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Yew Ern Au,1 Cheuk Ying Li,1 Nishaanth Dalavaye,1 Aarij Elahi,1 Rohan Vyas,2 Ravanth Baskaran,1 Stephen Mark Rutherford3 1School of Medicine, Cardiff University, Cardiff, UK; 2Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 3School of Biosciences, Cardiff University, Cardiff, UKCorrespondence: Ravanth Baskaran, Email ravanthb97@gmail.comBackground: The COVID-19 pandemic has resulted in medical students’ education being disrupted and a new direction of learning towards the online classroom, with students frequently learning to identify clinical signs via online conferencing platforms. Given this shift in student study techniques in the pandemic and post-pandemic era, we set out to analyse the confidence levels of students recognizing clinical signs in patients and the opinions and patterns of resources students would use to build up the knowledge and confidence for their future clinical practice.Methods: OSCEazy, a student-led medical education organisation, delivered an online teaching session and disseminated a questionnaire containing ten-point Likert scales, multiple-choice questions and free text options.Results: The majority (over 75%) of respondents reported using digital resources to learn physical examinations. Most respondents were somewhat confident with recognising clinical signs during physical examinations (Median 7, IQR 6– 8). Kruskal–Wallis H-test on students’ impression of the quality of current OSCE materials showed a statistically significant difference between cohorts (X2(2) = 14.209, p = 0.014). A large proportion of students (98.41%) agreed that an online resources bank would be beneficial for their learning. Wilcoxon rank test showed a statistically significant preference for learning physical examinations using clinical images rather than videos (p = 0.014). A 29% of respondents mentioned the use of physical textbooks as a resource, while online platforms such as OSCE revision websites, YouTube and Google Images had become the mainstream platforms.Conclusion: The findings reported here suggest that there needs to be a greater emphasis on providing online image-based resources to support medical students in learning clinical signs. A resource containing these clinical signs would prove to be of benefit for students to access high-quality self-directed learning to identify and verify clinical signs.Keywords: medical education, visual, multi-media, clinical, online, teaching

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

Srinjay Mukhopadhyay,1 Ravanth Baskaran,1 Movin Peramuna Gamage,1 Nishaanth Dalavaye,1 Wing Sum Vincent Ng,1 Sripradha Srinivasan,1 Sashiananthan Ganesananthan,2 Stephen Rutherford3 1School of Medicine, Cardiff University, Cardiff, UK; 2Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK; 3School of Biosciences, Cardiff University, Cardiff, UKCorrespondence: Sashiananthan Ganesananthan, Department of Digestion, Metabolism and Reproduction, Imperial College London, London, SW7 2AZ, UK, Email sashiganes96@yahoo.co.ukPurpose: The COVID-19 pandemic caused significant disruption to higher education, including medical studies. Online learner support became urgently necessary, and peer-support of learning was needed to supplement formal teaching. This study evaluates the impact and delivery media of OSCEazy, a student-led initiative supporting formal teaching across institutional and national boundaries.Methods: A survey was created on Google Forms and disseminated via the Zoom chat function to all the participants at the end of our event titled, “The Cardiology Station”.Results: A large proportion (99.5%) of the students have a Facebook account and (98.7%) use it to keep track of medical events (p=0.45 for comparison). However, a very small proportion of use their other social media to keep up with medical events (p< 0.0001 for comparison).Conclusion: It is evident from our results, that most of our participants used Facebook to keep track of medical events. The use of their other social media platforms (Instagram, etc) to keep track of medical events was limited. Thus, it is important for any organisation, such as ours, who conduct online events to evaluate which platform is most suitable for them to use to publicise their events.Keywords: clinical assessment, online, student perception, medical education, social media

Nishaanth Dalavaye Department of Medicine, Imperial College London, London, UKCorrespondence: Nishaanth DalavayeImperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, UK, Email nish.dalavaye21@imperial.ac.uk View the original paper by Dr Alotaibi and colleagues

α -humulene, a sesquiterpene found in essential oils of various plant species, has garnered interest due to its potential therapeutic applications. This scoping review aims to consolidate α -humulene's evidence base, informing clinical translation, and guiding future research directions. A scoping review was conducted of EMBASE, MEDLINE, and PubMed databases up to 14th July 2023. All studies describing original research on α -humulene extraction, as well as pre-clinical and clinical research, were included for review. Three hundred and forty articles were analysed. α -humulene yields ranged from negligible to 60.90% across plant species. In vitro experiments demonstrated cytotoxicity against adenocarcinomas (such as colorectal, pulmonary, breast, prostatic, lung, and ovarian), with varying responses in other cell models. Mechanistic insights revealed its involvement in mitochondrial dysfunction, diminished intracellular glutathione levels, and the induction of oxidative stress. In rodent studies, oral administration of α -humulene at 50 mg/kg reduced inflammation markers in paw oedema and ovalbumin-induced airway inflammation. Intraperitoneal administration of α -humulene (50 - 200 mg/kg) exhibited cannabimimetic properties through cannabinoid 1 and adenosine A2a receptors. α -humulene also exhibited a multitude of properties with potential scope for therapeutic utilisation. However, there is a paucity of studies that have successfully translated this research into clinical populations with the associated disease. Potential barriers to clinical translation were identified, including yield variability, limited isolation studies, and challenges associated with terpene bioavailability. Consequently, rigorous pharmacokinetic studies and further mechanistic investigations are warranted to effectively uncover the potential of α -humulene., Competing Interests: SE is the Head of Research at Curaleaf Clinic. MHS is the Chief Medical Officer at Curaleaf International., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Competing Interests: Conflict of InterestsThe author declares no conflict of interest.

Competing Interests: Conflict of InterestThe author declares no competing interests.

Background: The potential of popular culture as a tool for knowledge delivery and enhancing engagement in education is promising but not extensively studied. Furthermore, concerns exist regarding learning fatigue due to increased reliance on videoconferencing platforms following the COVID-19 pandemic. To ensure effective web-based teaching sessions that maintain attention spans and enhance understanding, innovative solutions are necessary., Objective: This study aims to evaluate the use of specific popular culture case studies to enhance student engagement in a web-based near-peer teaching session., Methods: We delivered a web-based teaching session to undergraduate medical students in the United Kingdom. The session included clinical vignettes and single-best-answer questions using characters from "The Simpsons" television show as patient analogies for various causes of jaundice. A pre-post survey, employing a 7-point Likert scale, was distributed to gather data from participants., Results: A total of 53 survey responses were collected. Participants reported significantly improved understanding of jaundice after the session compared to before the session (median 6, IQR 5-6 vs median 4, IQR 3-4.5; P<.001). The majority of participants agreed that the inclusion of "The Simpsons" characters enhanced their knowledge and made the teaching session more memorable and engaging (memorability: median 6, IQR 5-7; engagement: median 6, IQR 5-7)., Conclusions: When appropriately integrated, popular culture can effectively engage students and improve self-perceived knowledge retention. "The Simpsons" characters can be used pedagogically and professionally as patient analogies to deliver teaching on the topic of jaundice., (©Nishaanth Dalavaye, Ravanth Baskaran, Srinjay Mukhopadhyay, Movin Peramuna Gamage, Vincent Ng, Hama Sharif, Stephen Rutherford. Originally published in JMIR Medical Education (https://mededu.jmir.org), 17.08.2023.)

Introduction: There is growing evidence on the efficacy of cannabis-based medicinal products (CBMPs) for chronic pain (CP). Due to the interaction between CP and anxiety, and the potential impact of CBMPs on both anxiety and CP, this article aimed to compare the outcomes of CP patients with and without co-morbid anxiety following CBMP treatment., Methods: Participants were prospectively enrolled and categorized by baseline General Anxiety Disorder-7(GAD-7) scores, into 'no anxiety'(GAD-7 < 5) and 'anxiety'(GAD-7 ≥ 5) cohorts. Primary outcomes were changes in Brief Pain Inventory Short-Form, Short-form McGill Pain Questionnaire-2, Pain Visual Analogue Scale, Sleep Quality Scale (SQS), GAD-7 and EQ-5D-5L index values at 1, 3 and 6 months., Results: 1254 patients (anxiety = 711; no anxiety = 543) met inclusion criteria. Significant improvements in all primary outcomes were observed at all timepoints (p < 0.050), except GAD-7 in the no anxiety group(p > 0.050). The anxiety cohort reported greater improvements in EQ-5D-5L index values, SQS and GAD-7(p < 0.050), but there were no consistent differences in pain outcomes., Conclusion: A potential association between CBMPs and improvements in pain and health-related quality of life (HRQoL) in CP patients was identified. Those with co-morbid anxiety reported greater improvements in HRQoL.

Background: Near-peer medical education serves as an important method of delivering education to junior students by senior students. Due to the reduced clinical exposure because of the COVID-19 pandemic, we developed a mentorship scheme to help medical students with their Integrated Structured Clinical Examinations (ISCEs) by providing a combination of near-peer mentorship together with lecture-based teaching on a weekly basis for a 12-week period. Students attended a specialty-focused lecture every Tuesday followed by a small group teaching session organised by their tutor., Methods: A longitudinal evaluative interventional study was undertaken by the international student led medical education organisation, OSCEazy. The teaching programme was organised and conducted by third year medical students to a recruited cohort of second year medical students. Students' perceptions of ISCEs (confidence, anxiety, and overall performance) were evaluated using 5-point Likert scales while their knowledge of the specialty was assessed using 10 single best answer questions which were distributed via Google® forms at the start and end of each week. In addition, we assessed tutor perceptions of their teaching and learning experience., Results: Seventy-two tutees were enrolled in the programme (mean age: 24.4, female: 77.8%). 88.9% of the participants had not attended any online ISCE teaching prior to this. They preferred in-person ISCE teaching as compared to virtual sessions [median 4.5 (IQR 4-5) vs 3 (IQR 3-4), p <  0.0001), respectively]. There was a significant overall increase in knowledge when comparing pre-session and post-session performance [mean 53.7% vs 70.7%, p <  0.0001)]. There was a significant increase in student confidence [Confidence: median 3 (IQR:3-4) vs 4 (IQR 3-4), p <  0.0001] while no change was seen in the anxiety and perception of their overall performance in an ISCE. [Anxiety: median 3 (IQR 2-4) vs 3 (IQR 3-4), p = 0.37, Performance: median 3 (IQR 3-4) vs median 3 (IQR 3-4), p <  0.0001]. The tutors reported an increase in their confidence in teaching ISCEs online [median 3 (IQR 2-3.25) vs median 4 (IQR 4-5), p <  0.0001)]., Conclusion: Online near-peer teaching increases the confidence of both tutees and tutors involved while enhancing the tutees' knowledge of the specialty. Thus, medical schools should incorporate near-peer teaching in their curriculum to enhance the student learning experience., (© 2023. The Author(s).)

Objectives: Headache disorders are a common cause of disability and reduced health-related quality of life globally. Growing evidence supports the use of cannabis-based medicinal products (CBMPs) for chronic pain; however, a paucity of research specifically focuses on CBMPs' efficacy and safety in headache disorders. This study aims to assess changes in validated patient-reported outcome measures (PROMs) in patients with headaches prescribed CBMPs and investigate the clinical safety in this population., Methods: A case series of the UK Medical Cannabis Registry was conducted. Primary outcomes were changes from baseline in PROMs (Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), EQ-5D-5L, Generalized Anxiety Disorder-7 (GAD-7) questionnaire and Single-Item Sleep Quality Scale (SQS)) at 1-, 3-, and 6-months follow-up. P-values <0.050 were deemed statistically significant., Results: Ninety-seven patients were identified for inclusion. Improvements in HIT-6, MIDAS, EQ-5D-5L and SQS were observed at 1-, 3-, and 6-months (p < 0.005) follow-up. GAD-7 improved at 1- and 3-months (p < 0.050). Seventeen (17.5%) patients experienced a total of 113 (116.5%) adverse events., Conclusion: Improvements in headache/migraine-specific PROMs and general health-related quality of life were associated with the initiation of CBMPs in patients with headache disorders. Cautious interpretation of results is necessary, and randomized control trials are required to ascertain causality.

Objectives: Cannabis-based medicinal products (CBMPs) have shown promising preclinical activity in inflammatory bowel disease (IBD). However, clinical trials have not demonstrated effects on inflammation. This study aims to analyze changes in health-related quality of life (HRQoL) and adverse events in IBD patients prescribed CBMPs., Methods: A case series from the UK Medical Cannabis Registry was performed. Primary outcomes included changes from baseline in the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), Generalized Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L Index score at 1 and 3 months. Statistical significance was defined using p < 0.050., Results: Seventy-six patients with Crohn's disease (n = 51; 67.11%) and ulcerative colitis (n = 25; 32.89%) were included. The median baseline SIBDQ score improved at 1 and 3 months. EQ-5D-5L index values, GAD-7, and SQS also improved after 3 months (p < 0.050). Sixteen (21.05%) patients reported adverse events with the majority being classified as mild to moderate in severity., Conclusion: Patients treated with CBMPs for refractory symptoms of Crohn's disease and ulcerative colitis demonstrated a short-term improvement in IBD-specific and general HRQoL. Prior cannabis consumers reported greater improvement compared to cannabis-naïve individuals.

Background: The current paucity of clinical evidence limits the use of cannabis-based medicinal products (CBMPs) in post-traumatic stress disorder (PTSD). This study investigates health-related quality of life (HRQoL) changes and adverse events in patients prescribed CBMPs for PTSD., Methods: A case-series of patients from the UK Medical Cannabis Registry was analyzed. HRQoL was assessed at 1-, 3-, and 6-months using validated patient reported outcome measures (PROMs). Adverse events were analyzed according to the Common Terminology Criteria for Adverse Events version 4.0. Statistical significance was defined as p < 0.050., Results: Of 162 included patients, 88.89% (n = 144) were current/previous cannabis users. Median daily CBMP dosages were 5.00 (IQR: 0.00-70.00) mg of cannabidiol and 145.00 (IQR: 100.00-200.00) mg of Δ9-tetrahydrocannabinol. Significant improvements were observed in PTSD symptoms, sleep, and anxiety across all follow-up periods (p < 0.050). There were 220 (135.8%) adverse events reported by 33 patients (20.37%), with the majority graded mild or moderate in severity (n = 190, 117.28%). Insomnia and fatigue had the greatest incidence (n = 20, 12.35%)., Conclusions: Associated improvements in HRQoL were observed in patients who initiated CBMP therapy. Adverse events analysis suggests acceptability and safety up to 6 months. This study may inform randomized placebo-controlled trials, required to confirm causality and determine optimal dosing.