A Case Study: Lessons learned from online tutorial to improve clinical reasoning for Family Medicine residents in Palestine

Abstract

Background Geopolitical and socioeconomic challenges limit faculty development and clinical teaching in the Occupied Territories of Palestine and many other developing countries. The first, and still only, Family Medicine residency program is a four-year program based out of An-Najah University in the West Bank. Training in primary care clinics occurs in the final two years and there are many challenges to adequate supervision in the clinical setting that were exacerbated during the pandemic. To improve the clinical reasoning skills of 13 Palestinian FM residents a three-month tutorial program was organized in 2020. An NGO that has worked to support Family Medicine development in the region engaged experienced British General Practitioners trained as tutors to offer online tutorials. We evaluate the program as case study research to understand the factors that facilitated or impaired a positive virtual learning environment. Methods The tutors and residents were divided into groups and met virtually between June and September 2020. Evaluations and session reports collected during the program, the text of an online chat, and responses to an online survey two years later were collected. Using thematic analysis techniques, we evaluated the value for the residents at the time and two years later and identified factors that facilitated or impaired a positive virtual learning environment. Results Themes of knowledge, skills, attitudes, cultural disconnects, and tutorial logistics emerged. The group with the most stable tutor pairing, including one Arabic-speaker familiar with the context, was the most engaged. The all-female group formed a chat group to share real-time case questions during clinical practice, and focused on skills (e.g. conducting a thorough medication review) and attitudes (e.g. open to sharing and discussing uncertainties). Other groups were less cohesive. Conclusions Transnational tutorials that focused on clinical thinking and decision-making skills were most successful when the tutorial pair was stable, offered familiarity with the language and addressed cultural differences. Intrinsic factors such as lacking the motivation to participate and extrinsic factors such as unstable internet and rolling electric cuts, and clinical structures that made applying new skills challenging were more difficult to address but must be considered.