PURPOSE:Understanding the factors that influence prosocial behaviour during the COVID-19 pandemic is essential due to the disruption to healthcare provision.METHODS:We conducted an in-depth, mixed-methods cross-sectional survey, from 2 May 2020 to 15 June 2020, of medical students at medical schools in the United Kingdom. Data analysis was informed by Latané and Darley's theory of prosocial behaviour during an emergency.RESULTS:A total of 1145 medical students from 36 medical schools responded. Although 947 (82.7%) of students were willing to volunteer, only 391 (34.3%) had volunteered. Of the students, 92.7% understood they may be asked to volunteer; however, we found deciding one's responsibility to volunteer was mitigated by a complex interaction between the interests of others and self-interest. Further, concerns revolving around professional role boundaries influenced students' decisions over whether they had the required skills and knowledge.CONCLUSION:We propose two additional domains to Latané and Darley's theory that medical students consider before making their final decision to volunteer: 'logistics' and 'safety'. We highlight modifiable barriers to prosocial behaviour and provide suggestions regarding how the conceptual framework can be operationalized within educational strategies to address these barriers. Optimizing the process of volunteering can aid healthcare provision and may facilitate a safer volunteering process. Key messages  What is already known on this topic: There is a discrepancy between the number of students willing to volunteer during pandemics and disasters, and those who actually volunteer. Understanding the factors that influence prosocial behaviour during the current COVID-19 pandemic and future pandemics and disasters is essential. What this study adds: We expanded on Latané and Darley's theory of prosocial behaviour in an emergency and used this to conceptualize students' motivations to volunteer, highlighting a number of modifiable barriers to prosocial behaviour during the COVID-19 pandemic. How this study might affect research, practice, or policy: We provide suggestions regarding how the conceptual framework can be operationalized to support prosocial behaviours during emergencies for the ongoing COVID-19 pandemic and future crises.

Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements. We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 ‘lockdown’ period in the UK (March–July 2020). Analysis was informed by the conceptual framework of service and learning. 1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual’s experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop. The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.Practice pointsThere was a benefit for most students who provided clinical support compared to those who did not during Covid-19.Most students found clinical support roles more beneficial than clinical placements and most final years wanted their final year clinical placements replaced by a formal role within a clinical team.Not every student’s experience of clinical support was equal. The conceptual framework of service and learning can help explain this heterogeneity.The most beneficial roles for students complemented the curriculum and provided opportunities for clinical skill development, reflective practice, and meaningful contribution to the health service.There is an added benefit of combining service and learning if done correctly, and we can use this to inform the structure of clinical placements going forwards. However, there are risks, and we discuss principles of good practice and provide our own considerations. Practice points There was a benefit for most students who provided clinical support compared to those who did not during Covid-19. Most students found clinical support roles more beneficial than clinical placements and most final years wanted their final year clinical placements replaced by a formal role within a clinical team. Not every student’s experience of clinical support was equal. The conceptual framework of service and learning can help explain this heterogeneity. The most beneficial roles for students complemented the curriculum and provided opportunities for clinical skill development, reflective practice, and meaningful contribution to the health service. There is an added benefit of combining service and learning if done correctly, and we can use this to inform the structure of clinical placements going forwards. However, there are risks, and we discuss principles of good practice and provide our own considerations.

Introduction Professional identity formation is a priority of medical training. Covid-19 caused disruption to medical education. We ask how this disruption impacted professional identity formation through the lens of the activities performed – or not performed – by medical students during the first wave of the covid-19 pandemic, and perceptions of conflicts between these activities. Methods A pragmatic mixed-methods survey was distributed to medical students in the UK. The survey was active from 2nd May to 15th June 2020, during the height of the first wave of the Covid-19 pandemic in the UK. Operating within the paradigm of constructivism, we conducted a reflexive thematic analysis of qualitative responses to three open questions. Analysis was focused around the disruption to medical education, actions taken by medical students during this disruption, and the tension between student actions (where they existed in conflict). Results We analysed 928 responses and constructed three themes: Status and role as a future doctor Status and role as a student Status and role as a member of the wider community Conflict arose at the intersections between these three themes. Students noted that lack of clinical exposure was detrimental to their education, implicitly recognising that some aspects of professional identity formation require the clinical environment. Participants were keen to volunteer clinically, but struggled to balance this and academic work. Participants worried about risk to their families and the wider community and wanted to ensure their skills added value to the clinical environment. Volunteers felt frustrated when they were unable to perform tasks aligning with their identity as a future doctor. An exception was participants who worked as interim FY1s, aligned with the role of an FY1. Conclusions Medical students feel a duty to help during crises. There is conflict when different aspects of their identity demand different actions. Covid-19 heightened issues with developing professional identity for medical students, including lack of a defined role, and perceived undervaluing of their skills by other members of the healthcare team. Care must be taken to nurture professional identity formation even during periods of disruption.

BackgroundThe COVID-19 pandemic has presented substantial new challenges to clinical and research teams. Our objective was to analyse the experience of investigators and research delivery staff regarding the research response to COVID-19 in order to identify these challenges as well as solutions for future pandemic planning.MethodsWe conducted a survey of diverse research staff involved in delivery of COVID-19 clinical trials across the UK. This was delivered online across centres linked to the NIHR Respiratory Translational Research Collaboration. Responses were analysed using a formal thematic analysis approach to identify common themes and recommendations.Results83 survey participants from ten teaching hospitals provided 922 individual question responses. Respondents were involved in a range of research delivery roles but the largest cohort (60%) was study investigators. A wide range of research experiences were captured, including early and late phase trials. Responses were coded into overarching themes. Among common observations, complex protocols without adaptation to a pandemic were noted to have hampered recruitment. Recommendations included the need to develop and test pandemic-specific protocols, and make use of innovations in information technology. Research competition needs to be avoided and drug selection processes should be explicitly transparent.ConclusionsDelivery of clinical trials, particularly earlier phase trials, in a pandemic clinical environment is highly challenging, and was reactive rather than anticipatory. Future pandemic studies should be designed and tested in advance, making use of pragmatic study designs as far as possible and planning for integration between early and later phase trials and regulatory frameworks.

Abstract Introduction COVID-19 led to global disruption of healthcare and many students volunteered to provide clinical support. Volunteering to work was a unique medical education opportunity; however, it is unknown whether this was a positive learning experience. Methods The COVID Ready 2 study is a national cross-sectional study of all medical students at UK medical schools. We will compare opinions of those who did and did not volunteer to determine the educational benefit and issues they faced. We will use thematic analysis to identify themes in qualitative responses, in addition to quantitative analysis. Results The primary objective is to explore the effect of volunteering during the pandemic on medical education in comparison to those who did not volunteer. Our secondary objectives are to identify: whether students would be willing to assume similar roles in a non-pandemic setting; if students found the experience more or less beneficial than traditional hospital placements and reasons for this; what the perceived benefits and disadvantages of volunteering were; the difference in perceived preparedness between students who did and did not volunteer for foundation training year one and the next academic year; training received by volunteers; and to explore issues associated with volunteering, including safety issues and issues with role and competence. Conclusions We anticipate this study will help identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future; and help determine whether formal voluntary roles should be introduced into the non-pandemic medical curriculum.

ABSTRACTIntroductionCOVID-19 has caused major disruptions to healthcare, with voluntary opportunities offered to medical students to provide clinical support. We used the conceptual framework of prosocial behavior during an emergency – behaviors whose primary focus is benefiting others – to examine volunteering during COVID-19.MethodsWe conducted an in-depth, mixed-methods cross-sectional survey, from 2nd May to 15th June 2020, of medical students studying at UK medical schools. Data analysis was informed by Latane and Darley’s theory of prosocial behavior during an emergency and aimed to understand students’ decision-making processes.ResultsA total of 1145 medical students from 36 medical schools completed the survey. While 947 (82.7%) of students were willing to volunteer, only 391 (34.3%) had volunteered. The majority (92.7%) of students understood that they may be asked to volunteer; however, we found that deciding one’s responsibility to volunteer was mitigated by a complex interaction between the interests of others and self-interest. Further, concerns revolving around professional role boundaries influenced students’ decisions over whether they had the required skills and knowledge to volunteer. Deciding to volunteer depended not only on possession of necessary skills, but also seniority and identification with the nature of volunteering roles offered.ConclusionsWe propose two additional domains to Latane and Darley’s theory of prosocial behavior during an emergency that students consider before making their final decision to volunteer. These are ‘logistics’ – whether it is logistically feasible to volunteer – and ‘safety’ – whether it is safe to volunteer. This study highlights a number of modifiable barriers to prosocial behavior that medical students encounter and provides suggestions regarding how Latane and Darley’s theory of prosocial behavior can be operationalized within educational strategies to address these barriers. Optimizing the process of volunteering can aid healthcare provision and may facilitate a safer volunteering process for all.

Abstract Introduction We aimed to identify the willingness, attitudes, and practice of medical students towards volunteering in a clinical capacity during the COVID-19 pandemic. Method We distributed a cross-sectional survey from 2/5/2020 to 14/6/2020 to all medical students at UK medical schools. Results A total of 1145 medical students from 36 medical schools completed the questionnaire. 82.7% of students were willing to volunteer, but only 34.3% had volunteered. The strongest predictors of willingness to volunteer on multiple linear regression were the beliefs that volunteering to work would benefit their medical education (estimate=0.35±0.03, adjusted P < 0.001) and that they would have a positive impact (estimate=0.33±0.03, adjusted P < 0.001). The majority of students were willing to take up a clinical role and were confident in having the necessary skills, but there was a discrepancy between the role’s students were comfortable performing and those they were assigned. Thematic analysis of the issue’s students would face when volunteering identified five themes: safety, professional practice, pressure to volunteer, finances and logistics, and education. Conclusions This study identifies areas for consideration from those responsible for workforce planning, healthcare provision, and student safety. We provide recommendations to facilitate a volunteering process that is safer for students, staff, and patients.

Abstract Introduction In response to the disruption to medical education caused by COVID-19, there is a need for wide-scale robust medical education research and the generation of research capacity for the future. Trainee research collaboratives have demonstrated they can nurture the research skills of students and trainees while delivering high quality research outputs. However, we have been unable to identify a permanent medical education research collaborative for trainees and students. Methods We started the MedEd Collaborative in September 2020 to fill this gap, consisting of a trainee- and student-led medical education research collaborative supported by senior medical education experts and clinicians. Results Our vision is to increase engagement of students and trainees in high-quality medical education research that informs practice. The MedEd Collaborative will engage students and trainees in medical education research by completing at least one national multicentre study per year, the first being the COVID Ready 2 study. This is a national cross-sectional survey of the educational impact of medical student volunteering during the COVID-19 pandemic. Conclusions We anticipate the MedEd collaborative will: increase exposure to medical education research, thereby increasing the number of medical students and trainees aiming to pursue an academic medical education career; provide training in medical education research methodologies, such as qualitative analysis; improve the quality of medical education research outputs from students and trainees; encourage collaboration between medical schools and deaneries; and provide support to other trainee research collaboratives that aim to explore education research in their own specialties.

Background The coronavirus disease 2019 pandemic has led to global disruption of healthcare. Many students volunteered to provide clinical support. Volunteering to work in a clinical capacity was a unique medical education opportunity; however, it is unknown whether this was a positive learning experience or which volunteering roles were of most benefit to students. Methods The COVIDReady2 study is a national cross-sectional study of all medical students at medical schools in the United Kingdom. The primary outcome is to explore the experiences of medical students who volunteered during the pandemic in comparison to those who did not. We will compare responses to determine the educational benefit and issues they faced. In addition to quantitative analysis, thematic analysis will be used to identify themes in qualitative responses. Discussion There is a growing body of evidence to suggest that service roles have potential to enhance medical education; yet, there is a shortage of studies able to offer practical advice for how these roles may be incorporated in future medical education. We anticipate that this study will help to identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future, and help inform medical education in a non-pandemic setting. Trial registration Not Applicable.

Abstract Introduction Professional identity formation (PIF) is a priority of medical training. Covid-19 caused disruption to medical education. We ask how this disruption impacted PIF through the lens of the activities performed – or not performed – by medical students during the first wave of the covid-19 pandemic, and perceptions of conflicts between activities. Method A pragmatic survey was distributed in spring 2020. Thematic analysis was performed of qualitative responses to two open questions. A social constructivist approach linked participants’ comments to PIF theory. Results We analysed 928 responses. Three themes surrounding students’ activities during covid-19 and their impact on identity were constructed: Status and role as a future doctor Status and role as a student Status and role as a member of the wider community Conflict arose at the intersections between these themes. Students noted lack of clinical exposure was detrimental, implicitly recognising that aspects of PIF require the clinical environment. Participants were keen to volunteer but struggled with balancing academic work. Participants worried about risk to their households and the wider community and wanted their skills to add value in the clinical environment. Volunteers felt frustrated when they were unable to perform tasks aligning with their identity as a future doctor. An exception was participants who worked as interim FY1s, aligned with the role of an FY1. Conclusions Medical students feel a duty to help during crises. Conflict arises when different aspects of their identity demand different actions. Care must be taken to nurture PIF during periods of disruption.

Phenomenon Professional identity development is recognised as a core goal of medical education alongside knowledge and skill acquisition. Identity is a complex entity that can be conceptualised as externally influenced, but individually constructed. Integration from legitimate bystander to "old timer" of the medical community of practice provides a backdrop for individual negotiation of professional identity. During Covid-19, the medical community of practice and education experienced significant disruption. We sought to investigate how these disruptions impacted professional identity development by examining conflicts between students' identities highlighted by the pressures of the pandemic. Approach A mixed-methods survey was distributed to medical students in the UK. The survey was active from 2nd May to 15th June 2020, during the height of the first wave of the Covid-19 pandemic in the UK. Operating within the paradigm of constructivism, we conducted a reflexive thematic analysis of qualitative responses. Analysis was focused around the disruption to medical education, actions taken by medical students during this disruption, and the tension between student actions where they existed in conflict. Findings Three themes were constructed to describe the identities that participants felt were in conflict during the first wave of the Covid-19 pandemic: Status and role as a future doctor; status and role as a student; and status and role as a member of the wider community. Students noted that lack of clinical exposure was detrimental to their education, implicitly recognising that many aspects of professional identity formation are forged in the clinical environment. Participants were keen to volunteer clinically but struggled to balance this with academic work. Participants worried about the risk to their families and the wider community, and wanted to ensure that their skills would add value to the clinical environment. Volunteers felt frustrated when they were unable to perform tasks which aligned with their identities future doctors, with the exception of participants who worked as interim FY1s (FiY1s), which aligned well with the roles of FY1s. Insights As hypothesised, the participants in this study experienced disruptions to their professional identity development during the first wave of the Covid-19 pandemic in 2020. This work provides early evidence, collected at the beginning of the pandemic, that the effects of disruptions to professional identity development were wide-reaching, often negative, and represent an important topic for future exploration. Given that the pandemic has highlighted areas of identity tension, these findings have the potential to provide insight into how medical training can better nurture professional identity development during and beyond international crises.

Yamey and Walensky discuss some considerations for UK universities re-opening this academic year.1 This is important because rising covid-19 cases in the UK seem to be concentrated in younger people—many of whom are likely to begin or return to university this autumn.2\n\nHealthcare students face unique challenges because of the added risk of exposure to covid-19 in the clinical environment and the necessity for some aspects of medical training to be …

A previously healthy 7-year-old girl presented with altered sensorium and agitation following an upper respiratory tract illness. She became encephalopathic with dyskinesia and bilateral VI nerve palsy. She was treated with intravenous antibiotics and acyclovir for presumed meningoencephalitis and transferred to the regional neurology centre. MRI brain showed bilateral lesions in the thalami (figures 1 and 2) and dorsal pons with surrounding oedema. Acute disseminated encephalomyelitis was considered unlikely due to the site and …