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Medical students are the future of sustainable health systems that are severely under pressure during COVID-19. The disruption in medical education and training has adversely impacted traditional medical education and medical students and is likely to have long-term implications beyond COVID-19. In this article, we present a comprehensive analysis of the existing structural and systemic challenges applicable to medical students and teaching/training programs and the impact of COVID-19 on medical students and education. Use of technologies such as telemedicine or remote education platforms can minimize increased mental health risks to this population. An overview of challenges during and beyond the COVID-19 pandemic are also discussed, and targeted recommendations to address acute and systemic issues in medical education and training are presented. During the transition from conventional in-person or classroom teaching to tele-delivery of educational programs, medical students have to navigate various social, economic and cultural factors which interfere with their personal and academic lives. This is especially relevant for those from vulnerable, underprivileged or minority backgrounds. Students from vulnerable backgrounds are influenced by environmental factors such as unemployment of themselves and family members, lack of or inequity in provision and access to educational technologies and remote delivery-platforms, and increased levels of mental health stressors due to prolonged isolation and self-quarantine measures. Technologies for remote education and training delivery as well as sustenance and increased delivery of general well-being and mental health services to medical students, especially to those at high-risk, are pivotal to our response to COVID-19 and beyond., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Sharma and Bhaskar.)

Background and Purpose: South Western Sydney comprises of a culturally and linguistically diverse (CALD) and lower socioeconomic status population group within the state of New South Wales. Geographic location and sociodemographic factors play important roles in access to healthcare and may be crucial in the success of time-critical acute stroke intervention. The aim of this study was to examine the trends in the delayed presentation to emergency department (ED) and identify factors associated with prehospital delay for an acute stroke/transient ischaemic attack (TIA) at a comprehensive stroke centre., Methods: Patient health-related data were extracted for stroke/TIA discharges for the period 2009-2017. Electronic medical record data were used to determine sociodemographic characteristics and prehospital factors, and their associations with delayed presentation≥4.5 hours from stroke onset were studied., Results: During the 9-year period, population-adjusted stroke/TIA discharge rates increased from 540 to 676 per 100 000. A significant reduction in the proportion of patients presenting to ED<4.5 hours (56% in 2009 versus 46% in 2017, p<0.001) was observed. Younger patients aged 55-64 and 65-74 years, those belonging to Polynesia, South Asia and Mainland Southeast Asia, and those not using state ambulance as the mode of arrival to the hospital were at increased risk of prehospital delay., Conclusions: Comprehensive reappraisal of educational programmes for early stroke recognition is required in our region due to delayed ED presentations of younger and specific CALD communities of stroke/TIA patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)