In-house medical education: redefining tele-education

The Use of Tele-Education in Medicine, During and Beyond the COVID-19 Pandemic: A Commentary

Coronavirus disease 2019 (COVID-19), a disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged initially as an isolated illness in December 2019 and later progressed to a global pandemic. Hard-hit areas were lockdown, massively disrupting medical education activities. Tele-education, previously used as a means of long-distance education emerged as a solution in the field of medical education. Tele-rotations for medical students, journal clubs and lectures via Microsoft teams, medical conferences via zoom, residency, and fellowship interviews online, all emerged during this pandemic. Some medical students and trainees found it enjoyable, cost-effective, time saving, feasible, unbiased, and preferred mode of education. Challenges related to supervision, availability, affordability, diminished communication, disturbance of streaming, or distractions due to environment. Tele-education has had a boom in the era of COVID-19. Research is needed further on effective mentoring and supervision of trainees via tele educational teaching models.

Using medical reality television as a technology-enhanced learning strategy to provide authentic patient care experiences during clinical placements: a case study research investigation

BACKGROUND

Over the last decade, the use of technology-enhanced learning (TEL) has rapidly expanded and diversified. Since the COVID-19 pandemic, there is a growing demand for distance and online learning strategies to support and even replace learning experiences previously afforded by clinical placements and clerkships. An intriguing but under-researched modality is the use of medical reality television to provide authentic experiences of patient care. This strategy does not feature in published medical educational literature, though promising research is emerging from other disciplines.

METHODOLOGY

A programme of learning using medical reality television clips to facilitate case-based learning was developed according to the principles of 'anchored instruction', a technology-based educational theory. Clips were taken from the UK television show '24 hours in A&E'. Medical students' learning experiences were investigated using a qualitative approach addressing the following research questions: - What is the perceived emotional experience of medical students when watching reality television in an educational context? - How do medical students relate their experience of watching reality television in a formal educational setting to their perceived learning needs in the clinical environment? A case study research methodology was adopted within the interpretivist paradigm. Data were triangulated from semi-structured interviews with students and non-participant observation of the teaching session. Field notes and transcripts were analysed through an inductive thematic analysis.

RESULTS

In response to the medical reality television, a diverse range of emotions were expressed including: excitement, amusement, concern, nervousness, sadness and joy. Students identified gaps in their clinical knowledge such as interpreting results, practical aspects of prescribing and end of life care. Key themes were increased student engagement and a promotion of holistic care practices.

DISCUSSION

Students perceived reality television as a highly realistic and relatable medium and an enjoyable, memorable way to contextualise learning from the classroom to real life, a finding mirrored in previous studies in other fields. The high degree of emotion expressed may explain the improved subjective memorability of the cases.

CONCLUSION

Medical reality television offers a unique means of engaging students by providing authentic experiences of patient care and should be valued alongside other technology-enhanced learning strategies.

Changing the channel on medical ethics education: systematic review and qualitative analysis of didactic-icebreakers in medical ethics and professionalism teaching

As medical ethics and professionalism education continues to equip medical students and residents with long-lasting tools, educators should continue to supplement proven teaching strategies with engaging, relatable, and generationally appropriate didactic supplements. However, popular teaching aids have recently been criticized in the literature and summative information on alternatives is absent. The purpose of this review is to evaluate and assess the functional use and application of short form audiovisual didactic supplements or "icebreakers" in medical ethics and professionalism teaching. A systematic review of both the medical and humanities literature (i.e., PubMed/MEDLINE, Cochrane Library, and JSTOR) was conducted from inception to August 1, 2019. Final articles were subjected to a qualitative appraisal and thematic analysis. Thirteen articles were included for final analysis. Sixty-nine percent (n = 9) of the studies were published after 2000. Two studies were qualitative, one study was quantitative, and the remaining articles were commentaries. Short form audiovisual media was most popular outside of the United States (n = 10). Sixty-nine percent (n = 9) of articles advocated for self-contained media in the form of trigger films or short films/videos, while the remaining articles (n = 4) discussed the use of TV/film clips. Producibility of media was exclusive to short/trigger films. Nine themes were identified in the content analysis: adaptability, conversation catalyst, effective, engaging, nuance, practice, producibility, real, and subject diversity. The three most common themes in descending order of frequency were: conversation catalyst, realness, and adaptability. Trigger films represent an effective and unique pedagogical strategy in supplementing current medical ethics and professionalism teaching at the medical school level.

Enablers and Barriers of a Cross-Cultural Geriatric Education Distance Training Programme: The Singapore-Uganda Experience

Background: By 2050, 80% of the world’s older population will reside in developing countries. There is a need for culturally appropriate training programs to increase awareness of eldercare issues, promote knowledge of how to better allocate resources to geriatric services, and promulgate elder-friendly policies. A monthly distance geriatric education programme between a public hospital in Singapore and health institute in Uganda was implemented. This study explored the enablers and barriers to the delivery of culturally appropriate geriatric education programmes via a videoconferencing platform. Methods: We conducted 12 in-depth interviews with six teachers from Singapore and six learners from Uganda. The interviews were audio-recorded, transcribed and analyzed using an inductive thematic approach to analysis with the aid of the NVivo software. Results: Enablers included inter-personal real-time interactions between teachers and learners whereas misaligned perceptions of cross-cultural differences between Singaporean teachers and Ugandan learners were a barrier. Rapport building, teacher motivation and institutional support were perceived to contribute to the programme’s sustainability. Overall, Ugandan learners perceived that the training improved knowledge, skills, attitude and practice of geriatric care. Participants suggested that future initiatives consider aligning cross-cultural perceptions between partners, conducting a training needs analysis, exploring complementary modes of information dissemination, and allotting time for more interaction, thereby reinforcing mutual sharing. Adequate publicity and appropriate incentivisation may also better sustain the programme. Conclusions: Our findings suggest that cross-cultural training via a videoconferencing platform was feasible. Our results inform planners of future distance educational programmes of how to improve standards of cross-cultural competency and forge promising international partnerships.

Use of fictional medical television in health sciences education: a systematic review

While medical television programs are popular among health profession trainees, it is not clear to what extent these programs affect their knowledge, perceptions, and/or behaviors. Therefore, we conducted a systematic review of research evaluating associations between program exposure and outcomes. We conducted systematic literature searches in Pubmed, CINAHL, and PsycINFO. Selected studies were required to be scholarly research, involve exposure to fictionalized medical television programming by health professional students, and assess associations between exposure and outcomes. Studies were classified according to quality and factors related to population, exposure, and outcomes. Of 3541 studies identified, 13 met selection criteria. Six studies involved undergraduate medical students, one involved nursing students, two involved both medical and nursing students, two involved medical residents, one involved medical students, residents and attending physicians, and one involved graduate epidemiology students. Mean study quality according to the MERSQI was 8.27. The most commonly assessed television programs were ER and Grey's Anatomy (six each). Five studies assessed regular viewing habits, and found that fictional medical programs are popular among students and that students recall health topics from episodes. The eight studies that assessed the association with outcomes when using clips as educational tools reported high satisfaction and increased knowledge of the presented health topics. While relatively few published studies have explored influences of fictional medical television on health professional students, those conducted suggest that students often view these television programs independently and that integration of this programming into medical education is feasible and acceptable.

Teaching professionalism to first year medical students using video clips

BACKGROUND

Medical schools are confronted with the challenge of teaching professionalism during medical training. The aim of this study was to examine medical students' perceptions of using video clips as a beneficial teaching tool to learn professionalism and other aspects of physicianship.

METHODS

As part of the longitudinal Physician Apprenticeship course at McGill University, first year medical students viewed video clips from the television series ER. The study used qualitative description and thematic analysis to interpret responses to questionnaires, which explored the educational merits of this exercise.

RESULTS

Completed questionnaires were submitted by 112 students from 21 small groups. A major theme concerned the students' perceptions of the utility of video clips as a teaching tool, and consisted of comments organized into 10 categories: "authenticity and believability", "thought provoking", "skills and approaches", "setting", "medium", "level of training", "mentorship", "experiential learning", "effectiveness" and "relevance to practice". Another major theme reflected the qualities of physicianship portrayed in video clips, and included seven categories: "patient-centeredness", "communication", "physician-patient relationship", "professionalism", "ethical behavior", "interprofessional practice" and "mentorship".

CONCLUSIONS

This study demonstrated that students perceived the value of using video clips from a television series as a means of teaching professionalism and other aspects of physicianship.

An evaluation framework for defining the contributions of telestration in surgical telementoring

BACKGROUND

An increasing quantity of research in the domain of telemedicine show a growing popularity and acceptance of care over distance systems among both clinicians and patients. We focus on telementoring solutions, developed for providing remote guidance to less experienced surgeons. Telestration is often regarded as an extra functionality of some telementoring systems. However, we advocate that telestration must be viewed as a core feature of telementoring due to its advantages.

OBJECTIVE

To analyze and define concepts, parameters, and measurement procedures to evaluate the impact of using telestration while telementoring.

METHODS

A systematic review of research dealing with telestration during remote guidance sessions was performed by querying three major online research databases (MEDLINE, Association of Computing Machinery, and Institute of Electrical and Electronics Engineers) using a predefined set of keywords ("laparoscopy", "annotate", "telestrate", "telestration", "annotation", "minimally invasive", and "MIS").

RESULTS

The keyword-based search identified 117 papers. Following the guidelines for performing a systematic review, only 8 publications were considered relevant for the final study. Moreover, a gap in research defining the impacts of telestration during telementoring was identified. To fill this niche, a framework for analyzing, reporting, and measuring the impacts of telestration was proposed.

CONCLUSIONS

The presented framework lays the basics for the structured analysis and reporting of telestration applied to telementoring systems. It is the first step toward building an evidence knowledge base documenting the advantages of live video content annotation and supporting the presented connections between the concepts.

Medical dramas on television: a brief guide for educators

The popularity of medical television dramas is well-established and medical educators are beginning to recognize the power of medical media as a potential tool for education. The purpose of this study was to view a number of medical dramas and consider their potential use in medical education. A total of 177 episodes from eight popular television medical dramas produced between 1990 and 2009 were systematically viewed and analyzed and a brief guide was developed for each drama. The dramas analyzed contained a wealth of material applicable to medical education. In our experience, each drama may be best suited to a particular educational use: for example, clips from "ER" and "Scrubs" offer more examples of teaching and learning than "House" and "Grey's Anatomy", which are perhaps better suited for topics on ethics or team work. We hope that this brief guide will encourage others to consider integrating this material into their teaching, and to explore how television drama may be used most effectively in medical education.

Surgical telementoring in knowledge translation--clinical outcomes and educational benefits: a comprehensive review

BACKGROUND

Surgical telementoring has been reported for decades. However, there exists limited evidence of clinical outcome and educational benefits.

OBJECTIVE

To perform a comprehensive review of surgical telementoring surveys published in the past 2 decades.

RESULTS

Of 624 primary identified articles, 34 articles were reviewed. A total of 433 surgical procedures were performed by 180 surgeons. Most common telementored procedures were laparoscopic cholecystectomy (57 cases, 13%), endovascular treatment of aortic aneurysm (48 cases, 11%), laparoscopic colectomy (32 cases, 7%), and nefrectomies (41 cases, 9%). In all, 167 (38%) cases had a laparoscopic approach, and 8 cases (5%) were converted to open surgery. Overall, 20 complications (5%) were reported (liver bleeding, trocar port bleeding, bile collection, postoperative ileus, wound infection, serosa tears, iliac artery rupture, conversion open surgery). Eight surveys (23%) have structured assessment of educational outcomes. Telementoring was combined with simulators (n = 2) and robotics (n = 3). Twelve surveys (35%) were intercontinental. Technology satisfaction was high among 83% of surgeons.

CONCLUSION

Few surveys have a structured assessment of educational outcome. Telementoring has improved impact on surgical education. Reported complication rate was 5%.

Overcoming distance: video-conferencing as a clinical and educational tool among surgeons

Background

Since the 1960s, there has been substantial development in the uses of video-conferencing (VC) among medical personnel, including surgeons who have adopted the technology.

Methods

A report on our own experience with VC was combined with a comprehensive PubMed search with the key words telepresence, video-conferencing, video-teleconferencing, telementoring and surgery, trauma, follow-up, education, and multidisciplinary teams. A search through two peer-reviewed telemedicine journals—Journal of Telemedicine and Telecare and Telemedicine and e-Health Journal—and references of all included papers and identified additional reports was conducted.

Results

A total of 517 articles were identified with 51 relevant manuscripts, which included the key phrases. VC is widely used among surgeons for telementoring surgical procedures and in trauma and emergency medicine. Furthermore, VC is widely used by multidisciplinary teams and for the follow-up of patients after surgery.

Conclusions

VC is a common clinical tool for surgeons and provides a great opportunity to alter surgical practice and to offer patients the best expertise in surgical treatment despite long distances, especially in rural areas.