Distance learning strategies in medical education during COVID-19: A systematic review

Large Language Models in Pediatric Education: Current Uses and Future Potential

Generative artificial intelligence, especially large language models (LLMs), has the potential to affect every level of pediatric education and training. Demonstrating speed and adaptability, LLMs can aid educators, trainees, and practicing pediatricians with tasks such as enhancing curriculum design through the creation of cases, videos, and assessments; creating individualized study plans and providing real-time feedback for trainees; and supporting pediatricians by enhancing information searches, clinic efficiency, and bedside teaching. LLMs can refine patient education materials to address patients' specific needs. The current versions of LLMs sometimes provide "hallucinations" or incorrect information but are likely to improve. There are ethical concerns related to bias in the output of LLMs, the potential for plagiarism, and the possibility of the overuse of an online tool at the expense of in-person learning. The potential benefits of LLMs in pediatric education can outweigh the potential risks if employed judiciously by content experts who conscientiously review the output. All stakeholders must firmly establish rules and policies to provide rigorous guidance and assure the safe and proper use of this transformative tool in the care of the child. In this article, we outline the history, current uses, and challenges with generative artificial intelligence in pediatrics education. We provide examples of LLM output, including performance on a pediatrics examination guide and the creation of patient care instructions. Future directions to establish a safe and appropriate path for the use of LLMs will be discussed.

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.

Post-graduate Course in Palliative Medicine: Experiences from an E-Learning-Based Pilot Program, a Mixed Methods Study

Objective: To study whether E-learning methods are feasible in the post-graduate education of palliative medicine. Methods: A mixed-methods study. Evaluations from pilot course attendees were analyzed numerically and answers to open-ended questions about E-learning were analyzed using inductive content analysis. A national pilot E-learning-based post-graduate course in palliative medicine with 24 participating physicians in Finland. The evaluation of teaching modules and different aspects of the course was achieved from the participants through numerical statements and open-ended questions. Results: The feedback on most aspects of the course was good. For example, issues of pain and symptom control, lectures, pre-exams, and group discussions were deemed suitable for E-learning, while studying communication and existential issues through E-learning was considered more challenging. The benefits of E-learning included efficacy, better accessibility, and the possibility to go back to the teaching material. Reduced networking and face-to-face interactions were stated as challenges of E-learning. Conclusions: E-learning is feasible in the post-graduate education of palliative medicine and can be 'surprisingly rewarding'. It allows easy access to learn many important topics, while social networking may fall short. Further studies are needed to assess the increase in competence by different learning methods.

Expanding the Global Capacity for Childhood Cancer Registration: The ChildGICR Masterclass

PURPOSE

One determinant of the paucity of data on childhood cancer in low- and middle-income countries is the lack of capacity to register these cases. Combining expertise of the Global Initiative for Cancer Registry Development (GICR) and St Jude Global, we developed a ChildGICR educational program to promote data production.

METHODS

We first conducted a needs assessment to identify priority educational topics. Then, we designed the ChildGICR Masterclass, in which individuals with the potential to lead pediatric cancer registration were supported to prepare standard educational material. The outcomes were evaluated using qualitative and quantitative measures.

RESULTS

On the basis of indications by 38 GICR collaborators, we identified seven topics relevant to childhood cancer: burden description, registration principles, tumor classification, tumor staging, data quality control, data analysis, and data use. The ChildGICR Masterclass was held online in 2021 over 12 weeks. The 22 nominated participants created presentations in working groups and during live sessions. They also designed future training courses tailored to the needs of their region. Nineteen participants viewed the course experience as excellent, and 20 would continue engagement in the ChildGICR training activities. The developed material was 89% useful according to the faculty of the three online end courses, taught to 88 participants in 16 countries in 2022 and 2023. Among the 75 responding participants, 72 agreed that the learning objectives were attained and 60 were keen to engage in childhood cancer registration activities.

CONCLUSION

The ChildGICR Masterclass participants laid the foundation for a network of trainers. Knowledge dissemination in childhood cancer registration is the first necessary step toward evidence-based cancer control. The ChildGICR Masterclass can serve as a model to design, plan, and implement educational programs for health care professionals.

Analyzing research trends after the international journal transition of the Korean Journal of Medical Education: using topic modeling techniques

PURPOSE

This study aimed to analyze the research trends of the Korean Journal of Medical Education (KJME) since it became an English-language journal.

METHODS

A total of 274 articles published in KJME from 2016 to 2023 were analyzed. All article types were included in the analysis. NetMiner ver. 4.0 (Cyram Inc., Korea) was used for the main keyword and topic modeling analysis.

RESULTS

Of the 274 articles, 170 (62%) and 104 (38%) were by domestic and international authors, respectively. The main keywords with high frequency were "students," "learning," "experience," "pandemic," and "perception." Three topics were derived using topic matching analysis: "residents' perception and attitude of the pandemic," "assessment of learning and achievement," and "learning experiences in the pandemic."

CONCLUSION

Since the shift to English-language journals, medical education research has witnessed an increase in the number of articles published by international authors. Research on postgraduate education has increased. Research topics are relevant to situations such as the coronavirus disease 2019 pandemic. These findings can help researchers select research topics and encourage them to submit their research to the journal.

Learning to collaborate with medical interpreters in health professions education: A systematic review of training programs

BACKGROUND

Working effectively with medical interpreters is an increasingly valuable skill for clinicians to provide high-quality medical care. We aimed to assess the effectiveness of existing training programs that teach optimal collaboration practices between clinicians and interpreters during patient encounters.

METHODS

We searched MEDLINE, EMBASE, Scopus, and Cochrane Central for studies published from 1945 through June 21, 2022.

RESULTS

Out of the 1689 studies screened, we identified 19 studies that met inclusion criteria. Participants were from diverse professions, medical specialities, and training levels. Interpreter involvement in the development or delivery of the program was mentioned in 63% of the evaluated studies. There was substantial variability in training design, assessment methods, and reported outcomes. Only 10 of the programs included an objective knowledge or skills assessment. Only one study conducted a longitudinal assessment of skill maintenance over time. The training programs were generally well received.

CONCLUSIONS

There is a critical need for structured programs to train clinicians to effectively collaborate with medical interpreters to reduce healthcare disparities. An effective training program should involve interpreters in the development and delivery of the program, practical skills development through interactive activities, structured clinical skill assessment, and both in-person and virtual components.

Abrupt introduction of distance learning during the covid-19 pandemic: What psychological impact on teachers?

As soon as the COVID-19 pandemic appeared, the Moroccan education ministry decided to adopt distance learning (DL). Our target was to study the psychological impact of DL on Moroccan teachers during the pandemic. This cross-sectional study used an online questionnaire based on the Hospital Anxiety and Depression Scale. Among 148 responses, 64.9% were women, and the average age was 41.1±11.5 years. 79.1% participated in DL, 58.8% were required to acquire DL tools and 71.6% had never received DL training. Between the start and the end of confinement, we noticed a decrease in the motivation of teachers.36.2% had definite depressive symptomatology and 41.3% had certain anxiety symptomatology with a significant predominance in women. The frequencies of depression and anxiety were higher in those who had participated in DL, but the association was not significant. Depression was significantly frequent among teachers who were obliged to acquire tools to practice DL P=0.02, those who had never received training DL P=0.046, and those who were not satisfied with the situation P=0.03. We didn't find a direct association between DL and anxiety and depression, which the small sample size may explain, but we did find an association with the variables related to DL.

COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents

The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.

Blended learning in undergraduate dental education: a global pilot study

AIMS

To explore the global trends in blended learning in undergraduate dental education during the COVID pandemic and during the recovery phase by engaging with the students and faculty and evaluate the implications for dental education in the post-COVID era.

METHODS

It was a pilot cross-sectional study which employed a convenience sampling technique to recruit representatives of dental faculty and undergraduate students in 80 dental institutions globally. A previously validated questionnaire consisting of a combination of closed and open-ended items was used for data collection. Responses to these online questionnaires were processed and analysed using the R statistical computing environment.

RESULTS

A total of 320 dental students and 169 faculty members from 47 different dental institutions participated in the study. Video and Live Online Tutorials were considered to be the most effective method of online learning followed by online question banks by both groups. Significant differences were noted between faculty and students regarding time spent and effectiveness of online teaching and learning, respectively, both before and after the start of COVID. The results highlight the faculty need to engage more closely with the students to address their learning needs. Finally, the participants provided several recommendations regarding the future development of teaching and learning strategies as well as assessments in the post-pandemic era.

CONCLUSIONS

This is the first study which explores blended learning in dental education with participants from multiple institutions in different regions of the globe. Compared to the faculty, students considered online learning to be less interactive and preferred learning activities and all assessments to be delivered face-to-face. The results underscore the need to adapt teaching practices to suit the learning needs of the students.

An overview of the outreach of the 2019-2021 Endo-ERN knowledge generation webinars

The current study aims to assess the development of the knowledge generation program of the European Reference Network on Rare Endocrine Conditions (Endo-ERN) from its start in 2019 until December 2021, with special reference to webinars. We analyzed the number of webinars and live/postevent participants and whether participation and engagement of the attendees changed over time. A total of 30 (86%) self-prepared webinars comprising 300 h of knowledge and competence sharing were broadcasted (2019 - 3; 2020 - 13; 2021 - 14). A total of six webinars were broadcasted live prior to the coronavirus disease 2019 pandemic (https://endo-ern.eu/events/webinars/). The most active main thematic group (MTG) was MTG3 Genetic Disorders of Glucose and Insulin Homeostasis with eight (27%) webinars. Two (25%) MTGs fulfilled the goal to prepare at least two to three webinars per year. Patients were actively involved in 20% of the accounted webinars as both creators and presenters. The total number of live and postevent participants was 3023. The availability of the webinars after the live broadcast increased their outreach with a larger number of postevent viewers (n = 1629, 54%). Within the formal structured evaluation of the webinars, 40-85% of the participants replied on separate occasions and helped improve content. The free webinar access is among the perceived reasons for the rapidly increasing number of total hits to the Endo-ERN website. In conclusion, for its short existence, the Endo-ERN rapidly developed educational outreach, and further efforts to attract creators and learners are warranted.

Survey on digital dependency, writing by hand, and group learning as learning styles among Japanese medical students: Assessing correlations between various accomplishments

BACKGROUND

Although digital learning devices have become increasingly more common in medical education settings, it remains unclear how they influence medical student learning styles and various outcome measures. This study aimed to assess student learning styles, specifically as they relate to digital dependency, writing habits, and group learning practices among current medical students.

MATERIALS AND METHODS

This questionnaire study was approved by the Research Ethics Committee of Osaka Medical and Pharmaceutical University. We conducted a questionnaire survey of 109 medical students who were 5th year students during the 2021 school year. Medical students were asked about their level of digital dependency, writing by hand, and group learning practices. We also analyzed the correlation between student learning styles and their respective outcomes on several summative evaluations.

RESULTS

Of the 109 students targeted, we received responses from 62 (response rate, 56.8%). Among the respondents, digital dependency was 83.4 ± 18.6%, while hand writing ratio 39.8 ± 29.9% and group learning ratio 33.5 ± 30.5%. We also assessed correlations between these learning styles and scores on the CBT, OSCE, CC, and CC Integrative Test. Only writing by hand showed a small positive correlation with CC Integrative Test scores.

CONCLUSION

Our questionnaire survey assessed the rates of digital dependency, writing by hand, and group learning practices, and analyzed the correlations between these learning styles and respective outcomes. Current medical students exhibited high digital dependency which was not correlated with performance outcomes.

Effectiveness of a blended learning intervention in cardiac physiotherapy. A randomized controlled trial

Background

Blended learning (BL) combines both face-to-face learning (FL) and online learning. This study aims to compare the effectiveness of a BL intervention vs. a FL intervention in relation to the knowledge, competencies, satisfaction, perceptions, usability, and BL acceptance of physiotherapy students.

Methods

An assessor-blinded randomized trial was performed. A total of 100 students were randomly allocated to either the BL group (BLG, n = 48) or FL group (FLG, n = 52). The BLG received face-to-face classes plus access to online resources (online syllabus, Moodle, scientific-based videos and websites, activities, glossary, and apps). The FLG received face-to-face classes and hardcopy resources (hardcopy syllabus, scientific-based information, activities, and a glossary). Knowledge, ethical and gender competencies, satisfaction, perceptions, usability, and BL acceptance were assessed.

Results

The BLG showed higher scores than the FLG for knowledge (p = 0.011), three ethical/gender competencies (p < 0.05), increased motivation to prepare themselves before class (p = 0.005), increased motivation and ability of thinking (p = 0.005), improved understanding of important topics (p = 0.015), course organization (p = 0.017), educational material (p = 0.001), easiness of understanding (p = 0.007), comprehensive coverage of the subject (p = 0.001), and clarity of instructions (p = 0.004), while usability was acceptable.

Conclusion

The BL intervention can be used for improving the knowledge, competencies, perceptions, and satisfaction of the students. In addition, BL acceptance was positive, and usability was found to be acceptable. This study supports the use of BL as a pedagogical approach to foster innovative learning.

Introducing a mobile learning model in medical education during COVID-19; a critical review

INTRODUCTION

Mobile learning is one of the innovative teaching techniques that help medical students gain knowledge and skills. One of the factors that expanded the use of this strategy was the COVID-19 pandemic. However, the educational pedagogy of such technology has been neglected. This article aimed to critically review available mobile learning models in medical education to suggest a comprehensive model in the field of mobile learning.

METHODS

We conducted this critical review based on the five steps of the Carnwell and Daly method. For a comprehensive systematic search from 2000 to April 2021, the following keywords were used: Personal Digital Assistant, m learning, Mobile learning, Ubiquitous learning, U learning, medical students, and medical education. 3176 studies in PubMed, Scopus, ERIC, Magiran, and Web of Science were identified. In total, 8 articles entered the study.

RESULTS

Eight models of mobile learning in medical education were identified. The key features of each model were extracted and integrated into the new model for the successful design and implementation of mobile learning. This model includes three main elements of mobile learning: 1-stakeholders, 2-interaction, and 3-technology, which are influenced by external factors including Mobiquette, legitimacy, and awareness.

CONCLUSION

The results of this study are an important contribution to the knowledge collection in mobile learning in medical education. We introduced a comprehensive model of mobile learning including specific characteristics of strategies in the context of medical education.

Life Satisfaction and Perceived Stress versus Health Promoting Behavior among Medical Students during the COVID-19 Pandemic

AIM

The aim of this study was to evaluate health-promoting behaviors as a factor supporting life satisfaction and a protective factor against stress in a group of Polish medical students during the third wave of the SARS-CoV-2 pandemic.

MATERIAL

The study was conducted in October-December 2021. There were 306 people, including 203 students in the 1st year of medicine, aged 20.42 ± 1.92 years, and 103 students in the 5th year of medicine, aged 24.88 ± 1.7 years.

METHODS

The following were used: the Satisfaction with Life Scale (SWLS), the Health Behavior Inventory (IZZ), and the Perceived Stress Scale (PSS-10). The survey was conducted online.

RESULTS

In the study group, the average result of 23.66 ± 5.97 was obtained in the life satisfaction questionnaire. In the overall assessment of health behaviors (IZZ), an average score of 80.06 ± 13.81 points was obtained. In the PSS-10 questionnaire, the respondents obtained an average of 21.10 ± 5.89 points. There were significant, negative correlations between the results obtained in the health behavior inventory with the results obtained in the stress scale and positive correlations with the results obtained in the life satisfaction scale. Moreover, in the assessment of the influence of prohealth behavior parameters on perceived stress and life satisfaction, a positive effect of PMA on life satisfaction was demonstrated, as well as a protective effect of Positive Mental Attitude (PMA) and Prohealth Activities (PhA) in relation to stress.

CONCLUSIONS

Life in the period of the third wave of the pandemic was assessed by medical students as moderately satisfactory. Significant intensity of stress negatively correlated with life satisfaction. Health-promoting behaviors, and especially positive mental attitudes, seem to play a protective role in stressful situations and improve life satisfaction.

Deciphering Learning Motivation in Open Distance Learning towards Sustainable Medical Education

Open distance learning has become a new norm in medical education since the COVID-19 pandemic. The abrupt shift from conventional medical education to fully virtual learning deserves a reflection on how it affected the learning motivation among medical students. Hence, this study aimed to investigate the effect of open distance learning on their learning motivation during this pandemic period, with suggestions to improve through reflections and recommendations. This qualitative study involved 152 medical students undertaking the Doctor of Medicine program in Universiti Kebangsaan Malaysia, Malaysia, during the COVID-19 pandemic. All data were collected through a validated questionnaire. We found that medical students portrayed intrinsic motivation—mainly self-motivation, self-discipline, and self-adaptation—in open distance learning during the pandemic period. Feedback from medical students also showed that they advocated a better internet connection, innovative teaching, and learning, as well as new appropriate assessment methods and strengthening of the learning management system for a sustainable open distance learning outcome. Hence, medical educators should be creative in making use of open distance learning as an attractive complementary platform in medical education to ensure life-long learning.