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Background: Nearly 30% of patients with COVID-19 infection develop post-COVID Syndrome. Knowledge of post-COVID Syndrome is evolving, creating the need for adaptable curricula. Flipped classrooms (FC) are flexible and dynamic with demonstrated utility in continuing medical education (CME), yet there has been no research on application of FCs, or comparisons between livestream and in-person learning, in post-COVID CME. Methods: We implemented a novel post-COVID curriculum using FCs for in-person and livestream participants at four Mayo Clinic CME conferences. Outcomes were validated measures of knowledge; perceptions of FCs and CME teacher effectiveness; and learner engagement. Pre-conferences surveys were a post-COVID knowledge test and the Flipped Classroom Perception Inventory (FCPI). Post-conference surveys were a post-COVID knowledge test, the FCPI, the CME Teaching Effectiveness Instrument (CMETE), and the Learner Engagement Inventory (LEI). Pre-post knowledge and FCPI scores were analyzed using linear mixed models. CMETE and LEI were compared for in-person versus livestream participants using the Wilcoxon rank-sum test. Results: Overall, 59 participants completed the pre-test, and 72 participants completed the post-test, surveys. Participants were predominantly female (58%), were in nonacademic group practices (65%), and lacked prior experience with flipped classrooms (83%). Following the presentations, participants showed significant improvements in post-COVID knowledge (47% correct precourse to 54% correct postcourse, p-value = 0.004), and a trend toward improved FCPI scores. Teaching effectiveness, learner engagement, and pre-post change in COVID knowledge did not differ significantly between participants of in-person versus livestream sessions. Conclusion: This post-COVID FC curriculum was feasible and associated with improved knowledge scores among a diverse population of physician learners in CME, without any apparent compromise in learner engagement, or in perceptions of teaching effectiveness and FCs, among livestream versus in-person participants.

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AIM: To examine undergraduate nursing students' sense of belonging as they transitioned from online to in-person learning. DESIGN: A mixed-method design employing a Sense of Belonging Survey and three open-ended questions. METHODS: Participants were first-year undergraduate nursing students who were back to in-person learning after 3 years of online learning during the pandemic. The survey was administered online in April 2023 using Qualtrics survey software. The survey data were analysed using descriptive statistics, and the open-ended questions were analysed by deductive thematic analysis. RESULTS: Seventy-five (48%) of the 155 potential participants responded to the survey. The mean score on the Sense of Belonging Survey was 74%, a positive finding suggesting that many participants feel that they 'belong' in the classroom. Three overarching themes were identified in response to the open-ended questions: factors supporting students' sense of belonging, factors hindering students' sense of belonging and strategies for faculty, administrators and students to increase a sense of belonging. CONCLUSION: Understanding the factors that contribute to or hinder nursing students' sense of belonging during this transition will assist in developing strategies to mitigate challenges, foster a positive learning environment and enhance the overall sense of belonging among nursing students. IMPACT: The first year of a nursing programme is crucial for student retention as students require tailored programmes and strategies to support their success. Examining and analysing the transition from online to in-person classroom settings is crucial to identifying strategies to enhance and support first-year students' sense of belonging and academic success. Exploring nursing students' experiences of belonging during transitions contributes to a more inclusive and equitable educational experience, fostering an environment where all students can thrive and succeed. PATIENT OR PUBLIC CONTRIBUTION: Not applicable.

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Introduction The coronavirus 2019 pandemic highlighted virtual learning (VL) as a promising tool for medical education, yet its effectiveness in teaching clinical reasoning (CR) remains underexplored. Past studies have suggested VL can effectively prepare students for clinical settings. Informed by the Milestones of Observable Behaviours for CR (MOBCR) and whole-case theoretical frameworks, the Mock Wards (MW) program was created using a novel blended in-person learning (IPL) and VL platform. MW consisted of case-based small-group formats for medical students interested in learning approaches and differentials to commonly encountered presenting symptoms and diagnoses in internal medicine. This study sought to use MW's blended design to qualitatively analyze CR development and compare its utility between VL and IPL. Methods Qualitative analysis was conducted using in-depth semi-structured interviews with first-year pre-clerkship medical students (n = 8) who completed the MW program and participated in the study. The interview guide was informed by the MOBCR framework. Interview transcripts were analyzed using a directed qualitative content analysis approach. Translational coding and HyperRESEARCHTM (Researchware, Inc., Randolph, MA) software-generated mind maps guided the theme development. Results Three overarching themes were constructed: (1) tailoring pedagogical frameworks to learning modalities, (2) learning through interactivity, and (3) balancing accessibility with learner engagement. Participants emphasized that teaching CR skills is modality-specific and not fully interchangeable, with IPL being superior in facilitating social cohesion, non-verbal communication, and feedback. In contrast, VL required structured approaches and relied more on verbal communication and pre-made digital materials. IPL also enhanced interactivity, peer relationships, and spontaneous communication, whereas VL faced challenges such as social awkwardness and technological constraints hindering effective collaboration. VL provided superior accessibility to facilitate distributed learning and management of concurrent academic obligations. Conclusion The MW-blended platform highlights the importance of focusing on modality-tailored pedagogies, emphasizing group interactability, and balancing VL accessibility against decreased engagement within the IPL environment when teaching CR skills. Blended education models may benefit from a scaffolding approach, using IPL as a prerequisite to VL to improve CR development and alignment within a learner's zone of proximal development.

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OBJECTIVES: The interruption to clinical professions' instruction due to closures from the coronavirus disease 2019 pandemic posed a significant hurdle to clinical education and presented a necessity to shift how instruction was delivered to resume educational activities. This study sought to answer the research question: did the transition from in-person to virtual instruction for interprofessional education (IPE) have an impact on students' perceptions of team attitudes and skills to learn and work in interprofessional groups? METHODS: All participating first-year dental and second-year dental hygiene students enrolled in the campus-wide IPE course were invited to complete the Team Skills Scale (TSS) assessment before and after the course for two academic years 2019-2020 and 2020-2021. Paired t-tests were utilized to assess the change in student attitudes and skills from pre- to post-course assessment, and t-tests were used to assess mean differences between student cohorts 2019-2020 and 2020-2021. RESULTS: Within the student cohort 2019-2020 students reported significant improvement in all TSS items. Within the student cohort, 2020-2021 students reported significant improvement in all but three TSS items. There were only significant differences in mean values for student reported improvement in attitudes and skills for two TSS items between the 2019-2020 and 2020-2021 cohorts. CONCLUSIONS: Dental and dental hygiene students report significant improvement in team attitudes and skills after participation in a campus-wide IPE course. The mode of administration of the course, in-person or virtual, did not have a significant impact on student-reported improvements.

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COVID-19 accelerated continuing professional development (CPD) delivered online. We aimed to compare the impact of in-person versus online CPD courses on medical specialists' behavioural intentions and subsequent behaviour. In this comparative before-and-after study, medical specialists attended in-person courses on nine clinical topics. A second group attended an adapted online version of these courses. Behavioural intention and its psychosocial determinants were measured before and immediately after the courses. Behaviour change was measured six months later. Generalised estimating equation (GEE) models were used to compare the impact of course formats. A total of 82/206 in-person registrants (mean age: 52±10 years; 50% men) and 318/506 on-line registrants (mean age: 49±12 years; men: 63%) participated. Mean intention before in-person courses was 5.99±1.31 and 6.43±0.80 afterwards (average intention gain 0.44, CI: 0.16-0.74; p=0.003); mean intention before online courses was 5.53±1.62 and 5.98±1.40 afterwards (average intention gain of 0.45, CI: 0.30-0.58; p<0.0001). Difference in intention gain between groups was not statistically significant. Behaviour reported six months later was not significantly associated with post-course intention in either group. However, the intention difference increased significantly among those who said they had adopted the targeted behaviour (paired wilcoxon test: n = 40 and p-value=0.002) while it did not increase significantly in the group of those who had not adopted a targeted behaviour (paired wilcoxon test: n = 16 and p-value=0.223). In conclusion, the increase in intention of specialists after CPD courses was similar whether the course was in-person or online. Also, an increase in intention in both groups signalled more likelihood of adoption.

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Background: As children reintegrate with in-person classroom learning after COVID-19, health and education institutions should remain mindful of students' mental health. There is a paucity of data on changes in students' mental health before, during and after their return to in-person classroom learning. Methods: We collected and analyzed data on self-reported wellbeing, general mental health, perceived stress, and help-seeking attitudes from grade 7-12 students in a Catholic school division in Canada (n = 258 at baseline; n = 132 at follow-up). Outcomes were compared according to demographic differences such as gender, grade level, experience accessing mental health services, and presence of support staff between baseline and follow-up. Effects of time points and each demographic variable on each outcome and on the prediction of students' mental health were also analyzed. Results: No significant differences were apparent for outcomes between baseline and follow-up. However, specific subgroups: junior high students, male students, students who had not accessed mental health services, and students who had access to support-staff had better outcomes than their counterparts. From baseline to follow-up, male students reported mental health decline [Mean = 11.79, SD = 6.14; Mean = 16.29, SD = 7.47, F(1, 333) = 8.36, p < 0.01]; students who had not accessed mental health services demonstrated greater stress [Mean = 20.89, SD = 4.09; Mean = 22.28, SD = 2.24, F(1, 352) = 6.20, p < 0.05]; students who did not specify a binary gender reported improved general mental health [Mean = 19.87, SD = 5.89; Mean = 13.00, SD = 7.40, F(1, 333) = 8.70, p < 0.01], and students who did not have access to support-staff improved help-seeking attitudes [Mean = 22.32, SD = 4.62; Mean = 24.76, SD = 4.81; F(1, 346) = 5.80, p < 0.05]. At each time point, students indicated parents, guardians, and close friends as their most-preferred help-seeking sources. High stress predicted lower wellbeing at baseline, but higher wellbeing at follow-up. Conclusion: Students presented stable mental health. Subgroups with decreased mental health may benefit from extra mental health support through building capacity among teachers and health care professionals to support students following public health emergencies.

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Introduction: School-based COVID-19 testing may be an effective strategy for reducing transmission in schools and keeping schools open. The study objective was to examine community perspectives on school-based COVID-19 testing as a mitigation strategy to support safe school reopening. Methods: We conducted a qualitative study in Yakima County, an agricultural region of Washington state, where over half of residents are Hispanic/Latino. From June to July 2021, we interviewed 18 students (13 years old, on average) and 19 school employees, and conducted four focus groups (2 in Spanish, 2 in English) with 26 parents. We audio-recorded the semi-structured interviews and focus group discussions which were then transcribed. We used an inductive, constant comparison approach to code the transcripts and conducted a thematic analysis to generate themes. Results: We identified four main themes. Students, parents, and school employees desired a return to in-person learning (Theme 1). Schools implemented numerous COVID-19 mitigation strategies (e.g., masking) to facilitate a safe return to school but felt that adding testing would not be feasible due to a lack of resources and overworked staff (Theme 2). Parents and school employees' familiarity with COVID-19 testing procedures influenced their support for testing (Theme 3). Parents and school employees felt there were inadequate resources for individuals who test positive for COVID-19 (Theme 4). Discussion: Schools require adequate resources and medical personnel to implement COVID-19 testing. Individuals also need resources after testing positive, including physical space to isolate, financial resources for those without paid time off, and delivery of food and other necessities to households in rural communities.

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We document large temporal and geographical discrepancies among prominent trackers that measure in-person, hybrid, and remote schooling in the U.S. during COVID-19. We then propose a new measure of effective in-person learning (EIPL) that combines information on schooling modes with cell phone data on school visits and estimate it for a large, representative sample of U.S. public and private schools. The EIPL measure, which we make publicly available, resolves the discrepancies across trackers and is more suitable for many quantitative questions. Consistent with other studies, we find that a school's share of non-white students and pre-pandemic grades and size are associated with less in-person learning during the 2020-21 school year. Notably, we also find that EIPL was lower for schools in more affluent and educated localities with higher pre-pandemic spending and more emergency funding per student. These results are in large part accounted for by systematic regional differences, in particular political preferences.

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BACKGROUND: Online learning is the newest and most popular form of distance education today; within the past decade it has had a major impact on education. The aim of the present study was to know the effect of online learning basketball using social media on learners' performance of some fundamental skills in basketball and determine difference between online learning and in-person learning, knowing which one is better than the other. MATERIALS AND METHODS: The present experimental study was conducted in Sports Academy for Basketball in Zagazig-Egypt during March-April 2022. Thirty two female junior basketball players volunteered to participate in the study from Sports Academy for Basketball (age: 16.23 ± 0.66 years; body height: 164.5 ± 3.32 cm; body mass: 65.25 ± 3.22 kg). They were divided into two equally sized experimental groups, online learning (ONL) group (n = 16) and in-person learning (INL) group (n = 16), to perform (15) educational sessions for (5) weeks, (3) sessions per week, and the session time was 90 minutes. Junior basketball players were assessed before and after five-week training period. Data were collected by Basketball Passing test, Dribbling Skill test, Lay Up Shoot test, Speed Spot Shooting, and Free-Throw Shooting test. The collected data were analyzed using SPSS version 22 software using the descriptive statistical test. The level of significance was set at P ≤0.05. RESULTS: The results showed that the two groups made significant improvements in all variables but INL group had significantly greater improvements than ONL group. The percentage of improvement ranged from 13% to 223% for INL group versus 8% to 158% for ONL group. CONCLUSION: We conclude that in-person basketball learning was better than online learning basketball. Therefore, teachers and trainers must rely primarily on in-person learning and not rely on distance learning, especially with regard to learning motor skills, except in emergency cases.

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BACKGROUND: This paper describes the protocol for a longitudinal cohort study, "Project SafeSchools" (PSS), which focuses on measuring the effects of COVID-19 and the return to in-person learning on Diné (Navajo) and White Mountain Apache (Apache) youth, parents, and educators. The early surges of the COVID-19 pandemic led to the closure of most reservation and border town schools serving Diné and Apache communities. This study aims to: (1) understand the barriers and facilitators to school re-opening and in-person school attendance from the perspective of multiple stakeholders in Diné and Apache communities; and (2) evaluate the educational, social, emotional, physical, and mental health impacts of returning to in-person learning for caregivers and youth ages 4-16 who reside or work on the Diné Nation and the White Mountain Apache Tribal lands. METHODS: We aim to recruit up to N = 200 primary caregivers of Diné and Apache youth ages 4-16 and up to N = 120 school personnel. In addition, up to n = 120 of these primary caregivers and their children, ages 11-16, will be selected to participate in qualitative interviews to learn more about the effects of the pandemic on their health and wellbeing. Data from caregiver and school personnel participants will be collected in three waves via self-report surveys that measure COVID-19 related behaviors and attitudes, mental health, educational attitudes, and cultural practices and beliefs for both themselves and their child (caregiver participants only). We hypothesize that an individual's engagement with a variety of cultural activities during school closures and as school re-opened will have a protective effect on adult and youth mental health as they return to in-person learning. DISCUSSION: The results of this study will inform the development or implementation of preventative interventions that may help Diné and Apache youth and their families recover from the negative impact of the COVID-19 pandemic, and positively impact their health and wellness.

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Utilization of new technologies (ICT) and digital media has been a priority in recent years in the design and the implementation of educational programs around the world. The new educational reality, imposed by the pandemic, relies heavily on the replacement of in-person learning with distance learning, which is based on the use of digital tools and new technologies. The fact that distance learning has been massively and rapidly imposed due to the circumstances resulting from the pandemic and has been transformed from a supplementary to the main means of the educational procedure, has also highlighted the need for its tools to be linked to learning theories and to be extended to non-formal forms of education. Digital storytelling, in particular, that during the last years has been used as a means to all levels of formal and non-formal education, can be proved equally useful and productive in distance learning as well. This article presents a lesson plan for the literature course created in a secondary school in Greece. During the teaching, it was explored whether digital storytelling can provide a quality educational tool in which you can find a field for modern constructive-collaborative learning theories, in both formal and non-formal forms of education.

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OBJECTIVE: To examine the association between elementary school opening status (ESOS) and changes in pediatric COVID-19 incidence. METHODS: We conducted a cross-sectional study of US counties with school districts with ≥500 elementary school students. The main exposure was ESOS in September, 2020. The outcome was county incidence of COVID-19. Age-stratified negative binomial regression models were constructed using county adult COVID-19 incidence. RESULTS: Among 3220 US counties, 618 (19.2%) were remote, 391 (12.1%) were hybrid, 2022 (62.8%) were in-person. In unadjusted models, COVID-19 incidence after school started was higher among children in hybrid or in-person counties compared with remote counties. After adjustment for local adult incidence, among children aged 0 to 9, the incidence rate ratio of COVID-19 (IRR) compared with remote counties was 1.01 (95% confidence interval [CI] 0.93-1.08) in hybrid counties and 0.79 (95% CI 0.75-0.84) in in-person counties. CONCLUSIONS: Counties with in-person learning did not have higher rates of COVID-19 after adjustment for local adult rates.

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Background and objective Earlier uncertain implications of the coronavirus disease 2019 (COVID-19) pandemic on the pediatric population prompted the authorities to close schools worldwide under the premise that school settings would serve as drivers of an increase in the cases of COVID-19. Safe and equitable full-in-person school instruction is a critical factor in the continued educational gains of children and for their general well-being. The objective of this study was to report epidemiological trends related to the increasing percentage of students returning to in-person instruction, the suspected in-school transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, and countywide COVID-19 case rates during the first 21 weeks of school reopening in Marin County, CA, in the fall of 2020. Materials and methods The institutional review board (IRB) approval was waived for this study as it did not involve any identifiable human subjects data. Retrospective electronic reviews of countywide COVID-19 daily case count and COVID-19-related reports associated with in-person school participants from 77 schools in Marin County, CA, from September 8, 2020, to January 29, 2021, were conducted. The data were made available in collaboration with the Marin County Office of Education (MCOE) and Marin County Department of Health and Human Services (Marin HHS). Descriptive trends analyses were performed to determine whether the phased increase of students attending in-person learning was a significant contributor to countywide COVID-19 incidence rate, crude rate, and in-school COVID-19 viral transmission. This is the first long retrospective study of COVID-19 data among the reopened school population during the second half of the first pandemic year. It was conducted in a 21-week surveillance period involving an immense collaboration between Marin County's public health officials and school administrators. Results Over the 21-week observational period involving 17,639 students, 4,938 school staff, and 899,175 student days, the countywide COVID-19 crude rate decreased (from 89.9 to 35.89 per 10,000) as more students returned to in-person learning. The schools' strict adherence to public health guidance and site-specific safety plans against COVID-19 yielded a significantly reduced incidence rate of 0.84% among in-person learning participants; only nine cases were traced to suspected in-school SARS-CoV-2 transmission by way of rigorous contact tracing. The countywide COVID-19 incidence rate was 2.09%. Conclusions It is possible to minimize COVID-19 transmissions in in-person learning settings with cohesive mitigation strategies, specifically strict adherence to proper masking by students and staff while on school grounds. There is no clear correlation that the increasing phased return of students to in-person school drove an increase in countywide COVID-19 cases in Marin County, CA. Our findings revealed that schools were capable of safely resuming operations by following public health orders and recommendations. The increasing percentage of students returning to in-person school did not drive an increased COVID-19 case rate in the community. On the contrary, this analysis revealed that there was a drop in countywide COVID-19 cases as the phased student return percentage increased.