Qualitative exploration of medical student experiences during the Covid-19 pandemic: implications for medical education

Belongingness in medical students: did it change during lockdown?

Belongingness has been proposed as a potential proxy for legitimate peripheral participation in medical education. Previous studies have shown good internal and external validity for tools designed to measure this variable, with potential use measuring the effectiveness of clinical teaching environments and as a marker of student wellbeing. This study examined changes in belongingness in medical students at the University of Exeter measured in spring 2019 and the equivalent period in 2021, during which COVID-19 related restrictions were in place in the United Kingdom. This study used a validated assessment tool that was self-administered via an online survey platform in 2021. Anonymised data was collected from undergraduate medical students from all years of training and results compared with previous data collected in 2019. The belongingness assessment tool described here had validity in undergraduate medical students studying at the University of Exeter and identified statistically significant changes in belongingness (as measured with this tool) between 2019 and the period during which COVID-19 restrictions were in place. These results suggest that belongingness - in undergraduate medical students fluctuates and varies under different conditions and that there was a statistically significant change during the period of lockdown restrictions. The ability to measure this key facet of educational development has the potential to monitor teaching environments to ensure optimal learning conditions for all students. Further work is required to assess whether the impacts of lockdown restrictions are transient or persist beyond the period of teaching restrictions and to determine any association with academic outcomes.

Training healthcare professionals to be ready for practice in an era of social distancing: a realist evaluation

BACKGROUND

Programme changes due to the COVID-19 pandemic have impacted variably on preparation for practice of healthcare professional students. Explanations for such variability need exploration. The aim of our study was to understand what clinical learning, whilst under socially distanced restrictions, worked and why (or why not).

METHODS

We conducted a realist evaluation of the undergraduate healthcare programmes at one UK university in 2020-21. Initial programme theories to be tested in this study were derived from discussions with programme leads about the changes they implemented due to the pandemic. Study participants were students and teaching faculty. Online interview transcripts were coded, identifying why interventions had worked or not. This resulted in a set of 'context-mechanism-outcome' (CMO) statements about each intervention. The initial programme theories were refined as a result.

RESULTS AND DISCUSSION

29 students and 22 faculty members participated. 18 CMO configurations were identified relating to clinical skills learning and 25 relating to clinical placements. Clinical skills learning was successful whether in person, remote or hybrid if it followed the steps of: demonstration-explanation-mental rehearsal-attempt with feedback. Where it didn't work there was usually a lack of observation and corrective feedback. Placements were generally highly valued despite some deficiencies in student experience. Being useful on placements was felt to be good preparation for practice. If student numbers are to expand, findings about what works in distance learning of clinical skills and the value of various modes of induction to clinical workplace activity may also be relevant post-pandemic.

Rural healthcare workforce preparation, response, and work during the COVID-19 pandemic in Australia: Lessons learned from in-depth interviews with rural health service leaders

BACKGROUND

Low population density, geographic spread, limited infrastructure and higher costs are unique challenges in the delivery of healthcare in rural areas. During the COVID-19 pandemic, emergency powers adopted globally to slow the spread of transmission of the virus included population-wide lockdowns and restrictions upon movement, testing, contact tracing and vaccination programs. The aim of this research was to document the experiences of rural health service leaders as they prepared for the emergency pandemic response, and to derive from this the lessons learned for workforce preparedness to inform recommendations for future policy and emergency planning.

METHODOLOGY AND METHODS

Interviews were conducted with leaders from two rural public health services in Australia, one small (500 staff) and one large (3000 staff). Data were inductively coded and analysed thematically.

PARTICIPANTS

Thirty-three participants included health service leaders in executive, clinical, and administrative roles.

FINDINGS

Six major themes were identified: Working towards a common goal, Delivery of care, Education and training, Organizational governance and leadership, Personal and psychological impacts, and Working with the Local Community. Findings informed the development of a applied framework.

CONCLUSION

The study findings emphasise the critical importance of leadership, teamwork and community engagement in preparing the emergency pandemic response in rural areas. Informed by this research, recommendations were made to guide future rural pandemic emergency responses or health crises around the world.

Online learning during the COVID-19 pandemic: A qualitative study among final year medical students at the University of Zambia

Background Since the globe was faced with the COVID-19 pandemic in December 2019, numerous adjustments have been made in all sectors to curtail the spread of infection. Most elementary and tertiary schools were closed or suspended until the transmission rates dropped. Following the outbreak of COVID-19, medical schools in Zambia have sought ways to replace face-to-face medical learning with virtual clinical teaching. The objectives of this study were to explore the perceptions of online learning among University of Zambia medical students and understand the barriers and facilitators to effective online learning. Methods A qualitative descriptive approach was used, enrolling final year medical students from the University of Zambia; the consenting participants were sampled purposively and interviewed through virtual platforms until data saturation was reached upon interviewing the 11 th participant. A total of 14 participants were interviewed, audio recorded, transcribed verbatim and data was analyzed using six steps of thematic analysis. Results Three broad themes arose from the interviews: online learning perceptions, facilitators and barriers to online learning. Regarding perceptions of online learning, they highlighted that the delivery was simple to understand, with convenient scheduling and the benefit of being able to refer back to the recorded lectures. Some barriers encountered during the online learning were poor network connection, frequent power outages, lack of patient-student interaction and challenges with learning space in their homes. The facilitators were self-paced learning, availability of lecturers and the desire to complete their training despite the lockdown being in effect. Conclusions Most medical students had positive perceptions of online learning despite its challenges. With the improvement in technology, online education should be incorporated into the traditional training of medical students to get the best outcomes.

The impact of COVID-19-related educational disruption on final year medical students in Birmingham, United Kingdom: a mixed methods study

Background: The COVID-19 pandemic created unprecedented pressure on healthcare systems worldwide. Public health measures that intended to limit the spread of the virus had the unintended effect of necessitating the swift development of novel medical educational methods. The medical students most affected by this period of change were those entering their final year. This study aims to explore their perceptions of the impacts of COVID-19 on their clinical learning and mental health, as well as identify ways in which medical schools can mitigate these impacts.  Methods: This is a mixed method, single-site descriptive study comprising two parts: a questionnaire and semi-structured interviews. Participants were final year medical students at the University of Birmingham, UK.  Results: Key themes identified were learning opportunities, changes to assessments, communication, and wellbeing. Students were also found to experience higher levels of anxiety mid-pandemic compared to pre-pandemic.  Conclusion: The pandemic has had widespread effects on the learning and wellbeing of final year medical students, which may impact their competence and confidence as junior doctors. Improved two-way communication and access to wellbeing services have been identified as factors promoting the adjustment of students to rapid changes in teaching methods and assessments.

COVID as a catalyst: medical student perspectives on professional identity formation during the COVID-19 pandemic

BACKGROUND

As a result of the COVID-19 pandemic, a national decision was made to remove all medical students from clinical environments resulting in a major disruption to traditional medical education. Our study aimed to explore medical student perspectives of professional identity formation (PIF) during a nationally unique period in which there was no clinical training in medical undergraduate programs.

METHODS

We interviewed fifteen UBC medical students (years 1-4) regarding their perspectives on PIF and the student role in the setting of the COVID-19 pandemic. Data were analysed iteratively and continuously to create a codebook and identify themes of PIF based on interview transcripts.

RESULTS

We identified three key themes: (1) Medical students as learners vs contributing team members (2) Decreased competency as a threat to identity and (3) Doctors as heroes.

CONCLUSIONS

The impact of disruptions due to COVID-19 catalyzed student reflections on their role within the healthcare system, as well as the role of self-sacrifice in physician identity. Simultaneously, students worried that disruptions to clinical training would prevent them from actualizing the identities they envisioned for themselves in the future. Ultimately, our study provides insight into student perspectives during a novel period in medical training, and highlights the unique ways in which PIF can occur in the absence of clinical exposure.

Evaluation of an experiential clinical learning option during pandemic teaching suspensions

BACKGROUND

As students' direct patient contact was suspended because of COVID-19-related restrictions, we revised our clinical addiction medicine curriculum for students to learn about the different multidisciplinary clinical models delivered at our hospital and in community settings. Our aim was to provide an overview of clinical modalities and familiarize learners with clinician and patient experiential perspectives.

METHODS

We implemented a multi-pronged approach, offering an overview of clinical care programs through remote panels involving care providers at the clinics where students had previously been scheduled for in-person rotations. This included inpatient and office-based addiction services, addiction treatment program for adolescents and young adults, integrated addiction care and HIV primary care clinic, and opioid use urgent care clinic. Beyond having them join outpatient telehealth clinic visits, students also participated in an online panel involving patients in recovery to gain familiarity with their care perspectives; and joined a panel with recovery coaches to get further insights into patient challenges in clinical settings. Students further participated in remote opioid treatment trainings and observed clinical rounds of inpatient addiction consults and adolescent clinic team meetings.

RESULTS

With this revised curriculum, students learned about the variety of clinical modalities at the height of our hospital's COVID-19 pandemic burden. The evaluation suggested that students appreciated the authenticity of accounts from patients and providers about their challenges and satisfaction related to clinical care. While in a remote learning setting, students overall wished for more personal interaction with patients and providers. They also noted a lack of group cohesion and connection that they felt would otherwise have been met in an in-person program.

CONCLUSIONS

Remote learning allowed our program to connect trainees to the multidisciplinary field of addiction medicine despite the COVID-19 pandemic. In future program iterations, we will consider hybrid formats of in-person learning experiences with direct patient and faculty contact where possible, combined with online provider and patient panels possibly, in addition to virtual breakout formats to facilitate more personal student-patient and student-faculty interactions.

The effect of the COVID-19 pandemic on the patient safety attitude of medical students

PURPOSE

This study aimed to examine the differences in scores of the Attitude to Patient Safety Questionnaire (APSQ) by medical students before and after the outbreak of COVID-19.

METHODS

In total, 97 and 118 medical students completed patient safety courses at Yonsei University Wonju College of Medicine in 2019 and 2020, respectively. In 2019, the course was conducted using traditional learning in the classroom, whereas, in 2020, most of the classes were conducted using non-face-to-face learning methods.

RESULTS

In 2019 and 2020, 49 and 53 students responded to the APSQ. Only one item "Patients are not really aware of how safe their care is" had a lower score in 2020 than in 2019.

CONCLUSION

Although the total APSQ score did not differ between 2019 and 2020, the students in 2020 might have a poor understanding of the role of patients in medical errors.