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      Pre-clinical remote undergraduate medical education during the COVID-19 pandemic: a survey study

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          Abstract

          Background

          The Coronavirus Disease 2019 (COVID-19) pandemic has necessitated a sudden transition to remote learning in medical schools. We aimed to assess perceptions of remote learning among pre-clinical medical students and subsequently to identify pros and cons of remote learning, as well as uncover gaps to address in ongoing curricular development.

          Methods

          A survey was distributed to first- and second-year medical students at the University of California San Diego School of Medicine in March 2020. Frequencies of responses to structured multiple-choice questions were compared regarding impacts of remote learning on quality of instruction and ability to participate, value of various remote learning resources, living environment, and preparedness for subsequent stages of training. Responses to open-ended questions about strengths and weaknesses of the remote curriculum and overall reflections were coded for thematic content.

          Results

          Of 268 students enrolled, 104 responded (53.7% of first-year students and 23.9% of second-year students). Overall, students felt that remote learning had negatively affected the quality of instruction and their ability to participate. Most (64.1%) preferred the flexibility of learning material at their own pace. Only 25.5% of respondents still felt connected to the medical school or classmates, and feelings of anxiety and isolation were noted negatives of remote learning. Most second-year students (56.7%) felt their preparation for the United States Medical Licensing Examination Step 1 exam was negatively affected, and 43.3% felt unprepared to begin clerkships. In narrative responses, most students appreciated the increased flexibility of remote learning, but they also identified several deficits that still need to be addressed, including digital fatigue, decreased ability to participate, and lack of clinical skills, laboratory, and hands-on learning.

          Conclusions

          Videocasted lectures uploaded in advance, electronic health record and telehealth training for students, and training for teaching faculty to increase technological fluency may be considered to optimize remote learning curricula.

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          Most cited references42

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          Barriers and solutions to online learning in medical education – an integrative review

          Background The aim of this study is to review the literature on known barriers and solutions that face educators when developing and implementing online learning programs for medical students and postgraduate trainees. Methods An integrative review was conducted over a three-month period by an inter-institutional research team. The search included ScienceDirect, Scopus, BioMedical, PubMed, Medline (EBSCO & Ovid), ERIC, LISA, EBSCO, Google Scholar, ProQuest A&I, ProQuest UK & Ireland, UL Institutional Repository (IR), UCDIR and the All Aboard Report. Search terms included online learning, medical educators, development, barriers, solutions and digital literacy. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed with inclusion/exclusion criteria. A consensus was drawn on which articles were included. Data appraisal was performed using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist and NHMRC Appraisal Evidence Matrix. Data extraction was completed using the Cochrane Data Extraction Form and a modified extraction tool. Results Of the 3101 abstracts identified from the search, ten full-text papers met the inclusion criteria. Data extraction was completed on seven papers of high methodological quality and on three lower quality papers. Findings suggest that the key barriers which affect the development and implementation of online learning in medical education include time constraints, poor technical skills, inadequate infrastructure, absence of institutional strategies and support and negative attitudes of all involved. Solutions to these include improved educator skills, incentives and reward for the time involved with development and delivery of online content, improved institutional strategies and support and positive attitude amongst all those involved in the development and delivery of online content. Conclusion This review has identified barriers and solutions amongst medical educators to the implementation of online learning in medical education. Results can be used to inform institutional and educator practice in the development of further online learning. Electronic supplementary material The online version of this article (10.1186/s12909-018-1240-0) contains supplementary material, which is available to authorized users.
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            The impact of E-learning in medical education.

            The authors provide an introduction to e-learning and its role in medical education by outlining key terms, the components of e-learning, the evidence for its effectiveness, faculty development needs for implementation, evaluation strategies for e-learning and its technology, and how e-learning might be considered evidence of academic scholarship. E-learning is the use of Internet technologies to enhance knowledge and performance. E-learning technologies offer learners control over content, learning sequence, pace of learning, time, and often media, allowing them to tailor their experiences to meet their personal learning objectives. In diverse medical education contexts, e-learning appears to be at least as effective as traditional instructor-led methods such as lectures. Students do not see e-learning as replacing traditional instructor-led training but as a complement to it, forming part of a blended-learning strategy. A developing infrastructure to support e-learning within medical education includes repositories, or digital libraries, to manage access to e-learning materials, consensus on technical standardization, and methods for peer review of these resources. E-learning presents numerous research opportunities for faculty, along with continuing challenges for documenting scholarship. Innovations in e-learning technologies point toward a revolution in education, allowing learning to be individualized (adaptive learning), enhancing learners' interactions with others (collaborative learning), and transforming the role of the teacher. The integration of e-learning into medical education can catalyze the shift toward applying adult learning theory, where educators will no longer serve mainly as the distributors of content, but will become more involved as facilitators of learning and assessors of competency.
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              Advantages, Limitations and Recommendations for online learning during COVID-19 pandemic era

              Objective: During COVID-19 pandemic, the institutions in Pakistan have started online learning. This study explores the perception of teachers and students regarding its advantages, limitations and recommendations. Methods: This qualitative case study was conducted from March to April 2020. Using maximum variation sampling, 12 faculty members and 12 students from University College of Medicine and University College of Dentistry, Lahore were invited to participate. Four focus group interviews, two each with the faculty and students of medicine and dentistry were carried out. Data were transcribed verbatim and thematically analyzed using Atlas Ti. Results: The advantages included remote learning, comfort, accessibility, while the limitations involved inefficiency and difficulty in maintaining academic integrity. The recommendations were to train faculty on using online modalities and developing lesson plan with reduced cognitive load and increased interactivities. Conclusion: The current study supports the use of online learning in medical and dental institutes, considering its various advantages. Online learning modalities encourage student-centered learning and they are easily manageable during this lockdown situation.
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                Author and article information

                Contributors
                linalander@health.ucsd.edu
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                6 January 2021
                6 January 2021
                2021
                : 21
                : 13
                Affiliations
                [1 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, School of Medicine, , University of California at San Diego, ; La Jolla, California USA
                [2 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, , University of California San Diego, ; La Jolla, CA USA
                [3 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Health Sciences Department of Biomedical Informatics, , University of California San Diego, ; La Jolla, CA USA
                [4 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Department of Surgery, Division of Otolaryngology/ Head and Neck Surgery, , University of California San Diego, ; La Jolla, California USA
                [5 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Department of Family Medicine and Public Health, , University of California San Diego, ; La Jolla, CA USA
                [6 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Division of Medical Education, School of Medicine, , University of California San Diego, ; 9500 Gilman Drive, MC-0606, La Jolla, CA 92093-0606 USA
                Author information
                http://orcid.org/0000-0002-6180-223X
                Article
                2445
                10.1186/s12909-020-02445-2
                7786143
                33407376
                0f240613-60f5-47f4-88b1-4b2f4f98bd42
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 29 May 2020
                : 10 December 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000092, U.S. National Library of Medicine;
                Award ID: T15LM011271
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Education
                covid-19,medical education,pre-clinical,distance learning,remote learning
                Education
                covid-19, medical education, pre-clinical, distance learning, remote learning

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