Distance education for anatomy and surgical training - A systematic review

Medical education during the coronavirus disease 2019 pandemic: an umbrella review

Background

The coronavirus disease 2019 (COVID-19) pandemic affected many aspects of lifestyle and medical education during the recent years. We aimed to determine the impacts of COVID-19 pandemic on medical education to provide an overview of systematic reviews on it.

Methods

We searched PubMed, Scopus, Web of Science, Cochrane library, Google Scholar, and medRxiv, with the following keywords: "SARS-CoV-2," "COVID-19," "Medical Education," "E-learning," "Distance Education," "Online Learning," "Virtual Education," "systematic review," and "meta-analysis," up to 15 April 2023. Studies were included if they were systematic reviews assessing the impacts of the COVID-19 pandemic on medical sciences students. We used A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) checklist for quality assessment.

Results

A total of 28 systematic reviews were included. The eligible reviews included between five and 64 primary studies, ranging from 897 to 139,381 participants. Technology-enhanced learning and simulation-based learning were the most frequently used strategies. Virtual teaching has several drawbacks like technical difficulties, confidentiality problems, lower student involvement, connection problems, and digital fatigue. The overall satisfaction rate for online learning was above 50%. Also, favorable opinions about perception, acceptability, motivation, and engagement were reported. The quality of 27 studies were critically low and one was low.

Conclusion

There were reduced clinical exposure and satisfaction for medical students during the pandemic. Further high-quality systematic reviews are required.

Telesimulation Training for Endoscopic Mitral Valve Surgery: An Air-Pilot Training Concept for Distance Training

OBJECTIVE

The aim of this study was to validate and assess the feasibility and impact of telesimulation training on surgical skills using a portable mitral valve telesimulator.

METHODS

A telesimulation course composed of 3 online modules was designed based on backwards chaining, preassessment and postassessment, performance feedback, hands-on training on a telesimulator, and the theoretical content. A fully 3-dimensional-printed and transportable telesimulator was developed and sent out to the participants with instruments that were needed. Feedback about the platform was obtained from participants to validate its value as a training tool. Theoretical and technical assessments were carried out before and after the course. Technical assessments were based on the accuracy and time taken to place sutures at the anterior and posterior mitral annulus.

RESULTS

In total, 11 practicing cardiac surgeons from Oceania, Asia, Europe, and North America completed the course. Theoretical preassessment and postassessment showed that participants scored significantly higher on postassessment (mean 87.5% vs 68.1%, P < 0.004). The participant evaluation scores of the simulator as a tool for endoscopic mitral valve surgery was 4 to 5 out of 5. There was a significant improvement in the speed (median 14.5 vs 39.5 s, P < 0.005) and the accuracy to place sutures in the mitral valve annulus following course completion (P < 0.001).

CONCLUSIONS

Here we validated the educational value of a novel telesimulation platform and validated the feasibility to teach participants at a distance the knowledge and skills for endoscopic mitral valve surgery. Future studies will be required to validate the improvement in skills during surgery.

Plastinate Library: A Tool to Support Veterinary Anatomy Learning

The shortage of both time for anatomy courses in the new veterinary medicine curriculum and instructors prepared to teach biomedical sciences has raised a crisis in anatomical education. Often, students spend time out of their classes trying to learn not only concepts but also laboratory-wise content from 2D materials such as books and videos. In addition, since the global COVID-19 pandemic lockdown, studying and habits have been reviewed, with many people adopting an at-home style. The purpose of this study was to evaluate students' acceptance of taking plastinate anatomical specimens to study at home. Thirty-three students were divided into three groups. G1 took home a set of kidneys composed of equine, bovine, and swine materials; G2 took home a pig kidney; and G3 (control) did not take any plastinate specimen home. Acceptance was assessed using an anonymous survey and interview. The method had high acceptance by the students, who believed that having the plastinate library was advantageous from different perspectives, including aiding with learning the differences between kidneys from different species, time flexibility, no commute to study after hours of laboratory classes, and time redistribution to prioritize the laboratory topics. The plastinate library has the potential to be a supportive tool for anatomy students in the contemporaneous veterinary curriculum paradigm, considering that the G1 and G2 groups used the plastinate specimens at home to complement the time they spent in the laboratory.

EASIER: A new model for online learning of minimally invasive surgery skills

INTRODUCTION

Technology Enhanced Learning (TEL) can provide the tools to safely master minimally invasive surgery (MIS) skills in patient-free environments and receive immediate objective feedback without the constant presence of an instructor. However, TEL-based systems tend to work isolated from one another, focus on different skills, and fail to provide contents without a sound pedagogical background.

OBJECTIVE

The objective of this descriptive study is to present in detail EASIER, an innovative TEL platform for surgical and interventional training, as well as the results of its validation.

METHODS

EASIER provides a Learning Management System (LMS) for institutions and content creators that can connect and integrate TEL "external assets" (virtual reality simulators, augmented box trainers, augmented videos, etc.) addressing different skills. The platform integrates all skills under an Assessment Module that measures skills' progress in different courses. Finally, it provides content creators with a pedagogical model to scaffold contents while retaining flexibility to approach course design with different training philosophies in mind. Three courses were developed and hosted in the platform to validate it with end-users in terms of usability, performance, learning results in the courses and student self-perception on learning.

RESULTS

In total 111 volunteers completed the validation. The study was limited due to the COVID-19 pandemic, which limited access to external assets (virtual reality simulators). Nevertheless, usability was rated with 73.1 in the System Usability Scale. Most positive aspects on performance were easiness to access the platform, easiness to change the configuration and not requiring additional plug-ins to use the platform. The platform was rated above average in the six scales of the User Experience Questionnaire. Overall, student results improved significantly across the three courses (p < 0.05).

CONCLUSIONS

This study provides, within its limitations, evidence on the usefulness of the EASIER platform for distance learning of MIS skills. Results show the potential impact of the platform and are an encouraging boost for the future, especially in the aftermath of the COVID-19 pandemic.

Extended reality in surgical education: A systematic review

BACKGROUND

This review aims to evaluate the effectiveness of extended reality-based training in surgical education.

METHODS

This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

A total of 33 studies were included in the qualitative analysis. Nine studies evaluated the effectiveness of virtual reality-based training against no substitutional training. Seven studies looked at training for laparoscopic surgery, and the results were contradicting. Two studies focused on orthopedics training, and the outcomes were positive. Fourteen studies compared the outcomes of virtual reality-based training to conventional didactic teaching, all demonstrating superior outcomes for virtual reality-based training. Nine studies compared the outcomes of virtual reality simulation training to dry lab simulation training. The inferior outcomes of virtual reality simulation training were demonstrated by 5 studies for laparoscopic surgery, 1 study for arthroscopic procedures, 1 study for robotic surgery, and 1 study for dental procedures. One study found potential benefits of virtual reality simulation training on orthopedics surgeries. One study found virtual reality simulation training to be superior to cadaveric training, and 3 studies found augmented reality and virtual reality-based training to be comparable to supervised operative opportunities.

CONCLUSION

Extended reality-based training is a potentially useful modality to serve as an adjunct to the current physical surgical training.

The future of anatomy teaching post-pandemic: An academic viewpoint

The COVID-19 pandemic caused major disruption to anatomical teaching worldwide with both lectures and practicals being moved online. Throughout this period anatomists were able to find new and innovative ways to teach and to aid student learning via a variety of delivery modes. This study aimed to interview anatomists who were involved in teaching undergraduate medical students at UK universities to document the changes that occurred and to understand academic perceptions of pandemic delivery to comprehend how anatomy education may change in the long term. Results suggest that academics are likely to continue to deliver anatomical lectures online post-pandemic akin to a flipped classroom approach, although caution was noted regarding 'at-risk' student groups. No academics wished to see continued delivery of practical classes online, however, resources designed or invested in during the pandemic will be integrated into practical classes or pre-class preparation allowing for a more complete student experience. No clear picture emerged as to the preferred way staff and students will communicate in the current post-pandemic hybrid working environment and beyond. This will likely only be resolved when a new pattern of home working evolves in UK institutions. This report is the first to detail the academic vision of anatomy teaching in a post-pandemic world and will be useful to those adapting to these changes and for those pedagogical researchers targeting where anatomical education research should focus moving forward.

Distance versus face-to-face education of gross anatomy for dental hygiene students: Perceptions and academic achievements of learners

The provision of distance education has increased rapidly over the past few years owing to the COVID-19 pandemic. The core of gross anatomy distance education is three-dimensional (3D) visualization of anatomical structures, and the use of simple 3D visualization tools has increased as distance education has become more popular. The purpose of this study was to establish a more effective operation plan in dental hygiene by investigating learners' opinions about distance education of gross anatomy and 3D visualization tools, and by comparing and analyzing their academic achievements. The study involved 250 students and comprised an analysis of 120 students who took a head and neck anatomy class at the Department of Dental Hygiene at D University via distance learning during 2020-2022, and 130 graduates who had completed the class via face-to-face learning during 2015-2017. An online survey of 120 of the enrolled students comprised 10 questions asking for opinions on the head and neck anatomy distance learning classes, five questions on the 3D visualization tool, and five on general characteristics. Overall, the learners had positive perceptions of distance education for head and neck anatomy and the 3D visualization tool. Among the education methods compared, they generally preferred blended learning (n = 47, 39.2%). There was a significant preference for the distance learning method of asynchronous classes (n = 86, 94.5%). Analysis of academic achievements according to whether or not distance education was conducted revealed a significantly higher score in the face-to-face class group (P < 0.05). A blended learning method can be effective in increasing learner satisfaction and improving academic achievement in gross anatomy classes on dental hygiene. It is suggested that theoretical material should be learned through asynchronous content and knowledge expanded through small-group activities during face-to-face learning. This will help establish a standard model for teaching of gross anatomy in dental hygiene in the postpandemic era.

Undergraduate Skills Training in Pandemic Times: Where Is the Future of Medical Education?

BACKGROUND

The COVID-19 pandemic forced medical programs to rapidly switch to remote teaching from scratch, impacting hands-on skills training. This study compared the efficacy of a hybrid online format to a regular in-person session for a mandatory surgical skills class.

METHODS

Third-year undergraduate medical students attending the surgical skills class in the winter semester of 2020/21 at the Medical University of Graz were randomly assigned to either the hybrid or in-person class, depending on their course schedule and government regulations. The hybrid class involved online videos, one-on-one peer tutoring, and an Objective Structured Clinical Examination (OSCE). Pre- and post-class self-assessments were conducted to evaluate their theoretical and practical knowledge of a single interrupted suture.

RESULTS

The study included 85 students in the regular in-person class and 50 in the hybrid class. A pre-class assessment revealed higher self-assessments in the hybrid class for theoretical and practical knowledge, but a post-class assessment showed no significant difference. The advantages and disadvantages of both modalities were identified, providing valuable insights for future curriculum development.

CONCLUSIONS

Both teaching modes were effective for undergraduate surgical skills training. This study recommends implementing positive aspects of both the hybrid and in-person formats while recognizing their respective limitations.

The relationship between visual memory and spatial intelligence with students' academic achievement in anatomy

INTRODUCTION

Academic achievement is influenced by various factors. Spatial intelligence and visual memory are among the factors that seem to be related to learning anatomy. The aim of this study was to investigate the relationship between visual memory and spatial intelligence with students' academic achievement in anatomy.

METHODS

The present study is a descriptive cross-sectional study. All medical and dental students who had chosen anatomy courses (Semester 3 medicine and 2 dentistry) were the target population (n=240). The study tools were Jean-Louis Sellier 's visual memory test to determine visual memory and ten questions from Gardner Spatial Intelligence Questionnaire were employed to assess spatial intelligence. The tests were performed at the beginning of the semester and its relationship with the academic achievement scores of the anatomy course was examined. Data were analyzed by descriptive statistics, independent t-test, Pearson correlation and multiple linear regression.

RESULTS

Data of 148 medical students and 85 dental students were analyzed. The mean score of visual memory in medical students (17.1±5.3) was significantly higher than dental students (14.3±4.6) (P-value <0.001). But the mean score of spatial intelligence (31.5±5.9) was not significantly different between medical and dental students (31.9±4.9) (P-value=0.56). Pearson correlation coefficient showed that in medical students there was a direct relationship between visual memory score and spatial intelligence score with scores of anatomy courses (P-value<0.05). Moreover, in dental students, there was a direct relationship between the score of anatomical sciences with the score of visual memory (P-value=0.01) and the score of spatial intelligence (P-value=0.003).

CONCLUSION

The results of this study showed that there is a significant relationship between spatial intelligence and visual memory with learning anatomy and planning to enhance these characteristics can be fruitful in students. It is suggested that Visual memory and spatial intelligence should be considered for student admission, especially in the fields of medicine and dentistry.

Satisfaction of Medical Students with Surgical Training: A Survey of Northern Italy

Background: Medical student satisfaction regarding the inclusion of surgical education into the medical curriculum may vary among learners. In this study, we analyzed the satisfaction of medical students in regard to how surgical topics were taught in Italian schools in 2021 through a survey. The results collected can be used to not only improve the quality of medical education in the future but to help students make informed decisions about their own education. Methods: An electronic survey was sent out to medical students in their third to sixth years across three medical schools in Northern Italy via their respective institutional secretaries. The questionnaire was available in Italian and English. It included both closed and open-ended questions regarding satisfaction with the teaching of surgical topics in Italian medical universities. Results: Results were reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Most respondents (87%) preferred to have an increase in surgery-related electives and/or extracurricular courses. Further, 51.2% of respondents expressed an increased interest in surgery after having observed in the Operating Room (OR). The majority of respondents (73.3%) also expressed that the coronavirus disease 2019 (COVID-19) pandemic had negatively impacted the quality of teaching of surgical topics. Conclusion: In the present survey study, Italian medical students preferred hands-on practice over theoretical lectures for surgical education. The majority of students stipulated that the inclusion of suturing, scrubbing, and good surgical practice workshops along with an increased OR attendance would facilitate a better understanding of surgery. 

PBL teaching in ultrasonography resident standardization training in the COVID-19 pandemic

OBJECTIVE

To study the effect of the problem-based learning (PBL) method in ultrasonography (US) resident standardization training during the COVID-19 pandemic.

METHODS

Fifty residents were divided into two groups to participate in a 30-day US training program. The residents in the observation group underwent PBL combined with the lecture-based learning (LBL) method, while the residents in the control group experienced the LBL method alone, with 25 residents in each group. A basic theoretical test, practical examination, and questionnaire were used to evaluate the teaching effect of the PBL + LBL method and the LBL method alone.

RESULTS

The basic theoretical pretest score of the observation group was not significantly different from that of the control group. However, the posttest theoretical score and practical score were significantly higher in the observation group than in the control group (P < 0.01). The results of the questionnaire showed that the resident satisfaction level in the observation group with PBL combined with the LBL method was 96%, which was significantly higher than that of the control group with the LBL method alone (80%) (P < 0.05).

CONCLUSION

The combination of PBL with the LBL method has obvious advantages over the LBL method alone in regard to the training of US residents during the COVID-19 pandemic.

Academic surgery amid the COVID-19 pandemic: A perspective of the present and future challenges

This narrative review describes the trials and tribulations of academic surgeons in four major cities of their respective countries and the solutions they retained to keep academia alive in their practice. The four pillars of an “academic surgeon” _teaching, producing scientific works presented in meetings, publications and research_ are dealt with bearing in mind the modifications brought about by the pandemic and the solutions to keep academia active.

Throughout the pandemic, the ultimate goal has been and will be to improve care and train the next generation of surgeons and encourage and monitor researchers, guide the mentees through the tasks of leadership, and foster good sound presentations at scientific meetings and encourage innovative and fruitful publications.

The pros and cons of the alternatives imposed by the pandemic for the above-mentioned academic components, based on the literature, are reviewed and analyzed as they are taking place today in Shanghai, Milan, Graz, TaiChung and Hsinchu.

Our perspective for the future is that teaching will take a new aspect and make wide use of electronic platforms, but also, the face-to-face modality will surface again. According to local needs and funding, many will most likely choose the hybrid solution (electronic and presential). Production of scientific works in meetings has gained momentum, again with the hybrid solution being preferred. Scientific publications have already increased on topics that are no longer related to COVID-19, and both clinical and experimental research are flourishing.

This review can provide insight to guide young and accomplished academic surgeons through these difficult times and beyond, promoting a renaissance of clinical research and relevant publications, teaching of surgery and scientific meetings with a hybrid approach, and, finally, contribute to the training and formation of a new generation of surgeons for the future post-COVID-19 era.

Using clinical history taking chatbot mobile app for clinical bedside teachings - A prospective case control study

Introduction

A novel chatbot mobile app for training of undergraduate medical students' clinical history taking skills was developed in 2021. Students were able to take clinical history from the virtual patient for bedside teaching. A case-control study was conducted to evaluate the effectiveness of learning with chatbot mobile app, versus conventional bedside teachings with real patients.

Methods

132 final year medical students were randomized into two groups - Conventional bedside teaching with clinical history taken from a real patient, and Bedside teaching with clinical history taken from the Chatbot. Independent blinded assessment of students' history taking skills was conducted. Students' performance were assessed by standardized marking scheme.

Results

Median age was 23 years old (Range 21-30 years old). There were 62 female and 70 male students.64 students were randomized into conventional group while 68 students were randomized into the chatbot group. Baseline demographic data were comparable between the two groups.Blinded assessment of students' performance in clinical history taking were comparable between the conventional group and chatbot group (p > 0.05).

Conclusion

With the promising results we have demonstrated in this study, we believe training of history taking skills by chatbot will be a feasible alternative to conventional bedside teaching.

"Fun slipping into the doctor's role"-The relationship between sonoanatomy teaching and professional identity formation before and during the Covid-19 pandemic

The various psychological dimensions of professional identity formation (PIF) are an important aspect of the study course for undergraduate medical students. Anatomical learning environments have been repeatedly shown to play a critical role in forming such an identity; however, relevance of PIF during sonoanatomical training remains underexplored. At the end of their basic anatomy studies, third-semester medical students took part in a four-day block course on anatomy and imaging. Anatomical content was revised in small groups using peer teaching and imaging methods, including one hour of hands-on sonoanatomy sessions each day. On-site sonoanatomy was identified as an excellent format to support students' transition from the pre-clinical to clinical phase as medical experts-to-be. Students enjoyed practical exercises and the clinical input, which increased their interest in the medical profession and their academic studies. This study further examined the effects of the transition into an online-only format, necessitated by the current Covid-19 pandemic. A comparison was made between the quantitative and qualitative evaluation data, and the written results of examinations of several on-site (n = 1096, mean age = 22.4 years ± 2.18), and online-only cohorts (n = 230, mean age = 22.6 years ± 2.21). The online-only transition led to a reduction of all PIF-related variables measured, losing identity-related variables, increasing students' stress levels, and reducing their long-term academic performance. Together, this study demonstrates presence of PIF in undergraduate sonoanatomy teaching, and cautions against the uncritical online-only substitution of hands-on learning environments.

Face-to-face versus distance learning of basic suturing skills in novice learners: a quantitative prospective randomized trial

BACKGROUND AND AIM

Traditionally, practical skills are taught on face-to-face (F-F) basis. COVID-19 pandemic brought distance learning (DL) to the spotlight because of the social distancing mandates. We sought to determine the acceptability and effectiveness of DL of basic suturing in novice learners.

METHODS

A prospective randomized controlled trial involving 118 students was conducted. Participants were randomized into two groups for learning simple interrupted suturing: F-F and DL-groups. Evaluation was conducted by two assessors using a performance checklist and a global rating tool. Agreement between the assessors was calculated, and performance scores of the participants were compared. Participants' satisfaction was assessed via a questionnaire.

RESULTS

Fifty-nine students were randomized to the F-F group and 59 to the DL-group. Satisfactory agreement between the assessors was demonstrated. All participants were successful in placing three interrupted sutures, with no significant difference in the performance between the groups. 25(44.6%) of the respondents in the DL-group provided negative comments related to the difficulties of remotely learning visuospatial concepts, 16(28.5%) preferred the F-F approach.

CONCLUSION

DL of basic suturing is as effective as the F-F approach in novice learners. It is acceptable by the students despite the challenges related to the remote learning of practical skills.

The university students’ viewpoints on e-learning system during COVID-19 pandemic: the case of Iran

The outbreak of COVID-19 closed educational institutions and universities. The aim of this study was to explain the strengths and weaknesses of the e-learning system in Iranian universities of medical sciences in the COVID-19 pandemic. This is a qualitative study that was conducted with students enrolled in Iranian medical universities. Data was collected through an open-ended electronic questionnaire based on the interview guide and was analyzed through content analysis.

122 students from 46 medical universities participated in this study. 122 questionnaires from 46 universities of medical sciences were completed. From a total of 54 codes extracted from the results, seven (strengths/positive experiences) and six (weaknesses/challenges) themes were extracted, each of which had several subsets. E-learning has both visible and hidden layers in terms of advantages and disadvantages. The e-learning system is an essential tool to continue education during the COVID-19 pandemic. Most students believe that e-learning was a great complement to prevent academic failure, but it cannot replicate the same efficiency of face-to-face training.

E-learning in medical education during COVID-19 pandemic: experiences of a research course at Kenya Medical Training College

BACKGROUND

E-learning has been widely adopted as a teaching and learning approach in medical education internationally. However, its adoption in low- and middle-income countries is still at an infantile stage. The use of e-learning may help to overcome some of the barriers to access to quality education and provide flexible, low-cost, user-centred, and easily updated learning. To address the need for research education during the COVID-19 pandemic, we developed and implemented an e-learning course for students enrolled in higher diploma courses at the Kenya Medical Training College (KMTC). In this paper, we report our experience teaching the online research course in resource-constrained settings to enable other medical educators, students and institutions in similar settings to understand the most appropriate approaches to incorporating e-learning interventions.

METHODS

This was a cross-sectional study that reviewed the experiences of learners and lecturers on a research course at Kenya Medical Training College. All higher diploma students admitted to the college in the 2020/21 academic year were invited to take part in the study. We also included all lecturers that were involved in the coordination and facilitation of the course. We analysed qualitative and quantitative data that were collected from the e-learning platform, an online course-evaluation form and reports from course lecturers.

RESULTS

We enrolled 933 students on the online research course. These students had joined 44 higher diploma courses in 11 campuses of the college. The students struggled to complete synchronous e-learning activities on the e-learning platform. Only 53 and 45% of the students were able to complete the pretest and the posttest, respectively. Four themes were identified through a thematic analysis of qualitative data (1) Students gained research competencies (2) Students appreciated the use of diverse e-learning technologies (3) Students felt overwhelmed by the research course (4) Technological challenges reduce the effectiveness of online learning.

CONCLUSION

Our results suggest that e-learning can be used to teach complex courses, such as research in resource-constrained settings. However, faculty should include more asynchronous e-learning activities to enhance teaching and learning and improve student experiences.

Cross-sectional case-control study on medical students' psychosocial stress during COVID-19 pandemic in Hong Kong

INTRODUCTION

COVID-19 pandemic has resulted in significant changes in pedagogy for undergraduate medical curriculum. Many physical clinical teachings have been replaced by online pedagogy. This study aims to evaluate the relation between medical students' stress during COVID-19 pandemic and their academic performance at the final examination.

METHODS

This is a cross-sectional questionnaire-based study. Student's stress level were evaluated by the COVID-19 Student Stress Questionnaire (CSSQ). Correlation of stress level and students' performance at the final examination was performed.

RESULTS

110 out of 221 (49.8%) final-year medical students responded to the questionnaire, 13 students failed in the final examination (case) while 97 students passed in the final MBBS examination (control).Baseline demographic data between case and control were comparable. The median age for both cases and controls were 24 years.Compared to controls, cases reported higher levels of stress in all domains, namely in relation to risk of contagion, social isolation, interpersonal relationships with relatives, university colleagues and professors, academic life, and sexual life. Notably, a significantly higher proportion of cases reported academic-related stress compared to controls (p < 0.01), with 100% of cases perceiving their academic studying experience during the COVID-19 pandemic to be "very" or "extremely" stressful, compared to 35.1% of controls.

CONCLUSION

Increased stress to academic and study during COVID-19 was associated with worse examination outcome at the final examination. Extra academic support will be needed to cater students' need during the pandemic.