BackgroundENT is highly under-represented in the saturated UK medical school curriculum, comprising less than 1 per cent of the curriculum. A 1-day course was implemented in order to raise awareness of ENT among medical students, educate them in the specialty and teach a basic skill.MethodsThe skills day comprised lectures by consultants followed by a consultant-led workshop teaching tracheostomy. Pre- and post-course questionnaires assessed perceptions of ENT, confidence performing tracheostomy and interest in ENT as a career.ResultsPerceptions of ENT as a specialty were improved by up to 80 per cent (p < 0.01). There was improved understanding of and confidence in performing tracheostomies. Interest in a career in ENT was increased by 77 per cent (p < 0.01).ConclusionA 1-day course run by a student body can be a powerful adjunct to the medical school curriculum, in terms of educating undergraduates in ENT and inspiring the pursuit of ENT as a career.

I read with interest the article by Bayoumy et al 1 discussing the knowledge and attitudes by medical and nursing students regarding the use of placebo. Bayoumy found that overall knowledge was poor and attitudes varied depending on the speciality within which the placebo was used. As a medical student, I believe this is an important topic to discuss as placebo plays a vital role in research and clinical practice, however wanted to address certain aspects of the paper.The sample size used included 91 male medical students who had received prior ethics teaching. This means that it could have exhibited response bias, 2 suggesting that the study lacks internal validity, as the knowledge of placebo in this group may be higher than that within the general population. Furthermore, the inclusion criteria included students who had "finished professional years and started professional years of study" -clarification of this is needed to explain the level of study at which these students are. Additionally, all of the students were at an educational level of 5 and above; it is unclear what it is equivalent to in other countries. Nonetheless, the results indicate that students entering clinical years lack knowledge on placebo. These results can inform universities that teaching on placebo should be introduced at pre-clinical level and subsequently assessed during clinical years in the format of verbal role-play examinations. This would provide students with not only sufficient knowledge on the ethical considerations associated with placebo, but also increase its effectiveness if used as the authors found that 'listening carefully and expressing true concern for patients' increased its effectiveness -all traits that can be assessed in an exam setting.The authors found that medical students displayed significantly less knowledge about placebo compared to nursing students (P=0.029), despite doctors often being in charge of prescribing compared to nurses. For example, Howick et al 3 found that 97% of primary care practitioners had used placebo at least once in their career. This indicates that doctors are potentially prescribing medications that they are not sufficiently educated about. The General Medical council currently does not issue any guidance on the use of placebo in clinical practice, 4 therefore it may be beneficial to implement guidelines to provide standardised guidance to all doctors in order to tackle ethical dilemmas surrounding its use.Of note, the study was cross-sectional and therefore cannot explain at which point students gained knowledge of placebo, although 26% of medical students stated that they received their knowledge from "college" 5 More detail is required to

We read with interest the article by Shahid and Adams 1 discussing the effects of time off before commencing medical school on emotional intelligence (EI). The authors concluded that EI was greater in those who had taken a gap year regardless of age, gender or type of medical degree. We feel that EI is important to help doctors manage stressful working environments and wanted to address certain aspects of the paper that we believe should be taken into consideration. Firstly, residents were asked whether they took time off before medical school to work, carry out research or obtain an advanced degree; however EI of these trainees were not directly compared against each other. This means that it is difficult to determine which factor affects EI the most. Furthermore, the study does not account for other activities carried out during gap years such as travel or physical activity-which have been shown to increase EI. 2 Assuming that gap years alone increase EI is perhaps too simplistic a hypothesis as it could be the activity undertaken that increases EI. Moreover, the authors argue that there was no association between age and EI. These results are confounded by Joseph et al, 3 who found a statistically significant increase in EI in medical students aged 22 years or above compared to all younger students (p=0.04), thus highlighting that normal aging may be a greater factor than the gap year itself. The authors reasoned that during a gap year 'working with a diverse group of people leads to improved communication and relationship building'-however this can also be achieved during medical school itself. Once again, this indicates that perhaps the activity carried out during the gap year is of greater influence on EI development. Of note, this research was carried out on trainees: thus the scores achieved may not necessarily reflect the effects of a gap year, but rather all the experience gained throughout medical school. Although the paper discussed that type of medical school did not affect EI, some medical schools emphasise problem-based learning, oral examinations and reflective practise, all of which can increase EI. This means that further research is required to inform medical schools of the best methods of delivering teaching such that universities are aware of how to aid students in developing EI. Utilising the knowledge of what students carried out during their

Introduction and hypothesis Evidence on OAB management remains suboptimal and methodological limitations in randomized control trials (RCTs) affect their comparability. High quality meta-analyses are lacking. This study aimed to compare selection and reporting of outcomes and outcome measures across RCTs as well as evaluate methodological quality and outcome reporting quality as a first stage in the process of developing core outcome sets (COS). Methods RCTs were searched using Pubmed, EMBASE, Medline, Cochrane, ICTRP and Clinicaltrials.gov from inception to January 2020, in English language, on adult women. Pharmacological management, interventions, sample size, journal type and commercial funding were documented. Methodological and outcome reporting quality were evaluated using JADAD and MOMENT scores. Results Thirty-eight trials (18,316 women) were included. Sixty-nine outcomes were reported, using 62 outcome measures. The most commonly reported outcome domains were efficacy (86.8%), safety (73.7%) and QoL (60.5%). The most commonly reported outcomes in each domain were urgency urinary incontinence episodes (UUI) (52.6%), antimuscarinic side effects (76.3%) and change in validated questionnaire scores (36.8%). A statistically significant correlation was found between JADAD and MOMENT (Spearman’s rho = 0.548, p < 0.05) scores. This indicates that higher methodological quality is associated with higher outcome reporting quality. Conclusions Development of COS and core outcome measure sets will address variations and lead to higher quality evidence. We recommend the most commonly reported outcomes in each domain, as interim COS. For efficacy we recommend: UUI episodes, urgency and nocturia episodes; for safety: antimuscarinic adverse events, other adverse events and discontinuation rates; for QoL: OAB-q, PPBC and IIQ scores.