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Besche HC, Onorato S, Pelletier S, Ashrafzadeh S, Joshi A, Nelsen B, Yoon J, Zhou J, Schwartz A, Cockrill BA. A hierarchy of needs for remote undergraduate medical education: lessons from the medical student experience. BMC MEDICAL EDUCATION 2022; 22:423. [PMID: 35655160 PMCID: PMC9161626 DOI: 10.1186/s12909-022-03479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 03/03/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The disruption of undergraduate medical education (UME) by the COVID-19 pandemic has sparked rapid, real-time adjustments by medical educators and students. While much is known about online teaching in general, little guidance is available to medical educators on how to adapt courses not originally designed for the online environment. To guide our faculty in this transition we conducted a needs assessment of students enrolled in virtual courses across all 4 years of UME training. METHODS Using a mixed-methods approach, we conducted a single-institution virtual learning needs assessment in May and June of 2020. We developed and disseminated a survey to assess student experiences with virtual learning. We conducted quantitative and qualitative analysis of responses (n = 255 or 39%) to identify emergent themes. RESULTS We identified six interdependent themes that need to be met for medical students to fully reach their learning potential: access to stable internet and quiet study spaces, flexible course design with asynchronous, self-paced components, clear expectations for engagement with content and each other, a sense of connectedness with faculty and peers, synchronous classes that maximize interactivity, and assessments that foster a sense of learning over performance. Interpersonal relationships with faculty and peers affected students' sense of learning more than any other factor. CONCLUSIONS Based on our findings we propose a hierarchy of needs for virtual learning that provides guidance on adapting existing medical school courses to the remote setting and overcoming common challenges. We highlight opportunities for how virtual elements may enrich in-person courses going forward, including in the clinical setting. Although the solutions required to meet the threshold of need at each level may differ based on the context, attending to these same fundamental needs can be extrapolated and applied to learners across a range of environments beyond the virtual.
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Affiliation(s)
- Henrike C Besche
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA.
| | - Sarah Onorato
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA
| | - Stephen Pelletier
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA
| | - Sepideh Ashrafzadeh
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA
| | - Ashwini Joshi
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA
| | - Brenna Nelsen
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA
| | - Jaewon Yoon
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA
| | - Joyce Zhou
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA
| | - Andrea Schwartz
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA
- New England Geriatrics Research Education and Clinical Center, Boston, MA, USA
- U.S. Department of Veterans Affairs, Boston, MA, USA
| | - Barbara A Cockrill
- Office of Educational Quality Improvement, Harvard Medical School, TMEC 384 260 Longwood Avenue, Boston, MA, 02115, USA.
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Hovaguimian A, Joshi A, Onorato S, Schwartz AW, Frankl S. Twelve tips for clinical teaching with telemedicine visits. MEDICAL TEACHER 2022; 44:19-25. [PMID: 33556284 DOI: 10.1080/0142159x.2021.1880558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Telemedicine is now an established mode of clinical care for most medical specialties, and clinical teachers must teach and precept learners in this modality. However, faculty need training on how best to teach students when caring for patients via telemedicine. Effectively incorporating learners into telemedicine visits to optimize their education is a critical skill for clinical teachers. In this article, we review 12 practical tips unique to telemedicine to engage and educate undergraduate medical education learners in building their clinical skills. We outline synchronous and asynchronous elements before, during, and after the patient encounter to facilitate teaching while improving patient care. These principles can also be adapted for teaching in other health professions as well as postgraduate medical education.
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Affiliation(s)
- Alexandra Hovaguimian
- Instructor in Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashwini Joshi
- Fourth-Year Medical Student, Harvard Medical School, Boston, MA, USA
| | - Sarah Onorato
- Fourth-Year Medical Student, Harvard Medical School, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Assistant Professor of Medicine, Geriatrics, VA Boston Healthcare Center, New England Geriatrics Research Education and Clinical Center, Harvard Medical School, Boston, MA, USA
| | - Susan Frankl
- Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Farrell SE, Junkin AR, Hayden EM. Assessing Clinical Skills Via Telehealth Objective Standardized Clinical Examination: Feasibility, Acceptability, Comparability, and Educational Value. Telemed J E Health 2021; 28:248-257. [PMID: 33999715 DOI: 10.1089/tmj.2021.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In March 2020, students' in-person clinical assessments paused due to COVID-19. The authors adapted the June Objective Standardized Clinical Examination (OSCE) to a telehealth OSCE to preserve live faculty observation of students' skills and immediate feedback dialogue between students, standardized patients, and faculty members. The authors assessed students' reactions and comparative performance. Materials and Methods: OSCE and telehealth educators used draft Association of American Medical Colleges (AAMC) telehealth competencies to create educational materials and adapt OSCE cases. Students anonymously answered queries about the challenges of the telehealth encounters, confidence in basic telehealth competencies, and educational value of the experience. Cohort-level performance data were compared between the January in-person and June telehealth OSCEs. Results: One hundred sixty students participated in 29 Zoom® two-case telehealth OSCEs, equaling 58 h of assessment time. Survey response rate: 59%. Students indicated moderate challenge in adapting physical examinations to the telehealth format and indicated it to be cognitively challenging. Confidence in telehealth competencies was rated "moderate" to "very," but was most pronounced for the technical aspects of telehealth, rather than safety engagement with a patient. Although authors found no significant difference in cohort-level performance in total scores and history-taking between the OSCEs, physical examination and communication scores differed between the two assessments. Discussion: It was feasible to adapt a standardized OSCE to a telehealth format when in-person clinical skills assessment was impossible. Students rated this necessary innovation positively, and it adequately assessed foundational clinical skills performance. Conclusion: Given future competency needs in telehealth, we suggest several education and training priorities.
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Affiliation(s)
- Susan E Farrell
- Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew R Junkin
- Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily M Hayden
- Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Said JT, Schwartz AW. Remote Medical Education: Adapting Kern's Curriculum Design to Tele-teaching. MEDICAL SCIENCE EDUCATOR 2021; 31:805-812. [PMID: 33520396 PMCID: PMC7833892 DOI: 10.1007/s40670-020-01186-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 05/11/2023]
Abstract
COVID-19 has necessitated a rapid shift to the remote delivery of medical education. We present a timely collection of tips, techniques, and strategies for the facilitation of remote teaching sessions and modification of curriculum design, assessment, and evaluation. We step through Kern's six-step curriculum design, recommending to (1) consider session necessity and a variety of teaching models; (2) inform your session with surveys and polls; (3) keep session endpoints consistent; (4) make the most of technology and translate in-person strategies to virtual forms; (5) engage with individual learners and eliminate distractions; and (6) consider online methods of assessment and evaluation methods.
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Affiliation(s)
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA USA
- Division of Geriatrics & Palliative Care, New England Geriatrics Research Education and Clinical Center, VA Boston Health Care System, 150 South Huntington Avenue, Jamaica Plain, MA 02130 USA
- Brigham and Women’s Hospital, Boston, MA USA
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