department

Isn't here just there without a "t" -to what extent can digital Clinical Case Discussions compensate for the absence of face-toface teaching?

Provision of e-learning programmes to replace undergraduate medical students' clinical general practice attachments during COVID-19 stand-down

Healthcare support worker assistantships should form a mandatory part of medical school curricula: A perspective from UK medical students

Clinical placements for medical students in the time of COVID-19

Rising to the challenge: medical students as Doctors' Assistants; an evaluation of a new clinical role

New Paradigm of Pediatric Clinical Clerkship during the Epidemic of COVID-19

Necessity is the mother of invention: how the COVID-19 pandemic could change medical student placements for the better

Opportunity for change: Undergraduate training in family medicine

Alternative approaches for clinical clerkship during the COVID-19 pandemic: online simulated clinical practice for inpatients and outpatients-A mixed method

Classroom teaching with simulated patients during COVID-19: the communication skills course in the second year of the model medical curriculum HannibaL

ABC of Surgical Teaching: Time to Consider a Global Blueprint for Holistic Education

Recommendations for Clinical Skills Curricula for Undergraduate Medical Education

Clinical medical education: Cardiothoracic surgery in the era of COVID-19

Impact of COVID-19 on orthopaedic clinical service, education and research in a university hospital