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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 2  |  Page : 113-117

Reflections and insights on the Burden of COVID-19 on various facets of medical education, research, and training: An evaluation in the postpandemic era


1 Assistant Professor, Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, India
2 Assistant Professor, Department of Anatomy, JSS Medical College, JSSAHER, Mysore, Karnataka, India
3 Professor (Additional), Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
4 Assistant Professor, Department of Anatomy, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
5 Senior Resident, Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, Punjab, India
6 Assistant Librarian, Central Library, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

Date of Submission25-Feb-2022
Date of Decision28-Mar-2022
Date of Acceptance28-Apr-2022
Date of Web Publication26-May-2022

Correspondence Address:
Kumar Satish Ravi
Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJCA.NJCA_86_22

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  Abstract 


Medical education, an integral part of the modern health-care system, had faced the thrust of the outbreak for the last couple of years. Although the immediate impacts were trivial and managed with online pedagogical approach, on a long run, it seems to spill serious repercussions on medical students, teaching faculties, and administration. Different countries are handling with the situation depending on their financial conditions, task force, and resource allocation. Hence, momentarily, it is quite impractical to reach a global consensus regarding what is the best for students and communities in long run. Meanwhile, each country needs to formulate its own regime to continue with high standard medical teaching and training. Obviously, it may solicit time span, prioritization, and empathy to restructure the medical education without disfiguring its original fabric. The unprecedented use of online pedagogy (prerecorded lectures, medical simulations, virtual cadavers, and video conferencing) has transformed medical education drastically. Although these newer teaching–training policies assisted us to continue with the ongoing curriculum, medical placement/clerkship just resumed with necessary precautions. The assessment part needs extra care and vigilance, as any change or incorporation of newer methods of assessment may even worsen the present state of affairs for both the assessor and the student.

Keywords: Assessment, COVID-19, curriculum, medical education, remote learning


How to cite this article:
Patra A, Pushpa N B, Ravi KS, Singla R, Pasi R, Singh S. Reflections and insights on the Burden of COVID-19 on various facets of medical education, research, and training: An evaluation in the postpandemic era. Natl J Clin Anat 2022;11:113-7

How to cite this URL:
Patra A, Pushpa N B, Ravi KS, Singla R, Pasi R, Singh S. Reflections and insights on the Burden of COVID-19 on various facets of medical education, research, and training: An evaluation in the postpandemic era. Natl J Clin Anat [serial online] 2022 [cited 2022 Jul 1];11:113-7. Available from: http://www.njca.info/text.asp?2022/11/2/113/346079




  Introduction Top


Medical education has hurriedly drifted to online teaching–learning pedagogy to facilitate continuity of the ongoing curriculum,[1],[2] through platforms such as Zoom, Microsoft Teams, and Cisco Webex., While this has been proved to be effective as an interim solution in completing ongoing course content and lectures, the long-term outcomes might remain equivocal. Future consequences can even be worrisome.[3] The economic disparities, limitations in resourcefulness, and attitude of the government can further accentuate the detrimental postpandemic effects on medical education.

Medical education and indeed teaching medicine as a profession was never designed to be fully online. Learning medicine virtually was unrealistic and might be proven detrimental toward becoming professional in long run.[4],[5] Various countries, such as United Kingdom, United States, and Italy, have promoted final-year medical students directly to work places to support the frontline workers. These inexperienced fellows were straightway deployed in COVID care without much needed shadowing and supervision. Such steps, undoubtedly, helped re-enforce the skeletal workforce fighting across COVID-19, contrarily bound to hurt their spirit in long term.[6] Although such innovative approaches helped in consolidation of the available medical workforce to fight against this crisis, pedagogical experts might be cynical regarding the impacts of such hasty steps on ongoing medical education and training.[7] With this background, in the present review, we intend to throw light into the reflections of pandemic in post-COVID era in distinct facets of anatomy education and suggest possible ways to come out of this predicament.


  Curriculum in Medical Education Top


The typical length of medical school curriculum usually broken up into years of core science classes followed by clerkships or clinical rotations. Although the total duration of curriculum differs country wise, all are designed to produce competent medical graduates and clinicians. If we carefully study the century old pattern of anatomy education, it seems to be purposefully fabricated to take care of chronic noncommunicable diseases or conditions (e.g., hypertension, diabetes mellitus, and cancer) to reduce the morbidity. Although emergency care remains incorporated in the curriculum, adequate emphasis has never been given.[8]

Our curriculum needs to assimilate emergency care as a core competency and give equal weightage and focus to it as it gives to the chronic disease. Regarding online education, although it is there in practice, in the absence of concrete guidelines in ongoing curriculum, effective delivery is hardly possible. Hence, suitable integration of online teaching/training programs into the ongoing curriculum and careful guidance to the students through a learning experience rather than simply making it available as another resource is the need of the hour. Students need robust support systems and virtual learning environments that actively encourage them to learn through guided instruction, supervision, interaction, and a sense of community among them.


  Teaching in Medical Education Top


Medication education follows a symbiotic ecosystem made up of lecture sessions followed by practical or hands-on training.[9] In this long course of anatomy education, every subject taught follows the same pattern. Most of the subjects we taught during the course are so designed that theoretical knowledge cannot replace practical sessions and vice versa. Hands-on-training, clinical posting are of real help in building a confident self resilient medical practitioner. Hence, the prime motive of medical education system is to produce such graduates who can deliver standard patient care to the society with outmost professionalism.[10] In health-care system, professionalism means not only delivering the best possible treatment or clinical skills but also communication skills, understanding patient's pain, agony, and most importantly being empathetic.[11] Anatomy teaching, ranging from doing cadaveric dissections to suturing wound, helps develop such professional mind. The COVID-19 outbreak forced the medical schools to close their doors prematurely and led to an unplanned rapid transition of face-to-face teaching to virtual medium. Such modalities not only helped us to control the spread of infection to some extent by maintaining social distancing and confinement but also maintained the continuity of most educational sessions.[12] However, this seems to be an infringement of conventional anatomy teaching guidelines that take years to be drawn, designed, and implemented.[7] Medical teaching in clinical setting helps the students to learn by doing things practically; such hands-on training plays a pivotal role in evolving clinical acumen through reflection and feedback. Although remote teaching–learning methods enabling the institutions to continue the course but practically its far away from the reality. Unfortunately, remote teaching is creating a work force ready to serve the reality in virtual world.[13] Due to the current pandemic situation, most of the medical schools are suffering financial crunch. Moreover, their administration mainly focuses on decreasing mortality and preventing infection. In prepandemic era, patient care and medical education were going hand on hand. Now, there is paradigm shift, medical schools and teaching hospitals very conveniently prioritizes emergency cares over and above the educational requirements of medical students, mounting to abandonment of their future prospects as professionals. Although online or digital learning has been in existence for a long while and is hurriedly seeping into all facets of education together with medicine, its relevance in anatomy education is debatable. Moreover, only a few resourceful medical schools which can afford the state-of–the-art technology have optimized their regular usage.[7]

Educationalists have even designed remote learning approach to teach anatomy and surgical skills through video conferencing followed by case discussion.[14] Elseways, Chick et al.[15] are in favor of using simulation-based technologies as most convenient modalities, to learn anatomy and surgery during the period of social confinement. However, for many medical schools, especially those of developing countries, such modalities are mere dream as presently they are operating even without basic laboratory facilities. However, Khalil et al.[16] have highlighted the multiple benefits of blended learning and oppose the expensive, high-tech simulation laboratories. Considering the present scenario, institutions need long-term arrangements. Longhurst et al. suggested of acquiring flexible curriculum that will automatically transform to remote mode during times of confinement and lockdown, with the impending second wave in various countries.[17]

Technology can help in bridging the gap between teacher and learner and it should be made available for all. Hence, educational institutions need to address equality of participation issues first before starting remote teaching. Resourceful institutions should provide their students free access to these modalities and endeavor to do so for others too during the pandemic situation. However, to address the issue of “equality of opportunity” between institutions with varying financial freedom, software companies should come forward to provide temporary free access to their programs during the pandemic.[9]

Faculty may also need to be more empathetic to their students when using online modalities for formal assessment, or until students get habituated with newer modalities, such assessment can be deferred.

Fusion between remote learning and digital interactive images with the facility of self-testing tools may support students in their online learning.[18]

The personal online interactions through provision of chat rooms, collaborative bulletin, discussion boards, flipped classroom approach, or real-time tutorial may help reduce the gap between teacher and learner; moreover, these are the key elements toward successful online learning.[19] We have not yet reached the stage, where we can use virtual reality (VR) resources as a modern idea for home-based learning.[20] Indeed, most smartphones are compatible with Google Cardboard allowing students to experience VR from their own phones, if provided with suitable software.[21]


  Assessment in Medical Education Top


COVID-19 pandemic shattered the usual pedagogy of medical education, be it lectures, practical sessions, or clinical placements. Although faculty and students together managed to adapt with the online teaching–learning methodology still the assessment part remained an unresolved dilemma. Online assessment is a huge task; most of the faculty and students are struggling to get the appropriate one.[22],[23] Moreover, the unproctored online assessments may encourage academic delinquency or dishonesty, i.e., plagiarism and fornication.[24] Such malpractice may further negatively impact their conception about medicine and conduct as a future health-care provider.[25] Whatever may be the situation, assessments must be undertaken, so that students do not get penalized and future medical force do not get compromised; however, the ethics of conducting high-quality examinations remain debatable. Conventional oral assessments such as OSCEs are also very challenging despite necessary arrangements. Government and various accreditation boards throughout the globe are closely watching the pandemic situation and waiting for the situation to unfold on itself. But mere fluctuation in mortality and morbidity due to pandemic hindering them from taking any concrete decision. For instance, countries like India now facing tough time due to the second wave of the pandemic.[26]

Sabzwari suggested restoration of the conventional assessments with innovative one that can be merged into formative assessments.[27] Such method focuses on competency, rather than simply assessing knowledge, skills, and attitudes. Competency-based assessment depends on the use of virtual patients, log books record about learner's performance, and tools to demonstrate the acquired skills. Although, these forms of assessments are currently in existence and authentic ways to assess the learner's ability, might not be feasible for countries with limited resources.

Concept of virtual patient is all together a new and innovative concept, can be undertaken in the present scenario, although needs further enhancement to be considered as a regular method of assessment.


  Research and Clinical Trials Top


Research in medicine is the most crucial component and prerequisite for constant growth and betterment in health science and patient care. Medical schools conduct research work at three levels: research in basic science (human anatomy, medical physiology, and biochemistry), paraclinical, and clinical field (drug trials, pathological study of surgical specimens, and community health).

The ongoing COVID-19 pandemic has a potentially impacted all these domains of research, compromising the scientific integrity of data and patient safety. Research in basic sciences, especially in human anatomy are halted due to scarcity of human materials, human cadavers. COVID-19 guidelines are strictly against embalming and body preservation due to fear of contraction.[28] Population- or patient-based researches, such as clinical trials and investigations of novel therapies, are also halted due to loss of access to the study population. There are several critical challenges in the current situation such as (a) limited accessibility of clinics for critical visits, (b) difficulty in recruiting homebound patients or reluctant to visit clinics, (c) risk of contraction to the staff, (d) high dropout rate, (e) difficulty in timely delivery of logistics, and (f) failure to maintain study timelines; all may result in loss of data integrity and monitoring.[29]

Based on the current situation, appropriate changes need to be undertaken such as changing study sites, extending programs, and amendment of planned trial closure, monitoring and screening activities, site access, and application of machine learning-driven forecasting models.

The concept of telemedicine exists for the past two decades, but its applicability in the clinical research setting is a newer concept and may be useful in the current scenario.[4],[30],[31] Alternative methods may include telephonic conversation or the use of telemedicine for virtual visits or alternative sites for care/collecting study data. The use of teleconferencing and voice mails during the pandemic will be useful. To address the issues arising due to travel restrictions, alternative nearby locations may need to be considered for imaging, study procedure, and laboratory testing to safeguard the study participants.[32]

Finally, data monitoring and assessment regarding the benefits and risks of interventions for COVID-19 requires faster communication during health emergencies.[33] This could be possible through virtual meetings with the help of encrypted communication to protect data integrity. Research work or survey study addressing community health is still under way to some extent as data collection through Google Forms is easy and valid enough to carry such research.


  Discussion and Conclusion Top


Before pandemic, health-care systems in most of the countries used to focus both on patient care and medical education including research. With the advent of COVID-19 crisis, there is a paradigm shift, especially after deadly second wave, all the resources being diverted toward saving lives, putting a halt to everything else in the background. The burden is much more for medical students studying in developing countries. Continuous lockdown has broken their economy, financial crunch is so much more that, administration have no other options instead of putting halt to academic activities. As of now, saving patients is the only motto and it should be but long-standing compromisation is going to be detrimental for the future doctors and health care system. Till now, students are managing well with this new normal remote teaching and training pedagogy, but we need to think critically to decide on the best course of action for them. Various counties having different opinion regarding combating the situation. Hence, it is not possible to come to single-point agenda as the number of cases, fatality rate, financial conditions, and attitude of students vary widely.

The unprecedented use of online pedagogy (VR, medical simulations, and video conferences) has revolutionized medical education over the last few months. It has brought both challenges and opportunities. Although these newer teaching strategies helped us to continue with the ongoing curriculum, continuous monitoring is necessary to evaluate their effectiveness. While it helped continuity of curriculum, there is a lack of evidence to demonstrate that the patient outcomes and health outcomes are maintained. The main impediments to providing online learning include lack of reliable network infrastructure (hardware and software and network bandwidth) and compatible online platforms that work with existing learning management system. Other challenges included shortage of competent IT personnel to extend technical support, zoombombing/cyberattacks on online platforms, increased cost (schools, students, and faculty), time constraints, poor computer technical skills of faculty and students, inadequate infrastructure and resources, and absence of institutional policies, which will pose real challenges for low- and middle-income countries. The assessment part needs extra care and vigilance, as any change or incorporation of newer methods of assessment may make the situation even worse both for the assessor and for the student. While some assessments can be easily converted to online formats, others such as the OSCEs and viva voce can be more challenging, especially for resource-limited countries like India. All countries are trying their best to continue with whatever suitable alternative is available for them. Global consensus regarding the future course of medical education is yet not possible. The economic crisis following this deadly 2nd wave is most likely to shape the future policies and strategic planning in medical education.


  Take Home Messages Top


The COVID-19 crisis has injected turbulence and a hefty dose of uncertainty into anatomy students' education and career plans. Addressing these concerns requires digital solutions and pedagogical approaches that ensure students and their remote learning thrives online.[34] We need to involve personalized support systems to reduce the gap between the learners and resources, thus enhancing their morale.

The impact of pandemics on medical education is consequent urging governing bodies to devise solutions and contingency plans to limit the impact of future outbreaks and pandemics on medical education.

Medical curriculum needs assimilate emergency care as a core competency and gives the same weightage to it as it gives to the chronic disease care. Suitable integration of online teaching/training programs into the ongoing curriculum is the need of the hour.

Medical education should be made available for all irrespective of their economic condition. Hence, educational institutions need to address equality of participation issues first before starting remote teaching.

Clinical placement needs to be re-established as soon as possible with precautionary measures, to ensure that tomorrow's doctors are sufficiently trained.

Assessments are important facets of medical education and need to be improvised in the time of crisis, so that students don't get penalized and future medical force not get compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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