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: 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