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Movin Peramuna Gamage,1 Ravanth Baskaran,1 Srinjay Mukhopadhyay,1 Nishaanth Dalavaye,1 Becky Leveridge,1 Sashiananthan Ganesananthan,2 Robert Spencer,3,4 Susruta Manivannan,5 Malik Zaben3,4 1School of Medicine, Cardiff University, Heath Park Campus, Cardiff, CF14 4YS, UK; 2Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK; 3Neuroscience and Mental Health Innovation Institute (NMHII), Cardiff University, Cardiff, UK; 4Department of Neurosurgery, University Hospital of Wales, Cardiff, UK; 5Division of Psychological Medicine and Clinical Neurosciences, University Hospital of Wales, Cardiff, UKCorrespondence: Malik Zaben, Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK, Tel +442920748153, Email ZabenM@cardiff.ac.ukPurpose: Objective Structured Clinical Examination (OSCE) is a vital examination that must be passed to graduate as a qualified doctor. The delivery of OSCE teaching was changed to an online format to accommodate COVID-19 restrictions. Therefore, this study evaluates factors that students perceive to affect their virtual learning of clinical skills for OSCE.Methods: In this cross-sectional study, all medical students from across the world who attended “The Respiratory Station” session delivered by OSCEazy (a medical student organization providing free online medical education) in the academic year 2020– 2021 received an online questionnaire about their perceptions of this learning opportunity. The survey was created on Google™ forms and consisted of 5-point Likert scales as well as free-text boxes.Results: A total of 556 responses were received (mean age: 24, female: 76.6%). Most students agreed that online OSCE teaching offers more flexibility and convenience (median: 5, IQR: 4– 5) but their likeliness to ask questions in either format was similar (median: 4, IQR: 3– 5 vs median: 4, IQR: 3– 4, p value: 0.94). The use of visual aids (median: 5, IQR: 4– 5) and breakout rooms (median: 3, IQR: 2– 4) were thought to enhance the quality of virtual OSCE teaching. The biggest concern about online teaching was access to a stable internet connection (69.1%).Conclusion: The flexibility and convenience of virtual OSCE teaching enables the sharing of knowledge and skills to a wider audience and thus may be a very useful adjunct to face-to-face OSCE teaching in the future.Keywords: medical education, COVID-19, online learning, student perceptions

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Objective\ud Traumatic brain injury (TBI) is a global public health problem, causing long-term burden to patients and caregivers. Patients and their families often resort to seeking online information regarding TBI management whilst awaiting formal healthcare consultations. Although this information is accessible and immediately available, little is known about the quality of online resources. We evaluated the accessibility, relevance, and readability of information regarding TBI from major online search engines.\ud \ud Methods\ud TBI-related search terms were entered into two online search engines (GoogleTM, YahooTM), and the first 30 websites per search were assessed for eligibility. Quality (DISCERN score, JAMA Benchmark score) and readability (Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES)) were assessed. Associations between search ranking, quality, and readability were evaluated.\ud \ud Results\ud 202 websites were evaluated with mean DISCERN score 36.5±9.9/80, signifying poor global quality, and mean JAMA Benchmark score 2.8±1.1/4. The majority required 9 – 12 years of education (113/202; 55.9%) according to FKGL and categorised as ‘Difficult’ on FRES (94/202; 46.5%). Website quality was not associated with search ranking or readability.\ud \ud Conclusions\ud There is a paucity of high-quality online resources for TBI patients. Herein, we highlight: (i) the importance of guidance from healthcare professionals regarding online-information seeking; (ii) recommendations for the most useful online resources available.

Background: Intracranial arachnoid cysts (AC) are benign, cerebrospinal fluid filled spaces within the arachnoid layer of the meninges. Neurosurgical intervention in children and young adults has been extensively studied, but the optimal strategy in the elderly remains unclear. Therefore, we performed a single center retrospective study combined with a systematic review of the literature to compare cystoperitoneal (CP) shunting with other surgical approaches in the elderly cohort. Methods: Retrospective neurosurgical database search between January 2005 and December 2018, and systematic review of the literature using PRISMA guidelines were performed. Inclusion criteria: Age 60 years or older, radiological diagnosis of intracranial AC, neurosurgical intervention, and neuroradiological (NOG score)/clinical outcome (COG score). Data from both sources were pooled and statistically analyzed. Results: Our literature search yielded 12 studies (34 patients), which were pooled with our institutional data (13 patients). CP shunts (7 patients; 15%), cyst fenestration (28 patients; 60%) and cyst marsupialisation/resection (10 patients; 21%) were the commonest approaches. Average duration of follow-up was 23.6, 26.9, and 9.5 months for each approach, respectively. There was no statistically significant association between choice of surgical intervention and NOG score (P = 0.417), COG score (P = 0.601), or complication rate (P = 0.955). However, CP shunting had the lowest complication rate, with only one patient developing chronic subdural haematoma. Conclusion: CP shunting is a safe and effective surgical treatment strategy for ACs in the elderly. It has similar clinical and radiological outcomes but superior risk profile when compared with other approaches. We advocate CP shunting as first line neurosurgical intervention for the management of intracranial ACs in the elderly.