In March 2020, with the onset of the COVID-19 pandemic and in compliance with recommendations from the Association of American Medical Colleges (AAMC),1,2 Penn State College of Medicine (PSCOM) suspended all in-person patient encounters for medical students. To keep education on track, PSCOM transitioned to a virtual learning format.
In a 2021 review, Park et al reported that 84.2% of published articles on the development of virtual learning were targeted for clinical clerkships.3 Article topics included virtual clerkships,4-6 telemedicine,7-11 virtual rounds,5,7,12,13 virtual acting internships,14,15 and virtual electives for visiting students.16,17 While there have been many reports on virtual learning during the pandemic,3 there is a paucity of reports addressing how accelerated programs responded to the pandemic. This qualitative study reports the strategies used and the effects of virtual learning on accelerated MD students at PSCOM.
The PSCOM Institutional Review Board approved this study (Study#15567).
PSCOM offers 3-year accelerated MD programs where students achieve graduation competencies in 3 years instead of 4.18-20 Because of this shortened time frame, students in these accelerated programs are especially threatened by the loss of learning opportunities resulting from pauses in clinical exposure. To minimize the impact, remote learning was developed with the goal of front-loading knowledge and skills acquisition, to allow the students to function at a higher level once in-person learning resumed. Accelerated students participated in additional virtual learning activities, including telemedicine, virtual hospital rounds, virtual emergency rounds, and COVID-19 acute care clinic (virtually), to afford them additional clinical exposure to increase clinical skills competencies.
Our focus in developing virtual learning activities was to simulate in-person activities. Due to safety concerns, medical students were not allowed to participate in the care of patients with or under investigation for COVID-19 in-person. Virtual involvement in the COVID-19 acute care clinic allowed the unique advantage of engaging students with a patient population they otherwise would have been unable to care for. Faculty mentored students on the practice of oral presentations with a focus on clinical reasoning. Family medicine inpatient faculty felt that virtual student involvement mirrored in-person student involvement well (Table 1).
All five students enrolled in a PSCOM 3-year accelerated program were invited to participate in a semistructured interview at the completion of all clerkships. Questions asked about perception of the virtual learning experiences, comparative strengths and weaknesses of the clerkship activities, and recommended changes. Table 1 lists descriptions of the virtual learning environments.
Following the Standards for Reporting Qualitative Research framework, we transcribed and analyzed student comments using NVivo 12 (NVivo, QSR International, Cambridge, MA).
A total of four interviews were conducted (response rate=80%). Three themes emerged from the data (Table 2).
Theme 1: Virtual Medical Training Is Considered the Strongest When Physicians Leverage Video Technology and Provide Individualized Feedback.
Participants enjoyed virtual interaction with patients and immediate feedback from the preceptors and clinicians, making the experience feel genuine and similar to in-person visits.
Theme 2: For Virtual Medical Training, Small Group Sessions Were Preferred Over Large Group Didactic Zoom Sessions.
Students’ least appreciated virtual activity was large-group Zoom didactic sessions where there was little to no engagement, leaving students feeling distracted and/or fatigued.
Theme 3: In Both the Virtual and Traditional In-Person Learning Environment, Medical Students Craved Additional Opportunities for Engagement With Faculty, Physicians, and Peers.
Participants emphasized the wish for more engagement and feedback from faculty and clinicians as a way to better utilize time and resources in both the virtual and traditional in-person learning environment.
The COVID-19 pandemic has significantly disrupted medical education.21 The pause in in-person learning recommended by the Liaison Committee on Medical Education was a major challenge to keeping education on track, especially for 3-year accelerated MD programs. Virtual learning provides alternatives for this challenge. The students in Penn State’s accelerated MD program successfully graduated on time. Students felt that virtual learning gave them the skills needed when they returned to in-person clinical encounters. Just as with in-person learning, students yearn for timely feedback. Engagement and authentic learning experiences were key to success. Interestingly, students noted that in-person clerkship rotations are no guarantee of meaningful participation, citing examples of long waits in the operating room without active participation.
Overall, these findings help us as educators to design learning experiences that are most likely to be effective in virtual learning. Moving forward, with purposeful planning, all learning experiences, virtual or in-person, should be associated with meaningful engagement and timely feedback.
The authors thank Jessica Wolfe Connor for conducting the interviews and Joy Bowen for providing project management assistance for this study.
Financial Support: This research was supported by the Health Resources and Services Administration (HRSA) T0BHP30010, “A Campaign for Primary Care: Transforming Medical Education Today, to Develop the Leaders of Tomorrow,” Leong (PI).
Presentations: This research was presented virtually at the 2021 Consortium of Longitudinal Integrated Clerkships Conference on October 10-13, 2021 and the 2021 North American Primary Care Research Group Annual Meeting November 19-23, 2021.
- Guidance on Medical Students’ Participation in Direct In-person Patient Contact Activities. Association of American Medical Colleges; 2020. Accessed March 13, 2022. https://www.aamc.org/system/files/2020-08/meded-August-14-Guidance-on-Medical-Students-on-Clinical-Rotations.pdf
- (AAMC) AAoMC. Important Guidance for Medical Students on Clinical Rotations During the Coronavirus (COVID-19) Outbreak. Association of American Medical Colleges; 2020. Accessed March 13, 2022. https://www.aamc.org/news-insights/press-releases/important-guidance-medical-students-clinical-rotations-during-coronavirus-covid-19-outbreak
- Park H, Shim S, Lee Y-M. A scoping review on adaptations of clinical education for medical students during COVID-19. Prim Care Diabetes. 2021;15(6):958-976. doi:10.1016/j.pcd.2021.09.004
- Rydel TA, Bajra R, Schillinger E. Hands off yet all in: a virtual clerkship pilot in the ambulatory setting during the COVID-19 pandemic. Acad Med. 2021;96(12):1702-1705. doi:10.1097/ACM.0000000000004127
- Bala L, Kinross J, Martin G, et al. A remote access mixed reality teaching ward round. Clin Teach. 2021;18(4):386-390. doi:10.1111/tct.13338
- Bhatia RK, Cooley D, Collins PB, Caudle J, Coren J. Transforming a clerkship with telemedicine. J Osteopath Med. 2021;121(1):43-47. doi:10.1515/jom-2020-0131
- Gummerson CE, Lo BD, Porosnicu Rodriguez KA, et al. Broadening learning communities during COVID-19: developing a curricular framework for telemedicine education in neurology. BMC Med Educ. 2021;21(1):549. doi:10.1186/s12909-021-02979-z
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