Strategies for Digital Clinical Teaching During the COVID Pandemic: A Scoping Review

Abstract

Widespread “lockdowns” during the COVID pandemic in 2020–2021 restricted medical students’ access to patients. We used a scoping review with exploratory thematic synthesis to examine how reports of digital clinical teaching during the first year of the COVID pandemic could inform digital clinical teaching in the post-pandemic world. We looked at strategies used and outcomes reported, lessons learned about how best to use digital methods for clinical teaching, and learning theories used. The eighty-three articles included in the final review fell into four groups. These were telehealth interventions; virtual case-based teaching; multi-modal virtual rotations; and a small group of “other” strategies. Telehealth reports indicated that COVID has probably accelerated the adoption of telehealth, and these skills will be required in future curricula. Engagement with virtual case-based teaching was problematic. Virtual rotations were particularly valued in specialties that relied on visual interpretation such as radiology and dermatology. For general clinical specialties, digital clinical teaching was not a satisfactory substitute for real clinical exposure because it lacked the complexity of usual clinical practice. Sixty-seven articles reported students’ reactions only, and 16 articles reported a change in knowledge or skills. Demands on instructors were considerable. Few studies were theorized and none tested theory, which limited their transferability. While telehealth teaching may be a valuable addition to some curricula, digital clinical teaching is unlikely substantially to replace exposure to real patients outside of specialties that rely on visual interpretation. High demands on instructors suggest little potential for new, scalable digital clinical offerings after COVID.

25 Years of Digital Health Education - Looking Back and Looking Forward (Preprint)

“…These multitude of factors make it difficult, even in retrospect, to fully analyse the effectiveness of digital medical health education during the pandemic. However, what does seem certain is that the COVID-19 pandemic was associated with a much wider dissemination of digital health teaching [100].…”

“…Much of the early literature published during the time of the pandemic focused on the adaptations used by medical health educators to pivot to the digital environment. Many of these specifically looked at the practical steps that were required, including training on acceptable behaviours expected during these digital meetings, especially using videoconferencing [100]. There appear to be more studies performed in the USA that reported direct use of online discussions with a patient (telemedicine) as part of the digital education delivery to students as compared to the UK and Europe [100].…”

“…Many of these specifically looked at the practical steps that were required, including training on acceptable behaviours expected during these digital meetings, especially using videoconferencing [100]. There appear to be more studies performed in the USA that reported direct use of online discussions with a patient (telemedicine) as part of the digital education delivery to students as compared to the UK and Europe [100]. Whilst videoconferencing theoretically might enhance focus on history taking when direct physical examination was no longer possible, prolonged use of videoconferencing was associated with learner fatigue-in some cases postulated to be related to critical self-analysis of the learner's own face appearing on the screen during teaching [101].…”

“…Regular chunking of information and use of breakout rooms may have benefited some in these regards. With apparently less forthcoming students, sometimes referred to as 'lurkers' [100], these techniques may have been effective. The interactive behaviour of online learners has sometimes been sharply divided into 'The workers, the lurkers and the shirkers' [102].…”

“…Despite the challenges of the time, student surveys during the pandemic revealed some positive feedback regarding their enforced online medical education [104]. Since the last of the lockdowns in most countries was lifted, beginning in March 2021 in England [105], evidence overall indicates that there has been increased use of digital education methods since pre-pandemic time [100]. For example, in the USA, the total number of students enrolled in degree-granting post-secondary institutions who had at least one of their courses delivered online was over 14 million (75% of the total) at the height of the COVID-19 pandemic in autumn 2020, but was still over 11 million (60% of the total) in autumn 2021, well after nation-wide lockdowns had been lifted [106].…”