Alternative approaches for clinical clerkship during the COVID-19 pandemic: online simulated clinical practice for inpatients and outpatients—A mixed method

Abstract

Background The COVID-19 pandemic has created a need for educational materials and methods that can replace clinical clerkships (CCs) for online simulated clinical practice (online-sCP). This study evaluates the impact of using simulated electronic health records (sEHR) for inpatients, and electronic problem-based learning (e-PBL) and online virtual medical interviews (online-VMI) for outpatients, for an online-sCP using a learning management system (LMS) and online meeting system facilitated by a supervising physician. Methods The sEHR was reviewed by medical students and subsequently discussed with a supervising physician using an online meeting system. In the e-PBL, medical students reviewed the simulated patients and discussed on the LMS. For the online-VMI, a faculty member acted as an outpatient and a student acted as the doctor. Small groups of students discussed the clinical reasoning process using the online meeting system. A mixed-method design was implemented. Medical students self-assessed their clinical competence before and after the online-sCP. They answered questionnaires and participated in semi-structured focus group interviews (FGIs) regarding the advantages and disadvantages of the practice. Results Forty-three students completed the online-sCP during May and June 2020. All students indicated significant improvement in all aspects of self-evaluation of clinical performance after the online-sCP. Students using sEHR reported significant improvement in writing daily medical records and medical summaries. Students using e-PBL and online-VMI reported significant improvement in medical interviews and counseling. Students also indicated CCs as more useful for learning associated with medical interviews, physical examinations, and humanistic qualities like professionalism than the online-sCP. Eight FGIs were conducted (n = 42). The advantages of online-sCP were segregated into five categories (learning environment, efficiency, accessibility, self-paced learning, and interactivity); meanwhile, the disadvantages of online-sCP were classified into seven categories (clinical practice experience, learning environment, interactivity, motivation, memory retention, accessibility, and extraneous cognitive load). Conclusions Online-sCP with sEHR, e-PBL, and online-VMI could be useful in learning some of the clinical skills acquired through CC. These methods can be implemented with limited preparation and resources.

A scoping review on adaptations of clinical education for medical students during COVID-19

“…Whilst onsite modified clinical clerkships continued in parts of the world [ [57] , [58] , [59] , [60] , [61] ], in others it was combined with online teaching [ 28 , 62 , 63 ]. Thomas von Lengerke et al [ 64 ] described communication skills teaching for preclinical students using simulated patients in a classroom setting under social distancing and infection control guidelines.…”

“…Patient interview NA review NA Kaliyadan et al [ 46 ] An Online Dermatology Teaching Module for Undergraduate Medical Students amidst the COVID-19 Pandemic Indian Dermatol Online J. IN 2020 Clinical Univ Med Online clinical scen small group live interactive sessions, tutor acted as patient in history taking, relevant lab test discussed, student describe skin lesions in image & present tx plan 1 short report Cross-sectional; survey Kasai et al [ 63 ] Alternative approaches for clinical clerkship during the COVID-19 pandemic BMC Med Educ JP 2021 Clinical Univ Med both stand /sim assigment of one surgical case for each studendent, LMS review, EHR upload, e-PBL discussion. 1 original article Mixed;Pre-& post survey; FGIs Khalil et al [ 47 ] The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students' perspectives BMC Med Educ SA 2020 Clinical Univ MS Online clinical scen lectures, case discussions, 4-box case analysis, clinical case discussions, online seminars, and dry labs (online laboratory demonstrations).…”

Application of digital education in undergraduate nursing and medical interns during the COVID-19 pandemic: A systematic review

“…The 16 papers used a variety of methodologies, including one cross-sectional study, two quantitative descriptive studies, two quasi-experimental studies, one prospective cohort study and the rest of the ten mixed-method studies. The publications were devoted to exploring the different modalities of digital education, including virtual reality-based simulation training (3 studies) ( De Ponti et al, 2020 ; Kang et al, 2020 ; Weston and Zauche, 2020 ), teleconsultation and virtual rounds (3 studies) ( Bala et al, 2021 ; Sukumar et al, 2021 ; Weber et al, 2021 ), web-based specialized skills learning (2 studies) ( Alpert et al, 2020 ; Shahrjerdi et al, 2020 ), and multimodal online curriculums (8 studies) ( Coffey et al, 2020 ; He et al, 2021 ; Kaliyadan et al, 2020 ; Kasai et al, 2021 ; Michener et al, 2020 ; Samueli et al, 2020 ; Williams et al, 2021 ; Zhou et al, 2020 ). Study outcomes were measured utilizing a series of homemade tools.…”

The effect of the COVID-19 pandemic on the patient safety attitude of medical students

“…During clinical clerkship, students acquire knowledge, skills, and attitudes by forming relationships with patients [ 11 ], and peer learning takes place [ 12 ]. However, due to the COVID-19-restrictions, their opportunities to observe actual doctors’ practice and share in clinical and professional experience were not enough, making it difficult to learn about physical examinations and communicate with patients [ 4 ]. For patient safety, experiential learning through clinical practice is important, but there seems to be a limit to this.…”

“…Since medical students had limited chances to participate in clinical practice, they also had fewer chances of communicating with patients and meeting with clinical professors for feedback [ 1 ]. In addition, clinical practice has either been replaced by simulation or the time spent in hospitals has been limited for medical students in clinical clerkship when clinical practice is conducted [ 3 , 4 ].…”