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The COVID-19 pandemic resulted in an unprecedented shift from face-to-face to online teaching with a subsequent deleterious impact on the quality of teaching delivery within medical education Our aim was to demonstrate the feasibility of utilizing a novel approach to interactive, online simulated history-taking.The session was designed for students attending a virtual work-experience programme and is founded upon gamification principles. History-taking is a humanistic social process requiring effective communication skills and recognition of verbal and non-verbal cues. The session enabled students to directly instruct a passive clinician to take a history from a simulated patient actor, incorporating both verbal and non-verbal actions. This novel teaching method is analogous to Freire’s work, highlighting the importance of the learner being an active participant, thus enabling experiential learning This interactive approach required a simulated patient actor, a passive clinician and a verbal instructor to be present. Students were presented with a case scenario and viewed the interaction between the simulated patient actor and passive clinician online via a video conferencing service (in this case, Zoom). Students provided instructions to the passive clinician using the typed chat function. These typed instructions were relayed by the verbal instructor to the passive clinician via an earpiece and the passive clinician would then embody these instructions. This allowed students to work as a group to directly elicit a history and witness their instructions being actioned. Examples of instructions included questions to verbalize, adjustments to body language and alteration of the tone of voice. Following good student instruction, the passive clinician gradually grew in competence and confidence throughout the scenario, thus allowing real-time, interactive feedback of their history-taking approach. The session concluded with a reflection of the communication traits that helped to gain an effective history from the patient using a debrief model.

The COVID-19 pandemic has necessitated a transition from traditional face-to-face teaching to virtual equivalents, sometimes at the expense of teaching quality and student engagement Our aim was to demonstrate the feasibility of a novel gamified online simulation approach to teaching the management of acutely unwell patients.Using elements of gamification and interactive film, this virtual session was designed to teach prospective medical students the ‘A to E’ approach of managing an acutely unwell patient. The management of an acutely unwell patient is an iterative and dynamic process that requires one to manage uncertainty and constantly re-evaluate the clinical situation. The session was designed using interactive film, with students given the ability to influence a clinician’s actions and subsequent changes of clinical scenario dictated by student live-vote. This interactive and engaging approach allowed students to reflect-in-action and be active learners, in line with an experiential pedagogy Students attended a live session using a video conferencing service (Zoom) and their responses to clinical scenarios were recorded using an online voting tool (Mentimeter). Students were provided with a case history of an unwell patient and presented with an opening video. The session required video options to be pre-recorded to reflect the numerous potential avenues within the scenario as dictated by the students’ chosen actions. Depending on overall student voting consensus, pre-recorded videos of the clinician’s actions and changes to the clinical scenario were subsequently shown. For example, if the appropriate clinical action was selected, students would progress through the A-E approach. Students effectively guided the clinician to manage the unwell patient, with iterative and real-time feedback provided throughout the scenario. The session was concluded with a debrief, explanation of the case and key learning points.

Lower limb reconstruction is performed to replace like with like and achieve tissue durability. Free flaps are a method of reconstruction commonly used to manage cases of lower limb deficits. However, the failure rate is 8.5%, with venous thrombosis and congestion playing a significant role. Despite this, preoperative venous mapping of recipient site before free flap reconstruction is not routinely practiced, often resulting in pathologies remaining unidentified until the intraoperative stage. The aim of the review was to evaluate the existing literature on the topic of lower limb preoperative venous assessment, screening, and its effect on lower limb free flap survival. Five different databases were searched from their inception to August 2021. The search terms and included studies were independently reviewed by two investigators for their eligibility. Eleven articles were eligible for inclusion, with a combined patient population of 99, and 107 flaps were identified to have lower limb pathology at the donor or recipient vein. Venous pathology was detected preoperatively in 69 veins using ultrasound duplex scanning and computed tomography angiography; of them, 3 (4.34%) resulted in failure. In comparison, 38 veins were diagnosed with venous pathology intraoperatively; of them, 5 (13.85%) failed. The studies evaluated in this review demonstrated that preoperative screening for venous pathology showed a higher flap survival rate. It can therefore be inferred that developing a standardized preoperative process for identifying venous issues in lower limb free flap reconstruction may improve outcomes. This can be explored in future research, with a focus on assessing the validity and efficacy of such screening tools, and their role in the management of patients identified with venous pathology.