Converting to Connect: A Rapid RE-AIM Evaluation of the Digital Conversion of a Clerkship Curriculum in the Age of COVID-19

Incorporating implementation science principles into curricular design

Implementation science (IS) is an approach focused on increasing the application of evidence-based health interventions into practice, through purposive and thoughtful planning to maximize uptake, scalability, and sustainability. Many of these principles can be readily applied to medical education, to help augment traditional approaches to curriculum design. In this paper, we summarize key components of IS with an emphasis on application to the medical educator.

Beyond COVID-19: the impact of recent pandemics on medical students and their education: a scoping review

INTRODUCTION

Over the past two years, coronavirus disease (COVID-19) has greatly altered medical student education as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality medical education. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared medical educators for COVID-19? This scoping review investigated the educational and personal impact of recent pandemics on medical students.

METHODS

This review followed the PRISMA-ScR guidelines for scoping reviews. Nine databases including PubMed, ERIC, and EMBASE were systematically searched using keywords and subject headings related to medical students and SARS, H1N1, MERS, Ebola, Zika, and COVID-19. Studies were limited to research studies published between 2000 and 2020 and in English. Based on exclusion and inclusion criteria, all studies were independently screened by two reviewers first by the title/abstract and then via full text. Data were extracted from the included studies and analyzed qualitatively using thematic analysis.

RESULTS

A total of 174 studies fit the criteria. Seven major themes emerged from those studies: educational adaptations and online modifications, knowledge and attitudes of students, mental wellness of students, student involvement and use of telehealth, student vaccination, physical wellness of students, and stigma.

CONCLUSION

This review provided insights into how medical students were affected by recent pandemics and their perceptions of pivoting to online education, mental health, and knowledge of the diseases. Additionally, this review showcases the various educational adaptations that emerged uniquely during the COVID-19 pandemic, such as telehealth services or video conferencing tools, that can be utilized in a post-pandemic environment.

The Utility of a Virtual Emergency Medicine Elective for Visiting Medical Students

Background Away rotations allow emergency medicine (EM)-bound fourth-year medical students to experience a residency program's educational culture and influence the ranking of residency programs. The financial cost and geographic distance have limited student participation in away electives. In recent years, COVID-19 pandemic-related restrictions on away rotations resulted in the creation of multiple virtual courses. Despite the lifting of restrictions, these courses may still have utility in helping students circumvent barriers to away rotations. Limitations of previously described courses include insufficient student-faculty interaction, which influences students' understanding of the educational environment. We sought to develop and evaluate a virtual EM elective for fourth-year medical students, focused on student-faculty interaction including precepted patient contact. Methodology We developed a two-week virtual EM elective for fourth-year medical students incorporating teaching sessions designed to optimize student-faculty interactions and attending-supervised telemedicine visits. After completion of the course, students completed an anonymous course evaluation. Results Course evaluations showed that the course improved students' understanding of our residency's educational environment by providing students with access to our residency program. The most frequently cited factors preventing participation in a traditional away elective were financial cost, limit in the allowed number of away rotations, and challenges in finding housing. Conclusions We believe this course may be an effective way of improving visiting students' understanding of the educational culture of our EM residency program. Thus, although pandemic-related restrictions have been lifted, this course may serve as a valuable adjunct to the traditional away EM rotation.

Digital Transformation of Faculty Development: Responding and Supporting Academia During Disruptions Caused by the Coronavirus Disease 2019 Pandemic

INTRODUCTION

The coronavirus disease 2019 pandemic disrupted the current practices for teaching and learning in medical and health professions education, creating challenges and opportunities for rapid transition. The authors describe how McMaster University's Program for Faculty Development (MacPFD) responded to this disruption by engaging in a digital transformation.

METHODS

The digital transformation process of MacPFD was mapped to the conceptual framework of digital transformation: Vial's building blocks of the framework. A new website was launched to host and disseminate the content. Subsequently, both the website and the content were promoted using social media tools. Content generation, Google Analytics, event registrations, and Zoom webinar attendance records were data sources for the results. Analysis of the data was based on the reach component of the RE-AIM framework.

RESULTS

Six-month data range results were reported as producer-centered and user-centered outcomes. The former consisted of 54 resources from diverse content authors, whereas the latter received 33,045 page views from 26,031 unique users from 89 countries. Live webinar events had 1484 registrants, with 312 (21%) being guests from external institutions. Before the coronavirus disease 2019 disruption, MacPFD was a local program to support its faculty.

DISCUSSION

The MacPFD's digital transformation shows a clear transition to a new "glocal" approach: an expanded global reach while still tending to our local development needs of the home institution's faculty members.

Program evaluation: An educator's portal into academic scholarship

Program evaluation is an "essential responsibility" but is often not seen as a scholarly pursuit. While Boyer expanded what qualifies as educational scholarship, many still need to engage in processes that are rigorous and of a requisite academic standard to be labelled as scholarly. Many medical educators may feel that scholarly program evaluation is a daunting task due to the competing interests of curricular change, remediation, and clinical care. This paper explores how educators can take their questions around outcomes and efficacy of our programs and efficiently engage in education scholarship. The authors outline how educators can examine whether training programs have a desired impact and outcomes, and then how they might leverage this process into education scholarship.

Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 70

BACKGROUND

The novel coronavirus disease was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplace-based clinical learning in response to the pandemic. The objectives were to synthesise what adaptations/innovation were implemented (description), their impact (justification), and 'how' and 'why' these were selected (explanation and rationale).

METHODS

The authors systematically searched four online databases up to December 21, 2020. Two authors independently screened titles, abstracts and full-texts, performed data extraction, and assessed the risk of bias. Our findings are reported in alignment with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance.

RESULTS

Fifty-five articles were included. Most were from North America (n = 40), and nearly 70% focused on undergraduate medical education (UGME). Key developments were rapid shifts from workplace-based learning to virtual spaces, including online electives, telesimulation, telehealth, radiology, and pathology image repositories, live-streaming or pre-recorded videos of surgical procedures, stepping up of medical students to support clinical services, remote adaptations for clinical visits, multidisciplinary team meetings and ward rounds. Challenges included lack of personal interactions, lack of standardised telemedicine curricula and need for faculty time, technical resources, and devices. Assessment of risk of bias revealed poor reporting of underpinning theory, resources, setting, educational methods, and content.

CONCLUSIONS

This review highlights the response of medical educators in deploying adaptations and innovations. Whilst few are new, the complexity, concomitant use of multiple methods and the specific pragmatic choices of educators offers useful insight to clinical teachers who wish to deploy such methods within their own practice. Future works that offer more specific details to allow replication and understanding of conceptual underpinnings are likely to justify an update to this review.

Coping with COVID-19: medical students as strong and responsible stewards of their education

BACKGROUND

Due to the COVID-19 pandemic, clinical rotations at the University of Michigan Medical School (UMMS) were suspended on March 17, 2020, per the Association of American Medical Colleges' recommendations. No alternative curriculum existed to fill the educational void for clinical students. The traditional approach to curriculum development was not feasible during the pandemic as faculty were redeployed to clinical care, and the immediate need for continued learning necessitated a new model.

APPROACH

One student developed an outline for an online course on pandemics based on peer-to-peer conversations regarding learners' interests and needs, and she proposed that students author the content given the immediate need for a curriculum. Fifteen student volunteers developed content to fill knowledge gaps, and expert faculty reviewers confirmed that the student authors had successfully curated a comprehensive curriculum.

EVALUATION

The crowdsourced student content coalesced into a 40-hour curriculum required for all 371 clinical-level students at UMMS. This student-driven effort took just 17 days from outline to implementation, and the final product is a full course comprising five modules, multiple choice questions, discussion boards, and assignments. Learners were surveyed to gauge success, and 93% rated this content as relevant to all medical students.

REFLECTION

The successful implementation of this model for curriculum development, grounded in the Master Adaptive Learner framework, suggests that medical students can be entrusted as stewards of their own education. As we return to a post-pandemic "normal," this approach could be applied to the maintenance and de novo development of future curricula.

RE-AIMing COVID-19 online learning for medical students: a massive open online course evaluation

BACKGROUND

Clinical training during the COVID-19 pandemic is high risk for medical students. Medical schools in low- and middle-income countries (LMIC) have limited capacity to develop resources in the face of rapidly developing health emergencies. Here, a free Massive Open Online Course (MOOC) was developed as a COVID-19 resource for medical students working in these settings, and its effectiveness was evaluated.

METHODS

The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was utilized to evaluate the effectiveness of MOOC in teaching medical students about COVID-19. The data sources included the student registration forms, metrics quantifying their interactions within the modules, students' course feedback, and free-text responses. The data were collected from the Moodle learning management system and Google analytics from May 9 to September 15, 2020. The research team analyzed the quantitative data descriptively and the qualitative data thematically.

RESULTS

Among the 16,237 unique visitors who accessed the course, only 6031 medical students from 71 medical schools registered, and about 4993 (83% of registrants) completed the course, indicating high levels of satisfaction (M = 8.17, SD = 1.49) on a 10-point scale. The mean scores of each assessment modules were > 90%. The free-text responses from 987 unique students revealed a total of 17 themes (e.g., knowing the general information on COVID-19, process management of the pandemic in public health, online platform use, and instructional design) across the elements of the RE-AIM framework. Mainly, the students characterized the MOOC as well-organized and effective.

CONCLUSIONS

Medical students learned about COVID-19 using a self-paced and unmonitored MOOC. MOOCs could play a vital role in the dissemination of accurate information to medical students in LMIC in future public health emergencies. The students were interested in using similar MOOCs in the future.