A guide for evaluation of online learning in medical education: a qualitative reflective analysis.

BACKGROUND: With the strike of Covid-19, an unprecedented rapid shift to remote learning happened worldwide with a paradigm shift to online learning from an institutional adjuvant luxury package and learner choice into a forced solo choice. This raises the question of quality assurance. While some groups have already established standards for online courses, teaching and programs yet very little information is included on methodology of their development and very little emphasis is placed on the online learning experience. Nevertheless, no work has been done specifically for medical education institutions. AIM: To develop a set of descriptors for best practice in online learning in medical education utilizing existing expertise and needs. METHODS: This work utilizes a qualitative multistage approach to identify the descriptors of best practice in online learning starting with a question guided focus group, thematic analysis, Delphi technique and an expert consensus session done simultaneously for triangulation. This was done involving 32 institution in 19 countries. RESULTS: This materialized into the development of a set of standards, indicators, and development of a checklist for each standard area. The standard areas identified were organizational capacity, educational effectiveness, and human resources each of which listed a number of standards. Expert consensus sessions identified the need for qualification of data and thus the development of indicators for best practice. CONCLUSION: Standards are needed for online learning experience and their development and redesign is situational and needs to be enhanced methodologically in axes that are pertaining to the needs of the education community. Taking such axes into consideration by educators and institutions will lead to planning and implementing successful online learning activities, while taking them into consideration by the evaluators will help them conduct comprehensive audits and provide stakeholders with highly informative evaluation reports.

Evidence-based medicine (EBM) for undergraduate medical students: A six-step, integrative approach.

BACKGROUND: Nowadays, there is an increasing interest in practicing evidence-based medicine (EBM) to provide valid and up-to-date information about health problems and procedures for solving these problems. However, studying EBM among other medical education disciplines remains unsatisfactory. AIM: To design and pilot a basic course on EBM for undergraduate medical students in order to raise the awareness of the Saudi medical education community about this discipline. SUBJECTS AND METHODS: The developed course targeted undergraduate Year 4 medical students at Ibn Sina National College for Medical Studies in Jeddah, Saudi Arabia. The course was integrated longitudinally into ?Integrated Multisystem Module? of Year 4. Students and faculty perceptions were evaluated for program evaluation purposes. Course design was based on Kern et al. six-step approach for curriculum development. RESULTS: Students overall perception of this course was positive except for some points related to the time allocated and their training on using evidence databases. Faculty members who participated in implementing the course perceived it positively. CONCLUSIONS: Teaching EBM is recommended and applicable. It is not resource-intensive, and can be conducted through developing and integrating EBM courses in the undergraduate medical curriculum. Students and teachers agree upon the need and importance of teaching such discipline.

Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

BACKGROUND: In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. AIM: Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. METHODS: This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. RESULTS: The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. CONCLUSION: After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

Implementing Formative Assessment in Human Anatomy Practical Sessions: Medical Students' Perception and Effect on Final Exam Performance.

Background: Formative assessment with feedback is part of the assessment program in medical education to improve students' learning. Limited research has focused on its application and impact on practical anatomy education. Methods: This study aimed to examine medical students' perceptions of formative assessment in practical anatomy sessions of body systems-based educational units and explore its influence on final practical exam performance. A descriptive, cross-sectional study was conducted. Data was collected from 173 Year 2 medical students through a survey that addressed their perception of process and importance of formative assessment and feedback. The survey employed a 5-point Likert scale. Two open-ended questions were appended at the end of the survey. Students' performance in Unit 3 (where formative assessment was conducted) was compared to their performance in Unit 2 (where no formative assessment was conducted) and with the performance of the previous academic year's students in Unit 3 (where no formative assessment was conducted). Descriptive statistics were used. The level of statistical significance was set at p-value < 0.05. Responses to open-ended questions (qualitative data) were counted, categorized as themes, and presented as frequencies and percentages. Results: The survey showed high internal consistency, and its validity was established through exploratory factor analysis. Results showed that the mean mark for the unit with formative assessment and feedback was significantly higher than for the units without formative assessment and feedback. Students showed positive perception of formative assessment and feedback conducted after practical anatomy sessions. They reported useful insights regarding the benefits they gained from formative assessment and feedback as well as constructive suggestions for future improvements. Conclusion: The study indicates that students positively perceived formative assessment and feedback sessions after practical anatomy sessions. Findings also refer to a positive effect of formative assessment on students' performance in summative practical assessment in anatomy.

Readiness for Interprofessional Learning Among Students of Four Undergraduate Health Professions Education Programs.

Background: In interprofessional learning, students from different professions learn about, from, and with each other so that they can collaborate effectively, deliver high-quality healthcare, and achieve positive health outcomes. This study aimed to explore the readiness of students from four health professions education programs for interprofessional learning. Methods: A cross-sectional descriptive study was carried out on 339 students. The Readiness for Interprofessional Learning Scale (RIPLS) was used to collect data. Descriptive statistics were used. Paired-samples t-test and ANOVA test were used to compare the responses of participants. Correlations between dependent and independent variables were explored by Pearson's correlation test. The statistical significance level was set at p < 0.05. Results: The reliability study of the collected data showed excellent internal consistency (Cronbach's ɑ = 0.819). Results revealed a statistically significant difference between the responses of students from the four programs regarding the "Roles and Responsibilities" subscale (p = 0.000). A statistically significant difference between male and female students regarding two statements within the "Teamwork and Collaboration" subscale and one statement within the "Negative Professional Identity" subscale (p < 0.05) was also detected. The correlation study showed a weak but statistically significant correlation between RIPLS mean scores and the students' study program (p < 0.015). Conclusion: In conclusion, the students showed readiness for IPL as evidenced by their positive perception of the interprofessional learning concepts.

Predictive validity of admission criteria in predicting academic performance of medical students: A retrospective cohort study.

Introduction: Admission to medical school is one of the most competitive entry points in higher education. Medical school admissions committees need accurate and precise screening tools to select among well-qualified applicants. This study explores data from a cohort of graduated medical students over 6 years to offer a critical perspective on predictive validity in medical school admissions. Methods: A retrospective cohort study of 160 students was performed to identify the predictive validity of admission criteria for medical students to predict academic performance over 6 years for a cohort of all students enrolled in the medical program during the academic year 2013-2014. Results: The main results indicated that there was a statistically significant positive correlation between the admission criteria and Students' performance in Year 1, Year 4, B.Sc. (Bachelor of Medical Science) exam, and Medical Doctor (MD) exam across the 6 years of the medical program, except for the English Test, which showed that there was no significant correlation with average MD exam scores for students who enrolled directly in Year 1. The results related to students who were admitted to the Foundation Program showed that there was no significant correlation between high school Grade Point Average (HSGPA) and their academic performance in Year 1, Year 4, B.Sc. exam, and MD exam. The overall results related to all study samples indicated that all predictor variables correlate significantly with all outcome variables (academic performance), and the results showed that Science test scores demonstrated 27.7, 15.0, 19.7, and 12.6% of variation in Students' performance in Year 1, Year 4, B.Sc. exam, and MD exam, respectively. Conclusion: Science test scores were found to be more predictive of academic performance compared to other predictors. Not all the admission criteria used for student selection are good indicators of their achievement in the medical program. It is recommended that other valid and reliable admission tools, such as the multiple mini-interviews and the questionnaire for a candidate's suitability to follow a problem-based learning curriculum, should be considered.

Faculty development programmes in medical education in the Eastern Mediterranean Region: a systematic review.

Background: Faculty development is essential for enhancing medical education. The World Health Organization in 2013, promoted faculty development based on moderate quality of evidence and conditional recommendations. Aims: To conduct systematic review of faculty development programmes in medical education in the Eastern Mediterranean Region (EMR), during 2013 to 2020. Methods: A systematic research was conducted in PubMed, Google Scholar, EMBASE and ERIC using appropriate Boolean operators. Articles in English from the EMR, explicitly mentioning "faculty development" in medical education, in the title, abstract or anywhere in the text, during 2013-2020 were included. Results: Two thousand three hundred and forty-seven (2347) articles were retrieved, of which 54 were considered for further analysis based on Kirkpatrick's Model for program evaluation. Articles were grouped into 4 themes: evaluation of new interventions (n = 21), evaluation of already implemented interventions (n = 13), needs assessment (n = 16), and recommendations and guidelines (n = 4). It was revealed that 23 studies addressed level 1 (reaction), while 4 studies addressed level 4 (results) of the Kirkpatrick's Model of program evaluation. Conclusion: Faculty development should be need-based and provide hands-on training. Longitudinal programmes are recommended for maximum benefits.

Best Practices of the World Health Organization Collaborating Centres (WHOCCs) in the Eastern Mediterranean Region.

Background: World Health Organization Collaborating Centres (WHOCCs) cooperate with the WHO on a range of strategic areas such as nursing, nutrition, mental health, chronic diseases, education, and health technologies, depending on their speciality areas. As of 2021, WHO has 47 CCs in the Eastern Mediterranean Region (EMR) collaborating on diverse areas. Four CCs in the EMR located in Egypt, Kingdom of Bahrain, Sudan, and Pakistan focus primarily on medical education (ME). Objective: The objective of this review of the literature is to describe the best practices in ME based on published research from the four WHOCCs in EMR. The secondary objective is to classify them based on the level of Kirkpatrick's model (KM) of educational outcomes. Methods: The contributions of WHOCCs are categorised in to five domains namely "Curriculum Development and Course Design", "Student Assessment", "Quality, Accreditation, and Program Evaluation", "Teaching and Learning" and "Innovation in Medical Education". Initial extraction yielded 96 articles for review, while the second level of analysis reduced the number of publications to 37 based on the date of publication within the last 5 years. Numerous best practices in ME emerged from the recently published works of these WHOCCs in the areas of learning and teaching, curriculum development, innovations in medical education, quality, and assessments in medical education. Literature from the WHOCCs on assessment and curriculum design are limited, possibly indicating opportunities for additional research. Conclusion: The researchers conclude that the WHOCCs in the EMR show transformational impact on all principal areas of research and at multiple levels.

Adaptations of Clinical Teaching During the COVID-19 Pandemic: Perspectives of Medical Students and Faculty Members.

Background: The COVID-19 pandemic had serious implications on medical schools' programs that necessitated lots of adaptations of teaching, learning, and assessment to guarantee continuity of education in medical schools. Our study aimed to evaluate perspectives of clerkship students and faculty members regarding clinical teaching adaptations implemented during the COVID-19 pandemic. Methods: A descriptive, cross-sectional, survey-based study was conducted and targeted 5th and 6th year clerkship students and full- and part-time clinical faculty. The survey explored (1) perception of the degree of contribution of implemented adaptations to student achievement of expected clinical competencies, (2) degree of confidence regarding students' achievement of expected clinical competencies through such adaptations, and (3) perception of the effect of implemented educational adaptations on students' learning. Descriptive statistics were used, and statistical significance level was set at p < 0.05. Results: The survey exhibited high internal consistency. Both students and faculty members felt that most of the adaptations had moderate to high contribution to student achievement of expected clinical competencies. On a 5-point scale, the highest score was given by faculty members to "Interpretation of investigations" (3.93±0.84) while the lowest scores were given by faculty members (3.10±1.21) and students (2.57±1.36) to "Performing clinical procedures". Students and faculty members agreed that the adaptations had positive effect on students' learning except for the statement "Students were able to easily monitor their academic progress" where students gave less scores than faculty members, with a statistically significance difference (p=0.029). Conclusion: Students and faculty members had similar perspectives regarding the implemented adaptations and their impact and contribution to student learning and achievement of the basic clinical competencies. Both of them agreed on the need for and importance of the implemented adaptations. Our findings recommend such adaptations during the times of crises, which can be conducted through integrating online teaching with face-to-face teaching.

Impact of a Preparatory Year Programme on the Students of Health Professions Education Colleges: Perception of students and faculty members.

Objectives: The preparatory year programme (PYP) at King Abdulaziz University, Jeddah, Saudi Arabia, is a one-year programme for students preparing for a full multi-year degree curriculum at a university. It offers a bridge between high-school and university-level studies of the students. This study aimed to evaluate the impact of the King Abdulaziz University PYP on students of the health professions education colleges from the viewpoints of the students and the faculty. Methods: This descriptive study was conducted between May 2019 and January 2020 at King Abdulaziz University, in Jeddah, Saudi Arabia and was based on data collected from both students and faculty to assess their perceptions. The data were collected from students through self-administered questionnaires and from faculty members through structured interviews. Descriptive statistics were used for analysis. Results: A total of 633 students responded to the questionnaire (response rate: 88.3%), of which almost half agreed that the PYP made them self-confident and reinforced their discipline (49.2% and 46.9%, respectively). Less than two-thirds agreed that the preparatory year reinforced their sense of responsibility and helped them adapt to the university educational environment (60.6% and 64.3%, respectively). Conversely, more than half (58.5%) disagreed that the preparatory year classes helped them select their majors as well as that the preparatory year prepared them for their major classes (57.2%). A total of 24 faculty members who taught PYP students claimed that there should be careful consideration of the contents of the courses offered to the students in the preparatory year programme, especially the content related to the healthcare profession education. They argued that it is better to have a separate track in the PYP that includes subjects directly related to the study of health professions (such as molecular sciences, genetics, medical terminology, English for medical purposes, etc.). Conclusion: The impact of the PYP on students attending the health professions colleges was found to be weak as per the perceptions of both students and faculty members. In-depth studies are necessary for further investigation of this impact.

Online, Face-to-Face, or Blended Learning? Faculty and Medical Students' Perceptions During the COVID-19 Pandemic: A Mixed-Method Study.

BACKGROUND: COVID-19 pandemic forced educational institutions to adopt online methods which were inevitable to keep continuity of education across all academia after suspension of traditional educational systems. The aim of this study was to explore the experience of faculty and students of online and face-to-face learning, and their preference of the mode of learning after the pandemic. METHODS: This is a mixed-method study. Quantitative data was collected through a survey from 194 medical students and 33 faculty members, while qualitative data was collected through two focus group discussions with 9 students and another two with 13 faculty members. Quantitative variables were presented as means and standard deviations. Paired samples t-test and Chi-square test were used. Thematic analysis of qualitative data was used to code, interpret, and make sense of data. RESULTS: Mean scores of responses of faculty members and students were higher for face-to-face and blended learning compared to online learning in all survey statements with statistically significant differences. More than half of the students (53.1%) preferred the face-to-face mode of learning, while most of the faculty members (60.6%) preferred the blended mode of learning. Qualitative analysis identified five themes, namely: "Transforming the way theoretical teaching sessions are given," "Face-to-face teaching at campus cannot be replaced for some types of education," "Interaction in online sessions is limited," "Problems and challenges of online examinations," and "Technical issues and challenges of online education." It revealed suggestions that at least 30% of the curriculum could be taught online post-COVID-19. Some aspects of clinically oriented teaching including history taking and case discussions can also be delivered online in the future. Faculty members and students reported that dealing with online education was not difficult, although the transition was not smooth. CONCLUSION: Medical students and faculty members were in favor of face-to-face and blended modes of learning. However, they perceived online mode of learning as an acceptable adaptation in theoretical teaching and in some clinically oriented teaching including history taking and clinical case discussions. Although face-to-face education in medicine is irreplaceable, the blended mode of learning remains an acceptable and practical solution for the post-COVID era.

Evaluation of the Utility of Online Objective Structured Clinical Examination Conducted During the COVID-19 Pandemic.

Background: The COVID-19 pandemic led to profound restrictions on the face-to-face learning and assessment in all educational institutions, particularly the medical schools. The College of Medicine and Medical Sciences of the Arabian Gulf University (CMMS-AGU) conducted the final exams, both theoretical and clinical components, for its MD students online. This study was conducted to evaluate the utility of online clinical exams held at CMMS-AGU. Methods: This is a cross-sectional, mixed method study that included samples from final year medical students, examiners, and heads of clinical departments. Data were collected through surveys, structured interviews, documents' review, and calculation of online examination's psychometrics. Descriptive statistics were used. Quantitative data were presented in the form of means and standard deviations. Responses of heads of clinical departments in the structured interview were transcribed and analyzed thematically based on three pre-established themes. Results: Quantitative and qualitative data on the utility (validity, reliability, acceptability, educational impact, and cost and feasibility) of online objective structured clinical examination (OSCE) were collected. Content validity of the online clinical examination was established through high mean scores of content representativeness, which was confirmed by the heads of clinical departments regarding the proper coverage of clinical skills. Criterion validity was established through a high correlation between clinical and theoretical exam results (r = 0.75). Reliability of the exam was established through an acceptable Cronbach's alpha value (0.70 to 0.78) over the four days of the examinations. The examinations were perceived as highly acceptable by both students and examiners. High educational impact was inferred from students' responses and review of documents. The examination was found to be feasible and of reasonable cost. Conclusion: Online OSCE might be a good alternative of conventional clinical assessments in times of crises and impossibility of having in-person contact between students, examiners, and patients. An important major drawback is still present in such initiatives, which is the inability to assess students' physical examination skills.

Wet Specimens, Plastinated Specimens, or Plastic Models in Learning Anatomy: Perception of Undergraduate Medical Students.

BACKGROUND: Methods of teaching anatomy have shown major change as the medical undergraduate curriculum became more challenging. Traditional teaching methods like dissection and wet specimens are nowadays widely replaced by anatomical models, plastination, and technology-enhanced applications. AIM: To explore the perception of undergraduate students of three methods of learning anatomy, which are wet specimens, plastinated specimens, and plastic models. METHODS: This is a descriptive, cross-sectional, questionnaire-based study that included a sample of 268 male and female undergraduate medical students of the third and fourth study years at Ibn Sina National College for Medical Studies in Saudi Arabia. RESULTS: Students in this study preferred wet specimens in regard to motivation to gaining anatomical knowledge in clinical context and usefulness for surgical career. On the other hand, they preferred plastinated specimens when it comes to feasibility of use, ability to differentiate between structures, and understanding complex structures. CONCLUSION: Although the findings in general refer to preferring the use of wet specimens, no one modality seems to be enough for effectively learning anatomy. A combination of various modalities can provide the best benefit for medical students in this regard.

Developing, Validating, and Implementing a Tool for Measuring the Readiness of Medical Teachers for Online Teaching Post-COVID-19: A Multicenter Study.

BACKGROUND: While online education is by no means a new concept, it was recently thrust into the spotlight after school campuses all over the world were forced to close because of the COVID-19 pandemic. The sudden need to shift revealed emerging challenges to online teaching, both logistic and personal. One important challenge is the ability to assess the readiness of educators for online teaching, so that appropriate and specific feedback/training can be offered to those in need. This study aims at developing, validating, and implementing a tool to measure the teachers' readiness for online teaching in three medical schools from three different countries. METHODS: This was a multi-center, cross-sectional study that involved developing a survey through review of literature and previous studies, item development and revision, and pilot testing. The survey was then distributed electronically to a convenient sample of 217 teaching faculty members of different academic ranks from three medical schools in Egypt, Saudi Arabia, and Bahrain. Exploratory factor analysis and reliability study were performed. Descriptive statistics were applied, and the statistical significance level was set at 0.05. RESULTS: Factor analysis produced the following five factors: "Online Teaching and Course Design Skills", "Digital Communication", "Basic Computer Skills", "Advanced Computer Skills" and "Using Learning Management Systems". The tool showed high reliability (alpha = 0.94). Survey results showed highest mean scores for Basic Computer Skills with lower scores for Online Teaching and Course Design Skills and Using Learning Management Systems. ANOVA revealed statistically significant differences between the three studied schools regarding Digital Communication (F=5.13; p=0.007) and Basic Computer Skills (F=4.47; p=0.012) factors. CONCLUSION: The tool proved to be reliable and valid. Results indicated an overall acceptable readiness in the three involved schools, with a need for improvement in "Online Teaching and Course Design" and Using Learning Management Systems.

A toolbox for conducting an online OSCE.

This toolbox highlights the lessons learned and the tools used to run the online OSCE at the College of Medicine and Medical Sciences, Arabian Gulf University (CMMS-AGU) using Zoom™ï¸. The examiners considered the examination to be valid in assessing all clinical skills except for psychomotor skills and students found it to be highly acceptable. We describe three phases. Planning and preparation phase in which situation analysis, aligning stakeholders, mobilizing resources, creating a shared vision, and ownership of the exam project take place. For successful implementation of examinations, detailed plans are needed including manpower, timings, number of stations and detailed description of the steps of the examination process. We provide a set of guiding questions for proper decision making related to online clinical exams. Implementation Phase in which piloting is very useful to apply improvements to the original plan and to outline the needed capacity building of the participating staff. We give a detailed description of the guiding documents, means of communication and features of ZOOM that were used. Evaluation phase we provide a guide for evaluating the process and outcome, including a list of key performance indicators.

A Step-by-Step Guide to Managing the Educational Crisis: Lessons Learned from COVID-19 Pandemic.

BACKGROUND: Medical education is facing great challenges and uncertainties amidst the COVID-19 pandemic. AIMS AND OBJECTIVES: This article aims to provide tips that can provide a guide for medical education leaders to coordinate crisis management referring to the Egyptian context. MATERIALS AND METHODS: This work was done using a reflection on the COVID-19 response by Egyptian universities and analysis of such responses. RESULTS: Medical Education Institutions are required to build a taskforce team for crisis management. These should be committed to supporting sudden online education transition, academic support, and the psychological well-being of students, staff members, health care professionals, paramedics, and faculty administration. As the situation evolves, the taskforce has to monitor the challenges and provide appropriate plans, guidance, and solutions. Leaders in medical education have a crucial role in response to the pandemic crisis in securing a successful educational process while ensuring the mental and psychological well-being of the stakeholders. CONCLUSION: Crisis management is the skill of the future and more investment needs to be placed in designing crisis response and in enabling universities to accommodate this response.

Using Appreciative Inquiry to explore the effect of COVID-19 on student trust: medical students' perspective.

This article was migrated. The article was marked as recommended. Background Students' anxiety due to the COVID-19 pandemic was expressed by some medical students in the form of anger and mistrust. This study aims to explore the reasons for mistrust between students and faculty among medical schools in Egypt that have flared during the pandemic. Methodology This is a three-phase exploratory qualitative study depending on thematic emergence from appreciative interviews (AI) sessions. Phase 1 online Appreciative Inquiry (AI) session followed by thematic content analysis. Phase 2 The themes were approached by a smaller cohort of students using a design that relied mostly on the psychometric free association test. Phase 3 The themes were tested on a larger number of students through an online survey. Results Students are revealed to be very well educated regarding contemporary medical education concepts. The most important factors from the student perspective were the presence of a well-designed assessment system aligned with the learning outcomes and teaching methodologies and the presence of extracurricular activities and soft skills, respectively. A balanced student life respecting their mental health was found important to increase trust. Conclusion A roadmap to enhance the student trust must be planned on several pivots: curriculum structure, extracurricular life, communication strategies, and identifying student roles in their learning and decision-making.