Abstract

Introduction: This article summarises a report published in July 2021 by Medical Deans Australia and New Zealand (Medical Deans), the peak body representing the 23 medical programs in Australia and New Zealand. It explores how medical schools responded to the early impacts of COVID-19 in 2020, and how they might build on some of the changes to achieve fundamental improvements in medical education in Australia and New Zealand.

Methods: The Medical Deans report was based on: Responses to a survey midway through 2020 of its member schools about their experiences during the initial lockdowns; the contributions of presenters at the Medical Deans 2020 Annual Conference; subsequent discussions among communities of practice.

Results: Innovations introduced in response to the pandemic, included greater equity of learning opportunities across geographical locations; health services taking more responsibility for clinical placements; greater emphasis on competencies and less on clinical rotations in specific disciplines; strong collaboration between medical schools, and with providers in the medical training and research pipeline. Challenges include balancing the benefits of online learning with the need for human connection and a chronic lack of clinical training opportunities in community-based care.

Conclusion: While the impact of the pandemic on medical education and training was costly for all involved – both financially and personally – the scale of disruption provided a unique opportunity for step change. To fully realise this potential moving forward, medical schools will need to work in partnership with all those involved: students, health services, prevocational training, specialist colleges, regulators and governments.

Abstract

Introduction: The COVID-19 pandemic forced medical schools worldwide to transition online. While there are ample reports about medical education adaptations to this crisis, there are limited studies evaluating the impact.

Methods: This study includes a case study of how Taiwanese medical school deans maintained in-person education during the COVID-19 pandemic. Additionally, it demonstrates how SWOT analyses can help medical educators reflect on adaptations during the COVID-19 pandemic and future crises.  This study employed two online surveys and a semi-structured interview regarding curricular adaptations. Eligible participants were deans or associate deans of all medical schools in Taiwan.

Results: Through a SWOT analysis, this study identified Strengths as strong leadership, prior experience with SARS, and ability to promptly adapt curriculum; Weaknesses as lack of faculty confidence in online education, limited numbers of administrative staff, and inability to rapidly add new topics; Opportunities as centralised anti-epidemic policies, inter-institutional collaborations, and educational innovations; and Threats as concerns from parents, patients, and teaching hospitals. It is reported that the quality of education was maintained as students’ evaluations of courses, performances in written exams, clerkship supervisors’ assessments, national OSCE, and national board exams remained comparable to pre-COVID times. Strengths and Opportunities such as strong leadership and centralised anti-epidemic policies can overcome Weaknesses and Threats, such as lack of confidence in online education and familial pressure to suspend hospital-based education.

Conclusion: This study recommends that medical school leaders conduct SWOT analyses as early as possible to plan strategies to continue safe and quality medical education during COVID-19 and future crises.

Abstract

Introduction: Personal protection in aerosol-generating procedures is an important skill to safely deliver care to patients in the COVID-19 pandemic. This aim of this study was to evaluate the impact of “just-in-time” simulation training for airway management in a suspected COVID-19 patient.

Methods: This was a prospective mixed-method cohort study in a tertiary paediatric department. A mandatory “just-in-time” simulation training session for intubation of a suspected COVID-19 patient was conducted. Pre- and post-simulation questionnaires were administered. Participants were invited to attend focus group interviews to further delineate their experience. Quantitative and qualitative methods were employed to analyse the data.

Results: Thirty-three participants, including doctors, nurses and respiratory therapists attended the training. Self-confidence in intubation, managing and leading a resuscitation team and dealing with problems with intubation significantly improved. Simulation was valued for the experiential learning as well as for increasing confidence and awareness. Process improvement suggestions from both participants and trainers were raised.  There was a small signal of skill translation to real life scenarios.

Conclusion: Simulation-based training is a useful tool for infectious disease outbreak preparedness. Further research will need to be done to determine the impact on actual clinical practice in pandemics.

Keywords:           Simulation, COVID-19, Pandemic Preparedness, Training, Intubation

Abstract

Introduction: Practicals are core components of an undergraduate health sciences curriculum to promote experiential learning and motivation in students. With restrictions on traditional forms of face-to-face practicals during the COVID-19 pandemic, we designed and investigated the efficacy of remote practicals as a viable learning strategy in exercise physiology teaching.

Methods: Student volunteers were instructed to perform a graded exercise test in a remote setting and provide their collected data for subsequent discussion in an online lecture. The effectiveness of this remote practical in promoting students’ motivation and learning outcomes achievement was assessed via an anonymous questionnaire containing 29 closed-ended and 2 open-ended items. Continual Assessment (CA) results were also investigated. Unpaired student’s t-tests were performed for comparisons between interventions with significance level set at P<0.05.

Results: Sixty-one (out of 81; 75%) students responded to the questionnaires and 49 (60%) consented to the use of their CA results for this study. Results revealed that students were moderately motivated and attained strong achievement of learning outcomes. When compared to students who did not volunteer for the hands-on component of the remote practical, students who participated in the hands-on component reported significantly higher self-efficacy (P<0.05) in explaining the practical procedures to their peers. Qualitative analysis further revealed that experiential learning and real-life data analysis were the central reasons supporting the effectiveness of the remote practical. Students were generally satisfied and would recommend the remote practical to future students.

Conclusion: Our study highlights the potential of remote practicals as viable alternatives to traditional practicals.

Keywords:           Remote Practical, Experiential Learning, Student Motivation, Learning Outcomes

Abstract

Introduction: Magnetic Resonance (MR) safety is critically important in any Radiology Department, and MR-related accidents are preventable. Serious games provide opportunities for learners to build MR safety awareness through play in an immersive learning environment by using simulated scenarios such as screening virtual patients and managing an MR-related accident.

Methods: We developed a serious game, in partnership with a game developer, introducing MR safety concepts to learners as they navigate through a virtual 3D Radiology department. Drag-and-drop minigames are incorporated to aid the learner to identify hazards in and around the MR environment. Virtual patients are placed in waiting areas to provide realism, and learners are tasked to screen them as part of MR Safety Screening checks. A simulation of an MR-related accident prompts learners to make decisions or take actions to ensure safety and mitigate further risks during the accident. The learner also role-plays as a Risk Officer to identify the multiple key incidents that led to the accident. These formative assessments, with instantaneous feedback, assesses the learners’ knowledge of MR safety.

Results: Pilot feedback of this serious game revealed that it is realistic, engaging and relatable. The instructions within the game were clear and aided learning. The game has also been scaled up and customised for the radiology departments of 3 other healthcare institutions.

Conclusion: Serious games provide a training solution to raise MR safety awareness by simulating real-life scenarios in an immersive learning environment. It supplements face-to-face training and is scalable to other healthcare institutions.

Keywords:           Medical Education, Technology-Enhanced Learning, Gamification, MR Safety, Workplace Safety, Simulation

Abstract

Introduction: Advanced Cardiac Life Support (ACLS) course is one of the mandatory certifications for the majority of medical as well as some nursing professionals. There are, however, multiple variations in its instruction model worldwide.  We aim to evaluate the efficacy of traditional ACLS course versus a hybrid ACLS course utilised during the COVID-19 pandemic.

Methods: This retrospective study was carried out at SingHealth Duke-NUS Institute of Medical Simulation using course results of participants in the centre’s ACLS course between May to October 2019 for the traditional course were compared with participants attending the hybrid course from February to June 2021.

Results: A total of 925 participants were recruited during the study period. Of these, 626 participants were from the traditional group and 299 participants were from the hybrid learning group. There is no statistically significant difference between the two group (χ²=1.02 p = 0.313) in terms of first pass attempts; first pass attempt at MCQ (p=0.805) and first pass attempt at practical stations (p=0.408). However, there was statistically significant difference between the mean difference in results of traditional vs hybrid MCQ score, -0.29 (95% CI: -0.57 to -0.01, p=0.0409). Finally, senior doctors were also found to perform better than junior doctors in both traditional (p=0.0235) and hybrid courses (p=0.0309) at the first pass attempt of ACLS certification.

Conclusion: Participants in the hybrid ACLS course demonstrated at least equal overall proficiency in certification of ACLS as compared to the traditional instruction.

Keywords:           Advanced Cardiac Life Support, Teaching Model, COVID-19, Hybrid Learning

Abstract

Introduction: Medical students (MS) may lack the knowledge and experience in performing basic surgical skills (BSS) when they first commence their postgraduate surgical training. We conducted a pilot BSS workshop with specific learning outcomes for MS.

Methods: Our BSS workshop program consisted of reading the pre-workshop online modules, watching the instructional videos of skills demonstration, and completing the pre-workshop multiple-choice questions (MCQ). MS attended the onsite workshop a week later, which consisted of a basic surgical theory lecture, live demonstration of the skills by the teaching faculty and, supervised skills training coupled with feedback. Surgical skills taught were knot tying, suturing techniques, laparoscopic peg transfer, precision cutting, application of endoloop ties. A standardised surgical skills rubric was used to assess the competency and safety of BSS. A post-workshop MCQ was administered to assess the knowledge learned. The criteria for successful completion of BSS were a satisfactory grade in the surgical skills assessment and a pass score in the MCQ.

Results: All the participating MS achieved a satisfactory grade in the surgical skills assessment and passed the MCQ. Several pedagogical methods were used to enhance knowledge learning and practical skills competency including a flipped classroom in blended learning, technology-enhanced learning, kinesthetic learning, and providing effective feedback.

Conclusion: MS taught in BSS workshop can achieve competency in knowledge, skills, safe attitude and prepare them for future postgraduate surgical training. In the current COVID-19 pandemic, our challenge is to develop similar BSS in a safe environment using technology-enhanced tools such as online instructional videos and online feedback.

Keywords:           Assessment, Basic Surgical Skills, Competency, Feedback, Medical Students, Outcome-based Education

Abstract

Introduction: Personal statements are important documents in the admission and programme application processes, including international elective programmes, in medical education. However, writing these is challenging for international applicants not only because of their unfamiliarity with this genre but also their English academic writing skills. This study aims to explore the organisation and elaboration of text in personal statements written by Japanese medical students for international elective programme application.

Methods: Drawing on genre analysis, the first draft of personal statements written by eight fifth-year medical students at a Japanese university were analysed. The text data were deductively classified into moves and steps, using Chiu’s framework of the personal statement genre.

Results: In the introduction, Japanese medical students commonly described the context and issues of healthcare in Japan and the future goals for physicians. In the move of the relevant background, it was notable that six out of eight personal statements showed personality. Although a range of moves was covered when writing about the reasons for applying, only two students described their understanding of programmes and institutional attributes. In the move of conclusion, they focused more on writing their goals of future success and contribution to the course. Furthermore, no applicant expressed self-promotion and praise for academics, programmes, and institutions.

Conclusion: The findings of this study can provide a springboard for the development of support for Japanese students’ academic writing in English in medical education across cultures.

Keywords:           Medical Education, International Electives, Personal Statement, Genre Analysis, Discourse, Rhetorical Patterns, Written Communication

Abstract

Introduction: The transition from medical student to houseman is well recognised as a stressful period for newly qualified doctors. This stress is likely to be heightened when the transition occurs during a pandemic. We aimed to evaluate the perceived stress levels of housemen as they begin housemanship and explore their sentiments and preparedness in starting work amidst the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Housemen starting work at a tertiary institution in Singapore in May 2020 completed the following: (1) Perceived Stress Scale, (2) open-ended questions on perceived challenges and concerns and (3) questionnaire on preparedness and confidence in starting work. Descriptive statistics were used to analyse quantitative data and modified thematic analysis performed for qualitative data.

Results: Sixty-one housemen participated. Thirty-five (57.4%) reported high perceived stress. The themes for perceived challenges in this transition included coping with constant change, lack of reliable information from authorities, dealing with disappointment, physical fatigue, and loss of autonomy. The themes for concerns in beginning housemanship elicited relate to clinical competence, transitioning into new responsibilities, risk of infection with COVID-19, senior expectations, physical fatigue and training-related concerns. Despite these challenges and concerns, housemen were prepared to begin work during this pandemic.

Conclusion: Housemen transitioning during this pandemic experienced additional stressors and unique challenges pertaining to working in a pandemic. Encouragingly, they remain prepared to start work. Institutions and departments should be mindful of the specific concerns and challenges so that appropriate support can be put in place to support these junior doctors.

Keywords:            COVID-19, Junior Doctor, Intern, Pandemic, Challenges, Preparedness

Although there have been many calls for dental education to move to comprehensive training, many have remained in rhetoric. However, recently the strategic analysis of the American Dental Association of Education recommended a curriculum transformation to engage students in life-long learning and nurturing an educational community with well-qualified teachers to mentor students and model the values of the profession (Formicola et al., 2018).