MedEdPublish (ISSN 2312–7996) is a highly visible, open access, specialist practitioner e-journal that enables academics, teachers, clinicians, researchers and students to publish their experiences, views and research findings relating to teaching, learning and assessment in medical and health professions education. An innovative and key feature of MedEdPublish is that the peer review process begins following publication.

Introduction. Fungal infection is a cause of increased morbidity and mortality in intensive care patients. Critically unwell patients are at increased risk of developing invasive fungal infections. COVID‐19 patients in the intensive care unit (ICU) may be at a particularly high risk. The primary aim of this study was to establish the incidence of secondary fungal infections in patients admitted to the ICU with COVID‐19. Secondary aims were to investigate factors that may contribute to an increased risk of fungal infections and to calculate the mortality between fungal and nonfungal groups. Methods. We undertook a retrospective observational study in a tertiary ICU in Wales, United Kingdom. 174 patients admitted with COVID‐19 infection from March 2020 until May 2021 were included. Data were collected through a retrospective review of patient’s clinical notes and microbiology investigation results obtained from the online clinical portal. Results. 81/174 (47%) COVID‐19 patients developed fungal infections, 93% of which were Candida species, including Candida albicans (88%), and 6% had an Aspergillus infection. Age and smoking history did not appear to be contributing factors. The nonfungal group had a significantly higher body mass index (33 ± 8 vs. 31 ± 7, p = 0.01). The ICU length of stay (23 (1–116) vs. 8 (1–60), p < 0.001), hospital length of stay (30 (3–183) vs. 15 (1–174) ± 7, p < 0.001), steroid days (10 (1–116) vs. 4 (0–28), p = 0.02), and ventilation days (18 (0–120) vs. 2 (0–55), p < 0.001) were significantly higher in the fungal group. The mortality rate in both groups was similar (51% vs. 52%). The Kaplan–Meier survival analysis showed that the fungal group survived more than the nonfungal group (log rank (Mantel–Cox), p < 0.001). Conclusion. Secondary fungal infections are common in COVID‐19 patients admitted to the ICU. Longer treatment with corticosteroids, increased length of hospital and ICU stay, and greater length of mechanical ventilation significantly increase the risk of fungal infections. Fungal infection, however, was not associated with an increase in mortality.

Introduction: Methamoglobinemia is a condition characterized by impaired oxygen delivery to the tissues due to the formation of methemoglobin (Met‐Hb). Diagnosis is established when Met‐Hb levels exceed 5%. Levels over 30% are associated with severe symptoms and can be life‐threatening. Pulse oximetry may provide misleading readings, often reporting oxygen saturation around 85%, irrespective of actual oxygenation levels. Management involves discontinuing offending agents, providing supportive care, and use of specific treatment agents. Most commonly, cases report a quick and effective recovery following treatment. Case Presentation: We describe a case of a patient requiring four separate admissions over a 9‐month period, all for methemoglobinemia, where the cause remained uncertain. A 25‐year‐old female was admitted to the intensive care unit (ICU) with sudden onset shortness of breath and cyanosis, and Met‐Hb level 55.5%, suspected due to dapsone. She was treated with 1 mg/kg of methylene blue intravenously. Met‐Hb levels remained persistently above 20% for a number of days, and reaccumulated following initial decline. Repeated doses of methylene blue were required, and activated charcoal was given. She was readmitted 3 days later, with reaccumulation of Met‐Hb. This was again thought secondary to dapsone, given the long half‐life of dapsone and potential for enterohepatic recirculation. She had a third admission with methemoglobinemia almost 2 months after the first admission, and again 8 months later. Suggestion was that azathioprine could be the causative agent; however, this has not been reported previously. Discussion: We report a case of a 25‐year‐old female with repeated admissions with methemoglobinemia. This case highlights the potential for refractory methemoglobinemia requiring repeated treatment, and the importance of longer periods of close observation. It is important to consider the diagnosis in patients without a clear trigger for methemoglobinemia, as an identifiable cause may not always be clear.

Introduction: Smoking is known to be harmful to health, contributing to increased severity in respiratory infections such as influenza. The impact in COVID‐19 remains controversial. Social deprivation and inequality are associated with worse outcomes in infectious disease and may impact on mortality in COVID‐19. Methods: A retrospective cohort study in a tertiary hospital general adult Intensive Care Unit (ICU). 174 patients with COVID‐19 confirmed by polymerase chain reaction (PCR) testing between March 21st 2020 and May 15th 2021 included. Data collection was by retrospective review of clinical notes. Patients were grouped into three categories: current smokers, former smokers (ex‐smokers) and never smokers. Statistical analysis carried out on IBM Statistical Package for Social Sciences (SPSS) for Windows, version 28.0 (Armonk, NY:IBM Corp). Values reported as means, standard deviation (SD), median and interquartile ranges (IQR). Comparisons with the Mann–Whitney U test for median and IQR and two sample t ‐test for mean and SD. Survival analysis was performed using Kaplan–Meier. Results: Of 174 patients, 11 were current smokers (6.3%), 51 were former smokers (29%) and 112 were never smokers (64%). Current smokers were younger and frailer, with longer hospital and ICU length of stay (ICULOS). Welsh Index of Multiple Deprivation (WIMD) scores were collected using UK postcodes and ranked 1909 areas, showing current smokers from the most deprived areas. Kaplan–Meier survival analysis showed current smokers are less likely to survive. Discussion: Despite 6.3% prevalence of smoking in patients with severe COVID‐19 in the ICU, smokers had increased hospital and ICU LOS with reduced survival. The relationship between COVID‐19 and deprivation is multifaceted and complex and may relate to demographic, socioeconomic and environmental factors; health‐related risk factors; and practices. From our data we can see that current smokers admitted to ICU with severe COVID‐19 were from the most deprived areas in Wales, with a higher mortality risk.

Introduction Simulation is an effective teaching method with increasing growth and recognition and refers to the artificial representation of a real-life scenario. The aim of this study was to compare simulation with and without the use of a simulated observations monitor and to investigate differences in students’ impression of realism, engagement, learning, and enjoyment. Methods Simulation sessions were delivered to second and third-year Swansea University Medical Students, and a total of 15 students were included. Students carried out 2-3 scenarios each with and without the use of a simulated observations monitor. Data collection was conducted via student surveys and a joint interview. Results All students had an increased sense of realism with the use of the simulated observations monitor, feeling a closer resemblance to what would be experienced in clinical practice. They felt this improved their learning, making them more prepared for the real-life scenario. The monitor was more dynamic, responding to their interventions, helping them maintain focus and engagement throughout. A key theme was the reduction of interruptions or deviations from the scenario to communicate with the examiner or ask for observations. The visual and audible affects provided additional stimuli, adding to the realistic nature of the simulation. Discussion Simulation has been shown to be a useful education tool, but there is less evidence to support the use of higher fidelity over lower fidelity simulation. The terms are often used inconsistently, and many factors affect the students’ perceived sense of realism. This study shows that the addition of a simple device such as the simulated observations monitor can produce a higher level of fidelity, particularly in terms of the stimuli provided and student perceptions of realism, which may be effective in improving engagement with the simulation, learning, and aid recall when presented with similar scenarios in a real-life situation.