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      Challenges and Opportunities of Preclinical Medical Education: COVID-19 Crisis and Beyond

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          Abstract

          COVID-19 pandemic has disrupted face-to-face teaching in medical schools globally. The use of remote learning as an emergency measure has affected students, faculty, support staff, and administrators. The aim of this narrative review paper is to examine the challenges and opportunities faced by medical schools in implementing remote learning for basic science teaching in response to the COVID-19 crisis. We searched relevant literature in PubMed, Scopus, and Google Scholar using specific keywords, e.g., “COVID-19 pandemic,” “preclinical medical education,” “online learning,” “remote learning,” “challenges,” and “opportunities.” The pandemic has posed several challenges to premedical education (e.g., suspension of face-to-face teaching, lack of cadaveric dissections, and practical/laboratory sessions) but has provided many opportunities as well, such as the incorporation of online learning in the curriculum and upskilling and reskilling in new technologies. To date, many medical schools have successfully transitioned their educational environment to emergency remote teaching and assessments. During COVID-19 crisis, the preclinical phase of medical curricula has successfully introduced the novel culture of “online home learning” using technology-oriented innovations, which may extend to post-COVID era to maintain teaching and learning in medical education. However, the lack of hands-on training in the preclinical years may have serious implications on the training of the current cohort of students, and they may struggle later in the clinical years. The use of emergent technology (e.g., artificial intelligence for adaptive learning, virtual simulation, and telehealth) for education is most likely to be indispensable components of the transformative change and post-COVID medical education.

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          Most cited references 26

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          COVID-19 and medical education

          The coronavirus disease 2019 (COVID-19) outbreak has rapidly transitioned into a worldwide pandemic. This development has had serious implications for public institutions and raises particular questions for medical schools. Frequent rotations between departments and hospitals make medical students potential vectors for COVID-19. Equally, as trainee doctors we stand to learn a tremendous amount and can contribute to the care of patients. More immediate concerns among medical students centre on the impact of COVID-19 on medical education. A substantial number of medical students are in the process of preparing for or undertaking assessments that require clinical exposure. The effect of COVID-19 on medical education could therefore be considerable. Several teaching hospitals in the UK have reported cases of COVID-19, with some hospitals suspending medical and observership students from attending clinical attachments. This suspension might extend to more hospitals as the COVID-19 pandemic continues to develop, which could lead to clinical medical students receiving reduced exposure in specific specialties, causing a detrimental effect to exam performance and competency as foundation year 1 doctors. The situation is more complex for some final year medical students who are in the process of sitting their final assessments. Some medical schools have reduced clinical exposure in the weeks coming up to their final exams to reduce the risk of contracting the virus. Many electives could also be cancelled because of the global prevalence of COVID-19. This situation would not only cause financial losses for students, but also lead to a missed opportunity of working in a health-care system outside of the UK. At this stage, it is difficult to predict what will happen, and most medical schools are following advice from Public Health England to determine how to proceed. Despite widespread panic and uncertainty, the medical community must ask itself what history has taught us about medical education during pandemics. To answer this question, we reflect on the effects of severe acute respiratory syndrome (SARS) on medical education in China at the turn of the century. 1 Some Chinese medical schools officially cancelled formal teaching on wards and their exams were delayed, hindering the education of medical students in the face of the newly emerging epidemic. 1 Similarly, in Canada, the impact of the SARS restrictions led to the cessation of clinical clerkships and electives for students for up to 6 weeks. 2 The Canadian national residency match felt the effect of these limitations, particularly because electives are one of the most crucial factors determining allocation. 1 Despite the challenges posed by the SARS epidemic, several resourceful initiatives were implemented, leading to progress in medical education. In one Chinese medical school, online problem-based learning techniques were implemented to complete the curricula; these methods proved incredibly popular, to the extent that they were applied in subsequent years. These impressive feats illuminate how even in times of distress, solace can always be found. We are waiting to see what ingenuities for medical education will emerge in the face of the COVID-19 pandemic. This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on March 27, 2020.
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            COVID ‐19 and online teaching in higher education: A case study of Peking University

             Wei Bao (2020)
            Abstract Starting from the spring of 2020, the outbreak of the COVID‐19 caused Chinese universities to close the campuses and forced them to initiate online teaching. This paper focuses on a case of Peking University's online education. Six specific instructional strategies are presented to summarize current online teaching experiences for university instructors who might conduct online education in similar circumstances. The study concludes with five high‐impact principles for online education: (a) high relevance between online instructional design and student learning, (b) effective delivery on online instructional information, (c) adequate support provided by faculty and teaching assistants to students; (d) high‐quality participation to improve the breadth and depth of student's learning, and (e) contingency plan to deal with unexpected incidents of online education platforms.
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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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                Author and article information

                Contributors
                azim.majumder@cavehill.uwi.edu
                Journal
                SN Compr Clin Med
                SN Compr Clin Med
                Sn Comprehensive Clinical Medicine
                Springer International Publishing (Cham )
                2523-8973
                22 September 2020
                : 1-6
                Affiliations
                [1 ]GRID grid.412886.1, Faculty of Medical Sciences, , The University of the West Indies, Cave Hill Campus, ; Bridgetown, Barbados
                [2 ]GRID grid.430529.9, Deputy Dean, Quality Assurance & Accreditation, Faculty of Medical Sciences, , The University of the West Indies, St. Augustine Campus, ; Port of Spain, Trinidad and Tobago
                Article
                528
                10.1007/s42399-020-00528-1
                7508422
                © Springer Nature Switzerland AG 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                Categories
                Covid-19

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