COVID-19 as a chance for hybrid teaching concepts

COVID-19 has turned the 2020 spring semester upside down. Three days before the start of the block week of the "Teamwork" module, the Federal Office of Public Health (FOPH) announced the ban on live interaction, which made it impossible to conduct five days of practice in the simulation centre of the University Hospital of Zurich. But how can the teaching of all the learning objectives necessary for medical training be guaranteed during an exceptional situation with constantly changing conditions? In the case of the BSc Human Medicine at ETH Zurich (ETHZ), the answer is: Hybrid teaching. The field report "COVID-19 as a chance for hybrid teaching concepts" outlines how ETHZ switched to hybrid teaching within a very short time and how hospital placements were combined with video conferences. The qualitative surveys conducted at the end of the semester and the weekly quantitative surveys of students from March to June indicate the importance of personal exchange despite the ban on contact and that interactivity is possible even without physical proximity. An example from the autumn semester will also be used to show which aspects have proved to be successful and can therefore be retained.

Medical didactics during the pandemic: the asynchronous online seminar "Written Examinations" of the Frankfurter Arbeitsstelle für Medizindidaktik

Objective: Due to the prohibition of face-to-face courses during the Corona pandemic, the seminar "Written Examinations" of the Frankfurter Arbeitsstelle für Medizindidaktik (FAM) was converted into an asynchronous online seminar. This pilot project investigated how such a format is accepted and evaluated by the participants. Methodology: A forum-based online format with group and individual tasks was chosen, which was didactically designed according to the problem-oriented design by Reinmann and Mandl. Results: The seminar was attended by 14 people, 13 of whom took part in the evaluation. The overall evaluation was, with one exception, a grade of 2 (and better). The three items "practical relevance", "subjective learning success" and the question of recommendation also received very high approval ratings. The weekly workload reported by the participants was very heterogeneous (mean=2.4 hours; SD=1.1). For some participants, the use of the learning platform was not intuitive and group collaboration was somewhat faltering. Conclusion: The experiences made show that courses on medical didactics can be implemented online and are gladly accepted by the participants. Based on the experience gained, online seminars or blended learning formats will certainly continue to be part of the FAM course program in the future.

TEACHING MUST GO ON: flexibility and advantages of peer assisted learning during the COVID-19 pandemic for undergraduate medical ultrasound education - perspective from the "sonoBYstudents" ultrasound group

Background: Facing the global COVID-19 pandemic University teaching has been digitalized and German medical faculties took great effort to offer curricular contents online as they agreed that semesters during pandemic should not be suspended. Skill training is an essential part of medical education and cannot be fully digitalized nor should it be omitted. The pandemic demonstrates that skills like ultrasound are essential when treating critical ill patients. Medical faculties use peer assisted learning (PAL) concepts to teach skills, like ultrasound through specially trained student tutors. Aim: Here, we would like to share our experiences and elaborate how ultrasound teaching can be safely performed during the pandemic with an emphasis on adjustment of an existing PAL teaching concept. Method: At the hospital of Saarland University, we implemented a PAL teaching concept for abdominal, including emergency, ultrasound, and echocardiography, called "sonoBYstudents" to teach sonography to undergraduate medical students. Students are generally taught in small groups of 5 people in 90min sessions over a time of 8 weeks with an objective structured clinical exam (OSCE) at the end of the course program. Each semester nearly 50 students are taught in abdominal and emergency ultrasound and 30 students in echocardiography. Over five years, more than 600 students have been taught with at least 30 students being trained as student tutors. Given the pandemic, course size, course interval and total course time and total course time were adapted to the hygienic precautions. Results: 45 and 30 students were taught in abdominal ultrasound and echocardiography respectively achieving their learning goals measured via OSCE at the end of the courses. OSCE results were the same when compared to previous semesters. Conclusion: PAL as a teaching concept lives out of sustained educational strategies like practical and didactical trainings and an ongoing recruitment of new student tutors. Suspending PAL and its skill teaching would require starting from the beginning which is a time and cost consuming process. With sonoBYstudents we were able to demonstrate that an existing PAL concept can, with some effort, be adjusted to changing teaching circumstances. Apart from this ultrasound is a non-omittable part of medical skill training with easily appliable hygienic precautions during teaching sessions.

Clinical Reasoning: Adapting Teaching Methods During the COVID-19 Pandemic to Meet Student Learning Outcomes

BACKGROUND

The COVID-19 pandemic impacted all aspects of health care, including nursing education. Senior nursing students saw the elimination of in-person clinical opportunities in the final months prior to graduation as health care facilities restricted access to essential personnel in an effort to minimize transmission of the virus and conserve personal protective equipment.

METHOD

To fulfill course requirements, faculty created a COVID-19 assignment that implored students to research the most current infection control recommendations for COVID-19 and to describe the impacts of the virus on nursing care, patients, families, interdisciplinary collaboration, and public safety.

RESULTS

The COVID-19 assignment fostered clinical reasoning and encouraged personal reflection with application to practice. Students reported that the assignment greatly enhanced knowledge and awareness of COVID-19.

CONCLUSION

This assignment was beneficial for transition to practice in the midst of a pandemic, and it can be easily replicated for any future emerging health care topic that may affect nursing education. [J Nurs Educ. 2021;60(1):48-51.].

The use of the online Inverted Classroom Model for digital teaching with gamification in medical studies

Introduction: In 2014, a newly designed, case-based seminar was successfully implemented in the subjects of health systems, health economics and public health care (GGG). The seminar "The Lonely Patient" is based on a real patient case and deals with the German health care system from the perspective of a patient. In order to create more space for discussion and exchange among students, the seminar was redesigned on the basis of the Inverted Classroom Method (ICM). Project description: Due to the COVID-19 pandemic, new, purely digital teaching formats had to be developed quickly in the sense of Emergency Remote Teaching. Therefore, the Inverted Classroom concept of the seminar was transformed into an online ICM. In order to promote active learning based on the ICAP model (Interactive, Constructive, Active, Passive), the online face-to-face part was designed as a synchronous interactive learner-centered course using the gamified audience response system Kahoot! Results: Evaluation results to date and feedback rounds with students indicate that the online ICM-version of the seminar leads to at least as good evaluation results as the previous face-to-face course. In particular, the students positively emphasize the use of Kahoot! as an activating digital medium. Discussion: Through the use of the ICM and the gamified audience response system Kahoot!, students could be activated in meaningful ways. The resulting discussions about the patient case and teaching content of the quiz questions in the synchronous online course could be implemented just as well as in the classroom-based course of previous semesters. Conclusion: The application of the online ICM, along with the consideration of the ICAP Model, has led to the successful implementation of a digital course within the context of the increased difficulty surrounding the emergency remote teaching. Additionally, students' learning success has remained at a similar level as during traditional classroom-based courses of previous semesters.

Learning how to conduct medical interviews online for the first time - this is what we learned in Frankfurt am Main

Objective: The COVID-19 pandemic made it necessary to convert a course on history taking, in theory and practice, to an online format over a very short time. A key question was whether, and if so to what extent, basic theory and, in particular, the practical skills required to conduct medical interviews can be learned online. Methodology/project description: The teaching program in basic theory was didactically redesigned and asynchronously placed on a learning platform, while the practical program, which consisted of training in conducting history-taking interviews, took place with the help of video conferencing software during synchronous sessions. For the practical sessions, the lecturers received organizational and technical support. Results: Based on initial evaluation results, a positive picture of the conversion has emerged since the course was completed. The need to restructure the course and use new teaching methods because of the COVID-19 pandemic was well accepted by lecturers and students, and the course content was successfully adapted to an online format. Conclusion: Overall, the online format enabled the learning objectives of the course to be successfully achieved. For topics such as non-verbal communication, the evaluation results indicated that a classroom format is preferable. Asynchronous theory teaching was generally very well received. Blended learning formats thus represent an appropriate means of teaching how to conduct medical interviews. Overall, online courses on conducting medical interviews provide students with the opportunity to become acquainted with the use of digital formats to conduct doctor-patient interviews, and to develop the relevant skills.

Classroom teaching with simulated patients during COVID-19: the communication skills course in the second year of the model medical curriculum HannibaL

Objective: In the spring of 2020 in response to the COVID-19 pandemic, the question arose at Hannover Medical School as to how simulated patients (SP) could still be utilized in the communication course that is part of the module "Diagnostic methods" taught in the second year of the model medical curriculum known as HannibaL. Methods: This short report summarizes the process of implementing the utilization of SP in analog classroom teaching and describes the relevant results on the concluding Objective Structured Clinical Examination (OSCE) in comparison to the previous year. Results: Overall, the analog SP deployments were practicable under local conditions and in compliance with precautionary measures to curb the risk of infection, whereby the OSCE scores did not deviate significantly from those in the prior year. Conclusion: During the COVID-19 pandemic and perhaps other epidemics as well, it will continue to be important in the future to make locally adapted, purpose-oriented, and preventively effective decisions regarding university didactics in undergraduate studies.

How cognitive psychology changed the face of medical education research

In this article, the contributions of cognitive psychology to research and development of medical education are assessed. The cognitive psychology of learning consists of activation of prior knowledge while processing new information and elaboration on the resulting new knowledge to facilitate storing in long-term memory. This process is limited by the size of working memory. Six interventions based on cognitive theory that facilitate learning and expertise development are discussed: (1) Fostering self-explanation, (2) elaborative discussion, and (3) distributed practice; (4) help with decreasing cognitive load, (5) promoting retrieval practice, and (6) supporting interleaving practice. These interventions contribute in different measure to various instructional methods in use in medical education: problem-based learning, team-based learning, worked examples, mixed practice, serial-cue presentation, and deliberate reflection. The article concludes that systematic research into the applicability of these ideas to the practice of medical education presently is limited and should be intensified.

Using the jigsaw technique to teach patient safety

Background: Medical education is rapidly changing where there has been decreased emphasis on passive didactics and increased focus on novel modes of teaching and learning to address the unique needs of millennial learners. As educators, it is challenging to keep up and find active teaching strategies outside of routine small group exercises to engage learners. Although the traditional small group activities, such as cased-based learning, allows for interactive and effective teaching, this modality may require the use of multiple faculty facilitators, which can be a difficult resource to find. The jigsaw learning method is cooperative learning that utilizes peer teaching and promotes collaborative learning, and additionally, only one facilitator is required of this type of learning technique.Objectives: We aimed to assess the effectiveness of the jigsaw method by comparing it to the traditional small group learning method to teach principles of diagnostic reasoning. Design: Residents were assigned to either the traditional small group teaching method or the jigsaw method. We compared pre-test, post-test, one-year follow-up test results between participants, and resident perception of the exercises.Results: A 2 × 3 repeated measures ANOVA indicated statistically significant improvement in tests scores from before to after participation with the jigsaw method compared to the traditional small group method. Post-survey demonstrated higher resident satisfaction with the jigsaw method.Conclusion: Our study demonstrates that a jigsaw cooperative learning approach can be used as an effective method to promote collaborative learning and engagement.

Rapid transition of a preclinical health systems science and social justice course to remote learning in the time of coronavirus

As the coronavirus pandemic started, we rapidly transitioned a preclinical social justice and health systems sciences course at our medical school to asynchronous, remote learning. We describe processes, curricular innovations, and lessons learned. Small groups were converted into independent learning modules and lectures were given live via videoconferencing technology. We started with a simplified approach and then built technological capabilities over time. Current events were incorporated into curriculum and assessment. Our course ran from 16 March-3 April 2020 for the 155-person first-year class. Student attendance for optional, synchronous remote sessions was higher than in-person attendance in previous years. Completion rates for assignments were high but with minimal student collaboration. Faculty office hours were underutilized. Focus group and formal evaluations were largely positive, with numerical ratings for quality of the course and faculty teaching higher than the 2 years prior. Student engagement with social justice topics in aremote format was successful through modifications to small groups and lecture structure. Students, faculty, and administrative staff appreciated the consistency of session format throughout the course. Students exam performance was similar to prior years. Attention should be paid to what can be learned via self-study as opposed to small group learning. Better methods of soliciting real-time student feedback, and encouraging engagement with each other and with faculty in aremote environment are needed.

Longitudinally adaptive assessment and instruction increase numerical skills of preschool children

Social inequality in mathematical skill is apparent at kindergarten entry and persists during elementary school. To level the playing field, we trained teachers to assess children's numerical and spatial skills every 10 wk. Each assessment provided teachers with information about a child's growth trajectory on each skill, information designed to help them evaluate their students' progress, reflect on past instruction, and strategize for the next phase of instruction. A key constraint is that teachers have limited time to assess individual students. To maximize the information provided by an assessment, we adapted the difficulty of each assessment based on each child's age and accumulated evidence about the child's skills. Children in classrooms of 24 trained teachers scored 0.29 SD higher on numerical skills at posttest than children in 25 randomly assigned control classrooms (P = 0.005). We observed no effect on spatial skills. The intervention also positively influenced children's verbal comprehension skills (0.28 SD higher at posttest, P < 0.001), but did not affect their print-literacy skills. We consider the potential contribution of this approach, in combination with similar regimes of assessment and instruction in elementary schools, to the reduction of social inequality in numerical skill and discuss possible explanations for the absence of an effect on spatial skills.

Implementing Change in Neuroanatomy Education: Organization, Evolution, and Assessment of a Near-Peer Teaching Program in an Undergraduate Medical School in Greece

In light of the current shifts in medical education from traditional lectures to more active teaching modalities, a peer-teaching program was introduced to a compulsory, second-year neuroanatomy course. A cross-sectional survey of 527 medical students in the six-year medical program of the National and Kapodistrian University of Athens was administered. The primary aim of the survey, which was distributed to second- through sixth-year medical students, who had completed the neuroanatomy course, was to assess student perception of peer teachers (PTs). Across the five years assessed, students increasingly acknowledged the contribution of PTs to their learning (P < 0.001). Attributes of PTs (e.g., contribution to learning, motivation, effective usage of material, and team environment) were significantly related to the student's opinion of the importance of laboratory activities (P < 0.001). Students who received "average" final grades scored the importance of laboratory exercises, and by inference PTs, significantly lower than students who received "excellent" final grades (P < 0.05). The amount of training that PTs had received was also significantly related to student perceptions of a PT's contribution. Better trained PTs were associated with significantly higher scores regarding learning, motivation, and positive environment compared to less trained PTs (P < 0.05). The results of the present study show that peer-teaching was well received by students attending the neuroanatomy course. While the results express the evolution of the program across the years, the findings also show that learners believed that PTs and the laboratory program contributed significantly to their understanding of neuroanatomy.

Histology and Embryology Education in China: The Current Situation and Changes Over the Past 20 Years

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

Markers of achievement for assessing and monitoring gender equity in a UK National Institute for Health Research Biomedical Research Centre: A two-factor model

BACKGROUND

The underrepresentation of women in academic medicine at senior level and in leadership positions is well documented. Biomedical Research Centres (BRC), partnerships between leading National Health Service (NHS) organisations and universities, conduct world class translational research funded by the National Institute for Health Research (NIHR) in the UK. Since 2011 BRCs are required to demonstrate significant progress in gender equity (GE) to be eligible to apply for funding. However, the evidence base for monitoring GE specifically in BRC settings is underdeveloped. This is the first survey tool designed to rank and identify new GE markers specific to the NIHR BRCs.

METHODS

An online survey distributed to senior leadership, clinical and non-clinical researchers, trainees, administrative and other professionals affiliated to the NIHR Oxford BRC (N = 683). Participants ranked 13 markers of GE on a five point Likert scale by importance. Data were summarised using frequencies and descriptive statistics. Interrelationships between markers and underlying latent dimensions (factors) were determined by exploratory and confirmatory factor analyses.

RESULTS

The response rate was 36% (243 respondents). Respondents were more frequently female (55%, n = 133), aged 41-50 years (33%, n = 81), investigators (33%, n = 81) affiliated to the BRC for 2-7 years (39.5%, n = 96). Overall participants ranked 'BRC senior leadership roles' and 'organisational policies on gender equity', to be the most important markers of GE. 58% (n = 141) and 57% (n = 139) respectively. Female participants ranked 'organisational policies' (64.7%, n = 86/133) and 'recruitment and retention' (60.9%, n = 81/133) most highly, whereas male participants ranked 'leadership development' (52.1%, n = 50/96) and 'BRC senior leadership roles' (50%, n = 48/96) as most important. Factor analyses identified two distinct latent dimensions: "organisational markers" and "individual markers" of GE in BRCs.

CONCLUSIONS

A two-factor model of markers of achievement for GE with "organisational" and "individual" dimensions was identified. Implementation and sustainability of gender equity requires commitment at senior leadership and organisational policy level.

"Starting from a higher place": linking Habermas to teaching and learning clinical reasoning in the emergency medicine context

Teaching clinical reasoning in emergency medicine requires educators to foster diagnostic accuracy and judicious decision-making amidst chaotic ambient factors including clinician fatigue, high cognitive load, and diverse patient expectations. The current study applies the early work of Jurgen Habermas and his knowledge-constitutive interests as a lens to explore an educational approach where physician-educators were asked to make their expert reasoning visible to emergency medicine trainees, to more deliberately make visible and accessible the context-specific thinking that emergency physicians routinely use. An action research methodology was used. The 'making thinking visible' teaching approach was introduced to five emergency medicine educators working in large public hospital emergency departments. Participants were asked to trial this teaching method and document its impact on student learning over two reporting cycles. Based on written reports of trialing the teaching approach, participants identified a need to change from: (1) introducing thinking structures to cultivating enquiry; and, (2) providing explanations based on cognitive thinking routines towards encouraging the learner to see the relevance of the clinical context. Educators described how they developed a more diagnostic and reflexive approach to learners, recognized the need to cultivate independent thinking, and valued the opportunity to reflect on their usual teaching. Teaching clinical reasoning using the 'making thinking visible' approach prompted educators to decrease the emphasis on providing technical information to assisting learners to understand the purposes and meanings behind clinical reasoning in emergency medicine. The knowledge-constitutive interests work of Jurgen Habermas was found to provide a robust framework supporting this emancipatory teaching approach.

Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine

Objectives Violence against medical trainees confronts medical educators and academic leaders in perinatal medicine with urgent ethical challenges. Despite their evident importance, these ethical challenges have not received sufficient attention. The purpose of this paper is to provide an ethical framework to respond to these ethical challenges. Methods We used an existing critical appraisal tool to conduct a scholarly review, to identify publications on the ethical challenges of violence against trainees. We conducted web searches to identify reports of violence against trainees in Mexico. Drawing on professional ethics in perinatal medicine, we describe an ethical framework that is unique in the literature on violence against trainees in its appeal to the professional virtue of self-sacrifice and its justified limits. Results Our search identified no previous publications that address the ethical challenges of violence against trainees. We identified reports of violence and their limitations. The ethical framework is based on the professional virtue of self-sacrifice in professional ethics in perinatal medicine. This virtue creates the ethical obligation of trainees to accept reasonable risks of life and health but not unreasonable risks. Society has the ethical obligation to protect trainees from these unreasonable risks. Medical educators should protect personal safety. Academic leaders should develop and implement policies to provide such protection. Institutions of government should provide effective law enforcement and fair trials of those accused of violence against trainees. International societies should promulgate ethics statements that can be applied to violence against trainees. By protecting trainees, medical educators and academic leaders in perinatology will also protect pregnant, fetal, and neonatal patients. Conclusions This paper is the first to provide an ethical framework, based on the professional virtue of self-sacrifice and its justified limits, to guide medical educators and academic leaders in perinatal medicine who confront ethical challenges of violence against their trainees.

COVID-19 Pandemic Challenges and Lessons Learned by Pharmacy Educators Around the Globe

The coronavirus identified in 2019 (COVID-19) has affected peoples' lives worldwide. This pandemic forced both pharmacy faculty members and students to adapt to a new teaching and learning environment not only in the United States but around the globe. Pharmacy educators faced challenges and opportunities to convert classroom learning and experiences, as well as student assessments, to a remote or online format. The unique approaches taken to overcome difficulties in various countries showed pharmacy faculty members' resilience in the face of adversity and their determination to continue providing education to students. The pandemic also shed light on areas needing improvement for pharmacy educators to work on in the future.

Perspective from a Teaching and Learning Center During Emergency Remote Teaching

During the COVID-19 pandemic, universities around the globe frantically and emergently switched to remote teaching. This commentary provides the perspective from a teaching and learning center about the difference between emergency remote teaching and online learning, plus suggestions for preparing for an online fall semester.

How Teachers Meet in Interdisciplinary Teams: Hangouts, Distribution Centers, and Melting Pots

PURPOSE

To explore team learning processes among interdisciplinary teacher teams in the development of integrated health professions education and to investigate students' perspectives on the quality of the educational courses.

METHOD

Using an exploratory, sequential mixed-methods design, the first author conducted 17 vignette-guided, semistructured interviews with teachers originating from diverse disciplines. These teachers worked in different courses of integrated, undergraduate health professions programs at the Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. The interview guide and vignettes were based on team learning research. The interviews sought to establish how interdisciplinary teacher team members work together on integrated curricula. The vignettes reflected constructs of team learning processes: sharing, co-construction, and constructive conflict. Data were collected between November 2017 and March 2018 and analyzed using template analysis. Sequentially, course evaluation data were used to provide a descriptive analysis of students' perspectives on educational quality (course organization, structure, learning effect, and alignment).

RESULTS

Three team approaches were identified. In fragmented teams or "hangouts," teachers individually worked on tasks that they were interested in, leaving their disciplinary mark. Framework-guided teams or "distribution centers" aimed to work within the given frameworks and organizational expectations, striving for disciplinary balance. Integrated teacher teams or "melting pots" used an interdisciplinary approach on all topics and put students at the center. Integrated teams reflected high-level team learning processes and were most satisfied with their (team)work. In contrast, fragmented and framework-guided teams mainly reflected low-level team learning processes. Students evaluated courses of integrated teacher teams highest on all investigated quality items (course organization, structure, learning effect, and alignment).

CONCLUSIONS

Successful interdisciplinary teacher teams are represented by an integrated approach with high-level team learning behavior and the best course evaluations. Therefore, health professions education management should actively encourage and facilitate integrated teacher teamwork.