Learning without Borders: Asynchronous and Distance Learning in the Age of COVID-19 and Beyond

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.

Framing asynchronous interprofessional education: a qualitative study on medical, physiotherapy and nursing students

Objectives

To explore how virtual, asynchronous modules can be used in interprofessional health education curricula and to identify any advantages and shortcomings of asynchronous interprofessional education.

Methods

A sample of 27 health professional students who attended in-person interprofessional education workshops at the McMaster Centre for Simulation-Based Learning from 2019-2020 were recruited through email discourse. Participants were asked to complete an asynchronous interprofessional education module and take part in a semi-structured interview that was recorded and transcribed verbatim. Techniques of direct content analysis were used to analyze the qualitative data from recorded transcripts.

Results

The following emergent themes from participants' responses were identified: 1) the modules, as well as the features interspersed throughout, taught strategies for conflict resolution and interprofessional communication, 2) the modules have utility in preparing students for future interprofessional learning, 3) the convenience of virtual asynchronous modules introduces a sense of learner safety, and 4) a sense of isolation and fatigue was identified as a consequence of the lack of face-to-face interaction in these modules.

Conclusion

Asynchronous interprofessional education modules may be best suited to prepare students for future interprofessional learning in a synchronous setting. Asynchronous modules effectively provide an introduction to interprofessional objectives such as conflict resolution and role clarification, yet the competency of team functioning is more difficult to achieve in an asynchronous environment. Future studies may focus on establishing a sequence of completing asynchronous modules for ideal development of interprofessional competencies in health professions learners.

Resident Engagement With a Web- and App-based Journal Club Curriculum Utilizing Email and Text Notifications

Background

High learner engagement is important for the success of asynchronous and online learning for graduate medical education. Medical trainees have recently reported using medical mobile apps. App-based interactions may provide more participation than email-based interactions. We sought to investigate (1) if there were higher levels of engagement with an online curriculum using notifications sent via email as compared with via text, and (2) if there were higher levels of engagement with the mobile app or website format.

Methods

We implemented an online Journal Club curriculum with weekly topics for anesthesiology residents (postgraduate years 2-4) from July 2020 to June 2021. Weekly notifications were sent to residents via email for weeks 1-10, text for weeks 11-20, then email for weeks 21-49. Based on activity logs, we compared (1) the weekly numbers of interactions when email notifications were sent with the weekly numbers of interactions when text notifications were sent, and (2) the weekly numbers of interactions via the app with the weekly numbers of interactions via the website.

Results

Thirty-eight of the 54 anesthesiology residents in our department at the time of the study (70.4%) interacted with the online Journal Club at least once throughout the study. The weekly numbers of interactions with email notifications (median [interquartile range (IQR)]: 13 [7-28]) were significantly higher than with text notifications (median [IQR]: 6 [4-8]) (P = .023). The weekly numbers of interactions via the website (median [IQR]: 9 [4-24]) were significantly higher than via the app (median [IQR]: 0 [0-1]) (P < .001).

Conclusions

Although mobile technology may increase engagement and participation for some educational resources, learners may prefer accessing others through more conventional methods.

Reflection on the teaching of student-centred formative assessment in medical curricula: an investigation from the perspective of medical students

BACKGROUND

Formative assessment (FA) is becoming increasingly common in higher education, although the teaching practice of student-centred FA in medical curricula is still very limited. In addition, there is a lack of theoretical and pedagogical practice studies observing FA from medical students' perspectives. The aim of this study is to explore and understand ways to improve student-centred FA, and to provide a practical framework for the future construction of an FA index system in medical curricula.

METHODS

This study used questionnaire data from undergraduate students in clinical medicine, preventive medicine, radiology, and nursing at a comprehensive university in China. The feelings of medical students upon receiving student-centred FA, assessment of faculty feedback, and satisfaction were analysed descriptively.

RESULTS

Of the 924 medical students surveyed, 37.1% had a general understanding of FA, 94.2% believed that the subject of teaching assessment was the teacher, 59% believed that teacher feedback on learning tasks was effective, and 36.3% received teacher feedback on learning tasks within one week. In addition, student satisfaction results show that students' satisfaction with teacher feedback was 1.71 ± 0.747 points, and their satisfaction with learning tasks was 1.83 ± 0.826 points.

CONCLUSION

Students as participants and collaborators in FA provide valid feedback for improving student-centred FA in terms of student cognition, empowered participation, and humanism. In addition, we suggest that medical educators avoid taking student satisfaction as a single indicator for measuring student-centred FA and to try to build an assessment index system of FA, to highlight the advantages of FA in medical curricula.

Asynchronous online learning as a key tool to adapt to new educational needs in radiology during the COVID-19 pandemic

The risk of contagion and the lockdown caused by the COVID-19 pandemic forced a change in teaching methodologies in radiology. New knowledge about the disease that was being acquired on a daily basis needed to be rapidly spread worldwide, but the restrictions imposed made it difficult to share this information. This paper describes the methodology applied to design and launch a practice-based course on chest X-ray suggestive of COVID-19 right after the pandemic started, and aims to determine whether asynchronous online learning tools for radiology education are useful and acceptable to general practitioners and other medical personnel during a pandemic. The study was carried out from April to October 2020 and involved 2632 participants. Pre- and post-testing was used to assess the participants' gain of knowledge in the course content (paired t-tests and chi-squared tests of independence). A five-point Likert scale questionnaire inspired by the technological acceptance model (TAM) was provided to evaluate the e-learning methodology (ANOVA tests). The results from the pre- and post-tests showed that there were significant differences in the scores before and after completing the course (sample size = 2632, response rate = 56%, p<0.001). As for the questionnaire, all questions surpassed 4.5 out of 5, including those referring to perceived ease of use and perceived usefulness, and no significant differences were found between experienced and inexperienced participants (sample size = 2535, response rate = 53%, p=0.85). The analysis suggests that the applied methodology is flexible enough to adapt to complex situations, and is useful to improve knowledge on the subject of the course. Furthermore, a wide acceptance of the teaching methodology is confirmed for all technological profiles, pushing for and endorsing a more widespread use of online platforms in the domain of radiology continuing education.

Exploring dual career quality implementation at European higher education institutions: Insights from university experts

INTRODUCTION

This paper examines the convergence of the opinions of European higher education institution (HEI) experts on possible implementation of dual career policies and provision areas at university level.

METHODS

An online 32-item questionnaire encompassing 26 dual career aspects collected the opinion of European HEI experts as the last phase of a Delphi method preceded by i) focus groups with student-athletes who aimed to identify needs for dual careers and ii) a workshop with 21 dual career experts to generate the statements to be included in the survey. Seventy-one HEI experts from 12 EU member states participated in the survey, rating each dual career aspect identified in previous phases.

RESULTS

The relative position of each aspect has been plotted based on relevance (x-axis) and feasibility (y-axis). The Quadrant IV of the resulting scatterplots identified the following nine aspects rated as highly relevant and highly feasible for implementation: tutorship/mentorship, psychological support, programmes based on integration of academic departments and sports services, and adaptable programmes to the needs of each student-athletes (assistance/tutorship area), individual study plans and distance learning (curricula requirements area), publicity for student-athletes and initiatives for increasing the awareness of student-athletes and knowledge of dual career issues (social support area), and access to educational facilities (logistic support area).

DISCUSSION AND CONCLUSIONS

The HEI experts' views represent a coherent and useful starting point to develop a deep understanding of the considered 26 aspects founded on a phenomenological lifeworld-led approach and emphasizes the need for a minimum standard for dual career policies and provisions.

Podcasts as a Method to Deliver Education on Stigma Surrounding Opioid Use Disorder

The objective of this research was to evaluate the effectiveness of a podcast miniseries to reduce stigma surrounding opioid use disorder (OUD) among student pharmacists. Students in their second and third professional years from two schools of pharmacy listened to five, 10-23 min podcasts incorporated into their coursework. The podcasts highlighted: (1) interviews with OUD professionals and those with lived experiences; (2) types of stigma and how it affects health outcomes; (3) OUD disease state processes, and (4) harm reduction strategies. Surveys assessed changes in perception of OUD and its associated stigma and included free-response and Likert scale questions. Subjects (n = 121) who completed a pre- and post-podcast survey were included. Paired t-tests assessed changes in survey responses from baseline and a content analysis was performed on all free-responses. There was a statistically significant change from baseline for each survey question, demonstrating a decrease in stigma towards OUD. Free-responses were categorized into four learning domains: (1) Impact of stigma on access to care; (2) Compassion and empathy; (3) Resources and support; and (4) Call to action. Podcasts can be an effective tool to reduce student pharmacist stigma associated with OUD.

Student perceptions towards online learning in medical education during the COVID-19 pandemic: a mixed-methods study

BACKGROUND

This mixed-methods study was undertaken to ascertain undergraduate medical students' perceptions of remote learning following the COVID-19 restrictions. 545 students participated in this study.

METHODS

Data was collected using a validated questionnaire and four focus group discussions.

RESULTS

Regarding recorded lectures, the quantitative findings indicated that they were important during online learning and the qualitative findings explained that the recorded lectures enabled individual students to pace and customize their learning. The majority of the students agreed that recorded lectures were relevant to their learning, though they watched less than 50% of recorded lectures. Qualitative findings described procrastination as the rationale for not watching the videos. The online live lectures had a relatively higher percentage of contribution towards learning in comparison with instructor recorded video lectures. Students were more engaged with live lectures, and 63.3% of respondents agreed. Qualitative findings confirmed the opportunities for interacting with peers and better clarification of doubts by teachers during live lectures.

CONCLUSIONS

Online learning with recorded and live lectures provided continuity in medical education during the COVID-19 pandemic. When compared to recorded video lectures, synchronous live lectures were regarded as superior by students largely due to the opportunity to directly communicate with the instructor and receive quick feedback.

Trends in education during the pandemic: modern online technologies as a tool for the sustainability of university education in the field of media and communication studies

The involuntary shutdown at universities during the COVID-19 pandemic and the impossibility of full-time teaching forced university teachers to look for other ways of communication strategies through Internet platforms with students and in everyday academic activities. The aim of this study is to reveal the attitudes and perception of university teachers in the field of Media and Communication Studies in Slovakia during two years of online home learning (2020 and 2021) when the first two waves of the COVID-19 pandemic took place. The aim was to show changes in the perception of the situation in terms of existing positives and negatives during this period as well as to point out a possible trend in the communication strategies used to ensure the sustainability of the education system. Due to the lockdown, the survey was only conducted in electronic format using online questionnaires. The participants were university teachers from the field of Media and Communication Studies. As this is a progressive field the study of which is carried out at the intersection of the interests of several scientific disciplines, it can be assumed that the conclusions can easily be transferred to social, economic, humanities and arts disciplines. When communicating and teaching students in 2020 and also in 2021, online teaching through systems such as Zoom or Google Meet and individual consultations by e-mail, chat and social networks dominated. As the results of the study indicate, modern online technologies contribute to the sustainability of the educational process during an emergency and will become an integral part of university education even after the end of the pandemic situation.

COVID-19 and Clinical Pastoral Education: How ACPE Educators Pivoted Amid the Pandemic

Clinical Pastoral Education (CPE) programs faced extraordinary challenges during the COVID-19 pandemic. We examined how ACPE-certified educators responded to maintain program delivery. Survey results (n = 210) suggested a substantial and abrupt increase in remote delivery for CPE instruction and supervised clinical practice, primarily driven by those previously fully in-person. Respondents reported abrupt changes impacted 1152 students. Participants rated their utilization and helpfulness of professional, organizational, and technology resources during the pivot and beyond.

Accelerated HE digitalisation: Exploring staff and student experiences of the COVID-19 rapid online-learning transfer

In the UK, the first 'lockdown' of the COVID-19 pandemic necessitated a rapid shift to online learning and digital technologies in Higher Education (HE). While the situation was unprecedented, extant literature on online learning suggested there would be challenges, opportunities, and benefits to this transition, and we sought to understand these via a case study of one UK HEI department at this time. To draw out in-depth and nuanced accounts of this (at time of investigation-unstudied) scenario, qualitative data were collected via semi-structured online interview or written reflection. To explore, identify and understand the experiences from both sides, and with a diverse sample, we purposively recruited both staff (n = 10) and students (n = 12), from various roles and backgrounds, including those with additional learning and/or mental health needs. The 'bricolage' data were analysed inductively, utilising a latent reflexive approach, and organised into a framework around five core themes: 'methods and means of engagement'; 'learning maintenance, destruction and construction'; 'remote education and resource accessibility and literacy'; 'support and communication'; and 'life and learning: responses, adaptations and impacts'. Within these, a range of challenges, successes and, most importantly, future learning and innovation outcomes were identified by staff and students, particularly relevant to working with and supporting students with additional needs in the online learning forum. These discoveries informed a set of practical recommendations, provided here in Box 1, for (rapid implementation of) online learning (in times of stress).

Teaching Ultrasound at the Point of Care in Times of Social Distancing

Point-of-care ultrasound has become an integral aspect of critical care training. The Bedside Assessment by Sonography In Critical Care Medicine Curriculum was established at the University of Toronto to train critical care trainees in basic echocardiography and general critical care ultrasound. During the coronavirus disease (COVID-19) pandemic, our program needed to adapt quickly to ensure staff safety and adherence to infection-control protocols. In this article, we share our experience and reflect on the challenges and benefits of shifting from a primarily in-person teaching model to a hybrid model of remote and in-person teaching. Curricular changes were threefold: the transition to entirely web-based interactive didactic teaching and online imaging interpretation modules, the recruitment of sonographers at multiple academic sites as instructors to facilitate in-person practices with lower instructor to trainee ratio, and the use of a mobile application for informal group case-based discussions. Challenges included lost opportunities for scanning healthy volunteers, variability in attendance at online lectures, and a lower number of study submissions for review. However, curricular changes enabled maintenance of directly observed practice, high levels of engagement with recorded content, and an expansion of our reach to a global audience. We believe that future curricula should combine high-quality online curriculum and resources with the ongoing in-person delivery of key elements of curriculum to allow for direct observation and feedback as well as the maintenance of self-directed point-of-care ultrasound portfolios.

The impact of COVID-19 related educational disruption on children and adolescents: An interim data summary and commentary on ten considerations for neuropsychological practice

OBJECTIVE

The coronavirus 19 (COVID-19) pandemic resulted in educational disruption of historic breadth and duration. The authors describe early studies and interim standardized assessment reports to highlight effects of educational disruption and present critical questions for neuropsychologists.

METHOD

A summary of pre-pandemic and interim literature was compiled, including analyses of national and local assessment data and preliminary studies on academic gains related to remote learning, educational and school services disruption, chronic absenteeism, and child and adolescent mental and physical health during 2020-2021. Ten major themes were identified in the early reports on impacts of educational disruption.

RESULTS

Preliminary information indicates prolonged educational disruption has resulted in attenuated learning gains, most remarkably for those already at risk for educational disparities: students of color, students with disabilities, English learners, and students from low-income households. There have also been increased mental and physical health challenges for some youth during the pandemic. Other literature highlights challenges such as diagnosis of learning disabilities, reliance on normative data and development of academic recovery programs.

CONCLUSION

The effects of prolonged educational disruption and psychological stressors on learning and mental health should be considered in the neuropsychological evaluation of children and adolescents, especially marginalized students. Normative data collected prior to the pandemic may be insufficient for interpretation of scores, and evaluation and treatment may be delayed due to backlog and increased demand. Clinical practice considerations are presented.

Portuguese higher education students' adaptation to online teaching and learning in times of the COVID-19 pandemic: personal and contextual factors

The COVID-19 pandemic brought about a global crisis affecting all sectors of society. Higher education is no exception. The closure of higher education institutions has dictated a sudden and unexpected transition from face-to-face to remote teaching to mitigate the spread of the SARS-CoV-2. This paper draws upon a wider piece of research which aimed to understand how higher education students adapted to the closure of their institution and how they looked at their experience of online teaching and learning. In total, 2718 students from different Portuguese higher education institutions participated in the study. Findings showed that both personal and contextual factors explained students' positive or negative adaptation to online teaching and learning as a result of the closure of higher education institutions. Institutional and pedagogical responses, individual self-regulatory and socio-emotional competencies and adequate resources were factors that led to either a more positive or negative student experience of online teaching and learning in times of COVID-19.

Teacher Education during the COVID-19 Lockdown: Insights from a Formative Intervention Approach Involving Online Feedback

This paper examines preservice teachers’ perspectives on assessment feedback developed in a teacher education course during the first lockdown due to the COVID-19 pandemic. As initially negotiated with students, feedback was learner-centred and involved a formative intervention approach applied iteratively by the teacher educator over the course of one semester. Although such feedback was initially face-to-face, it had to be given exclusively online following the unexpected closure of the university. Analysis of student teachers’ perspectives, which were collected through an online questionnaire completed after their final assessment, reveals both positive and critical aspects regarding the feedback provided by the teacher educator. While reaffirming the significance of feedback as a crucial element for learning in online teacher education contexts, the findings also show that the clarity, affective bonding and multimodal meaning-making involved in face-to-face interaction are particularly challenging when the communication of feedback is digitally mediated. The implications and limitations of such findings are discussed.

Role of virtual modules to supplement neurosurgery education during COVID-19

The advent of the COVID-19 pandemic has disrupted all aspects of neurosurgery education, and it is now challenging to conduct routine sessions. Maintenance of essential standard education among novice neurosurgeons during the pandemic is of paramount importance. The aim of this study was the development of virtual modules and validation of its role to supplement the neurosurgery education program. We developed the virtual modules relevant to neuro-anatomy, neurosurgical procedures, instrumentation, and neurosurgical planning. These modules were virtually demonstrated to twenty-seven resident neurosurgeons through Cisco Webex online platform. They provided their rating on the aptness of virtual modules for different neurosurgery applications on various parameters using 10 points Likert scale. The parameters included quality, learning, confidence building capacity, usefulness, and overall satisfaction. The results obtained for each module were analysed and the average score was used for the comparison. The highest rating on quality was obtained by the neurosurgical instrumentation module. The highest rating for learning and confidence building capacity was given to neurosurgical procedure animation. The usefulness and overall satisfaction were highly rated for neurosurgical planning module. The results show that developed virtual modules provide an effective method to supplement the neurosurgery education program in the current scenario involving physical distancing and shift rearrangements. These virtual modules help in limiting the visits to operation room, anatomy and surgical training labs, and allow residents to learn online at their pace.

A Faculty Development Workshop for Planning and Implementing Interactive Virtual Case-Based Teaching

Introduction

The virtual learning environment has become increasingly important due to physical distance requirements put in place during the COVID-19 pandemic. The transition to a virtual format has been challenging for case-based teaching sessions, which involve substantial audience participation. We developed a faculty development workshop aimed at teaching health professions educators how to use various interactive virtual tools within videoconferencing platforms to facilitate virtual case-based sessions.

Methods

Two 90-minute workshops were piloted as a faculty development initiative. The facilitators demonstrated interactive teaching tools that could be used within virtual case-based sessions. Then, participants discussed how to incorporate these tools into case-based teaching sessions of different class sizes in small-group breakout sessions. Participants completed an online survey following each workshop to evaluate the sessions.

Results

A total of 18 and 26 subjects participated in the first and second workshops, respectively. Survey response rates were 100% (n = 18) and 65% (n = 17) for the first and second workshops, respectively. Both groups provided overall high ratings and reported that the workshop was clear, organized, and relevant. Participants were more familiar and comfortable with the use of various interactive tools for online teaching.

Discussion

Distance online teaching will be increasingly required for an undetermined time. Faculty development efforts are crucial to facilitate effective interactive teaching sessions that engage learners and maximize learning. This virtual teaching workshop is a simple and straightforward way to introduce a more interactive format to virtual case-based teaching in the health professions.

Virtual Conferences: Optimizing Oncology Nurses' Experience

One casualty of the COVID-19 pandemic was in-person professional conferences. Organizations, including the American Society of Clinical Oncology, American Association for Cancer Research, and Oncology Nursing Society, had to quickly pivot and radically transform the delivery of the traditional in-person conference to a virtual offering accessible to thousands of oncology healthcare professionals. However, what may have felt catastrophic has revealed unique opportunities to engage individuals in professional offerings, including those who, because of cost or travel, may not have previously participated. In this article, the authors present insights into how to optimize virtual learning experiences during the COVID-19 pandemic and beyond.