The concept of professionalism is embedded into our teaching practice and is inherently built up in practice as we develop. Teachers have been taught to monitor their professional behaviour and this is a construct that refers them to a number of acceptable behaviors that are within the educational culture norms. These acceptable behaviors have developed very little since their dawn and development of the educational platforms require that we revisit the core concept of professionalism. Tested against the test of time and technology, these norms are challenged every day and need to be addressed and updated to accommodate for new educational limitations and challenges (10).
Creating meaningful connections with students requires that we develop new ways to build virtual communities. Students often use social media to interact and share information with each other, but they can feel uncomfortable having their professor in this space. This calls for new norms that need to be adopted (the connection.com) (11).
Student and social Tension:
Sajid et al., 2016 (12) and Papanna et al., 2013 (13) reported that online lectures as a component of DL allow students to pace themselves individually and eliminate the barriers of time and location. Longhurst et al., 2020 (14) reported reduced student engagement as an environmental threat in 36% of universities in their SWOT analysis from 14 different universities in the United Kingdom and Republic of Ireland. This is in agreement with the findings in this study.
Distance learning must engage, guide and retain the student. In opposition to current dominant ideas about self-directed learning, distance learning works best when students are absolutely clear about the pathway that they must follow. Giving students options and choices at a distance is problematic. Distance learning students can get lost. They tend not to have a consistent or predictable approach to using such options which means that the distance teacher cannot be sure about what is being learned, unless the pathway is clear and specified (7).
Longhurst et al., 2020 (14) discussed the issue of teacher student relationship where 21% of the universities participating set off an alarm that student teacher relationship is an environmental threat they are facing.
Curriculum and logistics tension:
Our warning sign regarding clinical teaching is in agreement with Longhurst et al 2020 (14) who expressed that 50% of participating universities highlighted Lack of practical sessions and labeled that as a weakness point. Also in agreement with Papanna et al., 2013 (13) who emphasized the importance of the orientation classes to students fresh to clinics that it could help them understand the bedside clinics better and the other barriers identified by the students’ needs to be addressed by the management.
Nuffer and Duke (2013) (15) found that In the final year of a Doctor of Pharmacy program, live training was more effective than online training in preparing students to more quickly become oriented to diabetes management clinic operations and for students to have confidence seeing patients early in the rotation. This finding is similar to opinions that persist to this day and were evident in our map.
In our study a need emerged for combining DL with other forms of education. This demonstrates a better understanding of the concept of distance learning in its described definition in Grant 2008 (9). This form when best applied and executed will in itself be a hybrid form of education that allows for proper engagement and follow up of students. In DL learners can be lost when there is too much emphasis on self-directed learning. This led experts to renown self-directed learning when describing best DL practices (7).
Distance learning is a whole system which integrates a wide variety of elements for curriculum coverage. These might include print, use of resources, practical classes, technology-based methods, face-to-face learning, individual and group work and many others (7).
Warning Signs and action steps
From the identified steps, in the process of delivering the educational services, it seems of extreme importance that schools, and institutions focus on introducing and applying quality procedures as quality management routines have become an integral part of the global management structures of higher education institutions which in turn contributes to the consolidation of a more managerial and ‘governed’ university (16) & (17). The cross-cultural gaps and institutional discrepancies have to be taken in consideration when applying the standard measures of quality standards in higher education ensuring near zero errors in quality management (18).
Internal evaluations follow ups and assessments is a key driving factor for improvement of the faculty’s internal educational services. It is a necessity that internal quality procedures and focused questionnaire items are monitored closely all around the year to act as triggers for corrective action decisions. In addition, quality unit teams who are responsible for internal quality audits must liaise and work in alignment with the various stakeholders for suitable quality management (19). Shared knowledge of the academic faculty members as well as the administrative personnel would help the internal quality team develop a benchmark to enhance the internal performance targets for the upcoming years. ‘Faculty autonomy’ is another factor that encourages faculty members to innovate their research and teaching, sharing their individual thoughts and knowledge with the internal stakeholders (20).
Stensaker et al., 2011 (21) emphasized that external quality assurance had a significant impact on higher education institutions which aroused the need of these institutions to accommodate for these external expectations in terms of response to the quality concerns. Developing quality control, necessitates strengthening the managerial control which according to Brennan & Shah, 2000 (22) could be achieved by developing internal quality management systems directed to governing the educational provision through establishing more recognized organizational rules and routines. Compliance driven quality assurance is another factor that compels higher education institutions to share their knowledge with external interested parties like government agencies in order to develop a benchmark for the rest of the faculties and institutions.
According to Shah 2012 (23), striving to improve the quality assurance in the universities is primarily based in the board agreements and the synergy between the external quality audits and the internal university procedures The ultimate objectives for these quality systems is to enhance the students’ learning experience, through coordination and developing good quality indicators, by following robust Leadership and management strategies learning experience (24)
In their study Longhurst et al., 2020 (14), tested strength points in universities and identified that 71 % of the universities consider DL as one of their strength points; this is in contrast to our self-reported findings. This might be attributed to technological advancement in universities in his study and their possession of a well-established LMS.
Also Longhurst et al., 2020 (14) found that time constraints was a weak organizational point in 57% of the universities in DL which is opposing our finding. This can be explained that the perspective of time was different as in our study we were highlighting classroom efficiency while Longhurst's study discussed time frames in general.
Distance lectures allow students to pace themselves individually and eliminate the barriers of time and location (12) which describes the exact situation in our findings.
The identified warning signs also focus on signs that are relevant to practice like violence incident reports of teaching hospitals and the importance of these reports to stimulate decision to change educational courses and add more face to face interaction.
Content of the curriculum will be shaped by the health needs of the changing population, new medical knowledge and the possible changing role of the doctor from patient advocate to health resource manager (25).
Information for which change, and adaptation decisions are made can be deduced from practice and the incidental opportunities that arise in everyday physician patient encounter. To cope with the rapid pace, the curriculum will have to be a dynamic concept in itself and no single curriculum is likely to produce the variety of doctors we require to meet changing societal needs. Not only does the curriculum need to be flexible it also needs to adapt across the differing needs of the communities the product doctors will serve. This will offer learners more choice.
A number of data and valuable information is retrievable from OSCE station results as per the identified warning signs. This puts great emphasis on the analysis of results of OSCE in an analytical way in order to retrieve information usable for curriculum reform.
Evidence based medicine and evidence based medical education is now the baseline accepted practice. Many interventions have been conducted to validate the use of formative OSCE to guide curriculum decisions (26). Information from OSCE stations has for a long time been used to guide student learning.