Submitted: 31 January 2024
Accepted: 3 September 2024
Published online: 7 January, TAPS 2025, 10(1), 56-58
https://doi.org/10.29060/TAPS.2025-10-1/PV3239

Chan Choong Foong¹, Mohamad Nabil Mohd Noor¹ & Galvin Sim Siang Lin²

¹Medical Education and Research Development Unit, Faculty of Medicine, Universiti Malaya, Malaysia; ²Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Malaysia

I. INTRODUCTION

Contemporary undergraduate medical education is increasingly emphasising the cultivation of student ownership and autonomy, entrusting learners with the responsibility to take charge of their own studies. Across Asian countries, high school graduates embark on their medical education journey at the age of 19 to 20 years, stepping into the realm of adulthood and assuming accountability for their academic pursuits. As the landscape of medical education undergoes transformative shifts propelled by technological advancements and evolving pedagogical approaches, one enduring tradition faces scrutiny: the imposition of compulsory lecture attendance.

Intriguingly, amid the broader trend toward fostering student autonomy, some Asian medical schools grapple with concerns about low lecture attendance. Rather than embracing the prevailing ethos of adult learning, these institutions respond by adopting autocratic measures to enforce mandatory attendance. This perplexing approach begs the question: Why, in an era of educational evolution and empowerment, do certain medical schools resort to rigid mandates to address the issue of diminished lecture participation?

This article does not engage in a debate about the efficacy of lectures; instead, it delves into the heart of the matter — the compulsory attendance. Considering medical teachers’ dissatisfaction with students’ lecture attendance rates, it becomes imperative to explore the underlying frustrations that lead institutions toward autocratic measures. What lies at the core of this apparent contradiction between the shift toward learner autonomy and the persistence of compulsory lecture attendance?

II. THE FRUSTRATIONS AND OUR ARGUMENTS

1. Some medical teachers may argue that frustration lies in the association between lecture attendance and academic performance.

Our arguments are as follows. First, research data show a mixture of supporting and opposing evidence (Doggrell, 2020b). Second, if this association holds true, it implies that high-achieving students should be afforded the freedom to forego lectures. Alternatively, medical students who acquire lecture content from other media, such as recorded lectures or online resources (e.g. YouTube videos), and offline resources (e.g. reference books) should also have the freedom to skip lectures. Third, it appears more rational to correlate academic performance with students’ active engagement during lectures rather than their mere physical attendance. Students who attend lectures to avoid punishment may be reluctant to become involved. Despite their outward presence, if these students remain preoccupied with internet-connected devices, does their mere attendance satisfy the expectations of medical teachers? The scenario becomes even more poignant when considering the time medical teachers spend managing students who are not engaged in lectures. This time could otherwise have been meaningfully invested in students genuinely seeking to absorb and engage with the lecture content.

2. Some medical teachers contend that the crux of the frustration lies within professionalism, positing that attending lectures is an integral aspect of student professionalism.

Our arguments are as follows. First, a systematic review discussing unprofessional behaviours among medical students does not identify lecture attendance as a dimension of professionalism (mak-Van der Vossen et al., 2017). Second, even if one were to categorise lecture absenteeism as unprofessional, the AMEE Guide No. 61, titled “Integrating professionalism into the curriculum”, does not advocate for compulsory attendance as a prescribed professional solution (O’Sullivan et al., 2012).

Some medical teachers draw parallels by likening student absenteeism to the unacceptable conduct of on-duty medical practitioners. However, this analogy lacks validity. The execution of medical duties by practitioners necessitates a specific venue, such as a clinic, and adherence to fixed working hours. In contrast, medical students can fulfil their learning responsibilities at any time and from any location, exemplified by the ability to engage with recorded lectures. For the analogy to be valid, lectures must be proven irreplaceable in delivering certain medical content.

3. Some medical teachers contend that their frustration lies in low lecture attendance, adversely affecting their morale for teaching (Emahiser et al., 2021).

Our arguments are as follows. First, although low attendance can be upsetting and disappointing, medical teachers should not request compulsory attendance to appease their emotional and moral demands. While commenting on student absenteeism as unprofessional, do these teachers, in turn, project a more professional image by demanding mandatory attendance? Second, the variability in audience size for different lectures or lecturers warrants the teachers’ self-reflections on their teaching methods (Emahiser et al., 2021).  Third, there is perhaps no downside to the teaching styles employed by medical teachers; however, some medical students have preferences for different learning methods (Emahiser et al., 2021). Alternatively, the characteristics of Generation Z learners, marked by a limited attention span and a preference for online learning environments, may not align with the assumptions underlying compulsory lectures. Mandating attendance presupposes a one-size-fits-all approach, and debatably, lectures might not be the panacea for optimal academic performance among medical students.

4. Some medical teachers may argue that the frustration stems from the perception that many Asian high school leavers are not mature enough to make decisions.

Our central argument posits that, irrespective of the potential benefits of lectures, they should not be mandated. How can medical students cultivate maturity if they are not afforded the opportunity to exercise decision-making in the first place? It is ironic that, while Asian medical schools try to promote adult learning principles into their curriculum, they endorse paternalism in conditioning student behaviours. Our stance is not a discouragement of lecture attendance; rather, we oppose the imposition of paternalism in moulding the physicians of tomorrow.

III. OUR PROPOSALS

To address the challenge of low lecture attendance, our proposal for medical teachers is to reconsider the delivery method of lectures. Let us acknowledge the need for our teaching methods to evolve in response to technological advancements and the distinctive learning preferences of Generation Z. Following is an actual reason for absence – “I don’t consider the lecturer adds to the material given on the PowerPoints” and a reason for attending – “It allows for interaction with course staff and/or students” (Doggrell, 2020a). Thus, it becomes imperative for medical institutions to train educators with interactive strategies (e.g., inquiry activities) that complement lectures and motivate students to actively participate in the learning process. Consequently, faculty development programs that are in line with evolving learning science and the changing needs of learners are deemed necessary.

Next, we should reconsider the emotional need to see students physically. Theoretical and empirical evidence suggests that recorded lectures work effectively, as students can pause and play the recordings, which enables them to learn at their own pace. Medical teachers must accept that, with the tremendous amount of available teaching and learning materials online, attending lectures is no longer the sole source of knowledge. Considering flexible attendance policies that accommodate students’ individual needs and recognising the importance of adapting to evolving educational practices and preferences are equally essential.

For medical students, our suggestion is to foster ownership and autonomy in their studies, predicated on an understanding of the potential repercussions on their academic performance. Medical students should be empowered to make informed choices, cognisant that each choice carries consequences. This approach aligns with the principles observed in medicine, where patients retain the autonomy to continue or discontinue treatment at their own risk. If adult learning is deemed fundamental to the future medical curriculum, Asian medical teachers ought to relinquish paternalistic tendencies.

This shift does not imply a cessation of support for student learning. Instead, we shift to help students “learning to learn”, for instance, to promote the understanding of (including but not limited to) andragogy and self-regulated learning. It may not be the lecture attendance that some low-achieving medical students have missed; rather, it could be the cultivation of appropriate mindsets about learning, including aspects like time management and motivation.

IV. CONCLUSION

In conclusion, our scrutiny of compulsory lecture attendance reveals that it neither serves as a panacea for academic performance nor aligns seamlessly with the principles of professionalism or the preferred learning styles of Generation Z. Rather than acting as an antidote, the imposition of compulsory attendance manifests as a form of paternalism within Asian medical schools. This paternalistic approach, rather than nurturing, acts as a toxic element for aspiring medical professionals, hindering the cultivation of autonomy and adult learning principles in the trajectory of futuristic medical education. To remedy this issue, delivery method of lectures should consider state-of-the-art learning science, matched with the changing needs of students.

Notes on Contributors

Chan Choong Foong conceptualised and designed the work, and drafted the manuscript. Mohamad Nabil Mohd Noor conceptualised and designed the work, and drafted the manuscript. Galvin Sim Siang Lin interpreted the findings from past studies for the work, and revised the manuscript critically. All authors have read and approved the submitted manuscript.

Funding

The authors did not receive support from any organisation for the submitted work.

Declaration of Interest

The author declares that there is no conflict of interest.

References

Doggrell, S. A. (2020a). No apparent association between lecture attendance or accessing lecture recordings and academic outcomes in a medical laboratory science course. BMC Medical Education, 20, Article 207. https://doi.org/10.1186/s12909-020-02066-9

Doggrell, S. (2020b). A systematic review of the relationship between lecture attendance and academic outcomes for students studying the human biosciences. International Journal of Innovation in Science and Mathematics Education, 28(1), 60-76. https://doi.org/10.30722/IJISME.28.01.005

Emahiser, J., Nguyen, J., Vanier, C., & Sadik, A. (2021). Study of live lecture attendance, student perceptions and expectations. Medical Science Educator, 31, 697-707. https://doi.org/10.1007/s40670-021-01236-8

Mak-van Der Vossen, M., van Mook, W., van Der Burgt, S., Kors, J., Ket, J. C., Croiset, G., & Kusurkar, R. (2017). Descriptors for unprofessional behaviours of medical students: A systematic review and categorisation. BMC Medical Education, 17, Article 164. https://doi.org/10.1186/s12909-017-0997-x

O’Sullivan, H., van Mook, W., Fewtrell, R., & Wass, V. (2012). Integrating professionalism into the curriculum: AMEE Guide No. 61. Medical Teacher, 34(2), e64-e77. https://doi.org/10.3109/0142159X.2012.655610

*Chan Choong Foong
Medical Education and Research Development Unit,
Faculty of Medicine, Universiti Malaya,
50603 Kuala Lumpur, Malaysia
Email: foongchanchoong@um.edu.my

Submitted: 6 May 2024
Accepted: 23 September 2024
Published online: 7 January, TAPS 2025, 10(1), 59-61
https://doi.org/10.29060/TAPS.2025-10-1/CS3339

Kye Mon Min Swe¹, Amit Bhardwaj² & Hnin Pwint Phyu³

¹School of Medicine, Newcastle University Medicine Malaysia, Malaysia; ²Department of Orthopaedics, Sengkang General Hospital, Singapore; ³M Kandiah Faculty of Medical and Health Science, University Tunku Abdul Rahman, Malaysia

Table 1. The Challenges and Benefits When Conducting Virtual Follow-up Home Visits

IV. DISCUSSION

Although the experiences of VF visits are challenging, medical students found the experiences valuable. The students found the importance of VF for chronic illness, which made them aware of the challenges and benefits of telemedicine. The challenges were similar to the studies from literature, such as technological difficulties, lack of familiarity with telehealth platforms, lack of access to internet or devices and sufficient internet connection speed, especially with patients with low socioeconomic status, which hinder effective communication and assessment. Moreover, patients with physical, cognitive, and language disabilities may find it hard to use the technology. Another challenge was the inability to perform an in-person clinical examination, and the students found less confidence in evaluating patient conditions through a screen, which impacted the quality of care delivered (Cheng et al., 2022; Pathipati et al., 2016).

To overcome these challenges, it is essential to provide comprehensive training focused on telehealth skills to familiarise students with virtual platforms and their functionalities. Additionally, implementing a mentorship programme or clinical attachment with telehealth practitioners guiding medical students during VF visits can foster confidence and communication skills. Encouraging regular feedback sessions will allow students to improve their techniques and address specific concerns in real-time.

As medical education shifts toward integrating telehealth, understanding the challenges students encounter is essential in preparing the next generation of healthcare professionals. The study identified a range of challenges, including technological barriers, such as unfamiliarity with telemedicine platforms, as well as issues related to patient engagement and communication. Medical students reported difficulties building rapport with patients, which is essential for effective follow-up, and expressed concerns regarding their ability to conduct comprehensive assessments virtually.

By documenting these challenges, this study contributes to the existing literature by highlighting medical students’ specific hurdles in the VF context. While experiencing the challenges, the VF visits allowed students exposed to various acute and chronic patient cases to learn about a holistic approach to managing chronic illness, work with teamwork, and have the opportunity to communicate with the patient and their family members. (Cheng et al., 2022; Iancu et al., 2020).

The findings inform educators and curriculum developers of the need for enhanced training programmes focusing on telehealth competencies. Physical follow-up visits have resumed following the pandemic, and a hybrid approach has been embraced to nurture telemedicine concepts and overcome challenges. It recommended medical institutions integrate telemedicine into curricula, ensuring today’s students are prepared for the evolving landscape of medical practice.

V. CONCLUSION

In conclusion, challenges exist in conducting virtual follow-up visits for chronic illness patients, targeting educational strategies to mitigate these difficulties. By equipping medical students with the necessary skills and support, healthcare institutions can enhance the effectiveness of virtual follow-ups, ultimately improving patient care and outcomes in a digital healthcare environment.

Notes on Contributors

Dr Kye is the corresponding author for this paper. She designed the study, analysed the data, and prepared the manuscript, working with the co-author.

Dr Amit and Dr Hnin contributed substantially to the final manuscript’s design, editing and preparation.

Ethical Approval

The research study was approved by Universiti Tunku Abdul Rahman Scientific and Ethical Review Committee on 20^th April 2021 (Approval number: UTAR/SERC/92/2021).

Acknowledgement

We would like to acknowledge the Year 4 medical students of UTAR (Academic Year 2020/2021) for voluntary participation in this study. 

Funding

There was no funding for this research study.

Declaration of Interest

The authors declare no conflicts of interest, including financial, consultant, institutional or other relationships.

References

Aron, J. A., Bulteel, A. J. B., Clayman, K. A., Cornett, J. A., Filtz, K., Heneghan, L., Hubbell, K. T., Huff, R., Richter, A. J., Yu, K., & Weil, H. F. (2020). A role for telemedicine in medical education during the COVID-19 pandemic. Academic Medicine, 95(11), e4-e5. https://doi.org/10.1097/ACM.0000000000003572

Cheng, C., Humphreys, H., & Kane, B. (2022). Transition to telehealth: Engaging medical students in telemedicine healthcare delivery. Irish Journal of Medical Science, 191, 2405-2422. https://doi.org/10.1007/s11845-021-02720-1

Iancu, A. M., Kemp, M. T., & Alam, H. B. (2020). Unmuting medical students’ education: Utilizing telemedicine during the COVID-19 pandemic and beyond. Journal of Medical Internet Research, 22(7), e19667. https://doi.org/10.2196/19667

Pathipati, A. S., Azad, T. D., & Jethwani, K. (2016). Telemedical education: Training digital natives in telemedicine. Journal of Medical Internet Research, 18(7), e193. https://doi.org/10.2196/ jmir.5534

Waseh, S., & Dicker, A. P. (2019). Telemedicine training in undergraduate medical education: Mixed methods review. JMIR Medical Education, 5(1), e12515. https://doi.org/10.2196/12515

*Dr Kye Mon Min Swe
Newcastle University Medicine Malaysia,
No 1, Jalan Sarjana 1,
Kota Ilmu, Educity@Iskandar,
Nusajaya, 79200, Johor, Malaysia
601115133799
Email: drkyemonfms@gmail.com

Submitted: 13 May 2024
Accepted: 26 August 2024
Published online: 7 January, TAPS 2025, 10(1), 62-64
https://doi.org/10.29060/TAPS.2025-10-1/CS3346

Daniel Ardian Soeselo^1,2, Rennie Yolanda³, Gisella Anastasia¹, Dwi Jani Juliawati¹ & Natalia Puspadewi¹

¹Medical Education Unit and ²Department of Surgery, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Indonesia; ³School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Indonesia

I. INTRODUCTION

Providing comprehensive palliative care is a global challenge, particularly in resource-limited settings like Indonesia (Putranto et al., 2017). Palliative care education in Indonesia is often underrepresented in medical curricula, leading to gaps in understanding and application among future healthcare professionals. This issue is compounded by the dominance of lecture-based classrooms from elementary to high school in Southeast Asia, including most medical education in Indonesia. Implementing a flipped classroom approach, which reverses traditional lecture-based and promotes active learning, could transform the education of healthcare professionals by effectively integrating surgery and palliative care within the Indonesian context (Hew & Lo, 2018).

The flipped classroom has rapidly developed in recent years, proving effective in medical education by enhancing learning performance and student satisfaction (Hew & Lo, 2018). While widely adopted in parts of Asia, particularly in Taiwan, Korea, and China (Ha et al., 2019), it remains less common in Southeast Asia, especially within medical education.

This study introduces a flipped classroom model to promote active learning and better knowledge retention, shifting the focus from traditional lecture-based teaching to student-centered learning. We aim to enhance the comprehension and application of palliative care principles among pre-clinical students.

II. METHODS

This study explores the novel use of a flipped classroom method to teach the role of surgery in palliative care, and assessed using the Kirkpatrick model (Heydari et al., 2019). Participants were preclinical students in the palliative care elective module at the School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia.

In the asynchronous stage, students were divided into four groups and given two medical journals and four trigger questions (Supplementary) one week before the synchronous class. They independently studied the material and discussed the questions in groups, submitting their answers to the facilitator a day before the synchronous session. During the synchronous stage, each group had 15 minutes to present their answers, followed by 45 minutes of interactive discussions with the facilitator using case simulations and videos. The facilitator is an experienced educator in palliative surgery.

Kirkpatrick level 1 evaluates student reactions to the learning experience at the end of class sessions using a questionnaire with a Likert scale and open-ended questions on learning materials (journals and trigger questions), learning time, active participation of students, and facilitators. Kirkpatrick level 2 evaluates student learning outcomes through five multiple-choice questions (MCQs). Questionnaires are available in Supplementary. The flipped classroom effectiveness was assessed based on multiple criteria, specifically the student’s interest in attending classes, encouragement to seek additional knowledge sources, active involvement, and motivation to study the material more deeply.

III. RESULTS

Thirty-three out of 37 students who attended the learning agreed to be included in the study. Each group comprises 9 to 10 people with a similar mean GPA (3.21 to 3.33). We assumed identical average GPA scores to mitigate any bias in the study toward students’ learning abilities. Table 1 shows students’ reactions to the learning experience (Kirkpatrick level 1).

Table 1. Student reactions evaluation (Kirkpatrick level 1) towards the flipped classroom method

*Mean Likert scale
SD = Standard Deviation

Most students spend 1 to 2 hours reading journals (19 students; 57.6%) and discussing in groups (20 students; 60.6%) respectively. Kirkpatrick level 2 evaluation was conducted using five multiple-choice questions administered at the end of the class. The difficulty levels of the questions were assessed, comprising 80% moderate and 20% easy questions. The evaluation results indicated that the average percentage of correct answers was 43.76%, reflecting an unsatisfactory outcome. Specifically, four out of the five questions had correct answer rates below 50%. These results suggest that the learning objectives were not effectively met, highlighting the need for further refinement of the flipped classroom approach and instructional methods to improve comprehension and retention of the material. The data of this study are openly available at https://doi.org/10.6084/m9.figshare.25594335.

IV. DISCUSSION

The flipped classroom method increased student interest in attending classes and deepened their study of the material. The learning materials encouraged students to seek additional knowledge, enhancing understanding and active participation. Most students strongly agreed that the trigger questions helped them understand the material and were satisfied with both the time given and the facilitators. However, active participation in the learning process was scored the lowest (3.90 ± 1.07 SD), with some students citing embarrassment, fear, and difficulty expressing opinions. Additionally, group discussions during the asynchronous stage, which were conducted online, made it difficult for students to unite ideas and draw conclusions from the discussions.

The learning outcome evaluation (Kirkpatrick level 2) revealed that most students answered four of five questions incorrectly, likely due to a lack of clinical experience. Interestingly, question number 2 was the most accurately answered, likely because it aligned with the theoretical principles of palliative learning.

These findings align with other studies demonstrating the flipped classroom enhances medical students’ learning outcomes and experiences (Nichat et al., 2023). Nichat et al. (2023) found that the flipped classroom promotes active learning by allowing students to study foundational concepts independently during the asynchronous stage and use class time for interactive discussions and collaborative activities, fostering critical thinking and collective analysis.

The challenges observed, such as the low active participation and difficulties in online group discussions, align with findings from Ha et al. (2019). Ha et al. (2019) highlighting that students in flipped classrooms may initially struggle with active engagement and online collaboration due to a lack of experience and confidence. Providing structured guidance during the asynchronous phase, such as online forums and regular check-ins with facilitators, could enhance student participation and collaboration.

The need for clinical experience to answer certain questions suggests that incorporating practical, scenario-based learning activities, such as simulations and role-playing exercises, could bridge this gap. This approach can help students apply theoretical knowledge in a clinical context, improving their readiness for practical evaluations (Hew & Lo, 2018; Nichat et al., 2023).

V. CONCLUSION

The flipped classroom method enhances critical thinking, communication, and reasoning skills, leading to higher student satisfaction and engagement. These findings highlight flipped classroom potential impact in Indonesian medical education. Addressing challenges through targeted interventions, such as clinical simulations and improved online collaboration, can further optimise its effectiveness for preclinical students.

Notes on Contributors

Daniel Ardian Soeselo designed the study, reviewed the literature, analysed the data, and gave feedback during manuscript writing.

Rennie Yolanda participated in data analysis and coding of the qualitative data, reviewed the literature, and wrote the manuscript.

Gisella Anastasia, Dwi Jani Juliawati, and Natalia Puspadewi reviewed the literature, provided input at all stages of the study, and reviewed the manuscript.

Ethical Approval

This research has received ethical approval from the Research Ethics Commission of the Atma Jaya Catholic University of Indonesia No. 13/10/KEP-FKIKUAJ/2022.

Acknowledgement

We would like to thank all the medical students who willingly cooperated in the study.

Funding

No funding was obtained for this study.

Declaration of Interest

All authors have no declaration of interest.

References

Ha, A. S., O’Reilly, J., Ng, J. Y. Y., & Zhang, J. H. (2019). Evaluating the flipped classroom approach in Asian higher education: Perspectives from students and teachers. Cogent Education, 6(1), Article 1638147. https://doi.org/10.1080/2331186X.2019.1638147

Hew, K. F., & Lo, C. K. (2018). Flipped classroom improves student learning in health professions education: A meta-analysis. BMC Medical Education, 18(1), 38. https://doi.org/10.1186/s12909-018-1144-z

Heydari, M. R., Taghva, F., Amini, M., & Delavari, S. (2019). Using Kirkpatrick’s model to measure the effect of a new teaching and learning methods workshop for health care staff. BMC Research Notes, 12(1), 388. https://doi.org/10.1186/s13104-019-4421-y

Nichat, A., Gajbe, U., Bankar, N. J., Singh, B. R., & Badge, A. K. (2023). Flipped classrooms in medical education: Improving learning outcomes and engaging students in critical thinking skills. Cureus, 15(11), Article e48199. https://doi.org/10.7759/cureus.48199

Putranto, R., Mudjaddid, E., Shatri, H., Adli, M., & Martina, D. (2017). Development and challenges of palliative care in Indonesia: Role of psychosomatic medicine. BioPsychoSocial Medicine, 11(1), 29. https://doi.org/10.1186/s13030-017-0114-8

*Daniel Ardian Soeselo
Atma Jaya Catholic University of Indonesia,
Jakarta, Indonesia
+62 813 8193 7250
E-mail: daniel.ardian@atmajaya.ac.id

Submitted: 5 June 2024
Accepted: 24 July 2024
Published online: 7 January, TAPS 2025, 10(1), 65-66
https://doi.org/10.29060/TAPS.2025-10-1/LE3428

Sulthan Al Rashid¹ & Mohmed Isaqali Karobari²

¹Department of Pharmacology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), India; ²Department of Dental Research, Centre for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), India

Dear Editor,

Comprehensive review articles require more than just gathering information; they require careful synthesis, analysis, and effective communication (Dhillon, 2022). Benjamin Bloom’s Taxonomy offers a systematic framework, guiding authors through remembering, understanding, applying, analysing, evaluating, and creating (Adams, 2015). Leveraging Bloom’s Taxonomy enriches writing, ensuring impactful and thorough reviews.

At the foundational level of remembering, authors embark on a meticulous literature search to gather pertinent studies. For instance, in a review exploring “Innovative Pedagogical Approaches in Medical Education,” authors meticulously scour databases such as PubMed and ERIC using keywords like “medical education” and “innovative teaching methods.”

In transitioning to Understanding, the authors synthesise the literature, identifying key concepts such as problem-based learning and simulation-based training. This enables a more profound comprehension of fundamental principles, such as how active learning strategies enhance student engagement and knowledge retention.

Applying involves contextualising synthesised information within broader educational frameworks. By referencing theories such as cognitive load theory, the authors elucidate how instructional design principles can optimise learning outcomes in medical education.

Analysis necessitates evaluating the strengths and weaknesses of existing educational practices. Despite the prevalent use of lecture-based teaching, the review highlights the benefits of active learning approaches in improving critical thinking skills and clinical reasoning among medical students.

During evaluation, authors assess the overall quality and significance of synthesised literature. While some studies demonstrate the effectiveness of flipped classroom models in medical education, others yield mixed results, underscoring the need for further research with rigorous methodologies.

Lastly, creating involves synthesising information to propose innovative educational interventions. Drawing insights from the review, the authors propose a comprehensive model illustrating the integration of technology-enhanced learning tools and interprofessional education strategies. Future research recommendations include exploring virtual reality simulations’ impact on clinical skill acquisition.

By embracing Bloom’s Taxonomy, writers adeptly navigate the complexities of review article writing with clarity and depth. This systematic approach empowers scholars to recapitulate existing literature and assess, integrate, and expand knowledge within the field, thereby enhancing the credibility and significance of scholarly endeavours in any educational field.

Notes on Contributors

Sulthan Al Rashid contributed to the concept, scientific content, data collection, and manuscript preparation.

Mohmed Isaqali Karobari helped with the review and editing of the manuscript.

The final manuscript has been read and approved by all the authors.

Acknowledgement

The authors would like to acknowledge the director of Saveetha Medical College and Hospital for support in this educational research.

Funding

For this study, the authors were not given any funding.

Declaration of Interest

The authors claim to have no conflicts of interest.

References

Adams, N. E. (2015). Bloom’s taxonomy of cognitive learning objectives. Journal of the Medical Library Association, 103(3), 152-153. https://doi.org/10.3163/1536-5050.103.3.010

Dhillon, P. (2022). How to write a good scientific review article. The FEBS Journal, 289(13), 3592-3602. https://doi.org/10.1111/febs.16565

*Sulthan Al Rashid
Department of Pharmacology,
Saveetha Medical College and Hospital,
Saveetha Institute of Medical & Technical Sciences (SIMATS),
Chennai, Tamil Nadu, India
+919629696523
Email: sulthanalrashid@gmail.com

https://doi.org/10.29060/TAPS.2025-10-1/TT001

Marcus A. Henning

Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, New Zealand

Whenever I think about student and faculty wellness, I am reminded of two sayings. Firstly, a Taoist saying that recommends we should always “look close, not far” (Wee Kee Jin, personal communication, August 25, 2012). And secondly, William Osler’s saying, “Our main business is not to see what lies dimly in the distance but to do what lies clearly at hand” (Bryan, 1997). Both quotes suggest that the most prudent course of action for students and faculty is to always reflect on one’s own actions and focus on the tasks at hand.

There is also a strong sense of reflecting in- and on-action, whereby students and faculty need to reflect on their experiences in a timely manner to optimise the opportunity for constructive transformation (Schon, 1983). With this in mind, monitoring wellbeing engenders the prospect of the cultivation of wellbeing. To engage this mindset, it is crucial that students and faculty are aware of, and honest about, what is happening in their minds and bodies and accept that mistakes can happen, but these experiences can lead to transformation, i.e., that they invest in loss (Buchanan, 2024).

Therefore, the core principle is to solve problems and be task-oriented on what needs to be done to solve any issues as they arise, rather than attributing blame and creating a shame and blame cycle. It is further crucial that students and faculty embrace help-seeking strategies to mitigate emotional exhaustion and proactively engage health professionals when things go awry (Dyrbye et al., 2015). The earlier this engagement occurs, the more likely the outcome will be positive.

Help-seeking strategies have attitudinal components but need to be seen as an essential part of developing common-sense wellbeing strategies that enable wellbeing. Other factors include healthy eating, living in favourable accommodation, exercising regularly, and ensuring optimal sleep patterns (Trockel et al., 2000). It is also crucial that students and faculty allow for a recovery period after experiencing stress-provoking incidents to allow them to return to a healthy state. If this recovery period is not initiated, it may lay the foundation for a worsening response to future adversarial stress incidents (Sisley et al., 2010).

To summarise, students and faculty need to monitor their health status on a daily basis, create strategies that will enhance their wellbeing, and be open to seeking help if things go awry.

 

Bryan, C. S. (1997). Osler: Inspirations from a great physician. New York: Oxford University Press. http://ci.nii.ac.jp/ncid/BA34173998

Buchanan, M. (2024, March 17). The Chinese secret of investing in loss (with Professor Cheng Man Ching). https://morganbuchanan.substack.com/p/the-chinese-secret-of-investing-in

Dyrbye, L. N., Eacker, A., Durning, S. J., Brazeau, C., Moutier, C., Massie, F. S., Satele, D., Sloan, J. A., & Shanafelt, T. D. (2015). The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Academic Medicine, 90(7), 961-969. https://doi.org/10.1097/acm.0000000000000655

Schon, D. A. (1983). The reflective practitioner: How professionals think in action. New York: Basic Books. https://stars.library.ucf.edu/cirs/1748/

Sisley, R., Henning, M. A., Hawken, S. J., & Moir, F. (2010). A conceptual model of workplace stress: The issue of accumulation and recovery and the health professional. New Zealand Journal of Employment Relations, 35(2), 3-15. https://aut.researchgateway.ac.nz/handle/10292/3011

Trockel, M. T., Barnes, M. D., & Egget, D. L. (2000). Health-related variables and academic performance among first-year college students: Implications for sleep and other behaviors. Journal of American College Health, 49(3), 125-131. https://doi.org/10.1080/07448480009596294

 

 

Submitted: 20 December 2023
Accepted: 22 July 2024
Published online: 7 January, TAPS 2025, 10(1), 53-55
https://doi.org/10.29060/TAPS.2025-10-1/PV3196

Galvin Sim Siang Lin¹ & Chan Choong Foong²

¹Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan Campus, Malaysia; ²Medical Education and Research Development Unit (MERDU), Faculty of Medicine, Universiti Malaya, Malaysia

We are writing to express our strong support for a crucial initiative aimed at improving health profession education, particularly in dental education. Dental education, like all healthcare fields, evolves continuously due to advances in research, technology, and patient expectations (Wong et al., 2020). Dental schools have a pivotal role in shaping the future of oral healthcare professionals, and the absence of such departments may hinder their ability to prepare competent, patient-focused dental professionals. Currently, curriculum development in dental education often faces challenges in keeping pace with the rapidly evolving landscape of oral healthcare. While dental schools are renowned for their rigorous curriculum and comprehensive clinical training, the development of effective teaching methods, curriculum enhancement, appropriate assessment, and faculty development often receive insufficient attention. This can lead to a gap between the skills and knowledge imparted to students and the demands of modern dental practice. Similarly, assessment practices may lack the sophistication needed to adequately evaluate students’ competence in areas beyond technical proficiency, such as communication skills, ethical considerations, and understanding of diversity, equity, and inclusion. Moreover, faculty development initiatives, while crucial for ensuring teaching quality and staying abreast of advancements in educational techniques, may be sporadic and lack a coordinated approach. In most countries, obtaining a professional dental qualification is a prerequisite for becoming a dental lecturer, without the need for an academic qualification in education. Therefore, it is essential to establish dedicated dental education departments with full-time academic members and to define job scopes (Nafea, 2021).

Historically, dental education may have been perceived as a part-time commitment for full-time dental academicians or dental specialists in the teaching fraternities. Some dental schools also established dental education committees comprising representatives from various departments within the dental schools. However, it has become increasingly evident that the dedication to progress within these committees is in jeopardy. This is mainly because each staff member carries their own teaching and administrative duties within their respective dental disciplines. The effective functioning of a dental education department necessitates a multidisciplinary team comprising individuals with diverse expertise and academic qualifications, encompassing dental sciences, educational sciences, and information technology. This diverse team is fundamental to the department’s ability to undertake various responsibilities, including curriculum development, assessment, evaluation, and faculty development. While the responsibilities of dental education departments may involve academic roles such as serving as workshop trainers and providing guidance to dental specialists in module design, it is crucial to distinguish their primarily academic nature from administrative functions. Unlike administrative roles that involve managing events for other trainers or handling paperwork for modules, dental education departments primarily contribute to the academic advancement of dental professionals.

Undeniably, establishing dental education departments within dental schools will foster innovation in teaching and learning methodologies. These departments can serve as hubs for researching and implementing effective pedagogical approaches, ensuring students receive the most up-to-date knowledge and skills. By integrating evidence-based educational techniques, dental schools can improve education quality, encourage active student engagement, and cultivate more competent and compassionate dental professionals. For instance, consider the implementation of team-based and case-based learning in dental education. A specialised department could spearhead research into the effectiveness of this methodology, develop protocols for its integration into the curriculum, and assess its impact on student outcomes. By doing so, the department contributes not only to the enrichment of teaching methods but also to the optimisation of the learning experience.

Furthermore, the dental education department can serve as a cornerstone for supporting faculty development. Recognising the indispensable role of faculty in educational excellence, these departments can facilitate tailored training programs, workshops, and collaborative research endeavours which would have a direct impact on the teaching quality (Irby et al., 2015). They empower educators to stay abreast of the latest teaching methods and scientific advancements. This, in turn, translates into an enriched student learning experience, with educators equipped to effectively inspire and guide the next generation of dental professionals. Consider a scenario where a dental education department collaborates with faculty to implement a novel assessment tool that evaluates not only technical proficiency but also communication skills and ethical considerations. This multidimensional approach not only aligns with the evolving expectations of the dental profession but also contributes to the holistic development of future dental practitioners.

Curriculum development and evaluation represent another critical sphere that stands to benefit profoundly from the establishment of dental education departments. In an era marked by transformative trends, dental schools must adapt to changing healthcare landscapes, incorporating digital dentistry, teledentistry, and cultural competence into their curricula. Dental education departments can lead curriculum reform efforts, ensuring graduates are not only well-versed in traditional dental practices but also adept in navigating the complexities of modern oral healthcare. For instance, envision a dental education department driving the integration of artificial intelligence applications into the dental curriculum. This would prepare students to leverage cutting-edge technologies, ensuring their readiness for a technologically advanced dental landscape (Islam et al., 2022).

In addition, these departments can also play an essential role in assessment and accreditation. In maintaining high education standards and ensuring that graduates are adequately prepared for licensure, dental education departments become custodians of public safety. They serve as a quality assurance mechanism, safeguarding the integrity of dental education and, by extension, the well-being of patients. Consider a scenario where a dental education department collaborates with accreditation bodies to develop robust assessment criteria that encompass not only clinical competence but also ethical considerations, cultural sensitivity, and effective communication skills. This holistic approach not only ensures the competency of graduates but also aligns dental education with the broader goals of promoting patient-centred care.

Dental education departments can also catalyse interdisciplinary research initiatives, fostering collaboration between dental and other healthcare disciplines. This approach encourages the development of holistic healthcare professionals who can work seamlessly within multidisciplinary teams (Yusoff et al., 2014). For example, the department can initiate research projects exploring the intersection of oral and systemic health, thereby promoting a more comprehensive understanding of the impact of dental care on overall well-being. Establishing these departments also encourages global collaboration with dental institutions, benefiting students and the wider dental community by sharing and exchanging knowledge and best practices. This exchange benefits students and the wider dental community by providing exposure to diverse perspectives and approaches to dental education. For example, international partnerships between dental education departments, lead to collaborative research projects, student exchange programs, and shared educational resources, enriching the educational experience for all involved.

The dental education department can lead educational initiatives by actively engaging in student enhancement programs. Through strategic leadership, the department can orchestrate initiatives beyond dental schools, collaborating with the broader university and healthcare communities to address learning issues among dental students. For instance, the department can organise learning-to-learn or peer-assisted learning workshops, providing diagnostic and interventional programs to academically at-risk students. By forging partnerships with external organisations, dental education departments can contribute to the development of outreach programmes that broaden dental training initiatives. This leadership includes advocating policy changes that prioritise the affective domain of dental training agendas and fostering a more comprehensive and inclusive approach to dentists’ professionalism. Hence, dental education departments not only enhance the visibility of dental training within the community but also contribute significantly to society’s overall well-being.

Nonetheless, establishing dental education departments necessitates collaboration among various stakeholders, including governments, dental associations, and educational institutions. Adequate funding, infrastructure, and faculty support are imperative for the successful realisation of these departments. This is not merely an investment in dental education; it is an investment in the future of dentistry itself. To underscore the urgency and significance of this proposal, it is essential for relevant authorities and stakeholders to engage in earnest deliberations and collaborative efforts. Dental education departments with a multidisciplinary team of full-time and academically qualified members should be considered as a requirement for accreditation. The establishment of specialised dental education departments is not a mere augmentation of existing structures; it is a forward-thinking move towards aligning dental education with society’s changing needs. It represents a collective commitment to nurturing a generation of dental professionals who are not only technically proficient but also adaptable, empathetic, and attuned to the complexities of modern healthcare. By customising dental programmes to include modules such as diversity, equity, and inclusion in dentistry as well as communication skills, this department can instil in future dental professionals a greater understanding of patient experiences, fostering empathy and comprehension within the dental profession.

In conclusion, the establishment of specialised dental education departments within dental schools is a transformative initiative that holds the potential to reshape the landscape of dental education. One approach is to send academic staff within the dental schools for postgraduate training in health profession education. By addressing the nuanced aspects of teaching, curriculum development, assessment, and faculty development, these departments can contribute to the holistic preparation of dental professionals. This is not just a need; it is a strategic imperative for championing progress in dental education and ensuring the delivery of high-quality oral healthcare to communities worldwide.

Notes on Contributors

Galvin Sim Siang Lin conceptualised and wrote the manuscript. Chan Choong Foong edited and revised the manuscript.

Funding

The authors received no financial support for the authorship or publication of this article.  

Declaration of Interest

There is no conflict of interest.

References

Irby, D. M., O’Sullivan P, S., & Steinert, Y. (2015). Is it time to recognize excellence in faculty development programs? Medical Teacher, 37(8), 705-706. https://doi.org/10.3109/0142159X.2015.1044954

Islam, N. M., Laughter, L., Sadid-Zadeh, R., Smith, C., Dolan, T. A., Crain, G., & Squarize, C. H. (2022). Adopting artificial intelligence in dental education: A model for academic leadership and innovation. Journal of Dental Education, 86(11), 1545-1551. https://doi.org/10.1002/jdd.13010

Nafea, E. T. (2021). The dental education specialism in KSA: Are we there yet? Journal of Taibah University Medical Sciences, 16(2), 217-223.

Wong, M. L., Lee, T. W. O., Allen, P. F., & Foong, K. W. C. (2020). Dental education in Singapore: A journey of 90 years and beyond. The Asia Pacific Scholar, 5(1), 3-7. https://doi.org/10.29060/taps.2020-5-1/gp1086

Yusoff, M. S. B., Abdul Rahim, A. F., & Jaa’far, R. (2014). Medical education department roles and initiatives towards achieving APEX agenda. Education in Medicine Journal, 6(2), e1-e7. https://doi.org/10.5959/eimj.v6i2.261

*Galvin Sim Siang Lin
International Islamic University Malaysia,
Kuantan Campus, 25200,
Pahang, Malaysia
Email: galvin@iium.edu.my

Submitted: 9 June 2024
Accepted: 16 July 2024
Published online: 7 January, TAPS 2025, 10(1), 67-68
https://doi.org/10.29060/TAPS.2025-10-1/LE3433

Virak Sorn

Faculty of Health Science and Biotechnology, University of Puthisastra, Cambodia

Dear Editor,

In conclusion, concerted efforts and coordinated actions are essential to successfully tackling the NCDs epidemic in Cambodia. Prioritising prevention, early detection, and comprehensive healthcare services will be key to curbing the impact of NCDs and improving the overall health and well-being of the Cambodian population.

Notes on Contributors

Sorn, V. wrote and edited the manuscript.

Acknowledgement

Sorn, V. would like to thank Menghourn Pin, who has always provided care over the years. Also, thank you to Bella Virak, who was my personal assistant when I wrote this paper.

Funding

There is no grant or funding involved for this paper.

Declaration of Interest

The author declares no conflict of interest.

References

Kulikov, A., Mehta, A., Tarlton, D., Grafton, D., & Aarsand, R. (2019). Prevention and control of noncommunicable diseases in Cambodia: The case for investment. United Nations Development Programme. https://cdn.who.int/media/docs/default-source/unitaf/cambodia-ic-report-final.pdf?sfvrsn=f14b8683_3&ua=1

World Health Organization. (2023). Noncommunicable diseases. https://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases

*Virak Sorn
#55, St. 184-180,
Sangkat BoeungRaing,
Khan Daun Penh,
Phnom Penh, Cambodia 12211
Faculty of Health Science and Biotechnology,
University of Puthisastra
Email: viraksorn2013@gmail.com

Submitted: 15 November 2023
Accepted: 1 August 2024
Published online: 7 January, TAPS 2025, 10(1), 17-26
https://doi.org/10.29060/TAPS.2025-10-1/OA3146

Eugene Kua¹, Sinead Kado⁴, Valsan Philip Verghese⁵, Pauline Wake⁶ & Amy Gray^1,2,3

¹Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, Australia; ²The Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Australia; ³The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia; ⁴Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Western Australia; ⁵Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, India; ⁶School of Medicine and Health Sciences, University of Papua New Guinea, National Capital District, Port Moresby, Papua New Guinea

Abstract

Introduction: COVID-19 pandemic disruptions to medical educational programs have been felt worldwide. However, little is understood about the experience of Low to Middle Income Countries’ (LMIC) and the impact of ensuing disruptions on medical education. We aimed to develop a collective understanding of this through the perspectives of individual LMIC educators, exploring how they continued to deliver undergraduate and postgraduate medical education in the context of pandemic barriers, by reflecting on their successes and shortcomings.

Methods: A phenomenological study was conducted with ten purposefully recruited educators involved in medical education from mainly the Asia-Pacific region. In-depth interviews via web-conferencing were conducted, and data analysed using Braun & Clarke’s (2006) framework. 

Results: Four major themes were identified: ‘Navigating Change, ‘Altered and Divided Teaching Roles and Spaces’, ‘Curricula Impact’ and ‘Challenges and Affordances of Remote Learning’. Educators described major disruptions to delivering medical education, particularly clinical education. Remote learning was the mainstay of facilitating continued education, often requiring investment into infrastructure that was non-existent pre-pandemic.

Conclusion: LMIC educators’ pandemic response have been robust in pursuit of continued medical education. Necessary adoption of online teaching approaches has provided avenues to close healthcare education gaps by facilitating improved reach and quality of medical education in these regions. Building on this requires strategies that meet LMICs areas of need, focusing on capacity building that sustains and grows new pedagogical practices.  We must ensure educational advances are equitable and accessible for all, identifying and supporting countries and contexts at risk of being left behind.

Keywords:           Low to Middle Income Countries, COVID-19, Medical Education, Remote Learning, Qualitative

Practice Highlights

• Educational ramifications from COVID-19 were most acutely discernible within the clinical domain.
• LMICs demonstrated resilient responses, despite their comparatively limited resource availability.
• The pandemic necessitated remote learning and heralded investment into infrastructure.
• Remote learning may provide a means of narrowing health disparities.
• COVID-19 practices of remote learning should be leveraged and supported in LMICs.

I. INTRODUCTION

Declared a global pandemic by the World Health Organisation in March 2020, COVID-19 has had significant global influences, impacting the social fabric and operations of everyday living (Cucinotta & Vanelli, 2020). Governments and institutions were required to re-examine and enforce changes to social procedures in light of the need for infection control, whilst also finding ways to minimise the negative impacts of disruptions to healthcare provision and medical education (Kaul et al., 2021).

The United Nations Secretary-General warned that COVID-19 disruptions to education threaten to cause a ‘generational catastrophe’, widening existing inequalities and stifling what established and evolving progress has been made (UNESCO, 2020). Medical education was not exempt. Indeed, in a global survey of 424 universities and higher education institutes by the International Association of Universities in early 2020, 59% had ceased campus activities and closed, with indications that LMICs were being hit harder, struggling and lagging in their responses and abilities to adapt compared to high income countries (HIC) counterparts (Marinoni et al., 2020).

Adaptations, challenges and impacts to medical education during the pandemic are well described in HICs (Dedeilia et al., 2020; Gallagher & Schleyer, 2020; Gill et al., 2020; Kachra & Brown, 2020; Kaul et al., 2021; Rose, 2020). LMIC narratives in comparison have been relatively isolated, and often represented by single institutions (Adesunkanmi et al., 2021; Aslan & Sayek, 2020; Cecilio-Fernandes et al., 2020; Fiorillo & Javed, 2021; Kalayasiri & Wainipitapong, 2021; Kanmounye & Esene, 2020; Sahi et al., 2020; Sandal et al., 2021; Tokuç & Varol, 2020). Collectively, what has happened to medical education in LMICs, particularly in contexts with fever resources, already stretched healthcare systems and concerns for slower transitions (Aishat et al., 2020; Cecilio-Fernandes et al., 2020; Gill et al., 2020; Sandal et al., 2021)?

This study aimed to answer this question by highlighting the experiences of educators in LMICs during the COVID-19 pandemic, through distilling common themes across various contexts. Through understanding their narratives of successes and shortcomings, we hope to advocate for future needs and highlight opportunities.

II. METHODS

A. Study Design

We conducted a qualitative study using a phenomenological approach involving semi-structured interviews to evaluate the ‘lived experience’ of medical educators in LMICs as they aimed to change, adapt and sustain the delivery of medical education during the pandemic. Interviews were conducted between 7^th July and 21^st October 2021. We sought to capture a range of contexts rather than an in-depth experience of a single site.

B. Inclusion and Exclusion

LMIC educators involved in undergraduate and postgraduate medical programs were the target population. We included educators from tertiary (pre-vocational) and clinical (post-graduate) settings in primary roles of teaching, curriculum development and education oversight. We defined LMIC using the economic bands of low, lower-middle or upper-middle as described by The World Bank for the financial years of 2020 and 2021(World Bank Group, 2021).

C. Data Collection and Analysis

Participants were identified using existing professional networks through purposeful (Côté & Turgeon, 2005; Giacomini & Cook, 2000) and convenience sampling (Etikan et al., 2016). Subsequently, snowball sampling was used whereby existing participants identified future participants from their own professional network. Recruitment was ongoing during the analysis phase until data saturation was achieved. Data saturation was determined through continuous analysis of data and iterative development and review of themes until no new concepts were interpreted.

Invitations to participate were sent via email including a written description of the research goals, study design, and a consent form. Ten consenting participants were scheduled for an interview at a time convenient to them. 

Consistent with phenomenological research (Van Manen, 2016), data was collected via in-depth semi-structured interviews.  Individual interviews were conducted using a guide comprising open ended questions in combination with prompts to ensure consistency of scope while maintaining flexibility to explore experiences raised by participants (Table 1). Key areas of focus included the impacts of the pandemic on medical education at undergraduate and postgraduate levels, strategies used to adapt education, their outcomes and the factors influencing success, and future opportunities.

All interviews were conducted via a password-protected, video-conferencing platform (Zoom, https://zoom.us/) by the principal investigator (EK) who had no pre-existing relationships with participants. Video interviews were conducted and audio-recorded for verbatim transcription. Initial impressions were recorded in the researcher’s journal during or immediately after the interview. Participants were given the opportunity to review written copies of their transcripts on request. There were no withdrawals or repeated interviews.

Thematic analysis of data drew upon both essentialist and constructionist approaches described by Braun and Clarke (Braun & Clarke, 2006), illustrating the lived realities whilst also exploring the impact of the COVID-19 pandemic on institutional operations and subsequent educational outcomes. Interview data was coded by the principal investigator and subsequently reviewed by the chief investigator (AG) to enhance reliability and reduce biases. Theme generation occurred using an inductive approach whereby theoretical concepts were derived from data without a pre-existing framework (Braun & Clarke, 2006). Themes were developed, analysed and refined through iterative consensus meetings between the principal and chief investigators. A selection of interviewees (PW, VV, SK) were subsequently invited to peer review findings to ensure their voices were represented. To ensure trustworthiness of findings, actions taken to address credibility, dependability, confirmability, transferability and reflexivity are outlined in Table 2.

Table 1. Question guide

Table 2. Ensuring trustworthiness

III. RESULTS

A total of 10 educators participated, representing perspectives from eight countries: Vietnam, India, Indonesia, Fiji, Solomon Island, Papua New Guinea, People’s Democratic Republic (PDR) of Lao and Nigeria. Educators had backgrounds in paediatrics, community medicine, internal medicine, anaesthesiology, public health/hospital management and educational leadership.

Four major themes were identified. These were ‘Navigating Change’, ‘Altered and Divided Teaching Roles and Spaces’, ‘Curricular Impact’ and ‘Challenges and Affordances of Remote Learning’.

A. Navigating Change

Educators described operating in a volatile landscape, where the fluctuations of the COVID-19 pandemic forced a dynamic interplay between health policy, health systems and educational institutions. Efforts to control infection rates meant lockdowns, mask wearing, travel restrictions, prevention of mass gatherings, curfews and social distancing precautions were universal experiences. Geographical variability existed in responses within countries to local COVID-19 severity, resulting in a heterogenous distribution of restrictions, and impacts on education.

“Because they [other Pacific Island nations] shut their borders so early, I think most of them have carried on as normal… So don’t think it’s been such a big impact for the other smaller Pacific Islands.”

(Fiji)

Frequent changes in hospital policy, operations and organisational structure meant educators and learners were operating in dynamic environments, at the mercy of redirection of workforce redistributions and space divisions. The dependence of medical curriculum on healthcare environments meant changes invariably influenced the provision of education, with clinical learning hit hardest. How this occurred varied between LMICs over time waves of the pandemic.

“So what happened is you have less number of inpatients, even the consults that we got called to see reduced… And now our (COVID-19) numbers have started coming down so we are going back to normal. So it’s like a cycle as far as numbers and clinical teaching is concerned.”

(India)

B. Altered and Divided Teaching Roles and Spaces

Educators described periods of restricted access to university campuses. Continuing face-to-face teaching was difficult, with examples of existing architectural spaces poorly adaptable to COVID-19-safe measures.

“…ventilation is not very good…it’s not set up for social distancing. Students are backed up in a room …20 centimetres distance between each other.”

(Indonesia)

Clinically, most educators described a spectrum of hospital access, from periods marked by complete cancelation of bedside teaching, to limited access necessitating modified clinical activities, reduced time and crowd limitations.

The move towards remote learning resulted in the delivery of education from home spaces. Here educators described major challenges regarding infrastructure. Successful initiatives included faculty-initiated needs surveys with subsequent provision of required infrastructure for the home. Alternatively, some universities provided spaces fully equipped with remote teaching equipment for use.

 “…we have a survey to all of the lecturers, what they need so that they can give the lecture from their home.”

(Indonesia)

Social distancing necessitated investment into new infrastructure. In PNG, educators described procuring screens to facilitate telehealth to aid medical practice both internally within hospitals and remotely with peripheral healthcare centres. Such technology would then be used for enhancing educational experiences.

“So we now have screens in all the classrooms where we can connect directly to internet ….So I can honestly tell you, we used to ask for it, it never happened. And when COVID-19 came it forced them to make it happen and we’re happy.”

(Papua New Guinea)

For educators with clinical responsibilities, pandemic medicine pulled human resources away from education, driven by re-deployment and personal illness. Capacity was impacted further by fatigue and psychological stress. Educators reported the absence of international trainees normally present to buffer workforce. However, educators employed by universities felt at times underused on the clinical side.

 “The teaching is still ongoing, but it’s not regular …for example, for the Department of Infectious Disease, the teacher has to take responsibility of the COVID-19 ward. So at the time bedside teaching is not that easy to do.”

(Lao PDR)

C. Curricular Impact: Deficiencies in Clinical Content, Assessment and Trusting the New Workforce, and Compensation in Delivery

1) Deficiencies in clinical content: Theoretical content lent itself well to remote learning approaches and was delivered without much disruption to academic calendars. In contrast, clinical education, dependent on availability of clinical spaces and patients, suffered and often occurred over reduced time frames in settings where the content landscape was different and deficient.

“So by the end of January, we called the students in for clinics, and they had their paediatric posting …. I think we had to cram everything into a period of approximately four weeks …it was a struggle to make sure that we had those cases.”

(India)

Cancellation of elective surgical cases resulted in a heavy skew towards emergency cases. Common medical presentations became rare and patient numbers shrank due to travel restrictions and reduced health-seeking behaviour, fostering both clerical and procedure poor environments. At both undergraduate and post-graduate levels, educators lamented this loss of clinical breadth, opportunities and authentic workplace experiences normally afforded to learners. Many expressed concerns about the effects on job-preparedness and skill acquisition of new graduates and those in specialty training.

“…my students couldn’t see like severe malnutrition or TB with spondylosis. Actually, we still have a lot, but I don’t know where these patients are! They disappeared!”

(Indonesia)

“For the current batch of interns, if someone says there’s no spleen, no liver palpable, you don’t trust. You know, it’s quite possible that they’ve missed it completely, because the only exposure they’ve had is anywhere between two to four weeks…”

(India)

The COVID learning environment was not without its own merits. Educators described those at the forefront of COVID-19 care experiencing increased learning opportunities and greater depth of learning via involvement and active management of cases on the clinical floor. Furthermore, it was also viewed by some as a valuable experience for future pandemic preparedness.

“The pandemic will teach the students what we have never taught …they become better clinicians than us when they are exposed to the similar kinds of situations in the future.”

(Papua New Guinea)

2) Assessment and trusting the new workforce: The aforementioned impacts of COVID-19 had flow-on effects on assessments resulting in postponement, modification, replacement by other assessment modalities or cancellation. Irrespective of this, ensuring a continued cycle of new graduates or subspecialists was paramount, particularly in areas of need both locally and regionally, and meant that regardless of the quality and quantity of education learners received, transitions (e.g., undergraduate to postgraduate, postgraduate to subspeciality) were pushed through. Whilst this ensured continuity of workforce, educators voiced concerns regarding clinical competencies of COVID-era cohorts.

“…we can’t delay graduation because we need interns. We need the workforce. …if we don’t conduct exams and we don’t take the next batch … after three years, we actually have nobody.”

(India)

3) Compensation in delivery: Endeavoring to minimise faced shortcomings, educators compensated by trialing and implementing various low to high resource strategies. Delivering education by aligning judicious use of space, crowd management, session timetabling and utilising windows of ‘normality’ was commonplace. Collaborative interdisciplinary relationships were fostered to account for reduced patient pools available for clinical learning/interactions and simulation was used in a couple of settings to make up for the paucity in procedural opportunities.

“We were sharing cases between units. If we had one heart disease, that child would have three clinics in a day by three different sets of people.”

(India)

Evaluating risk of disease versus the benefits of learning, vaccinated students in Papua New Guinea (PNG) who consented were able to continue clinical clerkship schedules with a degree of normality. Recognising a need for increased senior supervision of the post COVID-era workforce, periods of extended internship were also discussed allowing for a longer period of supervised upskilling.

“So what we’ve said to the other clinicians is that don’t worry, everyone’s in the same boat after COVID-19. So the Ministry of Health has said, okay, we’re going to make it a two year internship now, so that they get bit more supervision.”

(Fiji)

D) Challenges and Affordances of Remote Learning

1) Challenges: Educators described limited pre- COVID-19 experiences with remote learning, with little to no incorporation of online teaching in medical education curricula. Furthermore, pedagogical knowledge was limited, with educators often learning how to teach via process of trial and error and little feedback. Time to self-educate was identified as a limiting factor. For those who received support, utility was mixed from helpful to lacking expert guidance.

“…we don’t get any training, on how to use the IT and the tools that can help us teach. This is something that I had to learn on my own, to figure out how to do. So I guess that’s the other barrier, not having that support to help with the students’ virtual learning.”

(Fiji)

Educators describe initial apprehension amongst colleagues with regards to online education, rooted in discomforts around change and pitted against the inertia of entrenched concepts of what constitutes proper teaching. Many had persistent concerns about quality of education provided by online methods and expressed preferences for face-to-face learning – ‘…nothing is equal to the human touch’. Common challenges included limited ability to interact with students, gauge understanding and assess competency. Video cameras were often off due to challenges with bandwidth, and lecture slides were commonly viewed on small smartphone screens.

“But I’ve definitely got the negative people, you know, the cohort of the negatives who decide this is just too hard, you shouldn’t be teaching online …they keep quoting to me Osler …‘you can’t learn medicine without books, but neither can you learn just from the books, you need to have some patient contact.’”

(Fiji)

Despite most learners having some sort of device that could facilitate e-learning, internet reliability was a constraint, alongside prohibitive costs of required data. Acknowledging existing socioeconomic inequities affecting access, provisions for infrastructure, data and reliable connectivity were provided by some educational institutes for learners and teachers.

2) Affordances: For educators, the ability to rehearse and edit lectures was felt to improve the quality of teaching. Many appreciated flexibilities in scheduling and abilities to extend educational sessions beyond the limitations of time and place normally associated with face-to-face teaching. Increased geographical reach provided opportunities for individuals and communities, particularly those limited by location, to access education and expertise previously not available. Accessibility to both domestic and international expertise also helped improve learner engagement.

“… technology has become something that’s sort of changed in our practice …and still plays a vital role in in medical education in our country. And we are now able to reach people we’ve never reached before; we could not reach before. And that’s a good thing.”

(Papua New Guinea)

The ability to bridge international borders provided further opportunities to support and improve programs of domestic education and assessment through international collaboration. Through existing professional relationships, the anaesthetics department in PNG was able to organise fortnightly online teaching sessions to assist with the burden of teaching, as well as invite subspecialty specialists via videoconference to help examine their trainee candidates in viva assessment exams.

IV. DISCUSSION

This qualitative study investigated the impact of COVID-19 on medical education in LMICs from the perspective of medical educators who described how the pandemic transformed their educational landscapes. Curricular impacts were felt most in the clinical domain, and educators conveyed concerns regarding the quality of education during this time and what this meant for the capabilities of future healthcare workers and service provision. In the face of social distancing and contextual barriers unique to LMIC settings, educators looked towards remote learning as a largely successful bridging solution despite some difficulties in establishing and supporting this approach. In recognising remote learning affordances as we emerge from the pandemic, positive changes can be and have been made – how we continue to best support this is currently unclear.

Medical educators early on anticipated challenges related to educational continuity during COVID-19 (Rose, 2020), with narratives from study participants reflecting both the projected impacts and consequential experiences reported by other individual LMICs (Adesunkanmi et al., 2021; Aslan & Sayek, 2020; Cecilio-Fernandes et al., 2020; Connolly & Abdalla, 2022; Fiorillo & Javed, 2021; Kalayasiri & Wainipitapong, 2021; Kanmounye & Esene, 2020; Sahi et al., 2020; Sandal et al., 2021; Tokuç & Varol, 2020). Our study adds by highlighting baseline gaps in pedagogical knowledge of more modern educational techniques, exemplified by the struggles encountered during implementation of remote learning. Where needs for educator instruction were recognised, the extent to which these occurred was heterogeneous, relying on funding and available expertise, connections or partnerships.

Educators without existing collaborations were and continue to be relatively isolated in educational endeavours, whereas those with existing partnerships were enabled to capitalise on opportunity. Collaborations between LMIC educators are powerful initiating tools for grassroots change and for local educators to play leading roles in the development and sustainment of their own competencies and capacities (Al Shorbaji et al., 2015).  Common challenges faced by educators are best addressed by connecting, sharing and learning from each other. This can be facilitated by prioritising ongoing investment in communities of practice that ensures sustainability through fostering continued learning, growth and independence (Ramani et al., 2020). We found that despite societal schisms engendered by the pandemic, proximity among individuals and communities traditionally separated have perhaps closed owing to the pronounced emphasis on online interactions, enabling collaborations that otherwise may not have occurred.

Whilst it would be safe to assume that barriers introduced by pandemics are not general considerations in curriculum design, the COVID-19 pandemic has highlighted how deficiencies in the use of modern educational practices and the consequent severer interruptions to medical education in LMICs compared to HICs, have the potential to widen existing gaps in health outcomes (Chahine et al., 2018; Dattani et al., 2013; Hunter & Reddy, 2013; Marinoni et al., 2020; Mossialos et al.; Roser & Ritchie, 2013). The compensations and affordances – the success stories – described here by LMIC educators serve to highlight how familiarity with technology-assisted education can safeguard education particularly in times of social disorder.

COVID-19 crisis has thus also been a transformative moment for education in LMICs, particularly with the widespread adoption of remote learning, previously under-exploited in many regions (Al Shorbaji et al., 2015). Where the benefits of remote learning have been well described – cost effectiveness, accessibility, portability, coverage, scalability, adaptability and diversity (Al Shorbaji et al., 2015; Barteit et al., 2020; Papapanou et al., 2022) – its potential for ‘revolutionary’ change for medical education in LMICs depends on how changes are taken forward beyond the pandemic. There is an opportunity to close pre- and post-COVID-19 educational and health gaps through the affordances of remote learning via improving educational equity in regions where access to ongoing professional development and education programs have been limited both in quantity and quality (Barteit et al., 2020; Mack et al., 2017). In doing so we must consider context-specific strategies that foster fidelity, adaptability, longevity and accessibility (McLean et al., 2017).

Momentum is key.  We know that attitudes in the broader literature about the longevity of remote learning practices post-COVID 19 are mixed (Adesunkanmi et al., 2021; Motte-Signoret et al., 2021). Indeed, gaps in technology-aided education could widen as countries where remote learning was done well continue to consolidate and innovate such approaches, while those who struggled to adapt may revert to more traditional practices. Nevertheless, there is room for optimism as educators in our study, particularly those of the younger generation, were enthusiastic about the place of remote learning in the future of medical curricula. How then do we support these individuals in capitalising, championing, and sustaining forward momentum? We provide six considerations.

A. Invest in Technology Infrastructure

Prioritise investing in technology infrastructure to ensure reliable and equitable access to remote learning resources. This includes internet connectivity, hardware and spaces, and allocating funds to support remote learning initiatives.

B. Pedagogical Training

Pedagogical training and support that meets educators in LMICs to upskill and adapt teaching methods for remote learning practice, emphasising ongoing efforts to enhance local expertise.

C. Innovating Curriculum

Develop long-term strategies for integrating technology-assisted education into curricula. Remote learning should not be seen as a temporary solution but as a valuable tool for enhancing educational quality, accessibility and ultimately quality healthcare provision.

D. Foster Collaboration

Encourage collaboration and sharing between LMICs, and with HICs on knowledge, resources, and best practices in education. These partnerships can help bridge knowledge gaps and provide mentorship opportunities that link experienced educators with younger generations to champion change.

E. Communities of Practice

Development of communities of practice among educators particularly among LMIC counterparts. These groups can serve as platforms for sharing experiences, challenges, and innovative solutions, thus promoting ongoing learning and growth, which in turn promotes self-sustainability, local expertise and resourcefulness.

F. Stakeholder Engagement

Engage stakeholders at individual, institutional, national, and international levels to commit to and support remote learning initiatives. Collaboration between governments, educational institutions, and non-governmental organisations is essential.

This study has limitations. Whilst our aim is to provide an initial window of understanding into the collective experience of LMICs, we acknowledge that this study is non-exhaustive in capturing all variations in experience. Educators were recruited via convenience, purposeful and snowballing sampling resulting in an Asia-Pacific sample bias. Furthermore, we appreciate that not all medical educational institutes nor specialty departments are necessarily equal in resources and varied experiences may exist domestically. However, the key themes we identified were broad, recurred across all interviews and may be applicable to other LMIC jurisdictions through reader generalisability, that is, where themes resonate with the others. Another limitation was that student perspectives were not included our study. We acknowledge that educational experiences exist in duality between educator and learner and that understanding both will be paramount in developing high fidelity educational strategies (Kachra & Brown, 2020; Zaharias & Poylymenakou, 2009).

V. CONCLUSION

This study gives insight into the degree and scope of disruptions the COVID-19 pandemic had on the medical education landscape and the adaptive changes to medical educational systems implemented by educators in LMIC settings. Despite reduced capacity and infrastructure, LMICs demonstrated resourcefulness and robustness in continuing medical education in a time of health crisis. Our study brings to light the enthusiasm and commitment educators in LMICs have in improving the education that they provide.  With the quality of education intrinsically tied to health outcomes there remains a risk that countries that did not succeed in embedding online learning and teaching approaches will now fall behind on the educational landscape.  There is not just an opportunity but an onus to build on educational progress triggered by COVID-19, particularly that of remote learning methods, and ensure it is grown and sustained, but at the same time identify and assist those at risk of falling behind. 

Notes on Contributors

Dr. Eugene Kua contributed to study design, interviewing of study participants, coding of data, subsequent thematic analysis and paper write up.

Dr. Sinead Kado contributed by means data analysis through peer review, with supplementary contributions in the form of additional content enhancements to the paper.

Prof. Valsan Philip Verghese contributed by means data analysis through peer review, with supplementary contributions in the form of additional content enhancements to the paper.

Dr. Pauline Wake contributed by means data analysis through peer review, with supplementary contributions in the form of additional content enhancements to the paper.

A/Prof. Amy Gray contributed to study design, subsequent thematic analysis and paper write up and review.

Ethical Approval

This project was approved by The Royal Children’s Hospital Melbourne Human Research Ethics Committee (reference number 75258).

Data Availability

No consent was given to share transcript data.

Funding

No funding was provided in conducting this research.

Declaration of Interest

There is no competing interest to be declared.

References

Adesunkanmi, A. O., Ubom, A. E., Olasehinde, O., Wuraola, F. O., Ijarotimi, O. A., Okon, N. E., Ikimalo, J. I., Fasubaa, O. B., & Adesunkanmi, A. R. K. (2021). Impact of the COVID-19 pandemic on surgical residency training: Perspective from a low-middle income country. World Journal of Surgery, 45(1), 10-17. https://doi.org/10.1007/s00268-020-05826-2

Aishat, T. O., Oluwayemisi, T. F., Eniola, I. A., Omolola, O. A., Oluwatobiloba, D. O., & Adeseye, M. A. (2020). Challenges with medical education in Nigeria in the COVID-19 era. Pan African Medical Journal, 37(223). https://doi.org/10.11604/pamj.2020.37.223.26418

Al Shorbaji, N., Atun, R., Car, J., Majeed, A., Wheeler, E. L., Beck, D., Belisario, J. M., Cotič, Ž., George, P. P., & Hirvonen, H. (2015). eLearning for undergraduate health professional education: A systematic review informing a radical transformation of health workforce development. World Health Organisation.

Aslan, D., & Sayek, İ. (2020). We need to rethink on medical education for pandemic preparedness: lessons learnt from COVID-19. Balkan Medical Journal, 37(4), 178-179. https://doi.org/10.4274/balkanmedj.galenos.2020.2020.4.002  

Barteit, S., Guzek, D., Jahn, A., Bärnighausen, T., Jorge, M. M., & Neuhann, F. (2020). Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review. Computers & Education, 145, Article 103726. https://doi.org/10.1016/j.compedu.2019.103726  

Braun, V., & Clarke, V. (2006). Using thematic analysis in pyschology. Qualitative Health Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa  

Cecilio-Fernandes, D., Parisi, M., Santos, T., & Sandars, J. (2020). The COVID-19 pandemic and the challenge of using technology for medical education in low and middle income countries [version 1]. MedEdPublish, 9(74). https://doi.org/10.15694/mep.2020.000074.1

Chahine, S., Kulasegaram, K., Wright, S., Monteiro, S., Grierson, L. E. M., Barber, C., Sebok-Syer, S. S., McConnell, M., Yen, W., De Champlain, A., & Touchie, C. (2018). A call to investigate the relationship between education and health outcomes using big data. Academic Medicine, 93(6), 829-832. https://doi.org/10.1097/acm.0000000000002217

Connolly, N., & Abdalla, M. E. (2022). Impact of COVID-19 on medical education in different income countries: a scoping review of the literature. Medical Education Online, 27(1), 2040192. https://doi.org/10.1080/10872981.2022.2040192  

Côté, L., & Turgeon, J. (2005). Appraising qualitative research articles in medicine and medical education. Medical Teacher, 27(1), 71-75. https://doi.org/10.1080/01421590400016308

Cucinotta, D., & Vanelli, M. (2020). WHO declares COVID-19 a pandemic. Acta bio-medica : Atenei Parmensis, 91(1), 157-160. https://doi.org/10.23750/abm.v91i1.9397  

Dattani, S., Spooner, F., Roser, M., & Ritchie, H. (2013). Child and Infant Mortality. Our World in Data. Retrieved January 9, 2023, from https://ourworldindata.org/child-mortality [Online Resource]

Dedeilia, A., Sotiropoulos, M. G., Hanrahan, J. G., Janga, D., Dedeilias, P., & Sideris, M. (2020). Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review. In Vivo, 34(3 Suppl), 1603-1611. https://doi.org/10.21873/invivo.11950

Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1-4.

Fiorillo, A., & Javed, A. (2021). Education and training in psychiatry in low‐ and middle‐income countries during and after the COVID‐19 pandemic. Asia Pacific Psychiatry, 13(4), Article e12500. https://doi.org/10.1111/appy.12500  

Gallagher, T. H., & Schleyer, A. M. (2020). “We signed up for this!” — student and trainee responses to the Covid-19 pandemic. New England Journal of Medicine, 382(25), Article e96. https://doi.org/10.1056/NEJMp2005234  

Giacomini, M. K., & Cook, D. J. (2000). Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. Journal of the American Medical Association, 284(3), 357-362. https://doi.org/10.1001/jama.284.3.357  

Gill, D., Whitehead, C., & Wondimagegn, D. (2020). Challenges to medical education at a time of physical distancing. Lancet, 396(10244), 77-79. https://doi.org/10.1016/S0140-6736(20)31368-4

Hunter, D. J., & Reddy, K. S. (2013). Noncommunicable diseases. New England Journal of Medicine, 369(14), 1336-1343. https://doi.org/10.1056/NEJMra1109345  

Kachra, R., & Brown, A. (2020). The new normal: Medical education during and beyond the COVID-19 pandemic. Canadian Medical Education Journal, 11(6), e167-e169. https://doi.org/10.36834/cmej.70317  

Kalayasiri, R., & Wainipitapong, S. (2021). Training of psychiatry and mental health in a low- and middle-income country: Experience from Thailand before and after COVID-19 outbreak. Asia-Pacific Psychiatry, 13(4), Article e12493. https://doi.org/10.1111/appy.12493  

Kanmounye, U. S., & Esene, I. (2020). COVID-19 and neurosurgical education in Africa: Making lemonade from lemons. World Neurosurgery, 139, 732-733. https://doi.org/10.1016/j.wneu.2020.05.126

Kaul, V., Gallo de Moraes, A., Khateeb, D., Greenstein, Y., Winter, G., Chae, J., Stewart, N. H., Qadir, N., & Dangayach, N. S. (2021). Medical education during the COVID-19 pandemic. Chest, 159(5), 1949-1960. https://doi.org/10.1016/j.chest.2020.12.026

Mack, H. G., Golnik, K. C., Murray, N., & Filipe, H. P. (2017). Models for implementing continuing professional development programs in low-resource countries. MedEdPublish, 6(1).

Marinoni, G., Van’t Land, H., & Jensen, T. (2020). The impact of COVID-19 on higher education around the world. IAU global survey report, 23, 1-17.

McLean, M., McKimm, J., & Gibbs, T. (2017). Medical education in difficult circumstances: A global responsibility to contribute. Medical Teacher, 39(1), 4-6.

Motte-Signoret, E., Labbé, A., Benoist, G., Linglart, A., Gajdos, V., & Lapillonne, A. (2021). Perception of medical education by learners and teachers during the COVID-19 pandemic: A cross-sectional survey of online teaching. Medical Education Online, 26(1), 1919042. https://doi.org/10.1080/10872981.2021.1919042  

Papapanou, M., Routsi, E., Tsamakis, K., Fotis, L., Marinos, G., Lidoriki, I., Karamanou, M., Papaioannou, T. G., Tsiptsios, D., Smyrnis, N., Rizos, E., & Schizas, D. (2022). Medical education challenges and innovations during COVID-19 pandemic. Postgraduate Medical Journal, 98(1159), 321. https://doi.org/10.1136/postgradmedj-2021-140032

Ramani, S., McKimm, J., Thampy, H., O’Sullivan, P. S., Rogers, G. D., Turner, T. L., Chisolm, M. S., Kusurkar, R. A., Hays, R., Fornari, A., Kachur, E. K., Wilson, K. W., Filipe, H. P., & Schumacher, D. J. (2020). From clinical educators to educational scholars and leaders: Strategies for developing and advancing a career in health professions education. The clinical teacher, 17(5), 477-482.

Rose, S. (2020). Medical student education in the time of COVID-19. JAMA, 323(21), 2131-2132. https://doi.org/10.1001/jama.2020.5227

Sahi, P. K., Mishra, D., & Singh, T. (2020). Medical education Amid the COVID-19 pandemic. Indian Pediatrics, 57(7), 652-657. https://doi.org/10.1007/s13312-020-1894-7  

Sandal, S., Boyarsky, B. J., & Cantarovich, M. (2021). The higher impact of the COVID‐19 pandemic on resident/fellow training in low‐ and middle‐income countries. Transplant International, 34(5), 988-989. https://doi.org/10.1111/tri.13853  

Tokuç, B., & Varol, G. (2020). Medical education in Turkey in time of COVID-19. Balkan Medical Journal, 37(4), 180-181. https://doi.org/10.4274/balkanmedj.galenos.2020.2020.4.003 

UNESCO. (2020). Policy brief: education during COVID-19 and beyond. https://unsdg.un.org/sites/default/files/2020-08/sgpolicy_brief_covid-19_and_education_august_2020.pdf

Van Manen, M. (2016). Researching lived experience: Human science for an action sensitive pedagogy. Routledge.

World Bank Group. (2021). World Bank Country and Lending Groups – World Bank Data Help Desk. Retrieved December 16. 2021 from https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups

Zaharias, P., & Poylymenakou, A. (2009). Developing a usability evaluation method for e-learning applications: beyond functional usability. International Journal of Human–Computer Interaction, 25(1), 75-98. https://doi.org/10.1080/10447310802546716  

*Eugene Kua
Royal Children’s Hospital,
50 Flemington Rd,
Parkville VIC 3052
(+61) 411 224 125
Email: ekua12@gmail.com

Submitted: 20 May 2024
Accepted: 26 August 2024
Published online: 1 October, TAPS 2024, SP01, 17-18
https://doi.org/10.29060/TAPS.2024-SP01/SP006

Usanarat Anurathapan¹, Pongtong Puranitee¹, Samart Pakakasama¹, Suchin Worawichawong², Anant Khositseth¹ & Artit Ungkanont³

Departments of ¹Pediatrics, ²Pathology and ³Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

I. INTRODUCTION

Established in 1965, the Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, embodies the fundamental belief that students possess the capacity to bring about positive transformations for the betterment of society. The faculty has firmly ingrained the Western paradigm of critical thinking and a progressive mindset into the organisation after receiving funding from the Rockefeller Foundation. In order to provide students with comprehensive exposure to various aspects of healthcare in a favorable educational setting, the faculty made the decision in 2010 to construct a student-centered campus called Chakri Naruebodindra Medical Institute (CNMI). The primary objective of this initiative was to enhance the capabilities of graduates to bring about positive transformations in societal health. As the new campus developed, we revised our curriculum to improve competency-based learning. The program spans over a period of six years and consists of 1,200 medical students. Every year, the program admits 200 students who have completed high school. The curriculum incorporates integrated modules and focuses on achieving specific outcomes.

II. OUR CONTRIBUTION TO THE ASEAN MEDICAL DEANS’ SUMMIT

The Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, has continuously contributed to the ASEAN Medical Deans’ Summit meeting, sharing perspectives and experiences from the faculty’s representatives regarding medical education, research, accreditation, and international exchanges.

In 2020, during the COVID-19 pandemic, AMSN organised a series of international webinars aimed at sharing experiences and solutions about medical innovation and development, as well as medical education. Our faculty members gave two honorable speeches at the 9th ASEAN Medical School Network Virtual Conference. Asst. Prof. Tulyapruek Tawonsawatruk, M.D., Ph.D., shared his experiences conducting online assessments for clinical skills in orthopedics and Asst. Prof. Chusak Okascharoen shared his perspective on the transition to online learning: the Ramathibodi Experience. In 2021, Prof. Suradej Hongeng, our senior researcher and oncologist, joined the 10th ASEAN Medical Dean’s Summit Virtual Conference and gave a fruitful talk about Thai herbs in COVID-19 research.

In 2022, AMSN organised the Global Classroom Initiative, and our faculty supported the program with our two expert speakers, Asst. Prof. Dr. Sirintorn Chansirikarnjana and Dr. Prin Vathesatogkit, M.D., contributed as content experts on Alzheimer’s and Ischemic Heart Disease. These can encourage ASEAN medical students and professionals to gain knowledge and understanding about the diseases and apply it to managing their patients. In the same years, our faculty also contributed to the AMSN webinar series Assist. Prof. Komsan Kiatrungrit and Assoc. Prof. Teerapat Yingchoncharoen shared their experiences supporting student well-being, establishing the student well-being center, and discussing simulation-based training and clinical outcomes. In 2023, we supported our faculty representative and two medical students attending the AMSN meeting to present their research projects and traditional Thai dance, Loy Krathong.

Recently, in 2024, the Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, with Clinical Prof. Artit Ungkanont, M.D., Dean of the Faculty, hosted the ASEAN Medical Deans’ Summit (13th AMDS) and the 9th AMSN Board Meeting in conjunction with the TMEC 23rd Thai Medical Education Conference 2024. The meeting was successful and fruitful, with 55 AMSN member representatives from 19 institutions and 9 countries attending. During the AMSN meetings, members presented and discussed various topics, such as AI in Radiology at Mahidol-Siriraj Hospital, presented by Assoc. Prof. Trongtham Tongdee, Chairman of the Department of Radiology; The Road to Sustainable Medicine and Net Zero Healthcare by NUS presented by Prof. Nick Watts, the Director of the Centre for Sustainable Medicine; Dr. Coralie Therese D. Dimacali, M.D., Associate Dean for Academic Development, oversees the accreditation of medical schools in the Philippines at UPPGH College of Medicine highlighted the importance of essential research for nation building and health policy development at the UP-PGH College of Medicine; Harmonisation of Curricula Across ASEAN: Education without Borders by the University of Malaya presented by Prof. Dr. April Camilla Roslani, Dean, Faculty of Medicine, Universiti Malaya; Do Admission Scores into Medical School Predict Academic Performance in Medical Students? by Universiti Brunei Darussalam presented by Dr. Hjh Fazean Irdayati Binti Hj Idris. This TMEC, in conjunction with the AMSN meeting, has drawn significant attention from more than 1,000 international participants and provided a research-sharing platform with around 100 research presentations. Furthermore, it strengthened international medical student networking, with 42 medical students from 7 countries participating and shredding 8 outstanding projects during the meeting and performing their national traditional dances during the welcome dinner.

Our faculty has continuously contributed to the ASEAN Medical Deans’ Summit and has a solid intention to support the growth and development of the ASEAN medical school community.

Notes on Contributors

Usanarat Anurathapan, Suchin Worawichawong, and Pongtong Puranitee wrote the manuscripts. All authors read and edited the final version.

Acknowledgement

We would like to thank all students, administrative persons, and faculty members who contributed to or participated in activities related to the ASEAN Medical Deans’ Summit.

Funding

No funding agency contributed to this report.

Declaration of Interest

There is no conflict of interest to declare.

*Pongtong Puranitee
270 Rama VI Road,
Ratchathewi, Bangkok,
10400, Thailand
662-201-1000
Email: pongtongung@gmail.com,
pongtong.pur@mahidol.ac.th

Submitted: 25 April 2024
Accepted: 21 August 2024
Published online: 1 October, TAPS 2024, SP01, 11-13
https://doi.org/10.29060/TAPS.2024-SP01/SP004

Kenneth Yuh Yen Kok

Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Intsitute of Health Sciences, Universiti Brunei Darussalam, Brunei

I. INTRODUCTION

Formerly known as Institute of Medicine which was inaugurated in September 2000, the institute was renamed Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah (PAPRSB) Institute of Health Sciences in July 2009, after the integration of Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah College of Nursing with the Institute of Medicine. The institute was established in line with the vision of the Government of Brunei Darussalam to provide medical training not only to Brunei students but also to students from other parts of this region, as expressed by His Majesty the Sultan in his speech during the 12^th Universiti Brunei Darussalam (UBD) Convocation (Ramassamy, 2006).

The Institute started its first programmes in collaboration with established international universities. The Biomedical Science undergraduate programme was set up in 2001 in collaboration with University of Queensland, Australia which ran on until 2005. The Medicine programme was introduced in 2004 when the Institute offered students with articulation medical degrees with partner medical schools in Australia, Canada and the United Kingdom.

The programmes offered are products of a continuous review of the curricula. All the undergraduate and postgraduate programmes as well as diplomas have undergone regular enhancements and are now designed to encourage innovation and entrepreneurship, and for students to assume leadership roles, tempered with a keen awareness of the environment. UBD ensures that the Institute remains relevant and sensitive to the rapidly changing needs of the country and work closely with the Ministry of Health, Brunei Darussalam (Ministry of Health, 2000).

PAPRSB Institute of Health Sciences has been actively and continuously developing and upgrading all aspects of its resources. The facilities at the institute include Problem-Based Learning base rooms, seminar rooms, lecture theatres, research labs, clinical and communication skills suites, and an Anatomy Resource Centre. In June 2014 a new purpose built facilities containing state-of-the-art resources building was opened. The new extension building is equipped with a medical clinic, simulation centre, more research laboratories facilities as well as teaching facilities.  The simulation centre includes 5 simulation rooms with dedicated Emergency Bay, Medical Surgical Bay, and Operating Theatre Bay. There are 2 separate simulation rooms i.e. Maternity Bay, and Children Bay equipped with audio visual control system. In addition, there is an 8 bedded simulation ward. These facilities are being used for inter-professional education and they provide a focus for multidisciplinary clinical scenarios.

As the institute continues to expand and develop, every effort is being made to ensure that the it is aligned with the broader vision of UBD, which is to become a highly reputable University at the international level and to support the development needs of the various stakeholders, both nationally and regionally. 

UBD prides itself as a socially responsible university. Thus, the Bachelor of Health Science (Medicine) programme was designed with the needs of the country in mind whilst at the same time ensuring that the graduates of the programme are well trained and able to compete in the international arena. The involvement of various participating partner medical schools in several different countries ensures that future Brunei doctors graduate from a diverse training background. Enrolment of international students into this programme also provides cultural enrichment exercise whereby these students learn more about Brunei Darussalam, its people, our national philosophy of Malay Muslim Monarchy and its healthcare system.

The Medicine programme was developed by building on programmes that have already been organised by the PAPRSB Institute of Health Sciences and by working with established partner medical schools from various countries worldwide. The programme is conducted in 2 phases. The first phase consists of 3 years at UBD after which students are transferred to one of the Partner Medical Schools (PMS) for the second phase of the programme.  Having successfully completed the first phase of the programme at UBD, the students are awarded the Bachelor of Health Science (Medicine) degree. The award of this degree is a requirement for students to progress to the PMS to complete the final phase of the undergraduate medical programme, after which successful students graduate with degrees from the partner universities. In summary, a student who has completed the whole programme successfully would be awarded a double degree i.e. BHSc (UBD) and Medicine (PMS). Such an innovative move is part of institute’s plan to produce “clinician scientists” (and not just pure clinicians) for the future (UBD PAPRSB Institute of Health Sciences, 2024).

II. THE FOUNDING MEMBER OF ASEAN MEDICAL SCHOOL NETWORK

PAPRSB Institute of Health Sciences’ journey in ASEAN Medical School Network (AMSN) began with visionary institutions that laid the foundation for the AMSN. Along with the 11 esteemed institutions from Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam, PAPRSB Institute of Health Sciences became one of the Founding Members of AMSN. The network welcomed 8 new member institutions from Indonesia, Malaysia, Myanmar, Vietnam, Thailand and Singapore, with the current membership of 20 institutions from 10 ASEAN member states.

III. ASEAN MEDICAL DEAN’S SUMMIT

AMSN’s key initiative is the annual ASEAN Medical Deans’ Summit (AMDS). The AMDS seeks to cultivate collaboration among esteemed medical institutions in the ASEAN region, with a focus on advancing global standards in medical education and healthcare systems. Its primary goal is to lay the groundwork for unified action. The inaugural Summit took place in 2012 at Siriraj Hospital, Mahidol University in Bangkok, Thailand. It is customary for member institutions to host the Summit on a rotational basis. The 2^nd Summit was held in Malaysia in 2013, the 3^rd Summit in Singapore in 2014, the 4^th Summit in the Philippines in 2015, the 5^th Summit in Indonesia in 2016, the 6^th Summit in Myanmar in 2017, the 7^th Summit in Vietnam in 2018, and Brunei Darussalam proudly hosted the 8^th Summit in 2019. In 2020, the 9^th Summit was hosted virtually by Thailand adapting to the global travel restrictions imposed due to the COVID-19 pandemic, physical attendance was resumed in the 10^th Summit in Cambodia in 2021, the 11^th Summit was held in Lao PDR, the 12^th Summit in Malaysia, and most recently 13^th Summit in Thailand.

IV. 8TH ASEAN MEDICAL DEANS’ SUMMIT MEETING IN PAPRSB INSTITUTE OF HEALTH SCIENCES, UBD

From 23^rd to 24^th August 2019, PAPRSB Institute of Health Sciences, UBD hosted the 8^th ASEAN Medical Deans’ Summit meeting and it was attended by the executive members of 12-member institutes of AMSN. The 4th ASEAN Students’ Collaborative Project (ASCP) was also held in conjunction with the 8^th AMDS.

The theme of the 8^th AMDS meeting was “Inter-Professional Education and Mental Health Issues”, and it provided a platform for the sharing of views, practices and advances in inter-professional education and mental health issues within the ASEAN region. The meeting also covered the discussions on the quality of medical education across ASEAN countries, professional training following graduation and the promotion of research culture and international collaboration amongst AMDS members.

The 4^th ASCP showcased and highlighted the community projects conducted by medical, dental, and health sciences students from AMDS member institutes. This platform enabled the students to share their research interests, to experience knowledge enrichment in ASEAN medical education, and to exchange the culture among the students from various countries.

V. GLOBAL CLASSROOM INITIATIVES AND AMSN WEBINAR SERIES

Faculty members and students from PAPRSB Institute of Health Sciences regularly attend the Global Classroom Initiatives and AMSN Webinar Series. The Global Classroom Initiative, hosted by the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand provides a platform for esteemed speakers from AMSN to share their expertise through lectures on various topics.

The AMSN Webinar Series, which is hosted by National University of Singapore is a dynamic platform dedicated to facilitating collaboration within the AMSN community, sharing cutting-edge knowledge, and exchange of ideas and expertise from experts in the field. These engaging and informative webinars exemplify AMSN’s commitment to advancing medical knowledge and fostering collaboration within the ASEAN region.

Notes on Contributors

Kenneth Yuh Yen Kok MS wrote, reviewed and approved the manuscript.

Funding

There are no funding sources to disclose.

Declaration of Interest

The author declares no conflict of interests.

References

Ministry of Health. (2000). National Health Care Plan. Ministry of Health, Brunei Darussalam. https://www.moh.gov.bn/SitePages/original/National%20Health%20Care%20Plan.aspx

Ramassamy, R. (2006). Promoting health sciences in Brunei Darussalam. Brunei Darussalam Journal of Health, 1, 4-10. https://ihs.ubd.edu.bn/wp-content/uploads/2017/06/2006-v1-01-p04-10.pdf

*Kenneth Yuh Yen Kok
Jalan Tungku Link, BE1410,
Brunei Darussalam
Email: kenneth.kok@ubd.edu.bn