Development and emergency implementation of an online surgical education curriculum for a General Surgery program during a global pandemic: The University of Southern California experience

Education and Training Adaptations for Health Workers during the COVID-19 Pandemic: A Scoping Review of Lessons Learned and Innovations

Introduction: The COVID-19 pandemic has considerably impacted the clinical education and training of health workers globally, causing severe disruptions to learning environments in healthcare facilities and limiting the acquisition of new clinical skills. Consequently, urgent adaptation measures, including simulation training and e-learning, have been implemented to mitigate the adverse effects of clinical education. This scoping review aims to assess the impact of COVID-19 on medical education and training, examine the implemented adaptation measures, and evaluate their effectiveness in improving health workers' education and training during the pandemic. Methods: Employing the PRISMA-ScR framework and Arksey and O'Malley's methodological guidance, we conducted a scoping review, systematically searching PubMed, medRxiv, Google, and DuckDuckGo databases to account for the grey literature. The search included studies published between 1 December 2019 and 13 October 2021, yielding 10,323 results. Of these, 88 studies focused on health worker education and training during the pandemic. Results: Our review incorporated 31,268 participants, including physicians, medical trainees, nurses, paramedics, students, and health educators. Most studies (71/88, 81%) were conducted in high-income and lower-middle-income countries. The pandemic's effects on health workers' clinical skills and abilities have necessitated training period extensions in some cases. We identified several positive outcomes from the implementation of simulation training and e-learning as adaptation strategies, such as enhanced technical and clinical performance, increased confidence and comfort, and an expanded global educational outreach. Conclusions: Despite challenges like insufficient practical experience, limited interpersonal interaction opportunities, and internet connectivity issues, simulation training, e-learning, and virtual training have proven effective in improving clinical education and training during the COVID-19 pandemic. Further research is required to bolster preparedness for future pandemics or similar situations.

Can Customized YouTube Videos Improve ABSITE Performance?

INTRODUCTION

The COVID-19 pandemic decreased in-person didactic sessions in our general surgery residency. We piloted a program to develop online tutorials posted to a YouTube channel designed to prepare our residents for the ABSITE examination.

METHODS

Study participants were General Surgery residents in our five-year ACGME accredited general surgery residency program who took the ABSITE in-service exam between 2019 and 2021. We compared raw scores and overall programmatic percentile scores for three academic years (2018-2019, 2019-2020, and 2020-2021).

RESULTS

From academic year 2018-2019 to 2019-2020, before introducing the YouTube teaching platform, average raw scores and percentile scores among our general surgery residents remained unchanged (raw scores 64 - 65% (p = ns), percentile scores 39 to 37% (p = ns)). However, raw ABSITE scores increased significantly after introducing the YouTube teaching platform. A one-way ANOVA showed a statistically significant difference in raw ABSITE scores for AY 2020-2021 compared to the two prior years (F(2, 30) = [1.193], P < 0.01). Mean percentile ranking scores (program-wide) increased 15% from AY 2018-2019 to AY 2020-2021 (Figure1).

CONCLUSION

Teaching via an online platform such as YouTube allows residents to review material at their own pace and schedule. It is other our hypothesis is that the online YouTube material presented in the Ventura Surgery School channel contributed, in part, to this relative improvement compared to resident peers in other institutions. Teaching via an online platform could be a valuable tool to educate surgical learners in our ever-changing teaching environment.

Neurosurgery Lectures Benefit from a Flipped Class Approach

BACKGROUND

In a flipped classroom, students learn lecture material before class then participate in active learning during in-person sessions. This study examines preferences for flipped classroom activities during a neurosurgery presentation on Traumatic Brain Injury (TBI).

METHODS

225 third- and fourth-year medical students on their core Neurology rotation watched an online podcast about TBI before meeting for in-person, active learning activities with a neurological surgeon. Before and after the class, students were given rank-based surveys with an optional section for comments. The initial survey assessed preference for specific active learning activities, and the final survey assessed satisfaction with the experience. The students also answered an online 20-question post-lecture test as part of the standard Neurology class assessment.

RESULTS

Every student scored over 90% on the post-lecture test. Of the 81 students who answered the first survey, most students (83.95%) strongly preferred or preferred case scenarios with group discussion. The average Likert score for case scenario preference (4.37/5) was significantly higher than the score for all other activities (p < 0.05). Of the 207 students who answered the second survey, 80.19% of students reported that they would probably or definitely like to see more flipped classroom activities.

CONCLUSIONS

Medical students highly preferred case scenarios because, according to their comments, this method was relevant to real-life situations and led to higher information retention. This information suggests that the flipped classroom model for neurosurgical based lectures is preferred, beneficial, and should incorporate case scenarios. This methodology may also apply to neurosurgical residency training.

Factors Influencing Online Learning Satisfaction

Online learning has received extensive attention in the field of education in the recent decade, especially after COVID-19 swept the globe in 2020. Online learning satisfaction (OLS) has become the focal point of the research, since it is of vital significance to enhance online learning efficiency. This paper reviews the research on OLS from the dimensions of online learners, online instructors, online platforms and online instructional design to have a clear picture of factors affecting OLS. Based on the review of previous studies, this mini review presents the prospect of future research on OLS and believes that breakthroughs on OLS research can be achieved by innovating research methods, expanding research subjects, and enriching research topics. OLS is a complicated dynamic system influenced by a diversity of factors, and it is worth more in-depth research by scholars and educators in future.

Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic - A BEME systematic review: BEME Guide No. 71

BACKGROUND

Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face 'classroom' activities for postgraduate learners.

METHODS

Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned.

RESULTS

Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher's use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment.

CONCLUSIONS

This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.

Impact of Simulation on Critical Care Fellows’ Electroencephalography Learning

Introduction

Continuous electroencephalography (EEG) is an important monitoring modality in the intensive care unit and a key skill for critical care fellows (CCFs) to learn. Our objective was to evaluate with CCFs an EEG educational curriculum on a web-based simulator.

Methods

This prospective cohort study was conducted at a major academic medical center in Florida. After Institutional Review Board approval, 13 CCFs from anesthesiology, surgery, and pulmonary medicine consented to take an EEG curriculum. A 25-item EEG assessment was completed at baseline, after 10 EEG interpretations with a neurophysiologist, and after 10 clinically relevant EEG-based simulations providing clinical EEG interpretation hints. A 50-minute tutorial podcast was viewed after the baseline assessment. Main assessment outcomes included multiple outcomes related to web-based simulator performance: percent of hints used, percent of first words on EEG interpretation correct, and percent hint-based EEG interpretation score correct, with higher scores indicating more correct answers. Participants completed a 25-item EEG assessment before (baseline) and after the web-based simulator.

Results

All 13 CCFs completed the curriculum. Between scenarios, there were differences in percent of hints used (F_9,108 = 11.7, p < 0.001), percent of first words correct (F_9,108 = 13.6, p < 0.001), and overall percent hint-based score (F_9,108 = 14.0, p < 0.001). Nonconvulsive status epilepticus had the lowest percent of hints used (15%) and the highest hint-based score (87%). Overall percent hint-based score (mean across all scenarios) was positively correlated with change in performance as the number of correct answers on the 25-item EEG assessment from before to after the web-based simulator activity (Spearman’s rho = 0.67, p = 0.023).

Conclusions

A self-paced EEG interpretation curriculum involving a flipped classroom and screen-based simulation each requiring less than an hour to complete significantly improved CCF scores on the EEG assessment compared to baseline.

Teachers' views related the middle school curriculum for distance education during the COVID-19 pandemic

This qualitative study aims to examine teachers' opinions concerning the middle school curricula that have been in use for years, in order to determine its suitability for distance education during the COVID-19 pandemic. The participants consisted of eighteen middle school teachers from different subject areas in Turkey. A maximum variation sampling method was employed for participant selection. The data was collected through semi-structured interviews. Due to the pandemic, the interviews were conducted using video conferencing applications. The data was analyzed through content analysis. According to the findings, the teachers report that while they are effective in achieving cognitive objectives, they have difficulties in achieving affective and psychomotor objectives. In addition, the teachers do not prefer to design their own materials, rather they mainly benefit from ready-to-use materials during emergency distance education. The teachers also reveal that direct instruction and questioning were the teaching methods and techniques they preferred in online courses and that they were unable to adapt other methods and techniques to distance education, which resulted in students experiencing teacher-centered activities. Moreover, the teachers complain about students not attending the online courses on time or even at all, their disinterest, a lack of instant feedback, limited communication with students, and insufficient course lengths. Another critical finding was that the teachers only use homework, end-of-unit quizzes, and participation to online courses as measurement and evaluation tools and agree that they are unable to administer reliable and valid evaluation tools. The limitations of the study and implications for future research are later discussed.

An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64

BACKGROUND

COVID-19 has fundamentally altered how education is delivered. Gordon et al. previously conducted a review of medical education developments in response to COVID-19; however, the field has rapidly evolved in the ensuing months. This scoping review aims to map the extent, range and nature of subsequent developments, summarizing the expanding evidence base and identifying areas for future research.

METHODS

The authors followed the five stages of a scoping review outlined by Arskey and O'Malley. Four online databases and MedEdPublish were searched. Two authors independently screened titles, abstracts and full texts. Included articles described developments in medical education deployed in response to COVID-19 and reported outcomes. Data extraction was completed by two authors and synthesized into a variety of maps and charts.

RESULTS

One hundred twenty-seven articles were included: 104 were from North America, Asia and Europe; 51 were undergraduate, 41 graduate, 22 continuing medical education, and 13 mixed; 35 were implemented by universities, 75 by academic hospitals, and 17 by organizations or collaborations. The focus of developments included pivoting to online learning (n = 58), simulation (n = 24), assessment (n = 11), well-being (n = 8), telehealth (n = 5), clinical service reconfigurations (n = 4), interviews (n = 4), service provision (n = 2), faculty development (n = 2) and other (n = 9). The most common Kirkpatrick outcome reported was Level 1, however, a number of studies reported 2a or 2b. A few described Levels 3, 4a, 4b or other outcomes (e.g. quality improvement).

CONCLUSIONS

This scoping review mapped the available literature on developments in medical education in response to COVID-19, summarizing developments and outcomes to serve as a guide for future work. The review highlighted areas of relative strength, as well as several gaps. Numerous articles have been written about remote learning and simulation and these areas are ripe for full systematic reviews. Telehealth, interviews and faculty development were lacking and need urgent attention.