Background Systematic reviews and meta-analyses allow a transparent, rigorous, and replicable analysis to summarize the results of multiple related studies and are considered top of the evidence-based medicine study hierarchy. The COVID-19 pandemic has shed light on the unmet educational needs of students worldwide, notably those from underprivileged backgrounds. This cross-sectional study aimed to ascertain students’ and junior doctors’ attitudes on their current knowledge, confidence and preparedness of appraising and conducting systematic reviews and meta-analysis internationally. Methods A free online webinar was held in May 2021 by the senior author and a pre-event questionnaire was distributed. Responses collected were used for analysis anonymously to ascertain students’ knowledge, experience, and confidence in preparing a systematic review and meta-analysis using a 1–5 Likert scale using IBM SPSS 26.0. Associations were examined using Chi-square and crosstabs analysis. Results Out of 2004 responses from 104 countries included in the analysis, the majority of delegates were from lower middle-income countries and were not familiar with the PRISMA checklist (59.2% and 81.1% respectively of the total number of participants). The majority had never attended any formal training (83%) and felt their medical institute gave them minimal advice (72.5%) in preparing systematic reviews. Among those who had attended formal training, the proportion was significantly higher in those belonging to high and upper middle-income countries combined (20.3%) than lower and lower-middle-income countries combined (15%). Conclusion This study highlights gaps that need addressing to enhance the knowledge of medical students and junior doctors performing systematic reviews and meta-analyses. Clear disparities are found in country income and the level of education. Future large-scale studies are needed to understand the rationale of working on online research projects and the opportunities available to medical students and junior doctors that may lead to medical curriculum changes.

Aims Spontaneous pneumomediastinum (SPM) is usually a self-limiting condition in clinically stable patients with no obvious causative factor. SPM can be difficult to distinguish from important secondary causes such as tracheobronchial injury or oesophageal perforation. Therefore, thorough clinical history and examination is of paramount importance. We aim to highlight lessons learnt from our experience to improve rapid diagnosis and clinical management of these patients. Methods Patients were identified through hospital records between October 2019 – December 2021. Data was collected on clinical presentation, precipitating events, radiological confirmation of SPM and compared with current reported literature. Results 11 patients were identified, 8 males (72.7%), 3 females (27.3%) with a mean age of 29 ± 17 years. The most frequent symptom was retrosternal chest pain 27.3%; and vomiting the most common precipitating event (54.5%). Mean white cell count was 14×109/l on admission. All patients underwent plain film chest radiography, and subsequent computerised tomography of thorax, abdomen and pelvis. Patients underwent gastroscopy selectively, showing no acute pathology. Mean length of stay was 4.6 days. No patients required operative intervention or any other intervention beyond antibiotics. No complications or recurrence were found in patients at follow up. Conclusion SPM is a self-limiting condition with low morbidity and mortality. If life-threatening causes have been excluded, SPM can safely be managed expectantly at a local level, without the need of transfer to tertiary centres and prolonged hospital admission. We propose a structured approach to aid in the management of SPM and help address these challenges.

Aim Spontaneous pneumomediastinum (SPM) is usually a self-limiting condition in clinically stable patients with no obvious causative factor. SPM can be difficult to distinguish from important secondary causes such as tracheobronchial injury or oesophageal perforation. Therefore, thorough clinical history and examination is of paramount importance. We aim to highlight lessons learnt from our experience to improve rapid diagnosis and clinical management of these patients. Method Patients were identified through hospital records between October 2019 – December 2021. Data was collected on clinical presentation, precipitating events, radiological confirmation of SPM and compared with current reported literature. Results 11 patients were identified, 8 males (72.7%), 3 females (27.3%) with a mean age of 29 + 17 years. The most frequent symptom was retrosternal chest pain 27.3%; and vomiting the most common precipitating event (54.5%). Mean white cell count was 14×109/l on admission. All patients underwent plain film chest radiography, and subsequent computerised tomography of thorax, abdomen and pelvis. Patients underwent gastroscopy selectively, showing no acute pathology. Mean length of stay was 4.6 days. No patients required operative intervention or any other intervention beyond antibiotics. No complications or recurrence were found in patients at follow up. Conclusion SPM is a self-limiting condition with low morbidity and mortality. If life-threatening causes have been excluded, SPM can safely be managed expectantly at a local level, without the need of transfer to tertiary centres and prolonged hospital admission. We propose a structured approach to aid in the management of SPM and help address these challenges.

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