The aim of this systematic review was to identify the challenges imposed on medical and surgical education by the COVID-19 pandemic, and the proposed innovations enabling the continuation of medical student and resident training. A systematic review on the MEDLINE and EMBASE databases was performed on April 18th, 2020, and yielded 1288 articles. Sixty-one of the included manuscripts were synthesized in a qualitative description focused on two major axes, "challenges" and "innovative solutions", and two minor axes, "mental health" and "medical students in the frontlines". Shortage of personal protective equipment, suspension of clinical clerkships and observerships and reduction in elective surgical cases unavoidably affect medical and surgical education. Interesting solutions involving the use of virtual learning, videoconferencing, social media and telemedicine could effectively tackle the sudden cease in medical education. Furthermore, trainee's mental health should be safeguarded, and medical students can be involved in the COVID-19 clinical treatment if needed. In December 2019, a case series of a novel type of pneumonia was reported in Wuhan, China. The causing viral agent was identified as a novel betacoronavirus, named SARS-CoV-2, and the respective infection was named as "Coronavirus Disease 2019 (COVID-19)". As of today, COVID-19 has affected world health to an unprecedented degree. More than 2.44 million cases and 165,000 deaths worldwide have been reported as of 20th April 2020 (1). The pandemic and subsequent mitigation measures have severely impacted all but the most essential activities, effectively shutting down operations in commerce and services. Education has also been disproportionately affected, as the congregation of the youngest members of the community in closed spaces can significantly contribute to the spread of the virus. In total, more that 900 million learners in all levels of education, including higher education, have been affected (2, 3). Medical education equips clinicians with the knowledge and skills to provide safe healthcare to patients. Those receiving medical education do so, ultimately to provide this service to patients, an essential process to ensure a competent workforce. However, those recipients have responsibilities primarily towards service provision and supporting their health system, particularly in times of crisis. This is exemplified by the shutdown of academic institutions worldwide, reallocation of academic trainees into clinical roles and cessation of mandatory training and teaching. Many trainees have been prevented from rotating into new specialties or training positions and supplementary research and audit work that is not essential has been postponed. The aforementioned measures, whilst drastic for medical education, are seen as necessary to ensure health systems can cope with the burden COVID-19.

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To explore the impact of the COVID-19 pandemic on the mental health of Obstetricians and Gynaecologists. Study design: A cross-section survey-based study amongst doctors working within Obstetrics and Gynaecology in the United Kingdom. Results: A total of 207 doctors completed the survey. Obstetricians and Gynaecologists reported significantly higher rates of both Major Depressive Disorder (versus, p = 0.023) and Generalised Anxiety Disorder (versus, p = 0.044) as compared to the UK-wide estimates. Subgroup analysis showed that anxiety was more common amongst female doctors as compared to males (versus, p = 0.047). Although the prevalence of GAD was higher amongst registrars compared to their Consultant and/or Senior House Officer counterparts, this was not statistically significant. Respondents felt that the most significant factor for work-related changes to mental health was keeping up to date with frequently changing guidelines and protocols related to COVID-19. Only of respondents felt able to talk to colleagues about their mental health. Conclusions: Key findings include the high prevalence of mental health conditions amongst doctors, demonstration of the persistent taboo that mental health carries within the speciality and the key contributory factors to poor mental health. Further work should be done to assess if changes to the way new and updating guidelines, protocols and pathways are disseminated reduces the impact on the mental health of doctors. With the threat of a second COVID-19 peak looming, now more than ever, it is vital that steps are taken to break the stigmatisation of mental health amongst doctors, encouraging doctors to seek help when required.

Endometrial cancer (EC) is the most common cancer of the female genital tract, resulting annually in 76,000 related deaths worldwide. EC originates either from oestrogen-related proliferative endometrium (type I, endometrioid), or from atrophic endometrium (type II, non-endometrioid). Each type of EC is characterized by different molecular profile alterations. The Kirsten rat sarcoma viral oncogene homolog (KRAS) gene encodes a signalling protein which moderates response to various extracellular signals via down-regulation of the mitogenactivated protein kinase (MAPK) or phosphoinositide-3-kinase/vakt murine thymoma viral oncogene (PI3K/AKT) pathways. This article reviews the role of KRAS in predicting transition from hyperplastic endometrium to early-stage well-differentiated EC, as well as further invasive proliferation of the tumour to advanced-stage disease. KRAS seems to be directly associated with type I EC, and most studies support its early involvement in carcinogenesis. Current evidence correlates KRAS mutations with increased cell proliferation and apoptosis, as well as upregulation of endometrial cell oestrogen receptors. Tumours positive for KRAS mutation can harbour hypermethylation-related changes in genome expression, and this can be the cause of concurrent loss of DNA repair proteins. Despite some evidence that KRAS mutation status affects cancer progression, a consensus is yet to be reached. Based on the available evidence, we suggest that screening for KRAS mutations in patients with hyperplastic endometrium or early-stage type I EC, may provide important information for prognosis stratification, and further provision of personalised treatment options. Endometrial cancer (EC) is the most common cancer of the female genital tract in developed countries (1). Each year 319,500 women are diagnosed with EC resulting in 76,000 deaths worldwide (2). EC develops from the inner lining of the uterine corpus (3), and it is currently divided into two types as firstly described by Llobet et al. (4). Type I tumours tend to be low or intermediate tumour grade; they overlap considerably (80%) with oestrogen-related endometrioid carcinomas. Contrary to type I, type II EC results from a sequence of genetic alterations occurring in atrophic endometrium; this can occasionally reflect a progression from polyps or pre-cancerous lesions to EC. Type II EC is mostly considered as non-endometrioid serous carcinomas (4); it tends to be high grade, deeply invasive into the myometrium, and of more advanced stage at presentation (4, 5). The estimated 5-year overall survival for patients with any type of EC is 81.5% (any stage) (6). Current Staging EC staging consensus keeps with the 2009 International Federation of Gynaecology and Obstetrics (FIGO) revised classification. Revised FIGO staging defines four stages 533 This article is freely accessible online.

ObjectivesThere is substantial lack of guidance when it comes to the implementation of non-technical skills (NTS) in undergraduate medical education. This review aimed to identify and critically evaluate published literature on learning strategies for NTS in undergraduate medical education and to derive a training framework targeted towards standardizing future training interventions.MethodsA systematic review of the MEDLINE database was performed using a prospective protocol following PRISMA guidelines. Studies evaluating undergraduate medical students exposed to NTS interventions, which measured subjective or objective outcomes in selected attributes, were included.ResultsInitial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. A total of 24 NTS were identified, with communication skills being the most commonly reported skill evaluated (n = 37). A variety of educational tools were used (n = 32), noteworthy being the use of simulated patients. Great heterogeneity was also observed in measured outcomes and methods of assessment. A ‘triad of outcomes’ in NTS training was devised (knowledge, skill performance and attitude towards skills) and used for classification of all reported outcomes. Extracted data were used to design a non-technical skill training framework.ConclusionsThe existing literature describes a plethora of NTS interventions in undergraduate medical education, with varied outcomes and assessments. We hereby propose the ‘NTS Training Framework’, in an attempt to coordinate future research and catalyze the identification of an ideal NTS course structure to form tomorrow's physicians.