{"id":71698,"date":"2022-06-14T08:51:23","date_gmt":"2022-06-14T00:51:23","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=71698"},"modified":"2022-10-04T00:19:36","modified_gmt":"2022-10-03T16:19:36","slug":"challenges-and-innovations-in-undergraduate-medical-education-during-the-covid-19-pandemic-a-systematic-review","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/challenges-and-innovations-in-undergraduate-medical-education-during-the-covid-19-pandemic-a-systematic-review\/","title":{"rendered":"Challenges and innovations in undergraduate medical education during the COVID-19 pandemic \u2013 A systematic review"},"content":{"rendered":"<p>Submitted: 13<span lang=\"EN-GB\">\u00a0December 2021<\/span><br \/>\r\nAccepted: 22 April 2022<br \/>\r\nPublished online: 5<span lang=\"EN-GB\"> July, TAPS 2022, <\/span><span lang=\"EN-GB\">7(3), 1-9<\/span><br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2022-7-3\/OA2722\">https:\/\/doi.org\/10.29060\/TAPS.2022-7-3\/OA2722<\/a><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Claire Jing-Wen Tan<sup>1<\/sup>, Cathryn Cai<sup>2<\/sup>, Farida Ithnin<sup>2<\/sup> &amp; Eileen Lew<sup>2<\/sup><\/span><\/p>\r\n<p style=\"text-align: justify\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; <sup>2<\/sup>Department of Women\u2019s Anaesthesia, KK Women\u2019s and Children\u2019s Hospital, Singapore<\/span><\/i><i><span lang=\"EN-GB\"><\/span><\/i><\/p>\r\n<p style=\"text-align: center\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-US\">Introduction:<\/span><\/b><span lang=\"EN-US\"> The COVID-19 pandemic has caused significant disruption to undergraduate medical education globally, with worldwide implementation of social distancing and lock-down measures. This systematic review aims to identify challenges in undergraduate medical education during the pandemic and report creative approaches that have been employed to ensure continuity of education. <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-US\">Methods:<\/span><\/b><span lang=\"EN-US\"> A MEDLINE (PubMed) search was performed for articles published between 1 February 2020 and 1 September 2020, corresponding to the pandemic\u2019s global upsurge. Studies, commentaries, perspectives, and correspondence <\/span><span lang=\"EN-US\">reporting challenges, adaptations and innovations in undergraduate medical education were screened. Data was grouped in accordance with the research questions it sought to address and analysed qualitatively.<b> <\/b><\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-US\">Results:<\/span><\/b><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">43 studies were included. The COVID-19 pandemic has resulted in lost opportunities for clinical exposure, reduced motivation, and heightened anxiety among medical students. Traditional teaching and assessment methods have transitioned to virtual platforms, harnessing video conferencing, social media, and virtual or augmented reality technologies. The long-term effectiveness of these solutions is uncertain, but immediate benefits conferred include increased access, improved time management, and cultivation of self-directed learning. The lack of authentic clinical experiences and patient interaction remains a major concern. Technical challenges and digital fatigue were also highlighted as pertinent challenges. <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-US\">Conclusions:<\/span><\/b><span lang=\"EN-US\"> The COVID-19 pandemic has provided unexpected, yet invaluable opportunities to explore new pedagogies that may be instrumental in shaping medical education in the new norm. As future members of the healthcare workforce, medical students should be integrated into current healthcare systems to equip them with knowledge and skills to manage future pandemics. <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">COVID-19, Education, Medical, Undergraduate, Medical Student, Telemedicine <\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">The COVID-19 pandemic has caused significant disruption to undergraduate medical education globally.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Undergraduate medical students faced diminished clinical exposure, poor motivation, and isolation.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">The pandemic has provided unexpected yet invaluable opportunities to explore new teaching pedagogies. <\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Institutions should continually adapt these strategies as methods of teaching in the new norm.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The appearance of the novel coronavirus (SARS-CoV-2) was first reported in December 2019 <\/span><span lang=\"EN-US\">(Huang et al., 2020)<\/span><span lang=\"EN-US\">. Since then, the COVID-19 outbreak has become a full-blown global health emergency, with more than 5.3 million deaths reported to date, disruptions in economies and education systems, and increased mental health issues amidst a climate of uncertainty <\/span><span lang=\"EN-US\">(Torales et al., 2020)<\/span><span lang=\"EN-US\">.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Major disruptions to medical education and training have been experienced worldwide. At the height of the pandemic, universities and medical schools suspended in-campus learning and clinical training to curb the spread of infections <\/span><span lang=\"EN-US\">(Murphy, 2020; Theoret &amp; Ming, 2020)<\/span><span lang=\"EN-US\">. Non-essential health services were ceased to focus resources on managing the pandemic. With medical faculty deployed to the frontlines, little time and capacity was available for training and teaching. There were reservations deploying medical students in clinical areas, due to safety concerns and consumption of personal protective equipment (PPE) in the face of shortages <\/span><span lang=\"EN-US\">(Hilburg et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Mitigating measures have challenged academic institutes to explore new pedagogies to sustain and bolster education efforts beyond the crisis. Creative approaches to ensure continuity of medical student education include the transition to e-learning and virtual clerkships, enabled through online video-conferencing platforms, social media, and virtual reality technology. Assessment formats have also been adapted to accommodate virtual evaluation of clinical competencies. While the effectiveness of these approaches remains to be proven, they are instrumental in allowing medical education to continue during the pandemic and into the new norm.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">This qualitative systematic review aims to define the challenges associated with medical student education at the height of the COVID-19 pandemic, highlight creative approaches and innovations that were employed to sustain medical education in these unprecedented times, and review their limitations and effectiveness. <\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement <\/span><span lang=\"EN-US\">(Page et al., 2021)<\/span><span lang=\"EN-US\">. Literature search was performed on MEDLINE (PubMed) using a combination of the following search terms: (COVID-19 OR pandemic) AND (undergraduate medical education OR undergraduate medical training). The search was tailored for the period of 1 February 2020 to 1 September 2020, to focus on the height of the pandemic.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Articles were included if they met the following criteria: published in English; reported challenges, strategies, and adaptations in conducting undergraduate medical education during the COVID-19 pandemic. To ensure comprehensive coverage, case reports, case and cohort studies, commentaries, perspectives, and correspondence were included. Articles pertaining to postgraduate medical education and non-medical education, non-English articles and systematic reviews were excluded.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Two reviewers (CJT and CC) independently screened the titles and\/or abstracts of all articles and selected only articles that met inclusion criteria. Any disagreement was resolved by discussion with senior authors (FI and EL). Data extracted included: challenges encountered in the implementation of undergraduate teaching; innovations, strategies and adaptations employed to facilitate teaching and assessment; perceived limitations and effectiveness of described strategies; original authors\u2019 conclusions. The data was collated on a spreadsheet, grouped by categories, and analysed qualitatively.<b><u><\/u><\/b><\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">A total of 123 studies were identified using the search strategy, of which 43 studies eventually met inclusion criteria. The PRISMA study flow-diagram (Figure 1)<b> <\/b>demonstrates our research algorithm. The data that support the findings of this study are openly available in Figshare at <\/span><span lang=\"EN-US\"><a href=\"http:\/\/doi.org\/10.6084\/m9.figshare.172968%20%20%2056\">http:\/\/doi.org\/10.6084\/m9.figshare.172968\u00a0\u00a0 56<\/a><\/span><span><span lang=\"EN-US\"> <\/span><\/span><span><span lang=\"EN-US\">(Tan et al., 2021).<\/span><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/06\/OA2722-Figure-1-300x170.png\" alt=\"\" class=\" wp-image-71699 aligncenter\" width=\"557\" height=\"316\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/06\/OA2722-Figure-1-300x170.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/06\/OA2722-Figure-1-1024x580.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/06\/OA2722-Figure-1-768x435.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/06\/OA2722-Figure-1.png 1077w\" sizes=\"auto, (max-width: 557px) 100vw, 557px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">Figure 1: PRISMA flow-diagram of study selection<\/span><\/p>\r\n<div>\r\n<p><i><span lang=\"EN-US\">A. Challenges Arising from the COVID-19 Pandemic<\/span><\/i><\/p>\r\n<p><i><span lang=\"EN-US\">1) Reduced clinical exposure: <\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Due to the enforcement of safe distancing measures, nearly all medical schools have suspended in-person classes and transitioned to online teaching. Scheduled summer and term breaks have been brought forward to provide a state of academic quarantine <\/span><span lang=\"EN-US\">(Ashokka et al., 2020)<\/span><span lang=\"EN-US\">. Loss of patient interaction has been consistently cited as one of the biggest challenges in delivering clinical education during the pandemic. Across institutions, medical students have been withdrawn from clinical postings to protect them from infectious transmission and mitigate PPE shortages <\/span><span lang=\"EN-US\">(Hilburg et al., 2020)<\/span><span lang=\"EN-US\">. With deployment of healthcare workers to the frontlines, clinicians focused attention and resources on patient care, with education taking a backseat <\/span><span lang=\"EN-US\">(Hilburg et al., 2020; Tolsgaard et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Pre-clerkship medical students were less affected by the online transition, as preclinical contents can be easily adapted for digital learning <\/span><span lang=\"EN-US\">(Newman &amp; Lattouf, 2020)<\/span><span lang=\"EN-US\">. In contrast, students on clerkship rotations for procedural-based disciplines who rely heavily on patient interactions were severely impacted <\/span><span lang=\"EN-US\">(Calhoun et al., 2020; Darras et al., 2021; Khalil et al., 2020)<\/span><span lang=\"EN-US\">. Without direct patient interaction, students cannot fully master physical examination skills, although history-taking and other communication skills can arguably be taught through virtual interactions with real or simulated patients. The development of professionalism and communication skills, including discussion of care plans in a multidisciplinary setting and presentation of academic work at professional platforms <\/span><span lang=\"EN-US\">(Hammond et al., 2020; Rafi et al., 2020)<\/span><span lang=\"EN-US\">, have also been compromised.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">2) Unpreparedness for the future:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">With a truncated curriculum and migration to digital learning, some students have been disheartened by missed learning opportunities <\/span><span lang=\"EN-US\">(Rallis &amp; Allen-Tejerina, 2020)<\/span><span lang=\"EN-US\">. They felt incompetent <\/span><span lang=\"EN-US\">(Hilburg et al., 2020)<\/span><span lang=\"EN-US\"> and unprepared for clinical examinations and patient encounters <\/span><span lang=\"EN-US\">(Shahrvini et al., 2020)<\/span><span lang=\"EN-US\">. A survey study conducted across 33 medical schools in the United Kingdom reported that 49.5% of final-year students started work in hospitals ahead of anticipated schedule to meet increased manpower demands during the pandemic <\/span><span lang=\"EN-US\">(Choi et al., 2020)<\/span><span lang=\"EN-US\">. Affected students admitted to feeling ill-equipped, due to the curtailing of final-year examinations and student assistantship programmes <\/span><span lang=\"EN-US\">(Choi et al., 2020)<\/span><span lang=\"EN-US\">. There is concern that loss of training opportunities could disrupt the supply chain of specialists <\/span><span lang=\"EN-US\">(Tolsgaard et al., 2020)<\/span><span lang=\"EN-US\"> and future workforce planning <\/span><span lang=\"EN-US\">(Halbert et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The sense of inadequacy among students is compounded by widespread cancellation of summer elective placements and research <\/span><span lang=\"EN-GB\">programs, <\/span><span lang=\"EN-US\">originally intended to provide avenues for further enrichment <\/span><span lang=\"EN-US\">(Rallis &amp; Allen-Tejerina, 2020)<\/span><span lang=\"EN-US\">. Consequently, students have missed out on opportunities to explore interests and immerse in rigorous clinical and research environments to guide them in making informed residency choices <\/span><span lang=\"EN-US\">(Go &amp; Rajasekaran, 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">3) Loss of motivation:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">With the move to online learning and cancellation of examinations in some universities, students reported diminished motivation to study <\/span><span lang=\"EN-US\">(Khalil et al., 2020)<\/span><span lang=\"EN-US\">, exacerbated by inexperience in distant-based learning, poor technical skills and frequent technical difficulties <\/span><span lang=\"EN-US\">(Muflih et al., 2020)<\/span><span lang=\"EN-US\">. Students have also expressed frustration at the lack of clear communication with faculty members regarding curriculum and assessment plans, fueling negative learning attitudes <\/span><span lang=\"EN-US\">(Shehata et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">4) Socio-emotional isolation:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">With loss of social interaction, medical students felt increasingly disconnected from their peers. Interruptions in normal routines and pressure from stay-home orders further <\/span><span lang=\"EN-GB\">fuelled <\/span><span lang=\"EN-US\">feelings of isolation, apprehension and uncertainty about the future <\/span><span lang=\"EN-US\">(Shahrvini et al., 2020)<\/span><span lang=\"EN-US\">. An increase in mental health issues was reported among medical students during the pandemic <\/span><span lang=\"EN-US\">(Shahrvini et al., 2020)<\/span><span lang=\"EN-US\">. To address this, institutions have strengthened peer support systems <\/span><span lang=\"EN-US\">(Ashokka et al., 2020)<\/span><span lang=\"EN-US\"> and initiated coaching <\/span><span lang=\"EN-GB\">programmes<\/span><span lang=\"EN-US\"> to impart coping skills and help students pursue <\/span><span lang=\"EN-GB\">personalised<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">goal setting <\/span><span lang=\"EN-US\">(Maini et al., 2020)<\/span><span lang=\"EN-US\">.<b><\/b><\/span><\/p>\r\n<p><i><span lang=\"EN-US\">B. Innovations, Adaptations, and Strategies Employed in Undergraduate Medical Education<\/span><\/i><\/p>\r\n<p><i><span lang=\"EN-US\">1) Online learning platforms:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Traditional face-to-face teaching has been largely replaced by online learning. \u2018Live\u2019 synchronous learning conducted over video-conferencing platforms, including <i>Zoom<\/i>, <i>Microsoft Team<\/i>, <i>Google Hangouts<\/i>, <i>Skype,<\/i> and <i>WebEx<\/i>, incorporate functions like screen-sharing, virtual whiteboards, mind-mapping tools, and polling for an interactive experience <\/span><span lang=\"EN-US\">(Shahrvini et al., 2020)<\/span><span lang=\"EN-US\">. \u2018Break-out\u2019 room functions allow students to be further divided into smaller groups for interactive discussions <\/span><span lang=\"EN-US\">(Darras et al., 2021; Ferrel &amp; Ryan, 2020)<\/span><span lang=\"EN-US\">. Students can also ask and answer questions using the chat function or microphones <\/span><span lang=\"EN-US\">(Singh et al., 2020)<\/span><span lang=\"EN-US\">. Synchronous tutorial sessions can also be recorded for future reference <\/span><span lang=\"EN-US\">(Atreya &amp; Acharya, 2020)<\/span><span lang=\"EN-US\">. Some institutions have adopted a flipped classroom approach, with learning material provided to students in advance of online discussions <\/span><span lang=\"EN-US\">(Naidoo et al., 2020; Singh et al., 2020)<\/span><span lang=\"EN-US\">. Asynchronous lectures, on the other hand, are pre-recorded and have the distinct advantage of cultivating self-directed learning <\/span><span lang=\"EN-US\">(Farooq et al., 2020)<\/span><span lang=\"EN-US\">. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Furthermore, learning management systems, like <i>Google Classroom<\/i>, <i>Blackboard<\/i>, <i>Impartus,<\/i> and <i>Slack <\/i>provide <\/span><span lang=\"EN-GB\">centralised<\/span><span lang=\"EN-US\"> platforms for tutors to share teaching materials and multimedia resources, with plug-ins to track students\u2019 progress <\/span><span lang=\"EN-US\">(Singh et al., 2020)<\/span><span lang=\"EN-US\">. Medical schools have also collaborated to share online resources, through <i>OnlineMedEd, Geeky Medics, Oxford Medical Simulation, <\/i>and<i> Aquifer <\/i><\/span><span lang=\"EN-US\">(Schaffir et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">2) Social media:<\/span><\/i><b><i><span lang=\"EN-US\"><\/span><\/i><\/b><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Taking advantage of its popularity, tutors have turned to social media platforms for the dissemination of class schedules and learning materials during the pandemic <\/span><span lang=\"EN-US\">(Iqbal et al., 2020)<\/span><span lang=\"EN-US\">. In one medical college, <i>Telegram<\/i> was used to create class groups and upload educational resources <\/span><span lang=\"EN-US\">(Iqbal et al., 2020)<\/span><span lang=\"EN-US\">. At another institution, ophthalmology faculty members created <i>Whatsapp<\/i> student groups to upload quizzes, reference materials, and teaching videos <\/span><span lang=\"EN-US\">(Sud et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The use of social media successfully enhanced student participation and collaborative learning <\/span><span lang=\"EN-US\">(Naidoo et al., 2020)<\/span><span lang=\"EN-US\">. The ability to stay anonymous gave students the confidence to discuss topics without fear of being judged by their peers <\/span><span lang=\"EN-US\">(Iqbal et al., 2020)<\/span><span lang=\"EN-US\">. As the complex technical interfaces, information overload and digital fatigue could cause distractions <\/span><span lang=\"EN-US\">(Iqbal et al., 2020)<\/span><span lang=\"EN-US\">, its use should be moderated.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">3) Virtual laboratory sessions:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Traditional anatomy classes, using \u2018live\u2019 cadaveric dissections, have been discontinued and substituted by novel online formats at some institutions <\/span><span lang=\"EN-US\">(Darras et al., 2021)<\/span><span lang=\"EN-US\">. Students have been taught to appreciate anatomy via three-dimensional (3D) computer models <\/span><span lang=\"EN-US\">(Remtulla, 2020)<\/span><span lang=\"EN-US\"> and virtual dissections on digital applications <\/span><span lang=\"EN-US\">(Longhurst et al., 2020)<\/span><span lang=\"EN-US\">. Comprehensive learning materials have also been uploaded on Virtual Learning Environments <\/span><span lang=\"EN-US\">(Ashokka et al., 2020; Longhurst et al., 2020; Naidoo et al., 2020)<\/span><span lang=\"EN-US\">. Institutions also conducted real-time tutorials and \u2018live\u2019 dissection sessions online <\/span><span lang=\"EN-US\">(Longhurst et al., 2020)<\/span><span lang=\"EN-US\">. The University of Hong Kong implemented a web-based <\/span><span lang=\"EN-GB\">program<\/span><span lang=\"EN-US\">me to provide basic surgical skills training to final-year undergraduate students. Tutors demonstrated surgical skills on \u2018live\u2019 camera, while students <\/span><span lang=\"EN-GB\">practised<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">suturing at home using kits that were distributed in advance <\/span><span lang=\"EN-US\">(Co &amp; Chu, 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">4) Virtual clinical experience:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Technological advancements have enabled the use of simulations and virtual reality to address gaps associated with distance learning <\/span><span lang=\"EN-US\">(Remtulla, 2020)<\/span><span lang=\"EN-US\">. Students have been able to learn history taking, clinical reasoning and communication skills via remote role-play with simulated patients <\/span><span lang=\"EN-US\">(Mukhtar et al., 2020)<\/span><span lang=\"EN-US\">. Videos demonstrating communication, physical examination and procedural skills have also been utilised as teaching aids <\/span><span lang=\"EN-US\">(Sam et al., 2020)<\/span><span lang=\"EN-US\">. Some universities have even implemented virtual placements with live-streamed ward rounds, empowering students to participate remotely in discussions and case presentations <\/span><span lang=\"EN-US\">(Sam et al., 2020)<\/span><span lang=\"EN-US\">. At one university, students on virtual surgical electives could observe surgeries remotely, as attending surgeons wore head-mounted cameras to capture the surgical field <\/span><span lang=\"EN-US\">(Chao et al., 2021)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">With the ramp-up of telemedicine services during the pandemic, students have had opportunities to facilitate patient care through telephone or video consultations, enabling them to develop to cultivate interpersonal skills. Students have been roped in to provide virtual updates to patients\u2019 families <\/span><span lang=\"EN-US\">(Hilburg et al., 2020)<\/span><span lang=\"EN-US\"> and assist in scribing during virtual consultations <\/span><span lang=\"EN-US\">(Rallis &amp; Allen-Tejerina, 2020)<\/span><span lang=\"EN-US\">. Time pressures <\/span><span lang=\"EN-US\">(Oki et al., 2021)<\/span><span lang=\"EN-US\"> and breaches in patient confidentiality <\/span><span lang=\"EN-US\">(Rallis &amp; Allen-Tejerina, 2020)<\/span><span lang=\"EN-US\"> were highlighted as potential concerns. With telemedicine being increasingly integrated into mainstream health services in the new norm, it is imperative to incorporate telemedicine training into the medical curricula to produce a telehealth-ready workforce <\/span><span lang=\"EN-US\">(Iancu et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Although virtual clinical clerkships cannot fully substitute for hands-on clinical experiences <\/span><span lang=\"EN-US\">(Nic Dhonncha &amp; Murphy, 2021; Rafi et al., 2020; Roskvist et al., 2020; Sud et al., 2020)<\/span><span lang=\"EN-US\">, they have a role \u00a0in promoting student engagement with tutors and patients, and helping students develop indispensable clinical skills <\/span><span lang=\"EN-US\">(Chao et al., 2021)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">5) Assessments:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Due to logistical, manpower and technical constraints, some universities have cancelled semester assessments <\/span><span lang=\"EN-US\">(Toku\u00e7 &amp; Varol, 2020)<\/span><span lang=\"EN-US\">. Others have adopted alternative methods to evaluate competencies. A study conducted at 14 medical universities in the United Kingdom and Republic of Ireland revealed that 7% of universities cancelled written examinations, 14% eliminated summative practical assessments and a further 36% cancelled assessments altogether <\/span><span lang=\"EN-US\">(Longhurst et al., 2020)<\/span><span lang=\"EN-US\">. Only 21% of schools implemented online digital spotter or open-book examinations <\/span><span lang=\"EN-US\">(Longhurst et al., 2020)<\/span><span lang=\"EN-US\">. Institutions that eliminated examinations altogether laid claim to facing difficulties adapting traditional examination formats to online assessments, and cited the lack of experience and training as underlying factors <\/span><span lang=\"EN-US\">(Farooq et al., 2020)<\/span><span lang=\"EN-US\">. <span style=\"text-decoration: line-through\"><\/span><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Open-book examinations were implemented at some universities and were associated with reduced pressure among students <\/span><span lang=\"EN-US\">(Hilburg et al., 2020; Nic Dhonncha &amp; Murphy, 2021)<\/span><span lang=\"EN-US\">. Due to its initial success, there are now calls for widespread adoption of open-book examination formats <\/span><span lang=\"EN-US\">(Hammond et al., 2020)<\/span><span lang=\"EN-US\">. Other institutions have <\/span><span lang=\"EN-GB\">opted for <\/span><span lang=\"EN-US\">continuous formative assessment in place of scheduled summative assessments <\/span><span lang=\"EN-US\">(Choi et al., 2020; Shehata et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">For strict proctoring to maintain academic integrity during online examinations, web cam and screen capture functions have been harnessed <\/span><span lang=\"EN-US\">(Hilburg et al., 2020; Mukhtar et al., 2020)<\/span><span lang=\"EN-US\">. Grading systems for examinations have also been modified. Instead of assigning specific grades based on performance, fourth-year medical students on elective courses at the University of Washington School of Medicine were assessed on a pass\/fail basis, significantly alleviating students\u2019 stress <\/span><span lang=\"EN-US\">(Calhoun et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Clinical examinations have been more challenging to administer in compliance with enforced risk mitigation measures. Some schools have chosen to focus on theory assessments instead, while others successfully conducted virtual Objective Structured Clinical Examinations (OSCE), <\/span><span lang=\"EN-GB\">focusing <\/span><span lang=\"EN-US\">on practical skills and communication capabilities <\/span><span lang=\"EN-US\">(Naidoo et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">C. Barriers and Limitations Associated with Innovations and Adaptations <\/span><\/i><\/p>\r\n<p><i><span lang=\"EN-US\">1) Reduced tutor-student interaction:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Some reports suggest that switching to online learning platforms has compromised student engagement and collaboration <\/span><span lang=\"EN-US\">(Ashokka et al., 2020; Ferrel &amp; Ryan, 2020; Longhurst et al., 2020)<\/span><span lang=\"EN-US\">. Unlike face-to-face tutorials that facilitate vibrant discussion, online tutorials involve tutors speaking to a blank screen <\/span><span lang=\"EN-US\">(Atreya &amp; Acharya, 2020; Khalil et al., 2020; Roberts et al., 2020; Sud et al., 2020)<\/span><span lang=\"EN-US\">. <\/span><span lang=\"EN-US\">The absence of visual cues may lead to communication gaps and loss of personal touch <\/span><span lang=\"EN-US\">(Khalil et al., 2020; Mukhtar et al., 2020)<\/span><span lang=\"EN-US\">. Specifically, tutors have claimed to face difficulty in gauging students\u2019 understanding <\/span><span lang=\"EN-US\">(Hilburg et al., 2020; Mukhtar et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Furthermore, it was observed that some students have adopted passive learning attitudes <\/span><span lang=\"EN-US\">(Sandhaus et al., 2020)<\/span><span lang=\"EN-US\">. It has become exceedingly difficult to engage students in virtual rooms and to retain their attention over prolonged periods <\/span><span lang=\"EN-US\">(Atreya &amp; Acharya, 2020; Farooq et al., 2020; Roberts et al., 2020)<\/span><span lang=\"EN-US\">. A handful of students were observed to switch off their cameras and mute their microphones, while others claimed they did not feel comfortable to speak up <\/span><span lang=\"EN-US\">(Roberts et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Strategies have been formulated to increase student participation. Tracking of attendance has been proposed as a means to improve attendance rate, although it remains possible that students may log on but engage in their own activities without paying attention <\/span><span lang=\"EN-US\">(Atreya &amp; Acharya, 2020)<\/span><span lang=\"EN-US\">. Some tutors have incorporated interactive online quizzes during tutorials <\/span><span lang=\"EN-US\">(Farooq et al., 2020)<\/span><span lang=\"EN-US\">, while others have decreased tutorial group sizes to optimise engagement <\/span><span lang=\"EN-US\">(Joseph et al., 2020)<\/span><span lang=\"EN-US\">. <\/span><\/p>\r\n<p><i><span lang=\"EN-US\">2) Reduced quality of instruction:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">With short notice for curricular re-design, universities have faced struggles to obtain the resources necessary for a smooth transition, resulting in disruption to students\u2019 learning in the interim <\/span><span lang=\"EN-US\">(Oki et al., 2021)<\/span><span lang=\"EN-US\"> and reduced quality of instruction <\/span><span lang=\"EN-US\">(Shahrvini et al., 2020)<\/span><span lang=\"EN-US\">. Medical students at one university experienced teaching disruption for four weeks during the transition to new teaching methods <\/span><span lang=\"EN-US\">(Roberts et al., 2020)<\/span><span lang=\"EN-US\">. Tutors have also reported knowledge gaps and time constraints in creating new online educational content, amidst competing professional and personal duties during the pandemic <\/span><span lang=\"EN-US\">(Newman &amp; Lattouf, 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">3) Digital fatigue:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Long hours spent in front of devices have led to exhaustion, poor concentration, and loss of engagement <\/span><span lang=\"EN-US\">(Shahrvini et al., 2020; Singh et al., 2020)<\/span><span lang=\"EN-US\">. Students also provided feedback on the excessive numbers of lectures and inappropriately long lessons <\/span><span lang=\"EN-US\">(Khalil et al., 2020; Rafi et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">4) Technical challenges:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">With the growing reliance on technology, technical issues could compromise the quality of learning and affect learners\u2019 and tutors\u2019 experiences <\/span><span lang=\"EN-US\">(Atreya &amp; Acharya, 2020; Farooq et al., 2020; Khalil et al., 2020; Sud et al., 2020)<\/span><span lang=\"EN-US\">. Online lectures have often been conducted without real-time technical support <\/span><span lang=\"EN-US\">(Longhurst et al., 2020)<\/span><span lang=\"EN-US\">, as most institutions lack a dedicated information technology (IT) department <\/span><span lang=\"EN-US\">(Farooq et al., 2020)<\/span><span lang=\"EN-US\">. Given the steep learning curve with IT <\/span><span lang=\"EN-US\">(Remtulla, 2020)<\/span><span lang=\"EN-US\">, it is not surprising that students have reported a lack of confidence in completing online assignments <\/span><span lang=\"EN-US\">(Muflih et al., 2020)<\/span><span lang=\"EN-US\">. Institutions should provide basic computer literacy courses to students and tutors <\/span><span lang=\"EN-US\">(Muflih et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">With families staying home during lockdowns, students often had to share devices <\/span><span lang=\"EN-US\">(Sud et al., 2020)<\/span><span lang=\"EN-US\"> and internet access <\/span><span lang=\"EN-US\">(Atreya &amp; Acharya, 2020; Roskvist et al., 2020)<\/span><span lang=\"EN-US\"> with household members. Online learning has also been adversely impacted by limited internet connectivity at remote geographical locations <\/span><span lang=\"EN-US\">(Cruess et al., 2014; Farooq et al., 2020; Remtulla, 2020; Roskvist et al., 2020)<\/span><span lang=\"EN-US\"> and electrical interruptions from bad weather <\/span><span lang=\"EN-US\">(Atreya &amp; Acharya, 2020)<\/span><span lang=\"EN-US\">. Although the subscription of costly internet data bundles could circumvent these challenges, socioeconomic disparities could result in the less privileged students falling through the cracks. Hence, institutions must ensure the benefits of online education can be shared equitably by all students <\/span><span lang=\"EN-US\">(Muflih et al., 2020)<\/span><span lang=\"EN-US\">. <\/span><\/p>\r\n<p><i><span lang=\"EN-US\">D. Effectiveness of Innovations and Adaptations in Delivering Medical Education<\/span><\/i><span lang=\"EN-US\"><\/span><\/p>\r\n<p><i><span lang=\"EN-US\">1) Effectiveness of digital learning: <\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Overall, medical students expressed satisfaction with digital learning during the pandemic <\/span><span lang=\"EN-US\">(Sandhaus et al., 2020)<\/span><span lang=\"EN-US\">, and reported ample opportunities for clarification <\/span><span lang=\"EN-US\">(Singh et al., 2020)<\/span><span lang=\"EN-US\"> and communication with classmates and tutors <\/span><span lang=\"EN-US\">(Muflih et al., 2020)<\/span><span lang=\"EN-US\">. Synchronous virtual lessons were reportedly well-attended, with active student participation <\/span><span lang=\"EN-US\">(Nic Dhonncha &amp; Murphy, 2021)<\/span><span lang=\"EN-US\">. Not only have online classes been viewed as a viable substitute for in-person teaching <\/span><span lang=\"EN-US\">(Sud et al., 2020)<\/span><span lang=\"EN-US\">, a significant proportion of pre-clinical students have expressed a preference for online learning over traditional teaching <\/span><span lang=\"EN-US\">(Khalil et al., 2020)<\/span><span lang=\"EN-US\">, leading to calls for online learning to be retained as a teaching modality post-pandemic. It might be worthwhile to consider the introduction of a hybrid model, comprising both online webinars and face-to-face teaching, in the medical curriculum <\/span><span lang=\"EN-US\">(Hammond et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">2) Access to learning:<\/span><\/i><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">With intermittent lock-down and return of international students to their native countries, online teaching platforms facilitated worldwide access to learning resources <\/span><span lang=\"EN-US\">(Mukhtar et al., 2020)<\/span><span lang=\"EN-US\">. Medical students have also reported benefits arising from flexibility of learning in the comfort of their homes at their own pace <\/span><span lang=\"EN-US\">(Cruess et al., 2014; Farooq et al., 2020)<\/span><span lang=\"EN-US\">, and feeling empowered to adopt an <\/span><span lang=\"EN-GB\">individualised <\/span><span lang=\"EN-US\">approach to learning <\/span><span lang=\"EN-US\">(Loh &amp; Nalliah, 2010)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">3) Time efficiency:<\/span><\/i><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Online learning reduces commute time <\/span><span lang=\"EN-US\">(Mukhtar et al., 2020; Shahrvini et al., 2020; Sud et al., 2020)<\/span><span lang=\"EN-US\"> and campus-based distractions <\/span><span lang=\"EN-US\">(Sud et al., 2020)<\/span><span lang=\"EN-US\">. With better utility of time, students have had capacity to engage in concurrent activities like volunteering in COVID-19 relief efforts, thereby contributing to their holistic development <\/span><span lang=\"EN-US\">(Shahrvini et al., 2020)<\/span><span lang=\"EN-US\">. There is also potential for improved academic performance due to efficient time management, better sleep patterns and reduced anxiety associated with learning within comfort zones <\/span><span lang=\"EN-US\">(Khalil et al., 2020)<\/span><span lang=\"EN-US\">. Some students have also reported satisfaction of having more family bonding time <\/span><span lang=\"EN-US\">(Sud et al., 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">4) Increased self-directed learning and student-led initiatives:<\/span><\/i><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Sudden cessation of traditional, classroom-based teaching has presented a serendipitous opportunity for students to cultivate active learning <\/span><span lang=\"EN-GB\">behaviours and initiate student-led<\/span><span lang=\"EN-US\"> teaching to their peers <\/span><span lang=\"EN-US\">(Newman &amp; Lattouf, 2020; Roberts et al., 2020)<\/span><span lang=\"EN-US\">. At the Bristol Medical School, a student-led society delivered peer-led teaching sessions via video conferencing platforms <\/span><span lang=\"EN-US\">(Roberts et al., 2020)<\/span><span lang=\"EN-US\">. These sessions not only helped mentees master content and clarify misconceptions, but also helped mentors reinforce foundational concepts. Students also leveraged on the prevailing volatility, uncertainty, complexity and ambiguity (VUCA) to learn coping skills and develop resilience and versatility, in preparation for their future careers <\/span><span lang=\"EN-US\">(Ferrel &amp; Ryan, 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">5) Opportunities for faculty development:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The COVID-19 pandemic has provided opportunities for universities to strengthen their current curricula by developing new relevant resources, exploring novel blended learning techniques, and developing alternative assessment methods <\/span><span lang=\"EN-US\">(Longhurst et al., 2020)<\/span><span lang=\"EN-US\">. In a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, 71% of British universities identified opportunities to develop new online resources, while 50% cited avenues for academic collaboration between universities <\/span><span lang=\"EN-US\">(Joseph et al., 2020)<\/span><span lang=\"EN-US\">. Faculty members have also reported opportunities to upskill in new technologies, incorporate innovative software into current curricula and boost their confidence in navigating virtual learning platforms.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">IV. <\/span><span lang=\"EN-GB\">DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The COVID-19 pandemic has caused major disruptions to medical education globally and left students feeling incompetent, unmotivated, and anxious. It has also challenged medical schools to explore novel ways of teaching and training that mitigate the risks associated with the pandemic. Insights gathered in this review could inform a strategy for the development of medical curricula in the post-pandemic era, integrating digital technology and novel pedagogy. As there is a paucity of good-quality studies, the effectiveness of virtual learning remains to be proven. However, online teaching cannot substitute for authentic clinical experiences. Modules using simulations and virtual or augmented reality may bridge the gap in procedural skills training, but the loss of inter-professional interactions could affect students\u2019 ability to internalise the core values of medical professionalism \u2013 a fundamental component in medical education. Professionalism is traditionally taught through observation of inter-professional interactions, experiential learning, and role-modelling <\/span><span lang=\"EN-US\">(Cruess et al., 2014; Loh &amp; Nalliah, 2010)<\/span><span lang=\"EN-US\">. Hence, it is important that clerkship rotations are maintained with risk mitigation measures in place so that students can continue to learn and internalise the attributes of medical professionalism, mentored by their tutors.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The present review also revealed the mind shift of medical educators saddled with a protracted pandemic. Early inclination to exclude medical students from all forms of clinical work at the start of the pandemic has progressed to a collective resolve to equip them with the skills and knowledge to manage a pandemic as the future healthcare workforce <\/span><span lang=\"EN-US\">(Halbert et al., 2020; Tolsgaard et al., 2020)<\/span><span lang=\"EN-US\">. The cautious re-introduction of clinical training has been facilitated by the availability of vaccination and regular testing. To further mitigate risks, students could be embedded in smaller care teams with close supervision. Clinical rotations could also be shortened to the minimum required to achieve competence, with provision for extension of training if students fail to attain proficiency. The opportunity to participate in the pandemic and show courage and altruism by fighting alongside other healthcare workers could go a long way to bolster their confidence and cultivate a shared sense of purpose among students <\/span><span lang=\"EN-US\">(Chandratre, 2020)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Mental health issues have taken a toll on medical students, stemming from social isolation, lack of work-life balance, experience of illness and death among colleagues and families, and perceptions of inadequacy. However, there is a paucity of published studies on effective measures to address mental health issues during the COVID-19 pandemic. As a group, medical students have a higher prevalence of mental health issues <\/span><span lang=\"EN-US\">(Molodynski et al., 2021; Schwenk et al., 2010)<\/span><span lang=\"EN-US\">, and are less likely to seek help <\/span><span lang=\"EN-US\">(Molodynski et al., 2021)<\/span><span lang=\"EN-US\">. Thus, it is imperative to increase surveillance for this at-risk group and strengthen peer support and engagement channels. Further research should seek to delineate the range of mental health conditions faced by medical students in this pandemic, the influence of socio-cultural factors and effective strategies for surveillance and support.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Nonetheless, this systematic review has its limitations. The search was conducted using PubMed for its comprehensive coverage of indexed journal articles, including &#8220;in process&#8221; citations and links to related citations. However, this could have led to the exclusion of journals not cited by PubMed and the presentation of a more restricted view. References in non-English languages were not analysed. As we have confined our literature search to 1 February 2020 to 1 September 2020 to capture the challenges and innovations in undergraduate medical education at the height of the pandemic, we were unable to report the adaptations to medical education emerging after 1 Sep 2020.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">V. <\/span><span lang=\"EN-GB\">CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The COVID-19 pandemic has provided unexpected, yet invaluable opportunities to explore new pedagogies that may be instrumental in shaping medical education in the new norm. Institutions should continue to evaluate and refine these new teaching techniques and content to ensure that the medical curriculum stays relevant and robust. As future members of the healthcare work force in the post-pandemic era, medical students should be integrated into current health systems to equip them with the knowledge, skills, and experience to manage future pandemics. This would also help forge a collective sense of purpose in these uncertain times.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">CJT performed the literature search and synthesis, wrote part of the manuscript, and prepared the figure. CC helped with the literature search and wrote part of the manuscript. FI helped in the resolution of disagreements in the literature search and constitution of the manuscript. EL helped in the planning the study, resolution of disagreements in the literature search and constitution of the manuscript.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">As this study is a systematic review, ethical approval and IRB application was not required.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p><span lang=\"EN-US\">The data that support the findings of this study are openly available in Figshare repository <\/span><span lang=\"EN-US\"><a href=\"http:\/\/doi.org\/10.6084\/m%209.figshare.17296856\">http:\/\/doi.org\/10.6084\/m 9.figshare.17296856<\/a><\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">All authors have no funding sources to declare.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">All authors declare that they have no competing interests.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Ashokka, B., Ong, S. Y., Tay, K. H., Loh, N. H. W., Gee, C. F., &amp; Samarasekera, D. D. (2020). Coordinated responses of academic medical centres to pandemics: Sustaining medical education during COVID-19. <i>Medical Teacher<\/i>,<i> 42<\/i>(7), 762-771. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1080\/0142159x.2020.1757634\">https:\/\/doi.org\/10.1080\/0142159x.2020.1757634<\/a><\/span><span lang=\"EN\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Atreya, A., &amp; Acharya, J. (2020). Distant virtual medical education during COVID-19: Half a loaf of bread. <i>The <\/i><i>Clinical Teacher<\/i>,<i> 17<\/i>(4), 418-419. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/tct.13185\">https:\/\/doi.org\/10.1111\/tct.13185<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Calhoun, K. E., Yale, L. A., Whipple, M. E., Allen, S. M., Wood, D. E., &amp; Tatum, R. P. (2020). The impact of COVID-19 on medical student surgical education: Implementing extreme pandemic response measures in a widely distributed surgical clerkship experience. <i>The American Journal of Surgery, 220<\/i>(1), 44-47. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1016\/j.amjsurg.2020.04.024%20\">https:\/\/doi.org\/10.1016\/j.amjsurg.2020.04.024<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Chandratre, S. (2020). Medical students and COVID-19: Challenges and supportive strategies. <i>Journal of Medical Education and Curricular Development<\/i>,<i> 7<\/i>. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1177\/2382120520935059%20\">https:\/\/doi.org\/10.1177\/2382120520935059<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Chao, T. N., Frost, A. S., Brody, R. M., Byrnes, Y. M., Cannady, S. B., Luu, N. N., Rajasekaran, K., Shanti, R. M., Silberthau, K. R., Triantafillou, V., &amp; Newman, J. G. (2021). Creation of an interactive virtual surgical rotation for undergraduate medical education during the COVID-19 pandemic. <i>Journal of Surgical Education<\/i>,<i> 78<\/i>(1), 346-350. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1016\/j.jsurg.2020.06.039%20\">https:\/\/doi.org\/10.1016\/j.jsurg.2020.06.039<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Choi, B., Jegatheeswaran, L., Minocha, A., Alhilani, M., Nakhoul, M., &amp; Mutengesa, E. (2020). The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: A national survey. <i>BMC Medical Education<\/i>,<i> 20<\/i>(1), 206. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-020-02117-1%20\">https:\/\/doi.org\/10.1186\/s12909-020-02117-1<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Co, M., &amp; Chu, K. M. (2020). Distant surgical teaching during COVID-19 &#8211; A pilot study on final year medical students. <i>Surgical Practice<\/i>, <i>24<\/i>(3), 105\u2013 109. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/1744-1633.12436%20\">https:\/\/doi.org\/10.1111\/1744-1633.12436<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., &amp; Steinert, Y. (2014). Reframing medical education to support professional identity formation. <i>Academic Medicine<\/i>,<i> 89<\/i>(11), 1446-1451. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1097\/acm.0000000000000427%20\">https:\/\/doi.org\/10.1097\/acm.0000000000000427<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Darras, K. E., Spouge, R. J., de Bruin, A. B. H., Sedlic, A., Hague, C., &amp; Forster, B. B. (2021). Undergraduate radiology education during the COVID-19 pandemic: A review of teaching and learning strategies. <i>Canadian Association of Radiologists Journal<\/i>,<i> 72<\/i>(2), 194-200. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1177\/0846537120944821%20\">https:\/\/doi.org\/10.1177\/0846537120944821<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Farooq, F., Rathore, F. A., &amp; Mansoor, S. N. (2020). Challenges of online medical education in Pakistan during COVID-19 pandemic. <i>Journal of the College of Physicians and Surgeons Pakistan<\/i>, <i>30<\/i>(6), 67\u201369. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.29271\/jcpsp.2020.Supp1.S67%20\">https:\/\/doi.org\/10.29271\/jcpsp.2020.Supp1.S67<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Ferrel, M. N., &amp; Ryan, J. J. (2020). The impact of COVID-19 on medical education. <i>Cureus<\/i>,<i> 12<\/i>(3), e7492. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.7759\/cureus.7492%20\">https:\/\/doi.org\/10.7759\/cureus.7492<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Go, B., &amp; Rajasekaran, K. (2020). Effect of COVID-19 in selecting otolaryngology as a specialty. <i>Head &amp; Neck<\/i>,<i> 42<\/i>(7), 1409-1410. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1002\/hed.26251%20\">https:\/\/doi.org\/10.1002\/hed.26251<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Halbert, J. A., Jones, A., &amp; Ramsey, L. P. (2020). Clinical placements for medical students in the time of COVID-19. <i>Medical Journal of Australia<\/i>,<i> 213<\/i>(2), 69-69. e61. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.5694\/mja2.50686%20\">https:\/\/doi.org\/10.5694\/mja2.50686<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Hammond, D., Louca, C., Leeves, L., &amp; Rampes, S. (2020). Undergraduate medical education and Covid-19: Engaged but abstract. <i>Medical Education Online, 25<\/i>(1), 1781379. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1080\/10872981.2020.1781379\">https:\/\/doi.org\/10.1080\/10872981.2020.1781379<\/a><\/span><span><span lang=\"EN\"><\/span><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Hilburg, R., Patel, N., Ambruso, S., Biewald, M. A., &amp; Farouk, S. S. (2020). Medical Education During the Coronavirus Disease-2019 Pandemic: Learning From a Distance. <i>Advances in Chronic Kidney Disease<\/i>,<i> 27<\/i>(5), 412-417. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1053\/j.ackd.2020.05.017%20\">https:\/\/doi.org\/10.1053\/j.ackd.2020.05.017<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., . . .<\/span><span lang=\"EN\"> <\/span><span lang=\"EN\">Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. <i>The Lancet<\/i>,<i> 395<\/i>(10223), 497-506. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1016\/S0140-6736(20)30183-5\">https:\/\/doi.org\/10.1016\/S0140-6736(20)30183-5<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Iancu, A. M., Kemp, M. T., &amp; Alam, H. B. (2020). Unmuting medical students\u2019 education: Utilizing telemedicine during the COVID-19 pandemic and beyond. <i>Journal of Medical Internet Research<\/i>,<i> 22<\/i>(7), e19667. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.2196\/19667\">https:\/\/doi.org\/10.2196\/19667<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Iqbal, M. Z., Alradhi, H. I., Alhumaidi, A. A., Alshaikh, K. H., AlObaid, A. M., Alhashim, M. T., &amp; AlSheikh, M. H. (2020). Telegram as a tool to supplement online medical education during COVID-19 crisis. <i>Acta Informatica Medica<\/i>,<i> 28<\/i>(2), 94-97. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.5455\/aim.2020.28.94-97%20\">https:\/\/doi.org\/10.5455\/aim.2020.28.94-97<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Joseph, J. P., Joseph, A. O., Conn, G., Ahsan, E., Jackson, R., &amp; Kinnear, J. (2020). COVID-19 pandemic-medical education adaptations: The power of students, staff and technology. <i>Medical Science Educator<\/i>,<i> 30<\/i>(4), 1355-1356. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1007\/s40670-020-01038-4%20\">https:\/\/doi.org\/10.1007\/s40670-020-01038-4<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Khalil, R., Mansour, A. E., Fadda, W. A., Almisnid, K., Aldamegh, M., Al-Nafeesah, A., Alkhalifah, A., &amp; Al-Wutayd, O. (2020). The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: A qualitative study exploring medical students\u2019 perspectives. <i>BMC Medical Education<\/i>,<i> 20<\/i>(1), 285. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-020-02208-z%20\">https:\/\/doi.org\/10.1186\/s12909-020-02208-z<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Loh, K. Y., &amp; Nalliah, S. (2010). Learning professionalism by role-modelling. <i>Medical Education<\/i>,<i> 44<\/i>(11), 1123. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/j.1365-2923.2010.03827.x\">https:\/\/doi.org\/10.1111\/j.1365-2923.2010.03827.x<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Longhurst, G. J., Stone, D. M., Dulohery, K., Scully, D., Campbell, T., &amp; Smith, C. F. (2020). Strength, Weakness, Opportunity, Threat (SWOT) Analysis of the adaptations to anatomical education in the United Kingdom and Republic of Ireland in response to the Covid-19 pandemic. <i>Anatomical Sciences Education<\/i>,<i> 13<\/i>(3), 301-311. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1002\/ase.1967\">https:\/\/doi.org\/10.1002\/ase.1967<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Maini, A., Saravanan, Y., Singh, T. A., &amp; Fyfe, M. (2020). Coaching skills for medical education in a VUCA world. <i>Medical Teacher<\/i>,<i> 42<\/i>(11), 1308-1309. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1080\/0142159x.2020.1788713%20\">https:\/\/doi.org\/10.1080\/0142159x.2020.1788713<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Molodynski, A., Lewis, T., Kadhum, M., Farrell, S. M., Lemtiri Chelieh, M., Falc\u00e3o De Almeida, T., Masri, R., Kar, A., Volpe, U., Moir, F., Torales, J., Castaldelli-Maia, J. M., Chau, S. W. H., Wilkes, C., &amp; Bhugra, D. (2021). Cultural variations in wellbeing, burnout and substance use amongst medical students in twelve countries. <i>International Review of Psychiatry<\/i>,<i> 33<\/i>(1-2), 37-42. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1080\/09540261.2020.1738064%20\">https:\/\/doi.org\/10.1080\/09540261.2020.1738064<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Muflih, S., Abuhammad, S., Karasneh, R., Al-Azzam, S., Alzoubi, K. H., &amp; Muflih, M. (2020). Online education for undergraduate health professional education during the COVID-19 pandemic: Attitudes, barriers, and ethical issues. <i>Research Square.<\/i> <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.21203\/rs.3.rs-42336\/v1\">https:\/\/doi.org\/10.21203\/rs.3.rs-42336\/v1<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Mukhtar, K., Javed, K., Arooj, M., &amp; Sethi, A. (2020). Advantages, limitations and recommendations for online learning during COVID-19 pandemic era. <i>Pakistan Journal of Medical Sciences, 36<\/i>(Covid19-s4), S27-S31. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.12669\/pjms.36.COVID19-S4.2785%20\">https:\/\/doi.org\/10.12669\/pjms.36.COVID19-S4.2785<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Murphy, B. (2020). <i>COVID-19: How the virus is impacting medical schools<\/i>. Retrieved 18 Dec, 2020, from <\/span><span lang=\"EN\"><a href=\"https:\/\/www.ama-assn.org\/delivering-care\/public-health\/covid-19-how-virus-impacting-medical-schools\">https:\/\/www.ama-assn.org\/delivering-care\/public-health\/covid-19-how-virus-impacting-medical-schools<\/a><\/span><span><span lang=\"EN\"><\/span><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Naidoo, N., Akhras, A., &amp; Banerjee, Y. (2020). Confronting the challenges of anatomy education in a competency-based medical curriculum during normal and unprecedented times (COVID-19 Pandemic): Pedagogical framework development and implementation. <i>JMIR Medical Education<\/i>,<i> 6<\/i>(2), e21701. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.2196\/21701\">https:\/\/doi.org\/10.2196\/21701<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Newman, N. A., &amp; Lattouf, O. M. (2020). Coalition for medical education\u2014A call to action: A proposition to adapt clinical medical education to meet the needs of students and other healthcare learners during COVID-19. <i>Journal of Cardiac Surgery<\/i>,<i> 35<\/i>(6), 1174-1175. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/jocs.14590\">https:\/\/doi.org\/10.1111\/jocs.14590<\/a><\/span><span lang=\"EN\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Nic Dhonncha, E., &amp; Murphy, M. (2021). Learning new ways of teaching and assessment: the impact of COVID-19 on undergraduate dermatology education. <i>Clinical and Experimental Dermatology<\/i>,<i> 46<\/i>(1), 170-171. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/ced.14364\">https:\/\/doi.org\/10.1111\/ced.14364<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Oki, O., Shah, S., Scrivens, L., &amp; Guckian, J. (2021). COVID-19: Challenges and solutions for the future of UK dermatology undergraduate curriculum delivery. <i>Clinical and Experimental Dermatology<\/i>,<i> 46<\/i>(1), 171-173. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/ced.14386\">https:\/\/doi.org\/10.1111\/ced.14386<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hr\u00f3bjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. <i>BMJ<\/i>,<i> 372<\/i>, n71. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1136\/bmj.n71\">https:\/\/doi.org\/10.1136\/bmj.n71<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Rafi, A. M., Varghese, P. R., &amp; Kuttichira, P. (2020). The pedagogical shift during COVID 19 pandemic: Online medical education, barriers and perceptions in Central Kerala. <i>Journal of Medical Education and Curricular Development, 7. <\/i><\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1177\/2382120520951795%20\"><span lang=\"EN-US\">https:\/\/doi.org\/10.1177\/2382120520951795<\/span><\/a><\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Rallis, K. S., &amp; Allen-Tejerina, A. M. (2020). Tele-oncology in the COVID-19 era: Are medical students left behind? <i>Trends Cancer<\/i>,<i> 6<\/i>(10), 811-812. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1016\/j.trecan.2020.08.001%20\">https:\/\/doi.org\/10.1016\/j.trecan.2020.08.001<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Remtulla, R. (2020). The present and future applications of technology in adapting medical education amidst the COVID-19 pandemic. <i>JMIR Medical Education<\/i>,<i> 6<\/i>(2), e20190. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.2196\/20190\">https:\/\/doi.org\/10.2196\/20190<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Roberts, V., Malone, K., Moore, P., Russell-Webster, T., &amp; Caulfield, R. (2020). Peer teaching medical students during a pandemic. <i>Medical Education Online<\/i>,<i> 25<\/i>(1), 1772014. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1080\/10872981.2020.1772014%20\">https:\/\/doi.org\/10.1080\/10872981.2020.1772014<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Roskvist, R., Eggleton, K., &amp; Goodyear-Smith, F. (2020). Provision of e-learning programmes to replace undergraduate medical students&#8217; clinical general practice attachments during COVID-19 stand-down. <i>Education for Primary Care<\/i>,<i> 31<\/i>(4), 247-254. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1080\/14739879.2020.1772123\">https:\/\/doi.org\/10.1080\/14739879.2020.1772123<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Sam, A. H., Millar, K. R., &amp; Lupton, M. G. F. (2020). Digital clinical placement for medical students in response to COVID-19. <i>Academic Medicine, 95<\/i>(8), 1126. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1097\/acm.0000000000003431%20\">https:\/\/doi.org\/10.1097\/acm.0000000000003431<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Sandhaus, Y., Kushnir, T., &amp; Ashkenazi, S. (2020). Electronic distance learning of pre-clinical studies during the COVID-19 pandemic: A preliminary study of medical student responses and potential future impact. <i>The Israel Medical Association Journal, 22<\/i>(8), 489-493. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Schaffir, J., Strafford, K., Worly, B., &amp; Traugott, A. (2020). Challenges to medical education on surgical services during the COVID-19 pandemic. <i>Medical Science Educator<\/i>,<i> 30<\/i>(4), 1667\u20131671. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1007\/s40670-020-01072-2\">https:\/\/doi.org\/10.1007\/s40670-020-01072-2<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Schwenk, T. L., Davis, L., &amp; Wimsatt, L. A. (2010). Depression, stigma, and suicidal ideation in medical students. <i>JAMA<\/i>,<i> 304<\/i>(11), 1181-1190. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1001\/jama.2010.1300\">https:\/\/doi.org\/10.1001\/jama.2010.1300<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Shahrvini, B., Baxter, S. L., Coffey, C. S., MacDonald, B. V., &amp; Lander, L. (2020). Pre-clinical remote undergraduate medical education during the COVID-19 pandemic: A survey study. <i>Research Square<\/i>. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.21203\/rs.3.rs-33870\/v1\">https:\/\/doi.org\/10.21203\/rs.3.rs-33870\/v1<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Shehata, M. H., Abouzeid, E., Wasfy, N. F., Abdelaziz, A., Wells, R. L., &amp; Ahmed, S. A. (2020). Medical education adaptations post COVID-19: An Egyptian reflection. <i>Journal of Medical Education and Curricular Development, 7. <\/i><\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1177\/2382120520951819%20\">https:\/\/doi.org\/10.1177\/2382120520951819<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Singh, K., Srivastav, S., Bhardwaj, A., Dixit, A., &amp; Misra, S. (2020). Medical education during the COVID-19 pandemic: A single institution experience. <i>Indian Pediatrics<\/i>,<i> 57<\/i>(7), 678-679. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1007\/s13312-020-1899-2%20\">https:\/\/doi.org\/10.1007\/s13312-020-1899-2<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Sud, R., Sharma, P., Budhwar, V., &amp; Khanduja, S. (2020). Undergraduate ophthalmology teaching in COVID-19 times: Students&#8217; perspective and feedback. <i>Indian Journal of Ophthalmologyy, 68<\/i>(7), 1490-1491. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.4103\/ijo.IJO_1689_20%20\">https:\/\/doi.org\/10.4103\/ijo.IJO_1689_20<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Tan, J. W. C., Cai, C., Ithnin, F., &amp; Lew, E. (2021). <i>Challenges and innovations in undergraduate medical education during the COVID-19 pandemic \u2013 A systematic review<\/i> [Data set]. Figshare. <\/span><span lang=\"EN\"><a href=\"http:\/\/doi.org10.6084\/m9.figshare.17296856\">http:\/\/doi.org\/10.6084\/m9.figshare.17296856<\/a><\/span><span lang=\"EN\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Theoret, C., &amp; Ming, X. (2020). Our education, our concerns: The impact on medical student education of COVID-19. <i>Medical Education<\/i>,<i> 54<\/i>(7), 591-592. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/medu.14181\">https:\/\/doi.org\/10.1111\/medu.14181<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Toku\u00e7, B., &amp; Varol, G. (2020). Medical education in Turkey in time of COVID-19. <i>Balkan Medical Journal<\/i>,<i> 37<\/i>(4), 180-181. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.4274\/balkanmedj.galenos.2020.2020.4.003\">https:\/\/doi.org\/10.4274\/balkanmedj.galenos.2020.2020.4.003<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Tolsgaard, M. G., Cleland, J., Wilkinson, T., &amp; Ellaway, R. H. (2020). How we make choices and sacrifices in medical education during the COVID-19 pandemic. <i>Medical Teacher<\/i>,<i> 42<\/i>(7), 741-743. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1080\/0142159x.2020.1767769\">https:\/\/doi.org\/10.1080\/0142159x.2020.1767769<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN\">Torales, J., O&#8217;Higgins, M., Castaldelli-Maia, J. M., &amp; Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. <i>International Journal of Social Psychiatry<\/i>,<i> 66<\/i>(4), 317-320. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1177\/0020764020915212%20\">https:\/\/doi.org\/10.1177\/0020764020915212<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN-US\"><span lang=\"EN-NZ\"><span lang=\"EN-AU\">*Eileen Lew<br \/>\r\n<span lang=\"EN-GB\">KK Women&#8217;s and Children&#8217;s Hospital<\/span>,<br \/>\r\n<\/span><span lang=\"EN-AU\"><span lang=\"EN-GB\">100 Bukit Timah Road<\/span><br \/>\r\n<span lang=\"EN-GB\">Singapore 229899<\/span><br \/>\r\n<span lang=\"EN-GB\">Telephone: +65 6394 2422<\/span><br \/>\r\n<\/span><\/span><span lang=\"EN-NZ\"><span lang=\"EN-AU\"><span lang=\"EN-GB\">Email: eileen.lew@singhealth.com.sg<\/span><\/span><\/span><\/span><\/p>\r\n<\/div>\r\n<p align=\"center\" style=\"text-align: left\"><\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":1,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61872],"class_list":["post-71698","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-7-number-3-july-2022"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - 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