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BackgroundVirtual reality (VR) simulation is a potential solution to the barriers surgical trainees are facing. There needs to be validation for its implementation within current training. We aimed to compare VR simulation to traditional methods in acquiring surgical skills for a TFN-ADVANCED™ Proximal Femoral Nailing System (TFNA; DePuy Synthes, Auckland, New Zealand) femoral nailing system.MethodsThirty-one surgical trainees were randomised to two groups: traditional-training group (control group) and a VR-training group (intervention group) for insertion of a short cephalomedullary TFNA nail. Both groups then inserted the same TFNA system into saw-bone femurs. Surveys evaluated validity of the relevant activities, perception of simulation, confidence, stress and anxiety. The primary outcomes were tip-apex distance (TAD) and user anxiety/confidence levels. Secondary outcomes included number of screw- and nail-guidewire insertion attempts, the time taken to complete and user validity of the VR system.ResultsThere was no statistical difference in TAD between the intervention and control groups (9mm vs 15mm, p=0.0734). The only TAD at risk of cut-out was in the control group (25mm). There was no statistical difference in time taken (2547.5ss vs 2395ss, p=0.668), nail guide-wire attempts (two for both groups, p=0.355) and screw guide-wire attempts (one for both groups, p=0.702).The control group versus intervention had higher anxiety levels (50% vs 33%) and had lower confidence (61% vs 84%).InterpretationThere was no objective difference in performance on a saw-bone model between groups. However, this VR simulator resulted in more confidence and lower anxiety levels whilst performing a simulated TFNA. Whilst further studies with larger sample sizes and exploration of transfer validity to the operating theatre are required, this study does indicate potential benefits of VR within surgical training.

IntroductionThe COVID-19 pandemic has illuminated disparities and inequities in healthcare globally, making it a necessity to identify, and address social and structural determinants of people’s everyday lives. Medical schools and education need to respond to and address social justice in undergraduate education. Social justice in medical education has the potential to be a foundational block to support the initiatives that have or are being implemented in our health systems.MethodsWe carried out a meta-synthesis and used an interpretative approach for the analysis. Searches were conducted of three databases: PsycINFO, Embase and Medline and were carried out in May 2021. We excluded articles that were not related to undergraduate medical students. The aim of this review was to explore literature on SJ teaching to elicit the experiences of learners to inform future SJ teaching and curriculum.ResultsUsing meta-synthesis methodology, four themes emerged: personal growth of learners and professional identities; developing commitment to working with marginalised populations in their environments; integrating traditional clinical skills with advocacy, interests in human rights and SJ work; learning processes and methods.ConclusionsFindings confirm that SJ in undergraduate medical education has an essential role. However, social justice in medical education was understood as a non-essential piece of professionalism, or as something to be learnt in the abstract method rather than as a part of everyday practice realities. Our findings suggest that creating globally competent doctors through a globally equivalent curriculum, which is balanced and with a locally invested training programme could lead to a supply or workforce that is fit for purpose for local populations.

IntroductionCurrent medical education prepares doctors to diagnose, assess and treat individual patients yet lacks the expectation to be responsible for the care of the wider community. Learning the skills to recognise and redress the social determinants of health are increasingly being recognised as an essential part of medical education.ObjectivesThe goal of this research was (1) to investigate how medical education can be leveraged to reduce health inequalities through the role and practice of doctors and (2) to elucidate how key innovations in medical education are a necessity that can support doctors as ‘change agents.’MethodsTwo international multidisciplinary roundtable focus groups with 23 healthcare leaders from various backgrounds were facilitated. The discussions were audiorecorded, transcribed and then thematically analysed with the qualitative analysis software QDA Miner.ResultsEight themes emerged: (1) Social innovation training in medical education; (2) Linking community working with social innovation; (3) Future curricula development; (4) Settings, context, environment and leaving the classroom; (5) Developing links with third sector organisations and community, including low-income and middle-income countries; (6) Including learners’ perspectives and lived experience; (7) Medical roles are political and need political support and (8) The need to address power imbalances and impact of discrimination.ConclusionsMedical education needs to fundamentally widen its focus from the individual doctor–patient relationship to the doctor–community relationship. Doctors’ training needs to help them become social innovators who can balance interventions with prevention, promote good health on a community and societal scale and tailor their treatments to the individuals’ contexts.

Background Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. Methods We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge. Results On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant ( p  = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. Conclusions Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission.