Our survey showed that all universities that participated were confronted with transformation of teaching and study material in a remarkably short period of time. Since this process was subject to each university and/or department individually, a wide variety of digital teaching concepts for lectures, seminars and practical training, as well as the used platforms were found. The remaining classroom teaching was also subject to each department. While a few universities restrained from doing any classroom teaching at all, others tried to prioritize bedside teaching for higher semesters to enable practical experiences.
A specific challenge arises for students of the model degree program of medicine. This program was designed to emphasize patient contact starting on the first day of medical studies and to improve practical skills through experience15. Due to the lack of classroom and especially bedside teaching, earlier semesters are deprived of practical experiences. The resulting deficit in basic skills could be difficult to compensate later on, since the program is arranged modularly and supposed to work as a learning spiral. But not only students of this program could be affected, the time lost for practical experiences could probably affect all medical students.
Considering existing national and international literature, our results generally confirm the findings of other subjects and lecturers around the world16–18.
Even though no other work explicitly focused on the subject of Orthopaedics and Trauma for this kind of topic regarding digital teaching, similar sources described pragmatic suggestions for solutions. This includes the usage of digital media to preserve a culture of interactive discussion between lecturers and students19, the usage of pre-existing communication tools to train professional conversations with patients and acquire their case history20, the continuation of knowledge transfer by digital recordings21 or digitalization of medical exams22. General challenges, such as the ability to give individual feedback to students in online classes is discussed23.
An advantage of online teaching could be the consistency in quality of knowledge transfer, e.g. in case of pre-recorded lectures available to all students. This includes the ability for students to repeat already watched as well as catch up with missed classes without depending on time and location. Also, lecturers could profit from this independence, easing the coordination of clinical work and teaching. The additional involvement of external lecturers could improve the professional exchange between universities and departments.
To completely overcome these didactic and organizational challenges, more time and experience is needed. Still, this paragraph will aim to provide an overview of promising concepts and potentials in Orthopaedics and Trauma teaching.
Students could be involved into telemedical consultations similar to the well-known bedside teaching concepts17. As soon as real patients are present, difficulties regarding data protection will arise and be of high importance to regulate.
Another interesting potential could be the usage of virtual reality (VR) and augmented reality (AR) to experience study material in new ways, e.g. anatomy24.
In Orthopaedics VR has already been used for quite a while, enhancing practical skills and knowledge of students25.
To enable good digital teaching, lecturers will be in need for adequate training on didactics in digital teaching. This includes knowledge on possibilities and limitations for each used online platform, basic conditions for privacy policy, and how to design digital exams.
Using previously named teaching materials, each class can be designed to be more attractive and exciting but also to appropriately convey knowledge to the students. Ultimately this could lead to an attachment of students to Orthopaedics and Trauma and their application for residency in this field.
To train students on being digitally competent, it will also be essential to the field of Orthopaedics and Trauma to partake in the organization and teaching of classes. Considering the growing implementation of digital media and tools in our daily and work lives, it keeps gaining importance. Experiences and knowledge besides the “standard medical knowledge” will be helpful to future doctors14 since they might use artificial intelligence and digitally-assisted systems to help with medical decision making27.
Limitations
Replies from the department of Orthopaedics and Trauma at 23 universities do not allow a generalization of our findings on teaching at all universities and departments in Germany. We decided to refuse a distinction between Orthopaedics and Trauma in order to create a general overview, even though they are still often organised and taught separately at German universities. Even before the start of the pandemic there were differences in the teaching of Orthopaedics and Trauma, meaning not all differences can be solely related to the pandemic.
The questionnaires were usually filled out by one person in charge of organising the teaching of their department at each medical university so some opinions could be subjective and not a proper reflection on the objective teaching situation.
Differences in the medical studies program, e.g. model degree vs. regular program, are designed differently and cannot necessarily be compared directly. Furthermore, the used definition of digital teaching is one of many and has to be kept in mind if comparisons to be made.
Outlook
With increasing relevance of digitalization and the expected importance of digital competencies for doctors, teaching of medical students has to be adjusted as well. Modern and digital classes, individually adjusted to the students’ needs and interests will be essential. This provides attractive teaching of high quality and will additionally improve the engagement of students in the field of Orthopaedics and Tauma28.
The exchange between universities and departments on experiences with old and new digital teaching concepts should be encouraged to provide overall improvement of teaching in this field. Larger concepts could be designed by several lecturers from different universities to achieve a high-quality result that can be distributed equally. The peer-reviewed videos from the German working group on teaching (AG Lehre) serve as an example here. By showing general examination skills using patient models as well as 3D animations, the basic anatomy of different joints is explained29.
To facilitate the exchange between universities it can be taken into consideration to use pre-existing platforms like the German Society for Orthopaedics and Trauma (DGOU) or the Working Group for Osteosynthesis (AO).