Online learning developments in undergraduate medical education in response to the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 69

The effectiveness of concept mapping as a tool for developing critical thinking in undergraduate medical education - a BEME systematic review: BEME Guide No. 81

BACKGROUND

Concept maps (CMs) visually represent hierarchical connections among related ideas. They foster logical organization and clarify idea relationships, potentially aiding medical students in critical thinking (to think clearly and rationally about what to do or what to believe). However, there are inconsistent claims about the use of CMs in undergraduate medical education. Our three research questions are 1) What studies have been published on concept mapping in undergraduate medical education; 2) What was the impact of CMs on students' critical thinking; 3) How and why have these interventions had an educational impact?

METHODS

Eight databases were systematically searched (plus a manual and an additional search were conducted). After eliminating duplicate entries, titles and abstracts and full-texts were independently screened by two authors. Data extraction and quality assessment of the studies were independently performed by two authors. Qualitative and quantitative data were integrated using mixed-methods. The results were reported using the STructured apprOach to the Reporting In healthcare education of Evidence Synthesis statement and BEME guidance.

RESULTS

Thirty-nine studies were included from 26 journals (19 quantitative, 8 qualitative and 12 mixed-methods studies). CMs were considered as a tool to promote critical thinking, both in the perception of students and tutors, as well as in assessing students' knowledge and/or skills. In addition to their role as facilitators of knowledge integration and critical thinking, CMs were considered both a teaching and a learning methods.

CONCLUSIONS

CMs are teaching and learning tools which seem to help medical students develop critical thinking. This is due to the flexibility of the tool as a facilitator of knowledge integration, as a learning and teaching method. The wide range of contexts, purposes, and variations in how CMs and instruments to assess critical thinking are used increases our confidence that the positive effects are consistent.

Re-conceptualizing medical education in the post-COVID era

PURPOSE

The COVID-19 pandemic has forced changes in the delivery of medical education. We aimed to explore these changes and determine whether they will impact the future of medical education in any way.

METHODS

We invited leaders in medical education from all accessible US-based medical schools to participate in an online individual semi-structured interview.

RESULTS

Representatives of 16 medical schools participated. They commented on the adequacy of online education for knowledge transfer, and the logistical advantages it offered, but decried its negative influence on social learning, interpersonal relationships and professional development of students, and its ineffectiveness for clinical education. Most participants indicated that they would maintain online learning for didactic purposes in the context of flipped classrooms but that a return to in-person education was essential for most other educational goals. Novel content will be introduced, especially in telemedicine and social medicine, and the students' roles and responsibilities in patient care and in curricular development may evolve in the future.

CONCLUSIONS

This study is the first to document the practical steps that will be adopted by US medical schools in delivering medical education, which were prompted and reinforced by their experience during the COVID-19 pandemic.

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.

In-Person Versus Online Training in Simulations of Helping Babies Breathe: A Randomized Controlled Trial

BACKGROUND

Birth asphyxia is a leading cause of neonatal deaths, but simple interventions may prevent it. The Helping Babies Breathe (HBB) course has significantly reduced neonatal mortality rates in lower and middle-income countries (LMICs) by training healthcare providers (i.e. midwives and nurses) on the essential skills of bag-and-mask ventilation and postnatal care. Although several studies have supported the efficacy of virtual learning in other medical education programs, there is still a lack of knowledge regarding a virtual approach to HBB. This study aims to compare the effectiveness of online versus in-person learning of the HBB course among medical and nursing students.

METHODS

The study is a two-arm parallel randomized non-inferiority controlled trial, that includes medical and nursing students. Participants were randomly assigned to either online or in-person debriefing during the hands-on simulations of HBB. They attended a pre-recorded lecture before being assigned to one of three instructors for the simulation lab. Participants completed a seven-point anonymous Likert-based questionnaire and a standardized Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV) Short Form. The primary outcome was the Objective Structured Clinical Exam (OSCE) grade. The trial is listed on ClinicalTrials.gov with the registration number NCT05257499.

RESULTS

47 participants completed the study, with similar baseline characteristics in each arm (gender, age, and class). The participants in both arms reported high levels of satisfaction and confidence, with no significant difference between the two arms. The DASH score over 7 was also similar in the online arm (6.27±0.26) compared to the in-person arm (6.55±0.13) (p=0.07). The mean OSCE score in the online arm (45.8±5.2) was comparable to the mean OSCE score in the in-person arm (41.3±5.0) (p=0.22). Both online and in-person participants failed the OSCE.

CONCLUSION

The survey responses conveyed that online simulation training is comparable to in-person simulation for the HBB course. Both online and in-person participants failed the OSCE most likely because they needed more training on HBB. This could be due to the fact that the material is too new to the students who needed more practice to pass the OSCE. Further research is needed to confirm these results and explore the long-term impact of online neonatal resuscitation training.

Everyone can draw: An inclusive and transformative activity for conceptualization of topographic anatomy

Anatomical drawing traditionally involves illustration of labeled diagrams on two-dimensional surfaces to represent topographical features. Despite the visual nature of anatomy, many learners perceive that they lack drawing skills and do not engage in art-based learning. Recent advances in the capabilities of technology-enhanced learning have enabled the rapid and inexpensive production of three-dimensional anatomical models. This work describes a "drawing on model" activity in which learners observe and draw specific structures onto three-dimensional models. Sport and exercise sciences (SES, n = 79) and medical (MED, n = 156) students at a United Kingdom medical school completed this activity using heart and femur models, respectively. Learner demographics, their perceptions of anatomy learning approaches, the value of the activity, and their confidence in understanding anatomical features, were obtained via validated questionnaire. Responses to 7-point Likert-type and free-text items were analyzed by descriptive statistics and semi-quantitative content analysis. Learners valued art-based study (SES mean = 5.94 SD ±0.98; MED = 5.92 ± 1.05) and the "drawing on model" activity (SES = 6.33 ± 0.93; MED = 6.21 ± 0.94) and reported enhanced confidence in understanding of cardiac anatomy (5.61 ± 1.11), coronary arteries (6.03 ± 0.83), femur osteology (6.07 ± 1.07), and hip joint muscle actions (5.80 ± 1.20). Perceptions of learners were independent of both their sex and their art-based study preferences (p < 0.05). Themes constructed from free-text responses identified "interactivity," "topography," "transformative," and "visualization," as key elements of the approach, in addition to revealing some limitations. This work will have implications for anatomy educators seeking to engage learners in an inclusive, interactive, and effective learning activity for supporting three-dimensional anatomical understanding.

Education in focus: Significant improvements in student learning and satisfaction with ophthalmology teaching delivered using a blended learning approach

PURPOSE

This study aimed to measure student satisfaction with a revised ophthalmology delivery format, which due to the pandemic had previously relied on a remote online flipped classroom (OFC) format compared to a blended learning format. This educational strategy combined online learning with in-person seminars and practical patient centred sessions. Our previous investigations demonstrated a significant lack of student satisfaction with a curriculum solely reliant on a remote OFC, as such we hypothesised that a blended learning approach would result in improved levels of student satisfaction and knowledge gain.

METHODS

Non-randomised intervention study of two groups; group 1 = OFC group and group 2 = BL group, compared perspectives of 4th year ophthalmology students using a validated course evaluation questionnaire (CEQ).

RESULTS

A total of 59 students from the BL group (n = 257; response rate = 23.0%) and 28 from the OFC group agreed to participate in the study (n = 114; response rate = 24.6%). Participants in the BL group felt it was easier to determine the standard of work that was expected (77.42% v 60.71%) and demonstrated significantly increased satisfaction with staff motivation of students (95.16% v 64.29%, p <0.001) and provision of feedback (74.19% v 46.43%, p = 0.004), compared to the OFC group. Furthermore, students in the BL group also felt the course significantly improved their analytical skills (64.52% v 42.85%, p = 0.023) and ability to work as part of team (69.36% v 25%, p <0.001) as well as reporting reduced dissatisfaction with the level of choice afforded in terms of how they would learn (33.88% v 60.71%, p = 0.31) and the how they were assessed (59.68% v 89.28%, p = 0.004). No evidence of a statistical difference in exam score was observed.

CONCLUSIONS

The COVID-19 pandemic necessitated an unavoidable pivot to online and distance learning, to meet the challenges presented by government mandates and social distancing requirements. Since many of these directives have been reversed, it is important to evaluate the effectiveness and learner perceptions' of the online and distance learning interventions. In this study we demonstrated a significant student preference for BL compared to the OFC approach, with comparable student performances determined by MCQ examinations. Our findings suggest a preference for reintroducing in-person and patient engagement activities in post-pandemic health professions education.

Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

As future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.

METHODS

We systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg's and Egger's tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.

RESULTS

We identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%-49%) and 48% (95% CI, 43%-52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%-32%) and 30% (95% CI, 26%-35%), respectively. There was high heterogeneity between studies, with I2 ranging from 99.58%-99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.

CONCLUSIONS

We demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

Graduating Medical Students' Perceptions of the COVID-19 Pandemic's Impact on Their Medical School Experiences and Preparation for Careers as Physicians: A National Study

PURPOSE

The COVID-19 pandemic resulted in unprecedented changes to the medical education learning environment. The graduating class of 2021 was particularly affected. To better understand how students were affected, the authors explored positive and negative experiences described by graduating U.S. medical students.

METHOD

Using the conceptual framework of affordances, the authors examined narrative responses to 2 new open-ended questions on the Association of American Medical Colleges 2021 Graduation Questionnaire in which graduating students described the pandemic's positive and negative effects on their medical school experiences and career preparation. Conventional content analysis was used to identify affordances and themes in responses.

RESULTS

Of 16,611 Graduation Questionnaire respondents, 8,926 (54%) provided narrative responses. Of these 8,926 respondents, responses from 2,408 students (27%) were analyzed. Students described positive and negative perceptions of affordances, centering around virtual learning, social connection, and transition to residency. Fewer in-person and increased virtual clinical rotations offered students flexible scheduling, allowing them greater opportunity to explore academic and professional interests. Additionally, students' sense of isolation from their medical school was alleviated when schools exercised intentional open communication and student involvement in decision making. Although many described a diminished sense of preparedness for residency due to limited access to in-person clinical experiences and to assessing residencies largely through virtual away rotations and interviews, the sense of community, adaptability, and resiliency gained through varied activities reinforced students' professional identity and commitment to medicine during a time of much uncertainty.

CONCLUSIONS

This national exploration of students' pandemic experiences highlights what students value as fundamental elements of medical education and student support and describes how innovation can improve long-standing practices. These findings, guided by students' insights, can help inform the work of educational leaders as they consider which innovations should remain to continue enhancing student learning, engagement, and well-being.

"But This Is the New Reality, and I Will Adapt": Understanding Lecturers' Experiences of COVID-19 Lockdown Online Learning and Teaching

Following the 2020 COVID-19 pandemic national lockdown in South Africa, the University of the Free State launched various support initiatives for academic staff and students. Teaching and learning activities and assessments were adapted for emergency remote teaching. Students and academic staff members experienced disruption due to the migration to the online environment. This study aimed to investigate the experiences of academic staff members in an undergraduate medical programme using a mixed-methods approach in the form of a sequential exploratory design in two phases. Quantitative data were obtained through an online questionnaire survey that were triangulated and complemented with qualitative data obtained from responses to open questions in the questionnaire survey and online reflective essays. Quantitative data revealed that although most academic staff members had received training in and used mostly administrative functions in the learning management system (Blackboard) prior to lockdown, its uses almost doubled during the lockdown. Qualitative data analysis gave an in-depth understanding of academic staff members' experiences identified in the themes Teaching and Learning, Assessment, Technology, Communication, and Personal Experience. Concerns were expressed regarding students' access to technology and adaptation to online learning, and training needs and challenges were identified. The lessons learnt through the resilient, transformative responses to this global disruptor can guide future strategies for medical education.

Effect of Feedback Modality on Simulated Surgical Skills Learning Using Automated Educational Systems- A Four-Arm Randomized Control Trial

OBJECTIVE

To explore optimal feedback methodologies to enhance trainee skill acquisition in simulated surgical bimanual skills learning during brain tumor resections.

HYPOTHESES

(1) Providing feedback results in better learning outcomes in teaching surgical technical skill when compared to practice alone with no tailored performance feedback. (2) Providing more visual and visuospatial feedback results in better learning outcomes when compared to providing numerical feedback.

DESIGN

A prospective 4-parallel-arm randomized controlled trial.

SETTING

Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Canada.

PARTICIPANTS

Medical students (n = 120) from 4 Quebec medical schools.

RESULTS

Participants completed a virtually simulated tumor resection task 5 times while receiving 1 of 4 feedback based on their group allocation: (1) practice-alone without feedback, (2) numerical feedback, (3) visual feedback, and (4) visuospatial feedback. Outcome measures were participants' scores on 14-performance metrics and the number of expert benchmarks achieved during each task. There were no significant differences in the first task which determined baseline performance. A statistically significant interaction between feedback allocation and task repetition was found on the number of benchmarks achieved, F (10.558, 408.257)=3.220, p < 0.001. Participants in all feedback groups significantly improved their performance compared to baseline. The visual feedback group achieved significantly higher number of benchmarks than the practice-alone group by the third repetition of the task, p = 0.005, 95%CI [0.42 3.25]. Visual feedback and visuospatial feedback improved performance significantly by the second repetition of the task, p = 0.016, 95%CI [0.19 2.71] and p = 0.003, 95%CI [0.4 2.57], respectively.

CONCLUSION

Simulations with autonomous visual computer assistance may be effective pedagogical tools in teaching bimanual operative skills via visual and visuospatial feedback information delivery.

Training simulated participants for role portrayal and feedback practices in communication skills training: A BEME scoping review: BEME Guide No. 86

BACKGROUND

Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence related to SPs' role as educators and identifies how SPs prepare for their role and feedback practices.

METHODS

The authors conducted a scoping review and included a group of international stakeholders with experience and expertise in SP methodology. Five online databases were systematically searched and ERIC, MedEdPortal and MedEdPublish were hand searched to identify relevant studies. Inclusion/exclusion criteria were developed. Data screening and subsequently data charting were performed in pairs. The results of data charting were thematically analysed including categories relating to the Association of SP Educators (ASPE) Standards of Best Practice (SOBP).

RESULTS

From 8179 articles identified for the title and abstract screening, 98 studies were included. Studies reported the benefit of SPs' authentic role portrayal and feedback interactions for learners and on the reported learning outcomes. Data was heterogeneous with a notable lack of consistency in the detail regarding the scenario formats for communication skills training interventions, SP characteristics, and approaches to training for feedback and role portrayal.

CONCLUSIONS

The published literature has considerable heterogeneity in reporting how SPs are prepared for role portrayal and feedback interactions. Additionally, our work has identified gaps in the implementation of the ASPE SOBP, which promotes effective SP-learner feedback interactions. Further research is required to identify effective applications of SP methodology to prepare SPs for their role as educators.

Online Learning in Medical Student Clerkship: A Survey of Student Perceptions and Future Directions

Background The coronavirus disease 2019 (COVID-19) pandemic had a major impact on medical education with clerkship students abruptly removed from clinical activities in 2020 and hastily immersed in online learning to maintain medical education. In 2022, students returned to in-person clinical experiences, but synchronous learning sessions continued online with extensive use of asynchronous online resources. This change offers a unique opportunity to gather information about students' perspectives regarding the acceptability and effectiveness of online learning strategies. This study aims to explore the clerkship student experience with the integration of online learning and in-person learning into formalized educational sessions in clerkship. Methodology The authors administered an online survey to clerkship students at the Cumming School of Medicine at the University of Calgary, Canada in spring 2022. The survey consisted of primarily Likert-style questions to explore the perceived effectiveness of various online learning strategies. Results are reported as the proportion selecting "quite effective" or "extremely effective." Results A total of 89 students responded to the survey (57.4% of graduating class). For synchronous online learning, case-based learning was perceived as the most effective teaching strategy (61.8%), and audience response systems were the most effective strategy for improving audience engagement (70.1%). For asynchronous online learning, interactive cases (84.9%) and student-developed online study guides (83.6%) were perceived as the most effective. Students held varying perceptions regarding how online learning impacted their well-being. When considering future clerkship curricula, the majority of clerkship students preferred a blend of in-person and online learning. Conclusions This study identified that most clerkship students prefer a hybrid of in-person and online learning and that ideal online learning curricula could include case-based learning, audience response systems, and a variety of asynchronous learning resources. These results can guide curriculum development and design at other medical institutions.

The impact of online education during the Covid-19 pandemic on the professional identity formation of medical students: A systematic scoping review

Evolving individual, contextual, organizational, interactional and sociocultural factors have complicated efforts to shape the professional identity formation (PIF) of medical students or how they feel, act and think as professionals. However, an almost exclusive reliance on online learning during the COVID-19 pandemic offers a unique opportunity to study the elemental structures that shape PIF and the environmental factors nurturing it. We propose two independent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA)s to map accounts of online learning environment and netiquette that structure online programs. The data accrued was analysed using the clinically evidenced Krishna-Pisupati Model of Professional Identity Formation (KPM) to study the evolving concepts of professional identity. The results of each SSR in SEBA were evaluated separately with the themes and categories identified in the Split Approach combined to create richer and deeper 'themes/categories' using the Jigsaw Perspective. The 'themes/categories' from each review were combined using the Funnelling Process to create domains that guide the discussion. The 'themes/categories' identified from the 141 included full-text articles in the SSR in SEBA of online programs were the content and effects of online programs. The themes/categories identified from the 26 included articles in the SSR in SEBA of netiquette were guidelines, contributing factors, and implications. The Funnelling Process identified online programs (encapsulating the content, approach, structures and the support mechanisms); their effects; and PIF development that framed the domains guiding the discussion. This SSR in SEBA identifies the fundamental elements behind developing PIF including a structured program within a nurturing environment confined with netiquette-guided boundaries akin to a Community of Practice and the elemental aspect of a socialisation process within online programs. These findings ought to be applicable beyond online training and guide the design, support and assessment of efforts to nurture PIF.

Developing discipline-specific online pedagogies for nursing education

BACKGROUND

Many nurse educators have pivoted their teaching to online formats since the COVID-19 pandemic began. Nurse educators face the dilemma that person-centred approaches are particularly challenging to replicate online. Current research provides general recommendations for designing and delivering online learning, but less is known about the usefulness of discipline-specific pedagogies for nursing education.

AIM

This study explores the value of creating discipline-specific pedagogies for online learning in baccalaureate nursing education.

METHOD

Using an action research approach, the authors document their lived experience of designing and delivering a course in two different formats - blended and entirely online. Drawing on existing and new educational models related to online learning, we explore how practice can inform the development of emergent frameworks to guide online education.

RESULTS

Using reflective practice, the authors developed an emergent framework that draws on embodied learning theory to enhance the online delivery of a disability and enablement course for nursing students.

CONCLUSIONS

The concept of embodied pedagogies may offer a starting point for developing guidelines for person-centred and student-centred nursing education online.

Online learning in Health Professions Education. Part 1: Teaching and learning in online environments: AMEE Guide No. 161

Online learning in Health Professions Education (HPE) has been evolving over decades, but COVID-19 changed its use abruptly. Technology allowed necessary HPE during COVID-19, but also demonstrated that many HP educators and learners had little knowledge and experience of these complex sociotechnical environments. Due to the educational benefits and flexibility that technology can afford, many higher education experts agree that online learning will continue and evolve long after COVID-19. As HP educators stand at the crossroads of technology integration, it is important that we examine the evidence, theories, advantages/disadvantages, and pedagogically informed design of online learning. This Guide will provide foundational concepts and practical strategies to support HPE educators and institutions toward advancing pedagogically informed use of online HPE. This Guide consists of two parts. The first part will provide an overview of evidence, theories, formats, and educational design in online learning, including contemporary issues and considerations such as learner engagement, faculty development, inclusivity, accessibility, copyright, and privacy. The second part (to be published as a separate Guide) focuses on specific technology tool types with practical examples for implementation and integration of the concepts discussed in Guide 1, and will include digital scholarship, learning analytics, and emerging technologies. In sum, both guides should be read together, as Guide 1 provides the foundation required for the practical application of technology showcased in Guide 2.Please refer to the video abstract for Part 1 of this Guide at https://bit.ly/AMEEGuideOnlineLearning.

Online learning resources and social media platforms used by medical students during the COVID-19 pandemic

BACKGROUND

The unprecedented COVID-19 pandemic has caused significant disruption to medical students' education. It imposed challenges that required rapid adaptation to enforced lockdowns and remote learning and changed curriculum delivery from in-person to online learning and virtual technology.

OBJECTIVE

This study aimed to determine the trends and ratings of using Internet resources and social media platforms by medical students during the COVID-19 pandemic.

METHODS

A validated questionnaire was used to explore preferences for Internet resources and social media platforms among undergraduate medical students (years 1, 3, and 5) at King Saud University. The questionnaire comprised three sections- (i) demographic information, (ii) access and use of Internet resources/social media platforms, and (iii) students' ratings and reasons for using technology-enabled learning during the COVID-19 pandemic.

RESULTS

A total of 320 undergraduate medical students responded to the online questionnaire. The difference in the number of students using the Internet daily across academic years increased significantly as they progressed in the medical course (p = 0.025). For learning, YouTube and Videoconferencing (e.g. Zoom) were used by 83.1% and 73.4% of students, respectively, followed by WhatsApp 198 (61.9%). For social interaction, WhatsApp, 310 (96.6%); YouTube, 296 (92.8%); Twitter, 288 (90%); and Zoom, 269 (84.1%) were the platforms used by most students. Regarding concerns about the impact of COVID-19 and social isolation, 250 (78.1%) agreed that technology helped them gain a sense of connectedness to their peers. Over half of students, 187 (58.4%) wished that technologies be integrated more often in their courses, as 245 (76.7%) agreed that it helped engage them with classes.

CONCLUSION

The study shows that the use of the Internet and social media resources is increasing at all levels to fill the gap in learning and social interaction because of the COVID-19 pandemic. Medical institutions should embrace the effective use of Internet resources and use the experience gained and lessons learned in guiding educators on what type of online resources should be created to add value to students learning even post-pandemic.

Development of complex pedagogical competencies and reflexivity in clinical teachers via distance learning: a mixed methods study

Clinical reasoning is the cornerstone to healthcare practice and teaching it appropriately is of utmost importance. Yet there is little formal training for clinical supervisors in supervising this reasoning process. Distance education provides interesting opportunities for continuous professional development of healthcare professionals. This mixed methods study aimed at gaining in-depth understanding about whether and how clinical teachers can develop complex pedagogical competencies through participation in a Massive Open Online Course on the supervision of clinical reasoning (MOOC SCR). Participants self-assed their clinical supervision skills before and after partaking in the MOOC SCR through the Maastricht Clinical Teachers Questionnaire. Item scores and the distribution of response proportions before and after participation were compared using paired t-tests and McNemar's tests respectively. In parallel, the evolution of a subset of MOOC participants' pedagogical practice and posture was explored via semi-structured interviews throughout and beyond their MOOC participation using simulated and personal situational recalls. The verbatim were analysed with standard thematic analysis. Quantitative and qualitative findings converged and their integration demonstrated that partaking in the MOOC SCR promoted the development of complex pedagogical competencies and reflexivity with the participants. This was quantitatively evidenced by significantly higher self-assessed supervision skills and corresponding attitudes after completing the MOOC. The qualitative data provided rich descriptions of how this progression in pedagogical practice and posture occurred in the field and how it was shaped by participants' interaction with the MOOC's content and their motivations to progress. Our findings provide evidence for the development of pedagogical skills and corresponding attitudes for the supervision of clinical reasoning through participation in the MOOC SCR and contribute to the literature body on the opportunities that distance learning provides for the development of pedagogical competencies. The extent to which the pedagogical underpinnings of the MOOC contributed to these developments remains to be determined.

An ethnographic study evaluating emergency obstetric care education and training in a remote, fragile region of Southeast Asia: Study protocol

AIM

To evaluate emergency obstetric care education and training within a medical assistant training program, being delivered in a remote, fragile region of Southeast Asia. This will aid in the identification of potential areas of enhancement to improve the management of obstetric emergencies.

DESIGN

An ethnographic study, adopting a multi-methods approach.

METHODS

Emergency obstetric care education and training will be assessed through documentary analysis and interviews (online or face-to-face) with educators and trainers (N ~ 6-7). Student experiences will be explored using in-person focus groups, facilitated by an external trainer involved in delivering the program (N ~ 10-12). A reflective field diary will provide insight into the lived experience of postgraduate students (N ~ 4-5). Data will be collected between May 2022 and May 2023. The full data set will be triangulated and analysed using the READ approach; (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. Institutional ethical approval was obtained from a university in October 2021, and inter-country regional access was gained following adherence to their local ethical requirements.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

The findings from this study may help to inform the future design of the medical assistant training program. It is anticipated that the knowledge gained from this study will enhance the education and training of mid-level health providers at local, national, and international levels. This work intends to contribute to addressing Sustainable Development Goal 3, Target 1 of reducing maternal mortality to 70:100,000 live births in low-income countries.

REPORTING METHOD

This protocol adhered to the Standards for Reporting Qualitative Research (SRQR) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No formal PPI has been undertaken; however, stakeholders involved in delivering the education and training have been consulted.

The change of the COVID-19 pandemic on medical education in Korea: a national survey of medical schools

PURPOSE

This study aims to investigate how medical schools in Korea managed their academic affairs and student support in response to the coronavirus disease 2019 (COVID-19) pandemic and their plans for the post-COVID-19 era.

METHODS

An online survey was conducted, and a link to a questionnaire was distributed to all the administrators of the 40 medical schools in Korea. The final analysis data involved responses from 33 medical schools and 1,342 students. Frequency analysis, cross-tabulation analysis, Fisher's exact test, and one-way analysis of variance were applied for statistical analysis.

RESULTS

Regarding instruction methods, most medical schools in Korea transitioned from in-person learning to video-on-demand learning (51.5%) and real-time online learning (42.4%). Among the school leaders, 36.4% planned to continue offering online classes combined with in-person classes beyond the end of the pandemic. Among the students, the online class concentration and participation score was 3.0 points or lower, but the class understanding score was 3.6 points, above a moderate level.

CONCLUSION

Students cited the shorter times needed to attend school and being able to take classes repeatedly as advantages of online classes, and over one-third of medical schools intended to continue with a hybrid of in-person and online learning even after the COVID-19 pandemic restrictions end.

First steps of learning analytics in a blended learning general practice curriculum at Saarland University - a quantitative approach

Objectives

Medical education has been revolutionized by the growing importance of digital learning. Little is known about students' online study behaviour and its relationship with exam performance. This quantitative study analyses and describes students' digital learning behaviours in a blended learning curriculum for General practice at Saarland University, Germany. It also examines the relationship between digital learning behaviour and exam performance.

Methods

Cohort and individualized AMBOSS® user data from 195 students at Saarland University was analysed quantitatively. Performance in course-specific multiple-choice question sessions and user data of the integrated online learning activities were correlated with each other and with General practice exam grades. Anonymized data from 10,534 students from 35 other German universities served as the reference cohort. Differences in digital learning behaviour between the groups were calculated using Mann-Whitney-U-Test for non-normally distributed data.

Results

Students in the blended learning course used integrated content more frequently than the reference cohort (U=48777, p<0.001). The number of digital learning cards read correlated moderately with digital formative assessment performance (ρ=0.331, p=0.005 and ρ=0.217, p=0.034). Formative assessment scores and exam results correlated strongly in the summer semester cohort (ρ=0.505, p<0.001), and moderately in the winter semester cohort (ρ=0.381, p<0.001).

Conclusion

There is a difference in the usage of online learning activities when they are purposefully integrated into a curriculum. Digital learning activities including formative assessment may serve as valuable, constructively aligned exam preparation. This is relevant for medical educators when planning future blended learning curricula and portfolio systems, as it may save financial and human resources.

Detour or New Direction: The Impact of the COVID-19 Pandemic on the Professional Identity Formation of Postgraduate Residents

PURPOSE

The COVID-19 pandemic has resulted in numerous disruptions to health professions education training programs. Much attention has been given to the impact of these disruptions on formal learning opportunities in training; however, little attention has been given to the impact on professional socialization and professional identity formation. This study explored the impact of the pandemic and resultant curricular changes on the professional identity of family medicine residents.

METHOD

23 family medicine residents at the University of Toronto were interviewed between September 2020 and September 2022. Using symbolic interactionism as a theoretical framework, thematic analysis explored the meanings residents attributed to both experiences that were disrupted due to the pandemic, and new experiences that resulted from these disruptions.

RESULTS

Participant responses reflected that disruptions in training did not always align with their expectations for family medicine and plans for future practice; however, these new experiences also reinforced their understanding of what it means to be a family physician. While participants felt the pandemic represented a loss of agency and negatively impacted relationships in their training program, it also provided a sense of belonging and membership in their profession. Finally, these new experiences continually blurred the line between professional and personal identities through the impact of the pandemic on participants' sense of well-being and safety.

CONCLUSIONS

The impact of the pandemic on training experiences extends beyond the loss of formal learning opportunities. Participant responses reflect the collective influence of the formal, informal, and hidden curriculum on the professional socialization and professional identity formation of residents-and how these different curricular influences were disrupted due to the pandemic. These training experiences have important implications for the future practice of residents who completed their training during the pandemic and highlight the role of training programs in supporting the professional identity formation of residents.

Integrating Virtual Teaching in a New Era of Medical Education: Lessons from a Neurology Course

The COVID-19 pandemic has led to a sudden shift toward virtual learning in neurology education, which presents challenges for educators. However, virtual learning is here to stay for three key reasons: demand among students, ease of dissemination, and potential to improve educational quality. Despite challenges, educators can teach effectively using appropriate virtual tools and methods, with innovative approaches that will ultimately lead to sustained improvements in neurology education. Here, we aim to help educators effectively incorporate virtual instruction into their "new normal" by offering practical, evidence-based tips for balancing in-person and virtual learning, selecting the appropriate tools and methods for virtual teaching, and creating a supportive virtual learning environment. Using a systematic approach, educators can identify specific, achievable goals, determine the content's scope, appropriate assessments, select appropriate teaching methods, and create the session schedule and materials. Here we described evidence-based strategies for best practices, developing virtual material, and creating the appropriate virtual learning environment.

How will the Covid-19 pandemic shape the future of primary care undergraduate teaching? Understanding modifications and developments deployed by UK academic units of primary care, and their implications for the future

BACKGROUND

Primary care has been under-represented in its contribution to the academic literature base on Covid-19 developments. We sought to understand how teaching and learning was modified and developed by primary care academic leaders to support the continuation of primary care-orientated learning during the Covid-19 pandemic; and explore how these changes may shape future educational delivery in primary care.

METHODS

We adopted a qualitative approach, using semi-structured interviews of seven General Practice Heads of Teaching (GP HoTs) from UK medical schools. We used mixed deductive and inductive coding to analyse interview transcripts. Modifications and developments were coded to four a priori themes (clinical off-site; clinical on-site; synchronous remote; asynchronous remote). We concurrently used inductive coding to identify developments that did not readily fit into these categories. To understand how participants perceived the developments may shape primary care teaching in the future, we carried out an inductive thematic analysis.

RESULTS

A range of modifications and developments were described. Examples of developments include: GP practices being provided with increased flexibility to support ongoing provision of clinical placements (on-site clinical), examples of initiatives enabling students to consult remotely from their homes (off-site clinical), transfer of face-to-face teaching to remote formats (synchronous remote) and development of new, interactive on-line teaching materials (asynchronous remote). One additional theme arose inductively: collaboration and co-operation. For future implications, five themes arose: the evolution of flexible and hybrid clinical placement models; an increased role for telemedicine; increased networking and collaboration; increased active student involvement in patient care; and opportunities for community-based teaching afforded by the pandemic.

CONCLUSION

This study highlights how teaching was modified to support the continuation of primary care-based learning during the Covid-19 pandemic, and implications for the future. Collaboration and placement flexibility were notable features in the response. Participants perceived that flexible placement models containing a mixture of clinical on-site with remote synchronous and asynchronous teaching and learning activities, may persist into the post-Covid era. Further research is required to understand which developments become routinely embedded into primary care teaching in the post-Covid era and explain how and why this occurs.

Equivalent Performance of Exam Items Associated with Case-Based Learning, Flipped Classroom, and Lecture in a Pre-clerkship Medical Curriculum

The purpose of our study was to determine if knowledge acquisition, as measured by exam item performance, differed for active or passive learning activities in our medical curriculum. Additionally, we looked for differences in exam item performance in one second-year course that varies the method of an active learning activity, case-based collaborative learning (CBCL). Finally, we assessed whether item performance was impacted when small group activities were conducted online due to the COVID-19 pandemic. Exam item difficulty values were collected for several years of lectures, flipped classroom, and CBCL. Statistical analysis and modeling of data were performed to identify differences in difficulty of exam items that assess content delivered by different learning activities. Our analysis revealed no differences in difficulty of exam items that assess content delivered by different learning activities. Similarly, we determined that varying the execution of CBCL in one course did not impact exam item performance. Finally, moving CBCL small group sessions online did not impact exam item difficulty. However, we did detect a minor reduction in overall exam scores for the period of online instruction. Our results indicate that knowledge acquisition, as assessed by our multiple-choice summative exams, was equivalent regardless of learning activity modality.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01842-8.

Innovations in assessment in health professions education during the COVID-19 pandemic: A scoping review

BACKGROUND

After an initial period of uncertainty during the COVID-19 pandemic, medical universities responded to the pandemic by innovating their methods of teaching-learning and assessment. This scoping review aimed to identify innovations in assessment in medical, dental and nursing education at the undergraduate and postgraduate levels during the pandemic.

METHODS

This review was conducted utilising Arksey and O'Malley's framework where three electronic databases-PubMed, Embase and Web of Science-were systematically searched in February 2022 for articles in English describing innovations in assessments published in or after January 2020.

RESULTS

A total of 70 articles were included in the review. Among the primary research articles, 82.1% reported online assessment, 76.1% were related to medical speciality, 74.6% described assessment at the undergraduate level, 68.7% described summative assessment and 58.2% reported assessment of practical skills. All assessments of theoretical knowledge were done virtually with MCQ being the most used assessment tool and virtual OSCE being the most popular assessment tool to assess practical skills; however, it was acknowledged that the assessment of procedural skills was its limitation. Although the studies described the newer forms of assessments as feasible and acceptable, few studies reported the reliability and validity of the assessments.

CONCLUSIONS

This scoping review identified several innovations in assessment during the COVID-19 pandemic with an overall shift towards virtual or hybrid forms of assessment. However, there was a dearth of evidence regarding the effectiveness of these assessment tools suggesting a need for more research before the tools can be implemented post-pandemic.

Survey of students' learning experience using a virtual slaughterhouse simulator in three UK veterinary schools during the COVID-19 pandemic

BACKGROUND

Although visiting an abattoir is mandatory for all UK veterinary students, this was challenging during the COVID-19 pandemic and virtual simulators were temporarily approved by the Royal College of Veterinary Surgeons. Subsequently, the virtual slaughterhouse simulator (VSS) was used by the University of Nottingham School of Veterinary Medicine and Science, the University of Liverpool School of Veterinary Science and the Royal (Dick) School of Veterinary Studies in Edinburgh. This study aimed to evaluate the student learning experience using the VSS.

METHODS

An online survey containing satisfaction and assessment questions was distributed to all final-year students who used the VSS from September 2020 to August 2021.

RESULTS

A total of 207 students completed the survey (n = 207/488, 42%). Students were mostly highly satisfied and found the VSS very useful for their learning (n = 164/207,79%); however, anxiety levels to visit a real abattoir lowered for less than half of the students (n = 97/207, 46%). Most students obtained an overall mark over 50% in the assessment questions (n = 197/207, 95%).

LIMITATIONS

Although the findings were very positive, extrapolation to other veterinary schools and postgraduate curricula should be done cautiously.

CONCLUSION

The VSS is a valid tool for training veterinary students. However, more research is advised to compare virtual and real experiences and assess students' long-term performance.

The effect of watching lecture videos at 2× speed on memory retention performance of medical students: An experimental study

AIM

This study aimed to determine how watching lecture videos at 1× and 2× speeds affects memory retention in medical students.

METHODS

A posttest-only experimental design was utilized. The participants were 60 Year-1 and Year-2 medical students. The participants were assigned to one of two groups through stratified randomization: Group 1 would watch the video at 1× speed, and Group 2 at 2× speed. Their performance was assessed using a test comprising 20 multiple-choice questions. The test has been applied immediately after watching the video (Immediate test), and, again after one week (Delayed test). Parametric and non-parametric statistical tests were performed.

RESULTS

In the Immediate test, the mean score of the 1× speed group was 11.26 ± 4.06, while 2× speed group's mean score was 10.16 ± 2.46. The difference was not significant t(58) = 1.26, p > .05. In the Delayed test, the mean score of 1× speed group was 9.66 ± 3.94, while 2× speed group's mean score was 8.36 ± 2.80. The difference was not significant t(55) = 1.42, p > .05.

CONCLUSIONS

Watching the video lecture at 2× speed did not impair memory retention in medical students. This may help students to save time in their dense curricula.[Box: see text].

Online education for prosthetics and orthotics students in the era of COVID-19 pandemic in Iran: challenges, opportunities, and recommendations

INTRODUCTION

With the advent of the COVID-19 pandemic, many higher education programs in Iran, including prosthetics and orthotics (P&O), had to shift to the online environment all at once. This unanticipated transition was challenging for the educational system. However, online education is superior in some aspects to conventional methods, and this situation may offer opportunities. This study was carried out from September 2021 to March 2022 to investigate the challenges and opportunities of online education in the P&O sector in Iran based on the opinions of students and faculty members. Relevant recommendations will also be discussed.

METHODS

In this qualitative study, semi-structured interviews were conducted in both oral and written formats. Purposive and snowball sampling techniques were used to recruit undergraduate and postgraduate P&O students, as well as P&O faculty members, for this qualitative study. The data gathered from interviews with study participants were analyzed by thematic analysis.

RESULTS

Based on the data analysis, many sub-themes of the three main themes were recognized: (1) challenges: technical, socioeconomic, environmental distractors, supervision and evaluation, workload, digital competence, interactions, motivation, sessions-related issues, class time, hands-on and clinical training; (2) opportunities: technological innovations, infrastructure development, flexible learning environment, student-centered learning, availability of contents, time and cost saving, high concentration, more self-confidence; (3) recommendations: technical infrastructure, team dynamics, hybrid courses, time management, awareness.

CONCLUSION

Online education of P&O during the era of the COVID-19 pandemic was accompanied by a series of challenges. Technical issues and the gravity of hands-on training in this field were significant challenges. This era, however, provided the opportunity to facilitate the establishment of needed infrastructure and support technological innovations for online education. Considering hybrid (mixed online and on-site) courses was recommended to improve the quality of learning.

Evaluation of medical school faculty members' educational performance in Korea in 2022 through analysis of the promotion regulations: a mixed methods study

PURPOSE

To ensure faculty members' active participation in education in response to growing demand, medical schools should clearly describe educational activities in their promotion regulations. This study analyzed the status of how medical education activities are evaluated in promotion regulations in 2022, in Korea.

METHODS

Data were collected from promotion regulations retrieved by searching the websites of 22 medical schools/universities in August 2022. To categorize educational activities and evaluation methods, the Association of American Medical Colleges framework for educational activities was utilized. Correlations between medical schools' characteristics and the evaluation of medical educational activities were analyzed.

RESULTS

We defined 6 categories, including teaching, development of education products, education administration and service, scholarship in education, student affairs, and others, and 20 activities with 57 sub-activities. The average number of included activities was highest in the development of education products category and lowest in the scholarship in education category. The weight adjustment factors of medical educational activities were the characteristics of the target subjects and faculty members, the number of involved faculty members, and the difficulty of activities. Private medical schools tended to have more educational activities in the regulations than public medical schools. The greater the number of faculty members, the greater the number of educational activities in the education administration and service categories.

CONCLUSION

Medical schools included various medical education activities and their evaluation methods in promotion regulations in Korea. This study provides basic data for improving the rewarding system for efforts of medical faculty members in education.

Teaching Medical Microbiology With a Web-Based Course During the COVID-19 Pandemic: Retrospective Before-and-After Study

BACKGROUND

The COVID-19 pandemic has imposed unprecedented hurdles on health care systems and medical faculties alike. Lecturers of practical courses at medical schools have been confronted with the challenge of transferring knowledge remotely.

OBJECTIVE

We sought to evaluate the effects of a web-based medical microbiology course on learning outcomes and student perceptions.

METHODS

During the summer term of 2020, medical students at Saarland University, Germany, participated in a web-based medical microbiology course. Teaching content comprised clinical scenarios, theoretical knowledge, and instructive videos on microbiological techniques. Test performance, failure rate, and student evaluations, which included open-response items, for the web-based course were compared to those of the on-site course from the summer term of 2019.

RESULTS

Student performance was comparable between both the online-only group and the on-site comparator for both the written exam (n=100 and n=131, respectively; average grade: mean 7.6, SD 1.7 vs mean 7.3, SD 1.8; P=.20) and the oral exam (n=86 and n=139, respectively; average grade: mean 33.6, SD 4.9 vs mean 33.4, SD 4.8; P=.78). Failure rate did not significantly differ between the online-only group and the comparator group (2/84, 2.4% vs 4/120, 3.3%). While lecturer expertise was rated similarly as high by students in both groups (mean 1.47, SD 0.62 vs mean 1.27, SD 0.55; P=.08), students who took the web-based course provided lower scores for interdisciplinarity (mean 1.7, SD 0.73 vs mean 2.53, SD 1.19; P<.001), opportunities for interaction (mean 1.46, SD 0.67 vs mean 2.91, SD 1.03; P<.001), and the extent to which the educational objectives were defined (mean 1.61, SD 0.76 vs mean 3.41, SD 0.95; P<.001). Main critiques formulated within the open-response items concerned organizational deficits.

CONCLUSIONS

Web-based courses in medical microbiology are a feasible teaching option, especially in the setting of a pandemic, leading to similar test performances in comparison to on-site courses. The lack of interaction and the sustainability of acquired manual skills warrant further research.

Resilient Coping is More Important Than Previous Virtual Learning Experience: Predicting Pharmacy Student Stress During the COVID-19 Pandemic

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.

Medical Student Experiential Learning in Telesimulation

OBJECTIVES

Telesimulation utilizes telecommunication technology to engage learners in simulation while in different physical locations. Despite this potential advantage, understanding of the student experience and assessment of student learning in telesimulation activities is limited. This study evaluates medical student emotional experience and self-identified learning in telesimulation through the Kolb experiential learning framework and qualitative analysis.

METHODS

Fourth-year medical students enrolled in the Spencer Fox Eccles School of Medicine at the University of Utah participated in 3 telesimulation activities as part of a required internal medicine course. Students were surveyed regarding their satisfaction with the activity (N = 114) and responded to questions about their emotional experience and self-identified areas of learning. Free-text responses were analyzed using qualitative content analysis to identify themes until thematic saturation (N = 66).

RESULTS

Students were highly satisfied with telesimulation, with greater than 90% of students expressing a positive view of simulation realism, debrief quality, and group size. Themes of anxiety and uncertainty, confidence versus incompetence, team dynamics, fun, and difficult patient interaction were identified regarding the emotional experience. Themes of communication and teamwork, managing emotions, information gathering, differential diagnosis, resource reference, executing treatment, and medical knowledge were identified regarding student-identified learning.

CONCLUSION

In this analysis of medical student experiences with telesimulation, we found students have rich emotional, cognitive, and behavioral experiences and self-identify learning across a variety of domains. Our findings support further study of telesimulation for medical student learning and demonstrate how assessment of outcomes via Kolb framework, using the learner's reflective observation and self-identified learning, may help better define learning outcomes from simulation.

Informed self-assessment during the transition to medical school: a longitudinal narrative study

OBJECTIVES

To explore how medical students' narratives of informed self-assessment (ISA) change during their first 18 months of study.

DESIGN

This longitudinal study used student narratives drawn from qualitative interviews and written reflections during the transition to medical school, to examine changes in ISA. Our analysis was informed by Situated Cognition Theory which recognises the impact and interplay of personal and environmental factors in cognition.

SETTING

To study medicine, first year students need to adapt their self-regulated learning in the context of a new peer group, study demands and educational culture. During this adaptation, students need to seek and interpret available cues to inform their self-assessment.

PARTICIPANTS

Longitudinal data were collected at five time points over 18 months from a diverse sample of seven first year medical students in an undergraduate medical programme, including 13.5 hours of interviews and 12 written reflections.

RESULTS

Before and after starting medical school, the participants' self-assessments were informed by environmental influences (exam results and comparison with peers), and personal influences (fear of failure and anxiety about not belonging). Early uncertainty meant self-assessments were overestimated and underestimated.By the end of first year, an enhanced sense of belonging coincided with less fear of failure, less emphasis on exam performance and reduced competition with peers. Self-assessments became increasingly informed by evidence of clinical skills and knowledge gained related to future professional competence.

CONCLUSION

Influences on medical students' ISAs change during the transition to studying medicine. A greater sense of belonging, and evidence of progress towards clinical competence became more important to self-assessment than comparison with peers and exam performance. Our findings reinforce the importance of formative assessments, opportunities to study and socialise with peers and early clinical experiences during first year. These experiences enhance ISA skills during the transition to medical school.

Moving forward: embracing challenges as opportunities to improve medical education in the post-COVID era

Pandemics affect every aspect of life, and Coronavirus Disease 2019 (COVID-19) is no exception. The impact of COVID-19 might be even greater in medical education, which involves close contact with patients. This comment reviews current trends in medical education in response to COVID-19, especially in the pre-clerkship curriculum, and discusses opportunities and challenges in medical education in the post-pandemic era. COVID-19 has accelerated the adoption of online teaching and learning and is expected to boost innovation in medical education. First, blended learning, which is a mix of online and offline learning intended to incorporate the best of both worlds, is expected to become more widespread. Second, more novel approaches to learning that involve student-led initiatives likely become popular mediated by various technologies. Third, there will be more use of online learning resources and assessments. As online learning is expected to play a prominent role in the post-COVID-19 era, such transitions offer both opportunities and challenges. These challenges include faculty development on online teaching skills, creation and sharing of online resources, and effective design and implementation of online assessments. This comment calls for institutional support and collaborations for faculty development and for the development and sharing of learning resources, more models and guidelines for effective technology integration, and use of the virtual learning environment to promote student-centered learning to embrace the challenges as opportunities to improve medical education in the post-COVID era.

Harnessing the disruption on medical trainee education due to COVID-19 in New South Wales, Australia

The coronavirus disease (COVID-19) pandemic has caused disruption and uncertainty for junior medical doctor training and education. This has compounded the existing stress experienced by this cohort. However, by choosing appropriate educational models, as well as using novel educational approaches and advancing our online technology capabilities, we may be able to provide acceptable and even, superior solutions for educational training moving forward, as well as promote trainee wellbeing during these uncertain times.

Approaches to integrating online videos into health professions curricula: educators' perspectives from multiple institutions

Background: The COVID-19 pandemic has accelerated a transition from lecture-based classes to blended and online learning, increasing the need to integrate publicly available online educational videos. Although online videos are widely available, it is challenging for educators to effectively integrate them into a curriculum. Years before the pandemic, educators from different institutions integrated videos from a library of microbiology and immunology resources into different curricula. Their experiences may inform current educators on the approach to incorporating external resources into their unique curricula. Methods: We interviewed US health professions instructors or course directors who had previously requested access to online microbiology and immunology videos. Using thematic analysis, we organized prominent themes into an existing framework for curriculum development. We then reflected on the meaning of the themes using the same conceptual framework. Results: We found that educators from different schools were able to integrate the same publicly available videos into varying contexts. Most used them as preparation for interactive sessions. For integrating videos, educators felt success when the following actions occurred. 1) Educators integrated videos as a tool to enhance active-learning activities. 2) Educators created activities that focused on clinical applications of knowledge, taught critical thinking, and developed enthusiasm for the subject. 3) They tested students on knowledge application and major concepts rather than solely on content for high-stakes exams. 4) Educators worked with administrators who understood the goals of integrating external videos and supported educators with time and resources to develop effective blended learning. Conclusion: Our study suggests that educators integrating external resources into their curricula may benefit from first establishing their goals and aspirations for their students. These goals then become the anchor for other curricular elements, including external videos, in-class activities, and assessments. Our study highlights the need for dedicated time to develop experienced and enthusiastic educators.

Distance Education for Basic Surgical Skills Using Homemade Tools—DIY Methods for Emergency Situations

The aim of our research was to establish a reproducible curriculum that offers the possibility to gain basic surgical skills (knot tying, suturing, laparoscopy basics) through distance education in emergency situations by using tools available in the household. Forty-six volunteering third- and fourth-year medical students were involved in the study. The distance education system was set up using homemade or easily obtainable tools (an empty can, shoe box, sponge, etc.) to teach surgical knotting, suturing, and basic laparoscopic skills. The reachable learning objectives were contrasted with the original course plan. Feedback from the students has been collected. The students’ results were compared to the regular course of the previous years. Seventy-nine percent of the original learning objectives could be reached completely, and 15% partially. The necessary tools were available for 82% of the students. The students evaluated the course for 4.26 in general and 4.86 considering the circumstances (on a 5-level-scale). The homemade trainers were assessed over four as an acceptable substitution. Students’ exam results decreased only by 7% compared to the previous two years. Basic surgical skills can be educated with acceptable efficiency and student satisfaction using distance teaching and homemade tools. This is the first study where not only the simulators but the surgical instruments were replaced with household tools and evaluated by a reproducible curriculum.

Approaches to integrating online videos into health professions curricula: educators’ perspectives from multiple institutions

Background: The COVID-19 pandemic has accelerated a transition from lecture-based classes to blended and online learning, increasing the need to integrate publicly available online educational videos. Although online videos are widely available, it is challenging for educators to effectively integrate them into a curriculum. Years before the pandemic, educators from different institutions integrated videos from a library of microbiology and immunology resources into different curricula. Their experiences may inform current educators on the approach to incorporating external resources into their unique curricula. Methods: We interviewed US health professions instructors or course directors who had previously requested access to online microbiology and immunology videos. Using thematic analysis, we organized prominent themes into an existing framework for curriculum development. We then reflected on the meaning of the themes using the same conceptual framework. Results: We found that educators from different schools were able to integrate the same publicly available videos into varying contexts. Most used them as preparation for interactive sessions. For integrating videos, educators felt success when the following actions occurred. 1) Educators integrated videos as a tool to enhance active-learning activities. 2) Educators created activities that focused on clinical applications of knowledge, taught critical thinking, and developed enthusiasm for the subject. 3) They tested students on knowledge application and major concepts rather than solely on content for high-stakes exams. 4) Educators worked with administrators who understood the goals of integrating external videos and supported educators with time and resources to develop effective blended learning. Conclusion: Our study suggests that educators integrating external resources into their curricula may benefit from first establishing their goals and aspirations for their students. These goals then become the anchor for other curricular elements, including external videos, in-class activities, and assessments. Our study highlights the need for dedicated time to develop experienced and enthusiastic educators.

Nontechnological Online Challenges Faced by Health Professions Students during COVID-19: A Questionnaire Study

COVID-19 forced universities to shift to online learning (emergency remote teaching (ERT)). This study aimed at identifying the nontechnological challenges that faced Sultan Qaboos University medical and biomedical sciences students during the pandemic. This was a survey-based, cross-sectional study aimed at identifying nontechnological challenges using Likert scale, multiple-choice, and open-ended questions. Students participated voluntarily and gave their consent; anonymity was maintained and all data were encrypted. The response rate was 17.95% (n = 131) with no statistically significant difference based on gender or majors (p-value > 0.05). Of the sample, 102 (77.9%) were stressed by exam location uncertainty, 96 (73.3%) felt easily distracted, 98 (74.8%) suffered physical health issues, and 89 (67.9%) struggled with time management. The main barriers were lack of motivation (92 (70.2%)), instruction/information overload (78 (59.5%)), and poor communication with teachers (74 (56.5%)). Furthermore, 57 (43.5%) said their prayer time was affected, and 65 (49.6%) had difficulties studying during Ramadan. The most important qualitative findings were poor communication and lack of motivation, which were reflected in student comments. While ERT had positive aspects, it precipitated many nontechnological challenges that highlight the inapplicability of ERT as a method of online learning for long-term e-learning initiatives. Challenges must be considered by the faculty to provide the best learning experience for students in the future.

A scoping review: virtual patients for communication skills in medical undergraduates

BACKGROUND

Communication is an essential competence for medical students. Virtual patients (VP), computerized educational tools where users take the role of doctor, are increasingly used. Despite the wide range of VP utilization, evidence-based practical guidance on supporting development of communication skills for medical students remains unclear. We focused this scoping review on VP affordance for student learning especially important in the current environment of constrained patient access.

METHODS

This scoping review followed Arksey & O'Malley's methodology. We tested and used a search strategy involving six databases, resulting in 5,262 citations. Two reviewers independently screened titles, full texts (n= 158) and finally performed data extraction on fifty-five included articles. To support consideration of educational affordance the authors employed a pragmatic framework (derived from activity theory) to map included studies on VP structure, curricular alignment, mediation of VP activity, and socio-cultural context.

RESULTS

Findings suggest that not only the VP itself, but also its contextualization and associated curricular activities influence outcomes. The VP was trialled in the highest proportion of papers as a one-off intervention (19 studies), for an average duration of 44.9 minutes (range 10-120min), mainly in senior medical students (n=23), notably the largest group of studies did not have VP activities with explicit curricular integration (47%). There was relatively little repeated practice, low levels of feedback, self-reflection, and assessment. Students viewed VPs overall, citing authenticity and ease of use as important features. Resource implications are often omitted, and costings would facilitate a more complete understanding of implications of VP use.

CONCLUSION

Students should be provided with maximal opportunity to draw out the VPs' full potential through repeated practice, without time-constraint and with curricular alignment. Feedback delivery enabling reflection and mastery is also key. The authors recommend educators to explicitly balance computerized authenticity with instructional design integrated within the curriculum.

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.

Educational adaptation to clinical training during the COVID-19 pandemic: a process analysis

BACKGROUND

The COVID-19 pandemic is unprecedented in terms of the extent and rapidity of the disruption forced upon formal clinical education, most notably the extensive transition of clinical skills learning to interactive video-based clinical education.

METHODS

In a phenomenologic study, we used thematic analysis to explore the COVID-19 disruption to clinical training and understand processes relating to adaptation in a large academic medical center. We conducted semi-structured interviews with 14 clinical teachers and 16 trainees representing all levels of clinical learning. Interviews occurred within the initial three months of the crisis, and data were analyzed following a thematic analysis coding process.

RESULTS

We constructed eight themes synthesizing our participants' perceptions of the immediate unanticipated disruption, noting in the process their alignment with a change management framework. These included: urgency in adapting, with an obvious imperative for change; overcoming inconsistent involvement and support through the formation of self-organized frontline coalitions; attempts to develop strategy and vision via initially reactive but eventually consistent communication; empowering a volunteer army through co-creation and a flattened hierarchy; and efforts to sustain improvement and positive momentum with celebration of trial, error, and growth. The majority of participants found positive outcomes resulting from the tumultuous change process. Moreover, they were now more readily accepting of change, and tolerant of the ambiguous and iterative nature inherent in the education change process. Many anticipated that some innovation would, or would at least deserve to, continue post- crisis.

CONCLUSIONS

The COVID-19 pandemic afforded an opportunity to study the content and process of change during an active crisis. In this case of clinical education, our findings provide insight into the ways an academic medical system adapts to unanticipated circumstances. We found alignment with broader organizational change management models and that, compared with crisis management models (and their shorter term focus on resolving such crises), stakeholders self-organized in a reliable manner that carries the potential advantage of preserving such beneficial change.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Perceptions of Pharmacy Students on the E-Learning Strategies Adopted during the COVID-19 Pandemic: A Systematic Review

BACKGROUND

E-learning strategies were globally adopted by academies because of the COVID-19 pandemic. The characterization of students' perception of online learning is fundamental to design appropriate models for pharmacy curricula. The study aim was to carry out a systematic review about the perception of pharmacy students on the e-learning strategies adopted during the COVID-19 pandemic.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was followed. PICOS criteria were applied. Five databases were screened: PubMed, Cochrane Library, DOAJ-Directory of Open Access Journals, SciELO-Scientific Electronic Library Online and b-on-Online Library of knowledge (Biblioteca do conhecimento online).

KEYWORDS

"pharmacy and (distant or remote or e-learning or online or zoom or education or training or digital) and (COVID or SARS and (student or undergraduate) and (opinion or satisfaction or perception or attitude)".

RESULTS

23 out of 176 papers were selected (28 duplicated and 125 excluded). Selected papers were classified, as follows: studies exclusively involving pharmacy students (n = 8); studies simultaneously involving pharmacy students and other healthcare students (n = 6); and studies related to the involvement of pharmacy students in specific courses (n = 9).

CONCLUSIONS

In general, the perception of pharmacy students on e-learning strategies adopted during the COVID-19 pandemic was positive. However, an expressive proportion of undergraduates reported negative issues about online education, which seems to support the necessity of optimizing e-learning strategies in the future.