4.1 Importance and necessity of the strategies for higher medical education in China during PHEIC
Before the COVID-19 pandemic, China’s higher medical education mostly adopted traditional education model, namely the second-generation education model. However, with the incredible growth of Internet since the 1990s, online education has begun to thrive. In 2009, Khan Academy and flipped class became popular in China, and a number of higher medical education institutions in China have begun to accept or try online education. In 2010, large-scale online courses such as MOOCs had a tremendous impact on China’s higher medical education. At present, there are numerous online platforms of MOOCs, including Coursera, Udacity and edX, the top three world-renowned education platforms as well as domestic platforms such as Chinese university MOOC, XuetangX and Icourses. The proliferation of online education has already been an inevitable trend, and the COVID-19 pandemic facilitate this transformation.
As speculated earlier, the findings of this study show that medical students prefer home-based online learning in terms of adaptability and acceptance of the course. With regard to the relevant observational indicators of competency-oriented medical education involved in this research questionnaire, the results also show that quite a number of medical students believe that home-based online education model can, to some extent, cultivate their professionalism, stimulate their motivation in learning and bring more fun to the study amid the pandemic. Meanwhile, medical students can obtain knowledge and improve learning skills through online education. In a sense, through online interaction based on WeChat groups, QQ groups and other platforms, home-based online learning can also foster their teamwork spirit. Therefore, the result of this study to some degree further confirm that Chinese government has implemented timely and correct strategies in response to the PHEIC, which extends higher medical education from school to home and accelerated the popularization of online education. It may be an inevitable trend for the development of medical education in the future.
4.2 The online teaching model of higher medical education in China under PHEIC
After the COVID-19 outbreak, students had to stay at home to eliminate chances of being infected. However, the devices and network environment for online learning differ among families. Given the Guidance on Online Education issued for schools in China amid COVID-19 pandemic, China’s higher medical education was conducted via PCs, mobile devices, TV and other media based on online platforms. The teaching models include online courses, live streaming, independent learning, etc.
Online courses are a series of lessons delivered on the website or to the mobile devices, which can be conveniently accessed anytime and anyplace. In recent years, with the booming of high-quality course resources, MOOCs and “golden courses” in the field of higher education and the popularity of micro courses and flipped classroom, the number of various online courses in high quality is increasing rapidly. In the face of COVID-19 pandemic, such massive resources can be accessed for free on the online platforms in China such as China University MOOC, Good University Online, Wisdom Tree, etc. As for the current teaching plan, it is recommended to employ MOOCs and SPOCs, meanwhile setting up Q&A groups as supplement for online courses. However, some shortcomings of online courses surfaced in its current application. For instance, the number of high-quality MOOCs, micro courses and “golden courses” are limited, which cannot cover all courses for all grades. As for the Internal Medicine courses, there is a lack of sufficient high-quality online course resources in China. Meanwhile, considering the nature of online courses, teachers cannot monitor students’ learning efficiency and test their real-time learning effectiveness. Thus, the following related measures are needed to improve the quality of online courses. ① Publish daily learning tasks at a fixed time to create a good online learning atmosphere, and check students' learning tasks in a timely fashion. ② Offer learning support services, such as designating an excellent student as an assistant, managing class discipline, and collecting questions raised by students. ③ Organize live streaming classes and answer students’ doubts to strengthen their sense of actually being in the class. ④ Drawing up a plan to promote high-quality MOOCs, “golden courses” and micro courses after the pandemic.
Live streaming teaching, as a new type of online teaching model, is becoming more familiar to and applied by increasing numbers of teachers and students. Compared with online courses, live streaming teaching allows teachers and students to communicate in real time, provides a strong sense of presence and offers more interactions. Especially with the development of internet and popularity of live streaming culture, it appeals to college students even more. Live streaming teaching is a teaching model that relatively resembles offline classes but unstable network environment like high network latency and low network speed may ruin the students’ experience of learning in the live streaming online classroom. Hence, followings are some advice to improve the quality of live streaming teaching : ① Familiarize with the live streaming platform in advance and test it, and make precautionary plans for unstable network environment. ② Promote the application of 5G network in live streaming teaching and increase the bandwidth. The results of this study show that image quality, voice clarity, network speed and latency of 5G network are all better than other forms of wireless network connection. ③ In the process of teaching, course content can be divided into several fragments or small units, and some content-related interactions and tests can be presupposed. ④ With flipped classroom, students can study on their own first, find some common problems through exercises, tests and tasks, and then attend the live streaming to solve those problems. ⑤The teacher ought to turn on the camera throughout the teaching process to maintain a sense of presence. ⑥ Avoid the online rush hours to ensure a stable live streaming during the pandemic.
Independent learning model mainly depends on individual student to study on their own with learning resources provided by teachers while teachers give guidance and answer questions online afterwards. Under the circumstance where teachers and students are in different places, such self-learning is almost inevitable with advantages like low cost, easy operation and high flexibility, but the disadvantages lie in its weak interaction, poor learning atmosphere, and high requirements for self-discipline. During the pandemic, it may become a preferential option for most schools, particularly for teachers who lack relevant experience in online teaching, or the network environment at students or teachers’ home is poor.
In summary, it is recommended teaching models such as online courses, live streaming and independent learning can be adopted amid COVID-19 pandemic to achieve a better study experience. The result of the questionnaire show that students respond well to online education and have high enthusiasm, especially female medical students who have higher expectations for online courses. The 5G network can present high-definition image quality, improve voice clarity, and make real-time interaction more appealing. However, in terms of observation indicators concerning the evaluation of competence-oriented capacity, most medical students are more inclined to use the blended teaching model based on 5G network that combined TBL and online interaction. That indicates online learning based on 5G network can better improve students' enthusiasm and sense of participation. We can try to diversify the form of online education to enhance the students’ learning experience. In particular, the model of flipped classroom can be adopted. Students in this model are encouraged to study independently through high-quality MOOCs and literature before class, and TBL can be carried out on social platforms such as online WeChat group or QQ group to cultivate students' teamwork spirit. After that, teachers summarize the class by integrating knowledge of medical humanity, public health and social economics to improve students' professionalism and analyzing the problems or questions raised by the students in the form of online live broadcast supported by 5G network to achieve a good learning experience.
4.3 Some suggestions on online teaching for different practitioners of higher medical education in China under major public health emergencies
During the COVID-19 pandemic, a variety of online teaching programs aimed at higher medical education has been formulated and implemented, but in this particular period the effectiveness and results of online teaching need joint efforts by subjects of practice involved in actual work such as higher medical education managers, teachers and students. ① Amid current pandemic, the administrative department of higher medical education and school administrators should take actions based on a long-term perspective, systematic thinking and top-level design. ② Teachers are the main body of the action of “keep medical schools running without suspending classes”. On the one hand,teachers have to change their ideas to form a "student-centered" teaching concept. On the other hand, teachers ought to improve their information literacy, familiarize themselves with online education, and master the method of online teaching. In addition to teaching basic professional knowledge, ideological and political concept, benevolence to patients, contribution to society, as well as the preventive medicine should be integrated into online courses. Moreover, it is necessary to raise medical students awareness of PHEIC during the pandemic, especially teach them about precautionary and preventive measures such as clinical diagnosis and treatment, isolation of patients and self-protection so that they can be competent in the future to handle public health emergencies and give medical guidance to the masses.