Letter
Open Access

Where is an experienced medical educator when you need one?

Ian Wilson[1], Pathiyil Ravi Shankar[1]

Institution: 1. International Medical University
Corresponding Author: Prof Ian Wilson ([email protected])
Categories: Education Management and Leadership, Teaching and Learning, Undergraduate/Graduate
Published Date: 10/08/2020
Keywords: Covid19; pandemic; adaption, medical education

Letter

Dear Editor

Change is often threatening because we must quickly adopt new modes and means of doing a task which are often contrary to our long-held beliefs and perceptions.  Rapid changes to education are occurring during the current corona virus disease-19 (COVID-19) pandemic when, in most places, face-to-face teaching and assessment are prohibited and teaching-learning and assessment must occur online (anon, 2020).

While lectures and tutorials are seen as practical to be conducted online, many academics are not able to conceive of teaching clinical skills or conducting high stakes examinations online.  For clinical academics who have little experience with the medical education literature it is hard to know where to begin. This is where the expertise of those in medical education is needed.

The International Medical University (IMU), of Malaysia has a dedicated, fully equipped centre for medical education which played an important role in sustaining teaching-learning and assessment during the ongoing pandemic. In Malaysia, government edict closed all university campuses and put a halt to any form of face-to-face teaching (anon, 2020).  Quite quickly online teaching was permitted and encouraged, and this model persists at the time of writing. This resulted in several international, national and local education sessions for staff being held online. The common topics designed to quickly build capacity among faculty members included creating quality presentations, facilitating sessions, teaching clinical skills and undertaking high stakes assessment including objective structured clinical examinations (OSCEs) online.

IMU has invested substantially in online learning and created an e-learning department, a learning management system and the software needed to offer courses online. The university had shifted many sessions to a blended format with resource persons facilitating sessions online with support from local rapporteurs during the recently concluded Ottawa -2020 conference. The challenge for the university was in shifting clinical teaching-learning and assessment online. The university had a well-equipped simulation centre and standardised patients for clinical teaching-learning.

Clinical teachers started exploring various solutions and began carefully considering options presented by educators.  Standardised patients were surveyed as to whether they would be prepared to work online with students.  A large proportion were, and they were particularly helpful with teaching communications skills and engagement in online sessions. Much use was made of existing videos and material on history taking and clinical examination available online.  Clinical examination skills were demonstrated, and students recorded themselves undertaking such skills for formative assessment and feedback by clinician teachers.  Finding family members willing to be used as “patients” was not always possible.  Over the last two months the clinical teachers developed a significant repertoire of techniques for teaching clinical skills. In preparing for this, teaching staff had to be prepared to work with students with poor internet connection (Jalli, n.d.).  This led to a focus on asynchronous presentations.

This process will enable students to return to the clinical setting with some ‘developed’ skills and will reduce the load of material that needs to be ‘assimilated’ in short intense teaching sessions once the situation improves.  This is particularly important for those medical students graduating at the end of this year and who will do their internship next year.

Again, the process of running examinations online, particularly high stakes examinations was seen as difficult, if not impossible.  While most were aware of proctoring systems for online examinations, the cost and student resistance (Zhou, 2020) were unexpected challenges.  Promotion of open book examinations with staff workshops exploring the processes involved went someway to overcoming the problem.

The combination of time-limited open-book examinations exploring higher-order cognitive skills, with a code of conduct and submission of examination material through a system such as Turn-it-in resolved many, but not all concerns. There is still a desire by some clinicians to defer all examinations until after the crisis when ‘traditional’ examinations with which they are familiar and in which they have confidence can be undertaken.

In working through the challenges brought by the COVID-19 pandemic we made use of the experience of educators in different contexts.  Experience with, for example, remote rural supervision in Australian General Practice training (Wearne, 2005), experience in the Malaysian and international contexts among others. We used the recording of patient-doctor consultations on tablets or smart phones for teaching students and trainee practitioners. Students submitted videos of consultations online for feedback and assessment from clinical preceptors. The preceptors with help from the educators have also developed a model for undertaking online OSCEs.

Addressing the crisis for the benefit of the students requires drawing on the experiences of staff and colleagues, adapting them for use in the current situation and finally disseminating them to staff who will use them. Studying, and adapting best practices from the literature can be helpful. The presence of an adequately staffed and equipped centre for education, resources for online learning and an open system of communication between faculty members, educators, educational technologists, administrators, and support staff involved is vitally important (Varpio et al., 2017).

Take Home Messages

  • During times of rapid change there are benefits of having experienced medical educators on staff.
  • Experience in broad aspects of medical education is very helpful in a crisis.

Notes On Contributors

Ian Wilson is an experienced medical educator in both undergradute and postgraduate fields.  He has recently started working for the International Medical University as director of IMU Centre for Education. ORCID: https://orcid.org/0000-0003-2603-2660

Ravi Shankar is an experienced medical educator, predominantly in undergraduate medciine.  He has particular expertise in teaching pharmacology.

Acknowledgements

None.

Bibliography/References

Anon. (2020) Malaysia cancels all Education Ministry programmes amid coronavirus fears. Available at: https://www.straitstimes.com/asia/se-asia/malaysia-cancels-all-education-ministry-programmes-amid-coronavirus-fears (Accessed: 19 May 2020).

 

Jalli, N. (n.d.) Lack of internet access in Southeast Asia poses challenges for students to study online amid COVID-19 pandemic. Available at: https://theconversation.com/lack-of-internet-access-in-southeast-asia-poses-challenges-for-students-to-study-online-amid-covid-19-pandemic-133787 (Accessed: 19 May 2020).

 

Varpio, L., Gruppen, L., Hu, W., O’Brien, B., et al. (2017) 'Working Definitions of the Roles and an Organizational Structure in Health Professions Education Scholarship: Initiating an International Conversation.' Academic Medicine, 92(2), pp 205-208. https://doi.org/10.1097/ACM.0000000000001367

 

Wearne, S. (2005) 'General practice supervision at a distance-is it remotely possible?' Australian Family Physician, 34, (12), Suppl: 31.

 

Zhou, N. (2020) Students alarmed at Australian universities' plan to use exam-monitoring software. Available at: https://www.theguardian.com/australia-news/2020/apr/20/concerns-raised-australian-universities-plan-use-proctorio-proctoru-exam-monitoring-software (Accessed: 19 May 2020).

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

Ethical approval was not required for this letter because it is not reporting research findings.

External Funding

This article has not had any External Funding

Reviews

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Wai Ching Lee - (27/08/2020)
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Interesting article, agree that in times of change - educators need to adapt fast and well to achieve the necessary learning objectives to benefit the students. It is very heartening to see that your university is immensely supportive to provide, train and grow the area of e-learning where in some areas it would be quite a big challenge.
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Tharin Phenwan - (24/08/2020) Panel Member Icon
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I enjoy reading this letter and can relate to these challenges that we are facing.
There are a lot that we need to adapt and improve, especially with asynchronous delivery methods i.e. how do we ensure that students can access the materials and engage as we want since some students do not have sufficient learning equipment. The lack of access to "patients" is another concern that we need to address and I am looking forward to the update from you.
Possible Conflict of Interest:

None

Sateesh Babu Arja - (15/08/2020) Panel Member Icon
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I really enjoyed reading this letter to the editor. This article is timely under the current circumstances. This paper reflects what we are doing. I teach clinical skills for the first-year and second-year medical students. We are using standardized patients teaching clinical skills online. We are also encouraging students to practice history taking skills and physical examination on their family members and friends. As authors mentioned relatives and friends are not available for all students. We are also involved in conducting online OSCE examinations for final year medical students which is a graduation requirement. The outcomes are not known yet as authors mentioned. But as a medical educator for fifteen years, I feel that we are doing the best under the current circumstances. But as we go on we learn from our experiences. Thank you.
Balakrishnan(Kichu) Nair - (12/08/2020) Panel Member Icon
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In these testing times, when students can not learn from patients , we have to be innovative. Medical educators all over the world are struggling to teach and assess senior medical students . We need them to be workforce -ready for next year . So this article is timely and provides some helpful advice . Evaluation from students ,and standardised patients would have been valuable . Hopefully this will be the next paper from this team.
Shazia Iqbal - (11/08/2020)
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The title of this letter just grabbed my attention because its the right time to engage medical educators for the sustainability of pedagogical changes in the current scenario. The authors have very well highlighted the current challenges and ongoing rapid adaptations in medical education management during the COVID-19 crisis.
International Medical University (IMU) has well managed the situation through a fully equipped center for medical education and e-learning department. However, the adjustments in distance clinical teaching and online assessments are extremely difficult, especially during the final year of the medical program. Moreover, the applicability is a great challenge in low resource countries in terms of massive investment in the development of e-learning units. We still need some practical and concrete solutions especially challenges related to clinical training and OSCE.
Authors' perspectives about the engagement of medical educators will not only be valuable to share distance teaching and online assessments but also be beneficial for improving the quality of medical education at the undergraduate level. The idea of the recording of patient-doctor consultations on tablets or smartphones for teaching students and trainee practitioners is very practical. I would suggest clinical academic faculty and medical educators to apply and test these adaptive measures mentioned in this letter. Good Luck