With a supportive hospital environment, ED HCWs chose adaptive coping in response to the outbreak and reported low psychiatric morbidity. Physicians chose humor and Filipinos chose turning to religion as their preferred responses. Psychosocial interventions to help HCWs need to take these preferences into account.

To determine the psychological morbidity among emergency department (ED) doctors and nurses six months after the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak. Methods: During the SARS outbreak from 13 March to 31 May 2003, the study ED was designated as Singapore's only screening centre for SARS and was closed to all other patients. A self-administered questionnaire survey was conducted in November 2003. Doctors and nurses of the study ED who had patient contact during the outbreak were included. Data collected were demographics and responses to (a) Impact of Event Scale (IES) and (b) General Health Questionnaire 28 (GHQ 28). Scores were assigned to the responses whereby an IES score ≥26/75 or a GHQ 28 score ≥5/28 was indicative of post-event and psychiatric morbidity respectively. Results: Thirty-eight out of 41 (92.7%) doctors and 58 out of 83 (69.9%) nurses responded. Fewer doctors reported post-event and psychiatric morbidity compared to nurses, with 5 (13.2%) doctors and 12 (20.7%) nurses scoring ≥26 on IES, 6 (15.8%) doctors and 12 (20.7%) nurses scoring ≥5 on GHQ 28. The doctors reported a median of 9.5 (range 0-47) on IES and 0 (range 0-11) on GHQ 28. The nurses reported a median of 15 (range 0-61) on IES and 1 (range 0-25) on GHQ 28. Conclusions: Six months after SARS, the rates of post-event and psychiatric morbidity were relatively low among the study ED doctors and nurses. The results might have underestimated actual morbidity as the study was conducted six months after the outbreak.

Although the SARS outbreak was not a bioterrorism event, the ED disaster response was applicable in the outbreak's management. The use of a screening questionnaire and admission criteria enabled the ED to screen, treat, and safely discharge the majority of the patients.

have had to adapt their campus-based and clinical educational provision in a context of rapidly changing circumstances and ongoing uncertainty.Different countries varied in the speed and nature of their responses to the spread of Covid-19. Our context of Singapore has well-developed protocols for outbreak preparation (MOH 2019) and on 7th February 2020 the Ministry of Health (MOH) risk assessed COVID-19 as "DORSON Orange" (Disease Outbreak Response System Condition) (MOH 2020). This introduced precautionary measures to minimise the risk of transmission of the virus in the country (e.g., daily health checks, stringent contact tracing and quarantining, enhanced focus on hygiene and protection, and segregating groups to contain disease spread). The specific implications of these measures for medical education and teaching were that: students in Singapore's three medical schools were taken out of clinical environments; students could not be taught on a whole or even half class basis; there was reduced availability of clinicians to participate in educational activities, and clinicians who were available could not always attend campus in person because of infection control measures.Our particular responses to these constraints were multiple. These included: shifting our pedagogy from face-to-face Team-Based Learning (TBL: Rajalingam et al. 2018) to e-TBL delivered online; reducing face-to-face class sizes and running classes repeatedly; and introducing some novel simulations to prepare final year students for postgraduate training. While undoubtedly the pedagogic, technical and operational aspects of what we did will be of interest, particularly to those with a digital learning interest, the focus of this editorial is not to tell you of our adaptations, or ask others to consider how they responded in these uncertain and volatile times. Instead, we position our response to unanticipated disruption as problem-posing rather than problem-solving (Biesta et al. 2019), and a potentially positive driver within the educational research space-if considered appropriately.

No abstract