Introduction
As the coronavirus (COVID-19) pandemic becomes widespread, its impact on society is
becoming more pervasive and is now threatening medical education. Numerous medical
schools have suspended all clinical placements and classes with the hopes of mitigating
viral transmission. The timing of this disruption is set to have profound consequences
as universities, particularly in the UK, are now conducting assessments remotely,
and some are considering deferring students due to the inability to carry out teaching
and clinical placements. Here, we discuss the different modes of teaching that may
be offered during this time.
Over the last several years, some medical schools have shifted from traditional forms
of ‘in-person’ lecture-based teaching to other modes, employing online, distance or
electronic learning [1]. Whilst not ideal, teleteaching or the delivery of live teaching
via online platforms may prove to be an apt solution to the cancellations that are
currently taking place. Rather than leaving students to their own devices, online
teaching guides student learning and places content within the overall context of
their curriculum. Currently, universities utilise lecture capture technology. However,
this is limited in its interactivity and ability for students to ask questions. Additionally, outside
of the current crisis many are worried that it may lead to empty lecture halls and
reduced participation, and often, the missed lectures are not caught up. Perhaps it
is now time for universities to consider utilising other modes of facilitating learning
such as live teleteaching video conference platforms whereby student engagement and
interactivity can be preserved, whilst observing appropriate COVID-19 social distancing
measures.
Teleteaching and Telemedicine
Whilst online platforms may be sufficient for students in their pre-clinical years,
senior medical students who are placed in clinical environments require patient contact.
Indeed, communication with and examination of patients is necessary for learning and
building a diagnostic clinical thought process, for as William Osler proclaimed, ‘He
who studies medicine without books sails an uncharted sea, but he who studies medicine
without patients does not go to sea at all’. As an alternative to clinical placements,
students at Imperial College London are being given access to an online repository
of patient interview recordings and cases. Many universities have released their clinical
academics to work in the National Health Service (NHS), and the acute timescale for
this event has meant that drastic reorganisation has needed to be done with little
time for actual teaching. However, Imperial clinicians are still delivering teleteaching
through computers on hospital sites, which have seen excellent student attendance and
interaction. Nonetheless, student-patient engagement is still necessary, and teleteaching
does not substitute actual patient contact. Patients have a multitude of pathologies
and present with varying signs and symptoms. They come with differing educational
backgrounds, each presenting with a unique challenge. By not being able to engage
with patients, developing key clinical skills will be more difficult. Whilst this
disruption may not affect senior students’ skills, younger years are more likely to
be adversely affected, as it is at this stage that their clinical foundation is set.
Rather than restricting student access to patients, telemedicine technologies may
be utilised. One such approach uses tablet computers which can be cleaned between
patients following appropriate infection control protocols. They can be used at sites
with a high risk of COVID-19 transmission; patients can be given a tablet and isolated
in an exam room. In turn, both students and physicians can communicate with these
patients without risking exposure to the pathogen and wasting personal protective
equipment [2]. Not only would this help clinical students to maintain and refine their
diagnostic thought process but could also allow them to aid healthcare systems by
reducing the burden of COVID-19 through the triage of patients. Healthcare provision
through telemedicine will become the mainstream in the coming years. Indeed, studies have
found that interaction with telemedicine technologies during undergraduate medical
training contributes to improved core competencies, medical knowledge, overall learning
and higher quality patient care [3].
Furthermore, examinations have suffered from cancellations. Students are examined
regularly throughout the course, and performances in different exams often have a
good correlation. In turn, examination disruptions in a single instance would not
alter the predictive ability of previous exams in assessing the competency of students.
As a compromise, some medical schools are turning to utilise tele-technologies in
order to conduct remote assessments in an effort to ensure that final year medical
students have met the required competencies before they begin to practise [4].
Looking to the future
A key educational dilemma involves looking at the length of the epidemic. If indeed,
as seems to be the case, it was set to last several months; this would lead to a substantial
loss of learning time for students and probable depreciation in confidence, although
the slight loss of clinical skills would likely be quickly rekindled once students
are back in a clinical environment. Importantly, throughout this crisis, what will
be ever-present is the use of textbooks. With the emergence of teleteaching platforms,
both can be combined to fill in the gaps that would otherwise normally be learned
from lecturers or clinicians on the wards. As a side note, learning should always
be placed in the modern context, and great novels of the plague, such as Daniel Defoe’s
Journal of the Plague Year, Manzoni’s The Betrothed, or Camus’s La Peste, can provide
students with highly relevant perspectives to the current predicament we find ourselves
in. This will not only illustrate why microbiologists have worried about ‘the big
one’ for so long but may even motivate students to pursue a career in infectious disease and
help in the prevention of futre outbreaks.
Conclusion
As healthcare systems are set to be further stretched with the increasing burden of
COVID-19, disruptions in medical education are inevitable across the world. Arrangements
need to be made whereby students can retain clinical skills and knowledge. Though
not without its problems, teleteaching technologies have the potential to substitute
in-person lecture and clinical-based teaching, particularly during this pandemic.
Such approaches may not only be necessary for effectively tackling the medical education
dilemma during this current crisis but will also serve to lay the foundation for teaching
during future disasters and beyond.