'You've got mail!': Clinical and practical skills teaching re-imagined during COVID-19

Comparing Face-to-Face, Blended and Online Teaching Approaches for Practical Skill Acquisition: A Randomised Controlled Trial

Introduction

The efficacy of blended and online teaching methods for practical skill acquisition remains ambiguous, particularly for skills requiring haptic awareness and/or sensory training. This study aims to compare three teaching methods (face-to-face, blended, online) for the acquisition of skills requiring sensory learning and haptic awareness. A secondary aim was to explore student experience of each teaching approach.

Design

A post-test only randomised controlled trial.

Methods

Forty-seven participants chose between learning two skills: manual measurement of blood pressure during exercise (BPM) and/or skin fold measurement using callipers (SKM). Participants were randomised to one of three learning groups: face-to-face (n = 23), blended (n = 22) and online (n = 26). Assessors determined skill competency during an in-person skill demonstration session. A survey captured student experiences.

Results

For SKM, there was a statistically significant difference in skill competency between the online learning group (17% achieved competency) and both the face-to-face (75% achieved competency; p = 0.011) and blended (89% achieved competency; p = 0.001) learning groups. For BPM, the online group had the lowest percentage of participants achieve overall skill competency. Both knowledge-based and sensory-based sub-competencies were negatively affected by the online learning method. For both skills, students in the face-to-face and blended learning group were significantly more confident in their knowledge and their ability to perform the skill in a clinical setting, compared to the online learning group.

Conclusion

Both face-to-face and blended teaching methods were more effective at leading to skill acquisition and were preferred by students when compared to a fully online teaching method.

Health science staff and student experiences of teaching and assessing clinical skills using digital tools: a qualitative study

INTRODUCTION

Once considered a supplement to traditional teaching approaches, digital tools now play a pivotal role in building core clinical competencies. This study aims to explore staff and student experiences of navigating the challenges of teaching and assessing clinical skills using digital technology. It also aims to provide insight into what skills, or aspects of skills, may be best suited to digitally enhanced teaching, thereby advancing the future of health science education.

METHODS

This qualitative study comprises the second phase of data generation for a mixed-methods research project entitled DEPTH (Digitally Enhanced Practical Teaching in Health Science). Health science staff and students expressed interest in taking part in the current study during the first stage of data collection. Qualitative data was collected in January 2022 through semi-structured group interviews and individual semi-structured interviews. An interpretivist qualitative research design underpinned by a critical realist epistemological position was used. Themes were generated following Braun and Clarke's 6-step process for reflexive thematic analysis.

RESULTS

Overall, 10 staff and 8 students across 11 health science disciplines participated in this research. Fourteen hours of transcripts were analysed and 4 themes generated. Our findings highlight the suitability of digitally enhanced teaching for low-stake skills requiring visual and auditory training, while skills requiring tactile training require in-person practice to build student competency. Importantly, our findings indicate a desire for increased remote teaching. While our work was not specifically aimed at documenting experiences related to the Covid-19 pandemic, all participants had lived experience teaching or learning during the pandemic and many spoke specifically about this.

CONCLUSIONS

The timing of this paper captures a novel moment in the history of clinical pedagogy. Staff and students advocate for the continued integration of technology into health science education generally, and clinical skills teaching specifically. For this to be successful, judicious selection of methods, skills, skill components and technology, that can be appropriately mapped onto specific learning outcomes, is required.

The application of an intraoral banana peel suturing model in surgical training of dental students

OBJECTIVES

This study investigated the application of an intraoral banana peel suturing model in helping students to acquire intraoral surgical techniques.

METHODS

This is a self-control study conducted from January 2021 to March 2021. An intraoral banana peel suturing model was implemented to provide oral suture experience for undergraduates majoring in stomatology. The sutures students placed in the model were photographed and evaluated blindly by a professional team using an established scoring system. Training scores were recorded before (training 1) and after 2 months of training (training 2). Linear regression was used to examine factors related to the scores. Suturing training was conducted in the School and Hospital of Stomatology at Peking University. A total of eighty-two students in Peking University School and Hospital of Stomatology were in their fourth pre-clinical year and followed a workshop on surgical sutures according to the curriculum. All students who should take this course were included, and the response rate was 100%.

RESULTS

The mean training 2 score (23.04 ± 3.83) was higher than the mean training 1 score (13.94 ± 3.15). The training 1 score was not significantly correlated with any of the students' general characteristics. The training 2 score was correlated with the training 1 score and the cumulative duration of practice outside of class.

CONCLUSION

The intraoral banana peel suturing model can be used for suture training, and dental students' suture ability was improved after using the banana peel for suture practice.

The Impact of the COVID-19 Pandemic on Veterinary Clinical and Professional Skills Teaching Delivery and Assessment Format

The limitations posed by the COVID-19 pandemic have been particularly challenging for courses teaching clinical and professional skills. We sought to identify how the COVID-19 pandemic has impacted the delivery of veterinary clinical and professional skills courses, including modifications to teaching and assessment, and to establish educators' perceptions of the efficacy of selected delivery methods. A branching survey was deployed to 35 veterinary schools in North America in March and April 2021. The survey collected data about curriculum and assessment in spring 2020, fall 2020, and spring 2021. Educators at 16 veterinary schools completed the survey (response rate: 46%). Educators quickly adapted curriculum to meet the requirements of their institutions and governments. Early in the pandemic (spring 2020), curriculum was delayed, delivered remotely, or canceled. Assessment methods frequently included virtual objective structured clinical examinations (OSCEs) and video-recorded skills assessments. Later in the pandemic (fall 2020, spring 2021), in-person clinical skills sessions resumed at many schools, often in smaller groups. Professional skills instruction typically remained virtual, as benefits were noted. Assessment methods began to normalize with in-person OSCEs resuming with precautions, though some schools maintained virtual assessments. Educators noted some advantages to instructional methods used during COVID, including smaller group sizes, better prepared students, better use of in-person lab time, more focus on essential course components, provision of models for at-home practice, and additional educators' remote involvement. Following the pandemic, educators should consider retaining some of these changes while pursuing further advancements, including improving virtual platforms and relevant technologies.

Development of virtual ophthalmic surgical skills training

BACKGROUND

This study aims to assess whether ophthalmic surgical skills can be taught successfully online to a diverse international and interprofessional student group.

METHODS

Mixed methods study involving 20 students and 5 instructors. Each student completed a pre-session and post-session questionnaire to assess their perceptions regarding online instruction. Changes in questionnaire responses were analysed using Wilcoxon signed rank (SPSS 25). Semi-structured interviews were conducted to assess instructor perceptions towards virtual surgical skills teaching. Thematic analysis was undertaken using NVivo 12.0 software.

RESULTS

There was a 100% completion rate of pre- and post-session questionnaires. Prior to the session, lack of instructor supervision and inability to provide constructive feedback were emergent themes from students. Pre-session concerns regarding online delivery: 40% of students thought their view of skills demonstration would be negatively impacted, 60% their level of supervision and 55% their interaction with instructors. Following the session 10%, 15% and 5% held this view respectively. All students were 'satisfied' or 'very satisfied' regarding the 'Surgeon's View' camera angle as well as the use of breakout rooms. 75% perceived an improvement in their confidence in instrument handling, 80% in cable knot tying and 70% in suture tying. Overall student rating for the virtual surgical skills session was 8.85 (±1.19) out of 10 (10 being most satisfied).

CONCLUSIONS

We demonstrate that successful delivery of a virtual ophthalmic surgical skills course is feasible. We were able to widen accessibility and participation through virtual delivery, which has future implications for ophthalmic surgical teaching and its reach.

Perception from students regarding online synchronous interactive teaching in the clinical year during COVID-19 pandemic

AIM

The global pandemic of COVID-19 has led to extensive practice of online learning. Our main objective is to compare different online synchronous interactive learning activities to evaluate students' perceptions. Moreover, we also aim to identify factors influencing their perceptions in these classes.

METHODS

A cross-sectional, questionnaire-based study focusing on clinical year medical students' perceptions and feedback was conducted between February 2021 -June 2021 at the University of Hong Kong. Online learning activities were divided into bedside teaching, practical skill session, problem-based learning (PBL) or tutorial, and lecture. A questionnaire based on the Dundee Ready Education Environment Measure (DREEM) was distributed to 716 clinical year students to document their perceptions.

RESULTS

One hundred responses were received with a response rate of 15.4% (110/716, including 96 from bedside teaching, 67 from practical skill session, 104 from PBL/tutorial, and 101 from lecture). For the mean score of the DREEM-extracted questionnaire, online PBL/tutorial scored the highest (2.72 ± 0.54), while bedside scored the lowest (2.38 ± 0.68, p = 0.001). Meanwhile, there was no significant difference when we compared different school years (p = 0.39), age (p = 0.37), gender (p = 1.00), year of internet experience (<17 vs ≥17 years p = 0.59), or prior online class experience (p = 0.62). When asked about students' preference for online vs face-to-face classes. Students showed higher preferences for online PBL/tutorial (2.06 ± 0.75) and lectures (2.27 ± 0.81). Distraction remains a significant problem across all four learning activities. A multivariate analysis was performed regarding students' reported behavior in comparison with their perception through the DREEM-extracted questionnaire. The results showed that good audio and video quality had a significant and positive correlation with their perception of online bedside teaching, practical skill sessions, and PBL/tutorial. It also showed that the use of the video camera correlated with an increase in perception scores for lectures.

CONCLUSION

The present analysis has demonstrated that students' perception of different online synchronous interactive learning activities varies. Further investigations are required on minimizing distraction during online classes.

The listening project: A qualitative study on the experiences of pre-registered nurses during the Covid-19 pandemic in Scotland

Background

During the COVID 19 pandemic academic institutes worldwide were forced to shift to online or socially distanced learning. Nursing students faced unique challenges due to the limited practical learning environment and removal of supernumerary status to meet increased pressure on health care resources.

Aim

To explore the experiences and perceptions of pre-registered nurses in relation to their university education during the COVID-19 pandemic.

Methods

Underpinned by Lizzio (2006) [1] five senses of student success model, a novel qualitative approach using peer-to-peer discussion was utilized to explore the experiences of pre-registered nurses during the COVID-19 pandemic. Students who were on their second and final year in the nursing program were invited to participate. Interviews were conducted and transcribed using an online meeting platform. Data were analyzed using the five main stages of framework analysis.

Results

Eleven peer-to-peer discussion with 22 students were conducted. The five themes were linked with the five senses student success model: capability, connectedness, purpose, resourcefulness, and culture. Six sub-themes emerged in the data: confidence and learning process, building relationships, communication, student as health professional and mental health consequences of COVID-19 pandemic.

Conclusion

Whilst there was strength in university provision, the pandemic was an opportunity for students and academics to reflect and learn about how to further programme resilience and enhance student support processes. We recommend that nursing programmes should include concepts of transition, pandemic preparedness, collaboration with professional partners, and provision of catch-up sessions to analyse gaps on their skills and knowledge.

Sustaining capacity building and practical skills training during the COVID-19 pandemic: Lessons from India

Background

The scale and duration of the COVID-19 pandemic posed a threat to provide the required support needed by emergency medicine (EM) trainees in India participating in the masters in EM program, a global partnership between the Ronald Reagan Institute for Emergency Medicine at the George Washington University and 14 institutions in India. While some of this support has been filled by remote education through thrice-weekly online video conferencing and webinars, the gap in procedural teaching posed a different challenge.

Methods

We developed a two-part innovation to teach suture skills, a required procedure for EM trainees. The innovation consisted of a hands-on procedure lab with the opportunity for live feedback followed by an independent competitive skill demonstration. Trainees were notified in advance of materials needed for the procedure lab to encourage attendance and participation.

Results

A total of 160 trainees attended the virtual suture skills lab; 74 trainees (46% of attendees) submitted feedback back of whom 94% were able to practice skills in real time. Written feedback was overwhelmingly positive and included requests to implement this method for other procedural skills. Twenty-one residents participated in the Innovative Suture Challenge, with the top three submissions receiving accolades in the following grand rounds-style session.

Conclusions

The combination of virtual teaching with the opportunity for real-time feedback and an integrated project to independently showcase skills learned is a way to continue procedural skills teaching in a remote environment. The aim of this innovation was to test the feasibility, acceptability, and level of engagement of conducting virtual, live supervised suturing remotely across multiple geographical locations. Our next step would be to gather pre and post data to measure the impact. Additionally, we believe this provides a proof-of-concept model to further explore sustainable, cost-effective, and scalable models for remote procedure-based teaching.

A Literature Review of Barriers and Opportunities Presented by Digitally Enhanced Practical Skill Teaching and Learning in Health Science Education

INTRODUCTION

An evidence gap exists identifying the challenges and opportunities presented by digitally enhanced practical skill teaching and learning in health science education. A literature review was carried out to address this gap and to provide recommendations for overcoming identified challenges.

METHOD

A systematic search strategy was carried out using PRISMA guidelines. The research databases PubMed, ERIC, Medline and CINHL, were searched using MeSH terms. Barriers and opportunities were identified through deductive thematic analysis of the included articles.

RESULTS

Of the 602 articles identified through the database screening, 29 were included in the current review. Potential challenges posed by technologically supported practical skill teaching identified were i) Inaccessibility and Inequity of Online Learning (ii) Digital illiteracy Among Staff (iii) Technological Challenges (iv) Lack of Engagement with Preparatory Material Hinders Practical Learning (v) Lack of Staff-Student Interaction (vi) Negative Attitudes Towards Online Learning and (vii) Skill Suitability. The opportunities presented by digital technologies identified were (i) Facilitates Higher Order Learning (ii) Ability to Practice in a Safe Environment (iii) Efficacious Use of Class Time (iv) Access to Education (v) Learning Brought to Life (vi) Diverse Range of Learning Materials (vii) Promotes Autonomous Learning.

DISCUSSION

This literature review demonstrates the acceptability and usability of digitally enhanced practical teaching in health science education among students and educators.

CONCLUSION

To consolidate the positive disturbances in higher education from the Covid-19 pandemic, potential barriers to online delivery and student engagement must be acknowledged and addressed by relevant stakeholders. Recommendations detailed as part of this paper suggest means of overcoming barriers and leveraging opportunities.

Adaptations of Clinical Teaching During the COVID-19 Pandemic: Perspectives of Medical Students and Faculty Members

BACKGROUND

The COVID-19 pandemic had serious implications on medical schools' programs that necessitated lots of adaptations of teaching, learning, and assessment to guarantee continuity of education in medical schools. Our study aimed to evaluate perspectives of clerkship students and faculty members regarding clinical teaching adaptations implemented during the COVID-19 pandemic.

METHODS

A descriptive, cross-sectional, survey-based study was conducted and targeted 5^th and 6^th year clerkship students and full- and part-time clinical faculty. The survey explored (1) perception of the degree of contribution of implemented adaptations to student achievement of expected clinical competencies, (2) degree of confidence regarding students' achievement of expected clinical competencies through such adaptations, and (3) perception of the effect of implemented educational adaptations on students' learning. Descriptive statistics were used, and statistical significance level was set at p < 0.05.

RESULTS

The survey exhibited high internal consistency. Both students and faculty members felt that most of the adaptations had moderate to high contribution to student achievement of expected clinical competencies. On a 5-point scale, the highest score was given by faculty members to "Interpretation of investigations" (3.93±0.84) while the lowest scores were given by faculty members (3.10±1.21) and students (2.57±1.36) to "Performing clinical procedures". Students and faculty members agreed that the adaptations had positive effect on students' learning except for the statement "Students were able to easily monitor their academic progress" where students gave less scores than faculty members, with a statistically significance difference (p=0.029).

CONCLUSION

Students and faculty members had similar perspectives regarding the implemented adaptations and their impact and contribution to student learning and achievement of the basic clinical competencies. Both of them agreed on the need for and importance of the implemented adaptations. Our findings recommend such adaptations during the times of crises, which can be conducted through integrating online teaching with face-to-face teaching.

Twelve tips for medical students to enhance clinical skills learning during disrupted placements

Disruption to healthcare settings can present a significant challenge to traditional, face-to-face models of learning in medical education. Reductions in undergraduate medical students' clinical exposure, whether due to periods of increased healthcare demand, localised service changes or infectious disease outbreaks, are likely to result in fewer opportunities to develop key clinical and practical skills. Proficiency in these skills is often essential to progression and future practice, creating a broad incentive for students to develop techniques to maintain and refine their clinical skills during disrupted placements. These tips, based on our experiences as senior medical students, are intended to help students on disrupted placements to engage in reflective practice, discover ways to facilitate further opportunities for clinical skills learning, and to make the most of clinical skills learning opportunities that they do receive.

Misjudgment of Skills in Clinical Examination Increases in Medical Students Due to a Shift to Exclusively Online Studies during the COVID-19 Pandemic

In medical school, practical capacity building is a central goal. During the COVID-19 pandemic, a shift to online teaching methods in university was mandated in many countries to reduce risk of SARS-CoV-2 transmission. This severely affected the teaching of psychomotor ability skills such as head and neck examination skills, resulting in a share of students that have only been taught such ENT-specific examination skills with online courses; our study aimed to measure performance and capacity of self-evaluation in these students. After completing a new extensive online Ear Nose Throat (ENT) examination course, we conducted a standardized clinical skills exam for nine different ENT examination items with 31 students. Using Likert scales, self-evaluation was based on questionnaires right before the clinical skills exam and objective evaluation during the exam was assessed following a standardized regime. Self-evaluation and objective evaluation were correlated. To compare the exclusive online teaching to traditional hands-on training, a historic cohort with 91 students was used. Objective examination performance after in-classroom or online teaching varied for single examination items while overall assessment remained comparable. Overall, self-evaluation did not differ significantly after online-only and in-classroom ENT skill teaching. Nevertheless, misjudgment of one’s skill level increased after online-only training compared to in-classroom teaching. Highest levels of overestimation were observed after online training in simple tasks. While gender and interest in ENT did not influence self-evaluation and misjudgment, higher age of participants was associated with an overestimation of skills. Medical students with online-only training during the COVID-19 pandemic achieved similar ENT examination skills to those with traditional on-campus training before the pandemic. Nevertheless, students with online-only training were more prone to misjudge their skills when they assessed their skills. Due to the COVID-19 pandemic, current medical students and graduates might therefore lack individual specific psychomotor skills such as the ENT examination, underlining the importance of presence-based teaching.

Online, Face-to-Face, or Blended Learning? Faculty and Medical Students' Perceptions During the COVID-19 Pandemic: A Mixed-Method Study

BACKGROUND

COVID-19 pandemic forced educational institutions to adopt online methods which were inevitable to keep continuity of education across all academia after suspension of traditional educational systems. The aim of this study was to explore the experience of faculty and students of online and face-to-face learning, and their preference of the mode of learning after the pandemic.

METHODS

This is a mixed-method study. Quantitative data was collected through a survey from 194 medical students and 33 faculty members, while qualitative data was collected through two focus group discussions with 9 students and another two with 13 faculty members. Quantitative variables were presented as means and standard deviations. Paired samples t-test and Chi-square test were used. Thematic analysis of qualitative data was used to code, interpret, and make sense of data.

RESULTS

Mean scores of responses of faculty members and students were higher for face-to-face and blended learning compared to online learning in all survey statements with statistically significant differences. More than half of the students (53.1%) preferred the face-to-face mode of learning, while most of the faculty members (60.6%) preferred the blended mode of learning. Qualitative analysis identified five themes, namely: "Transforming the way theoretical teaching sessions are given," "Face-to-face teaching at campus cannot be replaced for some types of education," "Interaction in online sessions is limited," "Problems and challenges of online examinations," and "Technical issues and challenges of online education." It revealed suggestions that at least 30% of the curriculum could be taught online post-COVID-19. Some aspects of clinically oriented teaching including history taking and case discussions can also be delivered online in the future. Faculty members and students reported that dealing with online education was not difficult, although the transition was not smooth.

CONCLUSION

Medical students and faculty members were in favor of face-to-face and blended modes of learning. However, they perceived online mode of learning as an acceptable adaptation in theoretical teaching and in some clinically oriented teaching including history taking and clinical case discussions. Although face-to-face education in medicine is irreplaceable, the blended mode of learning remains an acceptable and practical solution for the post-COVID era.