Year : 2021 | Volume
: 26 | Issue : 2 | Page : 77--80
Disruptive change in medical education during the COVID-19 pandemic: Challenges and opportunities
Medha Anant Joshi1, Mathangi Damal Chandrasekar2,
1 Medical Education Unit, International Medical School, MSU, Bangalore Campus, Bengaluru, Karnataka, India
2 Department of Mind Body Medicine and Lifestyle Sciences, Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
Dr. Medha Anant Joshi
K 43, Shriram Sadhana Apartments, M.S. Ramaiah Road, Gokul, Bengaluru - 560 054, Karnataka
|How to cite this article:|
Joshi MA, Chandrasekar MD. Disruptive change in medical education during the COVID-19 pandemic: Challenges and opportunities.J Mahatma Gandhi Inst Med Sci 2021;26:77-80
|How to cite this URL:|
Joshi MA, Chandrasekar MD. Disruptive change in medical education during the COVID-19 pandemic: Challenges and opportunities. J Mahatma Gandhi Inst Med Sci [serial online] 2021 [cited 2022 Dec 5 ];26:77-80
Available from: https://www.jmgims.co.in/text.asp?2021/26/2/77/337441
The COVID-19 pandemic has challenged institutes of higher education in multiple ways, and medical education was no exception. Students had to be sent back home from campuses to restrict the spread of the virus. As the campuses were shut down, offline classes were suspended even in the districts where the effect of the pandemic was yet to be seen. To maintain the academic continuity, faculty members and students were asked to embrace the comparatively unknown territory of online teaching and expected to adapt to this new learning environment without any prior experience or training. Health professions education had other challenges too. Faculty members, both from the clinical and the preclinical disciplines, were asked to take up the additional responsibility of managing COVID-19 patients. The clinical training of students came to a standstill to maintain physical distancing and avoid unnecessary exposure to the viral infection. Both faculty members and students faced even more challenges, such as sharing of hardware with other family members, limited internet data, unreliable wi-fi connectivity, and additional housework.
Disruptive change such as this causes upheavals in the educational environment. One could either be disillusioned by not being able to function normally or view this change as an opportunity for transformation of the health professions education sector. A constructive, open debate on the long-term impact of the COVID-19 pandemic on health professions education is in order.
Impact of Shifting to Online Environment without Prior Preparation
Unfamiliarity with online teaching platforms and attempts to convert face-to-face lectures into online content were daunting tasks. It must be remembered that merely uploading PowerPoint slides onto a digital platform is just digitalization and not digital transformation. Unlike the planned courses that are offered online, where a lot of rigor goes into planning and preparing the course content, this hurried move to online teaching in response to the COVID-19 pandemic suffered a major setback in terms of quality. This has been labeled “emergency remote teaching (ERT)” to differentiate it from the regular fully online courses.,
Although some of the pedagogical and technological tools used in ERT and online teaching are similar, actual online teaching involves meticulously developed courses where interactions between the instructors, students, course materials, and peers are well planned. On the other hand, in ERT, the faculty member has to make a quick transition from synchronous face-to-face teaching to technology-dependent online teaching. Our faculty members took up this task and managed to deliver the cognitive content of the curriculum.
ERT also brought the urban and rural divide among students out into the open. Students residing in remote and rural areas were often unable to log in to synchronous online teaching sessions due to paucity of hardware, unpredictable internet connectivity, and interrupted power supply. Quite often, faculty members adjust their teaching based on students' body language and seek out verbal and nonverbal cues during traditional lectures. This aspect is totally lost while conducting ERT. Another shortcoming of ERT was that faculty members were initially unfamiliar with online apps such as Kahoot, Mentimeter, and other audience response systems that could be utilized to make their classes interactive. Introducing quizzes and short tests during the online sessions is one way of keeping the students engaged at the same time assessing their understanding. The lectures delivered in a monologue were not appreciated by students. They also missed the peer interaction that is an integral part of on-campus classes.
While most institutions and faculty moved to ERT very quickly to provide uninterrupted theory classes, clinical training suffered most during the lockdown period. Faculty had no clue about how to provide clinical training remotely. Although many faculty members came up with several innovations to train students in psychomotor skills remotely using part-trainers and simulators, this has not been successfully adopted by all the institutions. This might have been because the skill laboratories were not well equipped or faculty members were not proficient in employing the simulators for online psychomotor skills training. As the primary focus during the first lockdown period was patient care, the clinical training of students was the casualty.
We could learn from international medical schools that introduced undergraduate students to telemedicine and videoconferencing. Either standardized patients (who had already been trained in prepandemic times) or real patients were deployed to teach and assess history taking, communication skills, and critical thinking components of clinical and interpersonal skills in the virtual mode. The pandemic has highlighted the need to introduce online modules for undergraduate and postgraduate programs, and telemedicine could be one such module. Teleconsultation was approved as an accepted mode of consultation during the pandemic. Training both undergraduate and postgraduate students in this modality would prepare them for any unexpected disruptions faced in the future, locally or globally.
Assessment of student learning was another issue that was difficult to tackle during the lockdown period. Our education system depends so heavily on summative assessment that conducting theory examinations online was not viewed robust enough to make pass and fail decisions. The issues of plagiarism and academic dishonesty were difficult to handle and were a major obstacle in implementing online assessments. Many universities delayed the examinations till such time that the students could come back safely to the campus to appear for face-to-face examinations. Had we previously established a rigorous continuous assessment system, or implemented programmatic assessment, this dependence on summative assessment could have been overcome to a significant extent.
Incorporation of Technology to Transform Medical Education
Several innovative technologies that were introduced into medical education offered the promise of addressing educational challenges currently faced by medical educators. One such technology that assisted health professions educators in meeting the new challenge is the “virtual patient.” The “'virtual patient” is “an interactive computer simulation of real-life clinical scenarios for the purpose of healthcare and medical training, education, or assessment.” The Association of American Medical Colleges (2007) defined it as “a specific type of computer program that simulates real life clinical scenarios [through which] learners emulate the roles of health care providers to obtain a history, conduct a physical exam, and make diagnostic and therapeutic decisions.” It has been suggested that educational outcomes in competency-based medical education can be improved by using virtual patient (VP) strategies. VP educational strategies are well suited for teaching and assessing learning outcomes such as deep learning, mastery and lifelong learning, clinical reasoning, and reducing medical errors. These multimedia, screen-based, well-designed, and interactive VP-based learning activities could be incorporated for learning and assessment to improve learning outcomes as part of postpandemic clinical teaching. VPs could be used along with standardized patients or real patients.
One avenue for inter-disciplinary or inter-institutional research would be developing and sharing of VP scenarios and generating large amount of educational data to understand the educational outcomes better. One such area is application of learning analytics. It refers to the use of educational data to assess current performance and predict future performance. VP-generated learning data could be used to predict success or failure of students in specific domains such as clinical reasoning and clinical decision-making.
Now that the institutions are limping back to new normalcy, it is the right time to invest in robust, user-friendly learning management systems (LMS) and train the faculty members and students to use the same efficiently. It is also the right time for the administrators to capitalize on the experiences gained, develop faculty capabilities by introducing some online courses, and train the students to interact effectively with their peers and teachers online. Offering asynchronous modes of student learning can be an efficient way of developing analytical and critical thinking skills along with written communication skills. In the international accreditation framework, digital skills are considered essential skills to be taught and assessed. For our graduates to be globally viable, developing their skills in asynchronous learning will be of tremendous help.
Opportunities and Innovations during the Pandemic
The COVID-19 pandemic has opened up doors to many opportunities and innovations. It is certain that the pandemic will have a profound long-term impact on the educational sector, and it is the right time for educators to critically evaluate the potential for positive change. The secondary financial effects of the pandemic will be felt by the medical fraternity, both in the immediate period and in the long term. While the sudden shift to ERT implemented by medical teachers around the country sustained learning and student progression through the disaster, one must proceed with a word of caution. The process has thrown up questions, opportunities, and risks that will affect our educational practices in the long run and thus warrants reflection. Hence, we need to be well equipped to handle the aftermath of this sudden transition.
One such aspect of student learning is their inadequate clinical training. Undergraduate students have lost their clinical posting period. This might affect their subsequent training, especially for the final-year medical students. One way to ensure that adequate clinical exposure is provided is to extend the training by the period lost due to lockdown. Postgraduates from all disciplines were engaged in COVID ward duties and have missed out on their specialty training. Postgraduate surgical specialties suffered further as elective surgeries were not performed during the lockdown period, depriving them of hands-on experience of assisting surgeries. Extending their training period seems to be the only logical solution, though it might not be accepted easily by the student community. However, looking at the long-term effects of incompetent doctors on the community at large, such hard decisions might be inevitable.
The government and regulatory bodies in India have also taken multiple initiatives during the pandemic to make study material freely accessible through online educational resources, such as Study Webs of Active learning for Young Aspiring Minds (SWAYAM), MOOCs, Harvard University links, and Kaushal Setu. Although most of these resources are for non-medical topics, ethics- and research-related topics are getting incorporated into these, like the most sought-after basic course in biomedical research. Accreditation and ranking agencies have currently introduced metrics that also assess the quality and quantity of open-resource educational material developed by the faculty. The self-review process too has initiated in its metric the revision of curriculum and academic accountability schemes.
National Education Policy 2020 and Online Education
The National Education Policy (NEP) 2020 has a special focus on online education for maximizing the benefits of digital learning in India. The currently used online tools and platforms such as DIKSHA and SWAYAM are being upgraded with training content, in-class resources, assessment aids, profiles, etc., for seamless interaction. In addition, NEP 2020 focuses on creation of virtual laboratories in addition to making the content available in multiple languages. To promote all these, a dedicated unit of digital learning has been promoted under the Ministry of Education. The dedicated unit will comprise experts from the field of education, educational technology, administration, and e-governance who will focus on online learning needs of both the school and higher education, including online assessment and examinations. NEP is a clear indication of the commitment from the government to make digital education feasible across the country.
The present age is driven by digital technology, and the pandemic forced the shift toward this transition globally. Thus, the internet equipped both the education seeker and education provider and laid them together under the virtual roof, bringing in the concept of virtual classroom. Seamlessly, adapting and adopting this online technology in providing education are vital and are sure to gain its popularity among the general masses, making it more accessible to the less privileged groups in comparison to the centralized classroom education system.
Online education has thus emerged as a suitable alternative amid this chaos caused by the pandemic. Moreover, it has become more of a necessity rather than an option. Hence, the quality enhancement of online teaching–learning is at a very crucial stage. Accreditation and ranking agencies in India are therefore giving importance to both facilities for online education and quality of online content developed. In addition, the platform used and access to the content beyond the students of the institution are also taken into account, like the use of MOOCS.
The pandemic has made both the teachers and the taught become more technology savvy, being quick enough to acclimatize with computers, tablets, smartphones, various other learning technologies and platforms.
During this post-COVID period, academic institutions should utilize the online technology effectively and bring in the blended mode of learning instead of shifting back fully to only the face-to-face mode. This would inculcate self-directed learning among the learners and increase their involvement in the subjects/topics learned. Training the faculty to create online courses and utilize the LMS to its full capacity would increase the faculty confidence in developing online content. Making quality educational content on the MOOCs platform would enable the learners' access to quality education through experts and make our students globally competent. In addition, several free educational resources have been shared by concerned owners (such as www.pdfdrive.net, ProQuest, Wiley, McGraw Hill, online.infobaselearning.com, and YouTube). Local television channels telecast video lectures prepared by faculty of concerned Higher Education Institutions (HEIs).
Expertise gained through this online teaching–learning methodology should now be utilized by academic institutions to commence other fully online programs offered by developed countries, such as Coursera and EdX. This would not only enable students from across India to join these programmes from their place of comfort but would also welcome international students. Higher education institutions should also explore this opportunity to partner with institutions of repute both within India and abroad in developing common curricula and also offer joint academic programs.
The digital divide that exists both culturally and geographically is an area to focus on to avoid the educational gap between the rural and urban becoming wider due to use of digital education. This is a major challenge, and a multipronged approach is the need of the hour, where the government, educational institutions, and corporates need to join hands through a robust and comprehensive strategy. Hardware and software support will be required, as will adequate training to use these effectively in the learning process.
This pandemic has given us opportunities to study the effects of closure of institutions and the effects of moving to emergency remote teaching and assessment on educational administrators, faculty members, and students. This rich experience of various successful and not-so-successful innovations adapted by various stakeholders should be reflected upon and studied systematically to establish scientific basis for the innovations. This type of action research initiated at individual institutions will help the educators to learn from these lessons and apply this collectively.
The COVID-19 pandemic has put resource development and e-learning for continuing education on a fast track. However, it will be prudent to invest in these pedagogical innovations over the long term and continue utilizing them in addition to periodically upgrade and update the resources and technology. This pandemic has set the right tone toward investment in digital technologies for teaching–learning and patient care and has enabled and empowered regulators, educational experts, and professional associations to utilize them. This probably permanent paradigm shift in medical education has also taught educators to share their learning and develop shared repositories. This is in line with the NEP, one of whose core objectives is generating and sharing ideas. This small but important transition is laudable and an opportune moment to bring in the much-needed change in the delivery of medical education, especially in our country.
|1||Bozkurt A, Sharma RC. Emergency remote teaching in a time of global crisis due to CoronaVirus pandemic. Asian J Distance Educ 2020;15:i-vi.|
|2||Hodges C, Moore S, Lockee B, Trust T, Bond A. The difference between emergency remote teaching and online learning. Educ Rev 2020;27:1-9.|
|3||Henschen BL, Jasti H, Kisielewski M, Pincavage AT, Levine D. Teaching telemedicine in the COVID-19 era: A national survey of internal medicine clerkship directors. J Gen Intern Med 2021;36:3497-502.|
|4||Ellaway R, Candler C, Greene P, Smothers V. An Architectural Model for MedBiquitous Virtual Patients. Vol. 6. Baltimore, MD: MedBiquitous; 2006.|
|5||Berman NB, Durning SJ, Fischer MR, Huwendiek S, Triola MM. The role for virtual patients in the future of medical education. Acad Med 2016;91:1217-22.|
|6||Ellaway RH, Pusic MV, Galbraith RM, Cameron T. Developing the role of big data and analytics in health professional education. Med Teach 2014;36:216-22.|
|7||Khan AM, Patra S, Gupta P, Sharma AK, Jain AK. Rapid transition to online teaching program during COVID-19 lockdown: Experience from a medical college of India. J Educ Health Promot 2021;10:99.|
|8||Inda SS, Ravi Kumar K. Role of E-learning in quality assurance during COVID 19 pandemic: Challenges and the road ahead. Purushartha 2020;13:97-105.|
|9||Blouin D, Tekian A, Kamin C, Harris IB. The impact of accreditation on medical schools' processes. Med Educ 2018;52:182-91.|
|10||Available from: https://www.education.gov.in/sites/upload_files/mhrd/files/NEP_Final_English_0.pdf). [Last accessed on 2021 Oct 25].|
|11||Panditrao MM, Panditrao MM. National Education Policy 2020: What is in it for a student, a parent, a teacher, or us, as a higher education institution/university? Adesh Univ J Med Sci Res 2020;2:70-9.|
|12||Sahi PK, Mishra D, Singh T. Medical education amid the COVID-19 pandemic. Indian Pediatr 2020;57:652-7.|
|13||Chakraborty D, Biswas W. Motivating factors in a teacher's research and developmental activities and their impact on effective quality teaching in higher education institutions. J Appl Res High Educ 2019;12:609-32.|