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Jiao XA, Bai RA, Li N, Liu K. Influencing factors on the psychosomatic health of medical staff since the normalized stage of COVID-19 in mainland China. Eur J Public Health 2024; 34:600-605. [PMID: 38423544 PMCID: PMC11161144 DOI: 10.1093/eurpub/ckae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, there were under-recognized and unaddressed psychosomatic health problems among medical staff. The purpose of this study was to investigate their psychosomatic status. METHODS An online questionnaire was performed to the medical staff of major hospitals in Jinan in January 2023. In total, 1244 valid questionnaires were collected, and their psychosomatic status was assessed by the Psychosomatic Symptom Scale (PSSS) and Perceived Stress Scale-10 (PSS-10). Finally, we analyzed the influencing factors for their psychosomatic status. RESULTS The psychological health of the medical staff was poor, and the level of stress perception was intense, accompanied by obvious psychosomatic symptoms. Regression analysis indicated that age, gender, frontline involvement, work experience, marriage, presence of disease history and COVID-19 infection history were risk factors for psychosomatic symptoms, while education, frontline involvement and presence of disease history were risk factors for stress feeling. CONCLUSION Medical staff often showed obvious psychosomatic symptoms and intense stress. Psychological health education and intervention should be given in order to improve their working quality.
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Affiliation(s)
- Xing-ai Jiao
- Venous Configuration Center, Qilu Hospital of Shandong University, Jinan, China
| | - Run-ai Bai
- Department of Nursing, Qingjian County People’s Hospital, Yulin, China
| | - Na Li
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
| | - Kao Liu
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
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Berberoglu I, Tang SYQ, Kozlow JH, Sezgin B, Sandhu G, Cederna PS. Integration of Virtual and Traditional Medical Education: Scholarship Pivots from the COVID-19 Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5910. [PMID: 38881964 PMCID: PMC11177807 DOI: 10.1097/gox.0000000000005910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 06/18/2024]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic required an unprecedented transformation of medical education, shifting from traditional, in-person learning to distanced, online learning. This study aimed to review changes to medical education and describe the advantages and disadvantages of virtual medical education experienced by medical students during the pandemic. Methods An online survey study was conducted at two medical schools, University of Michigan Medical School in the United States and Koc University School of Medicine in Turkey. Medical students completed questionnaires regarding their educational experience before and during the pandemic. Survey instruments were designed to assess differences in the educational curriculum, study methods, clinical skills self-evaluations, perceptions of the quality of in-person and online learning, and overall satisfaction. Results A total of 184 medical students completed the survey. There was an increase in the use of online study tools since the pandemic. There was no statistically significant difference in self-reported assessments of clinical preparedness and overall clinical competence during surgical clerkship. The percentage of students interested in pursuing a career in surgery has nearly doubled from 34% to 63%. A majority of students (83%) believed that the time available for self-study and research increased during the pandemic. Fifty-two percent of students believed that online education is less efficacious than in-person education, but 86% of students still preferred a blended approach. Conclusions Medical schools have continued to update their curricula following the COVID-19 pandemic. This study illustrates the transformations in medical education to ensure that the most effective and suitable teaching is delivered.
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Affiliation(s)
- Ipek Berberoglu
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Koc University Hospital, Istanbul, Turkey
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Sherry Y Q Tang
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Jeffrey H Kozlow
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Billur Sezgin
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Koc University Hospital, Istanbul, Turkey
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Paul S Cederna
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
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Wang W, Li G, Lei J. The impact of COVID-19 on medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc10. [PMID: 38504857 PMCID: PMC10946210 DOI: 10.3205/zma001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/07/2023] [Accepted: 11/29/2023] [Indexed: 03/21/2024]
Abstract
Objective The outbreak of COVID-19 has disrupted social order and placed a heavy burden on the healthcare system. The pandemic also has an unprecedented impact on medical students. Methods We searched PubMed for articles related to COVID-19 and medical students from January 2020 to December 2022. A total of 5358 studies were retrieved and after screening, 176 studies were finally included in this review. Results The impact of COVID-19 on medical students is widespread and profound. First reflected in the transformation of educational models. In the early days, education model quickly shifted from offline to online. In terms of clinical exposure, most students have been suspended from internships, while in some areas with staff shortages they have the opportunity to continue clinical work. Scientific research of medical students is also difficult to carry out due to COVID-19. The epidemic has also seriously damaged students' mental health, and this impact won't simply disappear with the improvement of the epidemic situation. The career intentions of medical students may also become firmer or change due to COVID-19. International medical electives have also been negatively affected by COVID-19 due to travel restriction. Even in the postpandemic era, with the gradual resumption of work, production and school, medical students are still affected in some ways by COVID-19. Conclusion The COVID-19 pandemic has had a profound impact on both the education of medical students and their personal development. Through COVID-19, we should reflect on what models of medical education should be developed in the future. Based on the experiences learned from COVID-19, we believe that a more flexible blended education model may be the most promising.
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Affiliation(s)
- Wenwen Wang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Genpeng Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianyong Lei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
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Metakides C, Pielemeier L, Lytras T, Mytilinaios DG, Themistocleous SC, Pieridi C, Tsioutis C, Johnson EO, Ntourakis D, Nikas IP. Burnout and motivation to study medicine among students during the COVID-19 pandemic. Front Med (Lausanne) 2023; 10:1214320. [PMID: 37700767 PMCID: PMC10493291 DOI: 10.3389/fmed.2023.1214320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
Aim To investigate medical students' burnout and motivation levels in each of the six years of their studies during the COVID-19 pandemic and identify independent predictors of burnout and motivation. Methods An anonymous cross-sectional survey was sent to the students of all six years within our school. Burnout was measured with the adapted Oldenburg Burnout Inventory questionnaire (OLBI-S) and motivation with the updated Strength of Motivation for Medical School (SMMS-R) questionnaire. Univariate analysis was performed with the Kruskal-Wallis test and Spearman's correlation, while multivariable analysis with linear regression models. Results A total of 333 medical students (52% of student body) responded. Higher burnout levels correlated with lower motivation to study medicine (rho = -0.30, p < 0.001). Burnout levels differed between the six years of medical studies, peaking in years two and four whereas being the lowest in year one (p = 0.01). Motivation levels differed significantly as well, peaking in years one and four whereas being the lowest in years five and six (p = 0.012). In the multivariable linear regression models, being a female (b = 2.22, p = 0.016), studying in the fourth year vs. first year (b = 2.54, p = 0.049), having a perceived beginner/intermediate vs. advanced/expert technology level (b = 2.05, p = 0.032) and a perceived poor school support system (b = 6.35, p < 0.001) were independently associated with higher burnout levels. Furthermore, studying in the fifth year vs. first year (b = -5.17, p = 0.019) and a perceived poor school support system (b = -3.09, p = 0.01) were independently associated with a reduced motivation to study medicine. Conclusion Our study highlighted potential areas for intervention to decrease the rate of burnout and low motivation among medical students. However, further research is needed to unravel the full effect of the pandemic on medical students.
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Affiliation(s)
- Clio Metakides
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Lena Pielemeier
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | | | | | - Chryso Pieridi
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | | | | | | | - Ilias P. Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus
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Hortsch M. The Michigan Histology website as an example of a free anatomical resource serving learners and educators worldwide. ANATOMICAL SCIENCES EDUCATION 2023; 16:363-371. [PMID: 36453096 DOI: 10.1002/ase.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 05/11/2023]
Abstract
With anatomical education becoming a global endeavor, free online resources offered via the Internet or other electronic venues are of increasing importance for teaching and learning communities worldwide. Students and instructors from developing countries, often limited in access to modern instructional resources by infrastructural and financial constraints, are frequent users of such online learning tools. During the recent Covid-19 pandemic when all academic institutions were forced to quickly switch to a non-contact mode of teaching, free online instructional resources were often essential for continuing the educational mission. However, there are a number of obstacles and issues that need to be considered when creating and offering such learning resources. These include the type, quality, and completeness of the content, their educational purpose, access to technical and financial resources, copyright and ethical issues, and more. Educators, who plan to generate and maintain free online resources, should also be aware that such projects usually require a considerable long-term time commitment. In this article, these issues are discussed using the Michigan Histology website as an example. The discussion also addresses how e-learning resources like the Michigan Histology website supported online learning during the recent Covid-19 pandemic.
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Affiliation(s)
- Michael Hortsch
- Department of Cell and Developmental Biology, University of Michigan Medical School, Michigan, Ann Arbor, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Michigan, Ann Arbor, USA
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Gellisch M, Morosan-Puopolo G, Wolf OT, Moser DA, Zaehres H, Brand-Saberi B. Interactive teaching enhances students' physiological arousal during online learning. Ann Anat 2023; 247:152050. [PMID: 36693546 DOI: 10.1016/j.aanat.2023.152050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023]
Abstract
The pure transfer of face-to-face teaching to a digital learning environment can be accompanied by a significant reduction in the physiological arousal of students, which in turn can be associated with passivity during the learning process, often linked to insufficient levels of concentration and engagement in the course work. Therefore, the aim of this study was to investigate whether students' psychobiological stress responses can be enhanced in the context of anatomical online learning and how increased physiological parameters correlate with characteristics of learning experiences in a digital learning environment. Healthy first-year medical students (n = 104) experienced a regular practical course in Microscopic Anatomy either in face-to-face learning, in passive online learning or in an interaction-enhanced version of online learning. Compared to passive online learning, students engaged in the interaction-enhanced version of online learning displayed a significantly reduced Heart Rate Variability (P 0.001, partial η2 = 0.381) along with a strong increase in salivary cortisol (P 0.001, partial η2 = 0.179) and salivary alpha-amylase activity (P 0.001, partial η2 = 0.195). These results demonstrated that the physiological arousal of students engaged in online learning can be enhanced via interactive teaching methods and pointed towards clear correlations between higher physiological responses and elementary criteria of learning experience such as engagement and attention.
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Affiliation(s)
- Morris Gellisch
- Department of Anatomy and Molecular Embryology, Institute of Anatomy, Medical Faculty, Ruhr University Bochum, Bochum, Germany.
| | - Gabriela Morosan-Puopolo
- Department of Anatomy and Molecular Embryology, Institute of Anatomy, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Dirk A Moser
- Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Holm Zaehres
- Department of Anatomy and Molecular Embryology, Institute of Anatomy, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Beate Brand-Saberi
- Department of Anatomy and Molecular Embryology, Institute of Anatomy, Medical Faculty, Ruhr University Bochum, Bochum, Germany
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Hortsch M, Rompolski K. The freedom to teach (at the best). ANATOMICAL SCIENCES EDUCATION 2023; 16:189-195. [PMID: 36453097 DOI: 10.1002/ase.2240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Over the past decades, biomedical education has changed considerably, mostly by the introduction of novel didactic strategies, as well as the addition of technology. As a consequence, the centuries-old lecture-style presentation has come under criticism for providing only a one-directional transfer of information. However, the delivery of traditional lectures has also seen considerable changes such as the use of Microsoft PowerPoint slides which can be projected and serve as lecture handouts to learners. Electronic technologies and the internet now allow for the permanent recording of lectures and the distribution of video recordings to students who are unable or choose not to attend lectures in person. This off-site consumption of lecture presentations can either be synchronous or, if the recorded videos are made available online, asynchronous. At the beginning of the Covid-19 pandemic, most schools were forced to change all lecture-style instruction to an online format. With students returning to classroom teaching, schools, and educators have to make a decision whether to offer online lecture recordings permanently, reintroduce in-person lecture presentations, or compromise on a combination of both. Each solution has its own advantages and disadvantages, some of which are discussed in this article. However, there appears to be no single 'best solution' to serve all learners, educators, and educational needs.
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Affiliation(s)
- Michael Hortsch
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Krista Rompolski
- Doctor of Physical Therapy Program, Moravian University, Bethlehem, Pennsylvania, USA
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Moro C, Mills KA, Phelps C, Birt J. The Triple-S framework: ensuring scalable, sustainable, and serviceable practices in educational technology. INTERNATIONAL JOURNAL OF EDUCATIONAL TECHNOLOGY IN HIGHER EDUCATION 2023; 20:7. [PMID: 36817635 PMCID: PMC9922542 DOI: 10.1186/s41239-022-00378-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
Educational institutions are increasingly investing into digital delivery, acquiring new devices, and employing novel software and services. The rising costs associated with maintenance, in combination with increasing redundancy of older technologies, presents multiple challenges. While lesson content itself may not have changed, the educational landscape constantly evolves, where tertiary institutions are incorporating new modes of content delivery, hybrid-style learning, and interactive technologies. Investments into digital expansions must be taken with caution, particularly prior to the procurement of technology, with a need for the proposed interventions' scalability, sustainability, and serviceability to be considered. This article presents the Triple-S framework for educators, administrators, and educational institutions, and outlines examples of its application within curricula. The paper synthesises research evidence to provide the foundation underlying the key principles of the Triple-S framework, presenting a useful model to use when evaluating digital interventions. Utilising the framework for decisions regarding the acquisition of educational technology, devices, software, applications, and online resources can assist in the assurance of viable and appropriate investments.
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Affiliation(s)
- Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226 Australia
| | - Kathy A. Mills
- Institute for Learning Sciences and Teacher Education, Australian Catholic University, Brisbane, QLD 4000 Australia
| | - Charlotte Phelps
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226 Australia
| | - James Birt
- Faculty of Society and Design, Bond University, Gold Coast, QLD 4226 Australia
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Xu T, Xue L. Satisfaction with online education among students, faculty, and parents before and after the COVID-19 outbreak: Evidence from a meta-analysis. Front Psychol 2023; 14:1128034. [PMID: 36860782 PMCID: PMC9968937 DOI: 10.3389/fpsyg.2023.1128034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023] Open
Abstract
The COVID-19 pandemic has presented a unique opportunity for the advancement of online education, as billions of students from 190 countries have been compelled to take classes remotely. The degree of satisfaction is considered one of the major factors in determining the quality of online educational programs. As a result, many empirical studies have been conducted on the level of satisfaction with online education over the last two decades. However, few studies have synthesized previous findings from similar research questions. Therefore, to reinforce statistical power, the study aimed to conduct a meta-analysis to examine satisfaction with online education among students, faculty, and parents before and after the COVID-19 outbreak. A total of 52 studies in English were screened from six academic electronic databases, yielding 57 effect sizes using Comprehensive Meta-Analysis (CMA) software. The results showed that the prevalence of satisfaction with online education among students, faculty, and parents before and after the COVID-19 outbreak was 59.5, 75.3, and 70.7%, respectively, with a significant difference between the satisfaction rates of students and those of their faculty and parents. Besides, we conducted a moderator analysis that found that (1) a significantly higher number of students in the pre-pandemic era in countries with developed digital infrastructure and emergency online learning environments were less satisfied with online education than their counterparts in the post-pandemic era, in countries with developing digital infrastructure, and in non-emergency online learning environments. Additionally, a significantly higher proportion of adult education learners reported being satisfied with online education compared to K-12 and university students. (2) The faculty in the non-emergency situation reported almost double the satisfaction rate of their counterparts in the emergency circumstance. With fewer satisfied remote learning students, efforts could be made by providing well-designed online lessons via faculty and strengthening digital infrastructure via governments to improve student satisfaction.
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Affiliation(s)
- Tianyuan Xu
- Centre for Humanities and Social Sciences, University of Wales Trinity Saint David, Lampeter, United Kingdom
| | - Ling Xue
- School of Foreign Languages, Zhongnan University of Economics and Law, Wuhan, China,*Correspondence: Ling Xue ✉
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Maity S, Nauhria S, Nayak N, Nauhria S, Coffin T, Wray J, Haerianardakani S, Sah R, Spruce A, Jeong Y, Maj MC, Sharma A, Okpara N, Ike CJ, Nath R, Nelson J, Parwani AV. Virtual Versus Light Microscopy Usage among Students: A Systematic Review and Meta-Analytic Evidence in Medical Education. Diagnostics (Basel) 2023; 13:558. [PMID: 36766660 PMCID: PMC9914930 DOI: 10.3390/diagnostics13030558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The usage of whole-slide images has recently been gaining a foothold in medical education, training, and diagnosis. OBJECTIVES The first objective of the current study was to compare academic performance on virtual microscopy (VM) and light microscopy (LM) for learning pathology, anatomy, and histology in medical and dental students during the COVID-19 period. The second objective was to gather insight into various applications and usage of such technology for medical education. MATERIALS AND METHODS Using the keywords "virtual microscopy" or "light microscopy" or "digital microscopy" and "medical" and "dental" students, databases (PubMed, Embase, Scopus, Cochrane, CINAHL, and Google Scholar) were searched. Hand searching and snowballing were also employed for article searching. After extracting the relevant data based on inclusion and execution criteria, the qualitative data were used for the systematic review and quantitative data were used for meta-analysis. The Newcastle Ottawa Scale (NOS) scale was used to assess the quality of the included studies. Additionally, we registered our systematic review protocol in the prospective register of systematic reviews (PROSPERO) with registration number CRD42020205583. RESULTS A total of 39 studies met the criteria to be included in the systematic review. Overall, results indicated a preference for this technology and better academic scores. Qualitative analyses reported improved academic scores, ease of use, and enhanced collaboration amongst students as the top advantages, whereas technical issues were a disadvantage. The performance comparison of virtual versus light microscopy meta-analysis included 19 studies. Most (10/39) studies were from medical universities in the USA. VM was mainly used for teaching pathology courses (25/39) at medical schools (30/39). Dental schools (10/39) have also reported using VM for teaching microscopy. The COVID-19 pandemic was responsible for the transition to VM use in 17/39 studies. The pooled effect size of 19 studies significantly demonstrated higher exam performance (SMD: 1.36 [95% CI: 0.75, 1.96], p < 0.001) among the students who used VM for their learning. Students in the VM group demonstrated significantly higher exam performance than LM in pathology (SMD: 0.85 [95% CI: 0.26, 1.44], p < 0.01) and histopathology (SMD: 1.25 [95% CI: 0.71, 1.78], p < 0.001). For histology (SMD: 1.67 [95% CI: -0.05, 3.40], p = 0.06), the result was insignificant. The overall analysis of 15 studies assessing exam performance showed significantly higher performance for both medical (SMD: 1.42 [95% CI: 0.59, 2.25], p < 0.001) and dental students (SMD: 0.58 [95% CI: 0.58, 0.79], p < 0.001). CONCLUSIONS The results of qualitative and quantitative analyses show that VM technology and digitization of glass slides enhance the teaching and learning of microscopic aspects of disease. Additionally, the COVID-19 global health crisis has produced many challenges to overcome from a macroscopic to microscopic scale, for which modern virtual technology is the solution. Therefore, medical educators worldwide should incorporate newer teaching technologies in the curriculum for the success of the coming generation of health-care professionals.
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Affiliation(s)
- Sabyasachi Maity
- Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s University School of Medicine, St. George’s, Grenada
| | - Samal Nauhria
- Department of Pathology, St. Matthews University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Narendra Nayak
- Department of Microbiology, St. Matthews University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Shreya Nauhria
- Department of Psychology, University of Leicester, Leicester LE1 7RH, UK
| | - Tamara Coffin
- Medical Student Research Institute, St. George’s University School of Medicine, St. George’s, Grenada
| | - Jadzia Wray
- Medical Student Research Institute, St. George’s University School of Medicine, St. George’s, Grenada
| | - Sepehr Haerianardakani
- Medical Student Research Institute, St. George’s University School of Medicine, St. George’s, Grenada
| | - Ramsagar Sah
- Department of Public Health, Torrens University, Ultimo, Sydney, NSW 2007, Australia
| | - Andrew Spruce
- Department of Pathology, St. Matthews University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Yujin Jeong
- Department of Clinical Medicine, American University of Antigua, St. John’s, Antigua and Barbuda
| | - Mary C. Maj
- Department of Biochemistry, St. George’s University School of Medicine, St. George’s, Grenada
| | - Abhimanyu Sharma
- Department of Pathology, Government Medical College, Jammu 180001, India
| | - Nicole Okpara
- Department of Pathology, St. Matthews University School of Medicine, Georgetown P.O. Box 30992, Cayman Islands
| | - Chidubem J. Ike
- Department of Clinical Medicine, American University of Antigua, St. John’s, Antigua and Barbuda
| | - Reetuparna Nath
- Department of Education Service, St. George’s University, St. George’s, Grenada
| | - Jack Nelson
- Medical Illustrator, The Centre for Biomedical Visualization, St. George’s University, St. George’s, Grenada
| | - Anil V. Parwani
- Department of Pathology, Wexner Medical Center, The Ohio State University, Cooperative Human Tissue Network (CHTN) Midwestern Division, Columbus, OH 43210, USA
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Peng P, Hao Y, Liu Y, Chen S, Wang Y, Yang Q, Wang X, Li M, Wang Y, He L, Wang Q, Ma Y, He H, Zhou Y, Wu Q, Liu T. The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis. J Affect Disord 2023; 321:167-181. [PMID: 36341802 PMCID: PMC9613786 DOI: 10.1016/j.jad.2022.10.040] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This meta-analysis and systematic review aimed to evaluate the global prevalence and risk factors of mental problems (i.e., depression, anxiety, stress, sleep disorder, posttraumatic stress disorder (PTSD), burnout, psychological distress, and suicidal ideation) among medical students during the COVID-19 pandemic. METHOD We searched PubMed, Embase, Web of Science, psycARTICLES, PsycINFO, CNKI, and Wan Fang for studies on the prevalence of mental problems among medical students from January 1, 2020, to April 1, 2022. The pooled prevalence was calculated by random-effect models. We performed a narrative review to identify the risk factors. RESULTS The meta-analysis included 201 studies (N = 198,000). The prevalence of depression (41 %, 95 % CI, 37-45 %,), anxiety (38 %,95 % CI, 34 %-42 %), stress (34 %, 95 % CI, 27 %-42 %), sleep disorder (52 %, 95 % CI, 44 %-60 %), psychological distress (58 %, 95 % CI, 51 %-65 %), PTSD (34 %, 95 % CI, 22 %-46 %), suicidal ideation (15 %, 95 % CI, 11 %-18 %) and burnout (38 %, 95 % CI, 25 %-50 %) was high. The major risk factors were being female, being junior or preclinical students, exposure to COVID-19, academic stress, psychiatric or physical disorders history, economic trouble, fear of education impairment, online learning trouble, fear of infection, loneliness, low physical activity, low social support, problematic internet or smartphone use, and young age. LIMITATIONS Most studies were cross-sectional. Few studies provided a reasonable response rate, suggesting potential selection bias. CONCLUSIONS The study demonstrated a high prevalence and risk factors for mental problems during COVID-19, calling for mental health services. Our findings are valuable for college and health authorities to identify high-risk students and provide targeted intervention.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuzhu Hao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yueheng Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Shubao Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yunfei Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qian Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Manyun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yingying Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Li He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qianjin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuejiao Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Haoyu He
- Department of Psychology, College of Education, Hunan First Normal University, Changsha 410205, China
| | - Yanan Zhou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Qiuxia Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Tieqiao Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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12
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Xu T, Wang H. High prevalence of anxiety, depression, and stress among remote learning students during the COVID-19 pandemic: Evidence from a meta-analysis. Front Psychol 2023; 13:1103925. [PMID: 36704682 PMCID: PMC9871576 DOI: 10.3389/fpsyg.2022.1103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has influenced all aspects significantly, and an estimated 1.5 billion students across the globe have been forced to keep up with online courses at home. Many recent empirical studies reported the prevalence of mental health problems among students caused by remote learning during the COVID-19 pandemic, but a few studies aggregated these results. Therefore, to strengthen statistical power, the article aimed to examine the prevalence of anxiety, depression, and stress among remote learning students during the COVID-19 pandemic via a meta-analysis. A total of 36 original articles have been selected from five academic databases, including Web of Science, PubMed, Scopus, EBSCO, and Google Scholar, covering 78,674 participants in 19 nations, and yielding 60 effect sizes (22 for anxiety, 17 for depression, and 21 for stress) based on the random effects model via Comprehensive Meta-Analysis (CMA) software. The results showed that the prevalence of anxiety, depression, and stress among remote learning students during the COVID-19 pandemic was as high as 58, 50, and 71%, respectively. Besides, the moderator analysis found that (1) the prevalence of anxiety and depression among students in higher education was significantly higher than that of students in elementary education. (2) an increasing number of medical students and students in emergency remote learning context suffered from mental stress than their non-medical and traditional distance learning counterparts. Thus, the COVID-19 pandemic triggers concerns related to physical health and mental disorders, especially for remote online learning students. The current situation should be brought to the forefront by educators to develop psychological interventions for relieving students' anxiety, depression, and stress during the pandemic period.
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Affiliation(s)
- Tianyuan Xu
- School of Foreign Languages, Zhejiang Gongshang University, Hangzhou, China
| | - Huang Wang
- School of Foreign Studies, Hunan First Normal University, Changsha, China,*Correspondence: Huang Wang, ✉
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Campbell MH, Maharaj S, Khan K, Sa B, Adams OP, Majumder MAA. Resilient Coping is More Important Than Previous Virtual Learning Experience: Predicting Pharmacy Student Stress During the COVID-19 Pandemic. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:443-451. [PMID: 37143569 PMCID: PMC10153405 DOI: 10.2147/amep.s402178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
Purpose The COVID-19 pandemic precipitated a swift transition to online learning in medical and health sciences. This study investigated the associations of previous experience with online learning, current confidence with online learning, and resilient coping skills with perceived stress reported by pharmacy students during the emergency transition to online learning. Methods Undergraduate pharmacy students (N=113, response rate = 41%) completed an online, self-report, cross-sectional survey during April-June 2020. Measures included Likert items measuring prior experience and current comfort levels with online learning, the Brief Resilient Coping Scale (BRCS), and the Perceived Stress Scale 10-Item Version (PSS-10). Experience, comfort with online learning, reported scores, and internal consistency for the BRCS and PSS-10 were summarized. A linear regression model examined the associations of prior experience with online education, gender, and resilient coping with perceived stress. Results Of the 113 respondents (78% female, mean age 22.3 years), > 50% had only occasional prior experience with online learning, coursework, and examinations, but 63% expressed confidence with online learning. Mean PSS-10 and BRCS scores were 23.8 and 13.3, respectively, and both scales demonstrated good internal consistency (α > 0.80). BRCS score was the single predictor of the PSS-10 score (r2 = 0.18, p < 0.001). Female gender was not a significant predictor (p = 0.11). A multiple regression model explained moderate variation in perceived stress (adjusted R2 = 0.19). Conclusion PSS-10 and BRCS scores indicated moderate levels of stress and coping skills among students during online teaching. Most students had some prior exposure to online learning, coursework, and examinations. Higher resiliency scores, but not prior online learning experience, predicted lower perceived stress.
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Affiliation(s)
- Michael H Campbell
- The Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | - Sandeep Maharaj
- The Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Katija Khan
- The Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
- The Faculty of Social Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Bidyadhar Sa
- The Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - O Peter Adams
- The Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | - Md Anwarul Azim Majumder
- The Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
- Correspondence: Md Anwarul Azim Majumder, Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, Tel +1 246 8228160, Email
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De Gagne JC, Koppel PD, Wang EJ, Rushton S, Ledbetter L, Yamane SS, Lee E, Manturuk K, Jung D. A systematic review of videoconferencing in health professions education: the digital divide revisited in the COVID-19 era. Int J Nurs Educ Scholarsh 2023; 20:ijnes-2022-0068. [PMID: 36608319 DOI: 10.1515/ijnes-2022-0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/18/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, educators shifted from traditional lectures to videoconferencing. This systematic review explored the use of videoconferencing as a teaching tool in response to the pandemic as well as issues related to digital equity and inclusion. CONTENT The review was conducted using the Joanna Briggs Institute for Systematic Reviews methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. SUMMARY A total of nine studies met eligibility criteria. The participants in the included studies were medical students from various parts of the world. Technical difficulties and lack of human interactions were identified as barriers to learning through videoconferencing. OUTLOOK To achieve full success, pedagogical videoconferencing must prioritize digital equity and a universal design for learning. Although useful for maintaining education during the pandemic, in the future, videoconferencing will present challenges related to the digital divide as well as opportunities as a teaching tool for nurse educators globally.
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Affiliation(s)
| | | | | | | | | | - Sandra S Yamane
- School of Nursing, University of North Carolina, Greensboro, NC, USA
| | - Eunhee Lee
- Hallym University School of Nursing, Chuncheon, South Korea
| | | | - Dukyoo Jung
- College of Nursing, Ewha Womans University, Seoul, South Korea
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15
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Hortsch M, Girão-Carmona VCC, de Melo Leite ACR, Nikas IP, Koney NKK, Yohannan DG, Oommen AM, Li Y, Meyer AJ, Chapman J. Teaching Cellular Architecture: The Global Status of Histology Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1431:177-212. [PMID: 37644293 DOI: 10.1007/978-3-031-36727-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Histology or microanatomy is the science of the structure and function of tissues and organs in metazoic organisms at the cellular level. By definition, histology is dependent on a variety of microscope techniques, usually light or more recently virtual, as well as electron microscopy. Since its inception more than two centuries ago, histology has been an integral component of biomedical education, specifically for medical, dental, and veterinary students. Traditionally, histology has been taught in two sequential phases, first a didactic transfer of information to learners and secondly a laboratory segment in which students develop the skill of analyzing micrographic images. In this chapter, the authors provide an overview of how histology is currently taught in different global regions. This overview also outlines which educational strategies and technologies are used, and how the local and cultural environment influences the histology education of medical and other students in different countries and continents. Also discussed are current trends that change the teaching of this basic science subject.
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Affiliation(s)
- Michael Hortsch
- Departments of Cell and Developmental Biology and of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
| | | | | | - Ilias P Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Nii Koney-Kwaku Koney
- Department of Anatomy, University of Ghana Medical School, University of Ghana, Korle Bu, Ghana
| | - Doris George Yohannan
- Government Medical College, Thiruvananthapuram, Kerala, India
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Aswathy Maria Oommen
- Government Medical College, Thiruvananthapuram, Kerala, India
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Yan Li
- Department of Human Anatomy, Histology and Embryology, Fudan University, Shanghai, China
| | - Amanda J Meyer
- Department of Anatomy, Physiology, and Human Biology, School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Jamie Chapman
- Tasmanian School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Chimmalgi M, Hortsch M. Teaching Histology Using Self-Directed Learning Modules (SDLMs) in a Blended Approach. MEDICAL SCIENCE EDUCATOR 2022; 32:1455-1464. [PMID: 36407816 PMCID: PMC9640883 DOI: 10.1007/s40670-022-01669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION New technologies like virtual microscopy have revolutionized histology education. However, first-year students often require additional assistance with virtual slides. Online self-directed learning modules (SDLMs) were developed to provide such support to learners by offering them short instructional videos that are uploaded to YouTube and the instructional website. The purpose of this study was to determine the effectiveness of SDLMs and to sample students' opinions about SDLMs. METHOD Over a 3-year time span, SDLMs were used to augment histology lessons, and their effectiveness (on learning outcomes) was measured by using traditional steeple-chase and/or virtual slide assessments. Average percentage scores for both methods of assessment were compared using paired or independent t-tests. Student opinions about SDLMs were collected using an anonymous survey. The survey results were analyzed by average scores and thematic analysis of the narrative responses. RESULTS Using SDLMs in a blended approach showed significant improvement in students' academic performance - irrespective of the method of assessment. There was a strong positive correlation with the performance when students were assessed using the virtual slide method. However, a standalone approach using SDLMs did not positively impact learning outcomes. Survey results indicated that most students perceived the videos as helpful for understanding the subject better and as quick review opportunities. CONCLUSION The results support the use of SDLMs in a blended instructional approach and as an adjunct resource to conventional microscopy. This use of SDLMs was positively received by learners and significantly improved the learning outcome. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01669-9.
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Affiliation(s)
- Mamata Chimmalgi
- Department of Anatomy, Sree Gokulam Medical College & Research Foundation, Venjaramoodu, Trivandrum, Kerala India
| | - Michael Hortsch
- Departments of Cell & Developmental Biology and of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI USA
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Gellisch M, Wolf OT, Minkley N, Kirchner WH, Brüne M, Brand-Saberi B. Decreased sympathetic cardiovascular influences and hormone-physiological changes in response to Covid-19-related adaptations under different learning environments. ANATOMICAL SCIENCES EDUCATION 2022; 15:811-826. [PMID: 35968688 DOI: 10.1002/ase.2213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
To examine the implications of the transition from face-to-face to online learning from a psychobiological perspective, this study investigated potential differences in physiological stress parameters of students engaged in online or face-to-face learning and determined whether these can be identified as possible mediators between learning experience and achievement emotions. In a randomized experimental field study, medical students (n = 82) attended either regular face-to-face classes of the microscopic anatomy course or the same practical course online using Zoom videoconferencing platform. The present study investigated Heart Rate Variability (HRV) and salivary cortisol concentration as stress correlates, within the contexts of online and face-to-face learning and compared these parameters with a control group that was measured at rest. Additionally, participants completed a standardized questionnaire about their experienced emotions in relation to task achievement and subjective stress levels. A significant reduction in HRV was found in face-to-face learning, suggesting stronger stress responses in the face-to-face learning environment (η2 = 0.421, P < 0.001). Furthermore, participants engaged in face-to-face learning showed significantly higher cortisol concentrations (η2 = 0.115, P = 0.032). Additionally, increased sympathetic activation correlated with the discrete positive emotion of enjoyment exclusively within the face-to-face condition (r = 0.365, P = 0.043). These results indicate that the transfer of a face-to-face practical course in microscopic anatomy to an online learning environment is associated with decreased sympathetic and enhanced vagal cardiovascular influences, together with lower cortisol concentrations in healthy medical students.
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Affiliation(s)
- Morris Gellisch
- Department of Anatomy and Molecular Embryology, Institute of Anatomy, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Nina Minkley
- Behavioral Biology and Biology Education, Faculty of Biology and Biotechnology, Ruhr University Bochum, Bochum, Germany
| | - Wolfgang H Kirchner
- Behavioral Biology and Biology Education, Faculty of Biology and Biotechnology, Ruhr University Bochum, Bochum, Germany
| | - Martin Brüne
- Department of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Landschaftsverband Westfalen-Lippe (LWL) University Hospital of Ruhr University Bochum, Bochum, Germany
| | - Beate Brand-Saberi
- Department of Anatomy and Molecular Embryology, Institute of Anatomy, Medical Faculty, Ruhr University Bochum, Bochum, Germany
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Ishak A, AlRawashdeh MM, Meletiou-Mavrotheris M, Nikas IP. Virtual Pathology Education in Medical Schools Worldwide during the COVID-19 Pandemic: Advantages, Challenges Faced, and Perspectives. Diagnostics (Basel) 2022; 12:diagnostics12071578. [PMID: 35885484 PMCID: PMC9321717 DOI: 10.3390/diagnostics12071578] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic shifted pathology education in medical schools worldwide towards online delivery. To achieve this goal, various innovative platforms were used by pathology educators and medical students, facilitating both synchronous and asynchronous learning. The aim of this study was to review the published evidence regarding remote pathology teaching at the medical school level during this period, present our own experience, and provide some perspectives regarding the best mode of pathology teaching post-pandemic. Among its advantages, virtual pathology education was considered among students and educators as convenient, flexible, and engaging, while learning outcomes were met and students’ academic performance was in general satisfactory. However, several challenges were faced. For instance, suboptimal internet connection compromised the flow of classes and was even associated with a lower academic performance. The lack of hands-on laboratory activities, such as operating the light microscope and tissue grossing, and the reduced student interactions among themselves and their instructors, were also pointed out as significant drawbacks of remote pathology education. Whereas online education has multiple advantages, experiencing the physical university environment, in-person interactions and teamwork, exposure to the “hidden curriculum”, and hands-on activities are vital for medical school education and future student development. In conclusion, the implementation of a blended approach in pathology education—where online and face-to-face sessions are jointly used to promote students’ engagement, interaction with their instructors and peers, and learning—could be the most optimal approach to pathology teaching in medical schools post-pandemic.
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Affiliation(s)
- Angela Ishak
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (A.I.); (M.M.A.)
| | - Mousa M. AlRawashdeh
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (A.I.); (M.M.A.)
| | | | - Ilias P. Nikas
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (A.I.); (M.M.A.)
- Correspondence:
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