The aim of this preliminary study was to describe the response of one medical school to the outbreak of the COVID-19 pandemic, to document the changes in pre-clinical and clinical teaching and learning, and to present an initial evaluation of these changes.
In this study, we have examined the trainees’ and trainers’ reaction to online teaching and learning. We have described the improvement in online teaching and learning skills and the presumed change in attitudes. We have no data from our medical school regarding original attitudes toward online teaching and learning, but the literature describes obstacles to online teaching 13,14, and we presume that these were also the attitudes in our school. Regarding academic achievements after online learning, it is difficult to compare non-proctored examination results with previous proctored examination results. However, students’ results during this period were similar to normal years and in some cases were even marginally better. As to on-the-job behavior regarding online teaching and learning, there was no choice but to change under the unique circumstances that evolved. However, it does seem that both lecturers and students would, without doubt, like to see online teaching combined in faculty practices in the future.
It is clear that the transition to online teaching and learning mandates more thorough and in-depth evaluation in the future. However, we believe that due to the lack of literature describing these issues, and the unusual circumstances in which medical schools all over the world found themselves, there is much to be learned from the initial experiences of medical schools.
All in all, the transition to online teaching and learning was seamless, and was met with almost universal satisfaction. A transition that under normal circumstances might have taken years of planning, preparation and careful and gradual implementation, was brought about almost immediately. This presents a unique opportunity to retain some or even most of these practices in the future.
Open avenues of communication between students and faculty were found to be essential during these times of uncertainty. The students expressed high levels of satisfaction with the frequent meetings between student representatives and faculty, and with the way students’ concerns were heard and addressed.
Sixty-eight percent of the pre-clinical medical students participating in the Bar-Ilan University online learning survey supported either exclusive online teaching or blended teaching combining mainly online teaching and less face-to-face teaching in the future. To our knowledge, there are no similar results in the medical literature for comparison, but these are, in the authors’ opinion, impressive and surprising results. Regarding students in clinical years, although a high satisfaction rate was demonstrated during online courses, it should be emphasized that online teaching was the only option available at that time.
Studies have shown that students consider lecture recordings beneficial, and they use the recordings primarily to review the lecture at their convenience. While faculty members reported concerns with decreased attendance, few students reported using recordings as an alternative to class attendance 15,16. In this study, students and faculty expressed satisfaction with the possibility of reviewing lectures at a later stage, in a place and time of the students’ choosing, at a desired pace, and as many times as necessary. There was wide agreement that lecture recording should be adopted in the future.
In times of crisis, with limitations on attendance and learning, some curricular content can be postponed or cancelled.
No significant decline in online classroom attendance was seen. Compulsory attendance has been shown to improve attendance rates but the range and mean marks of absentee students was similar to the class as a whole 17,18. Some students may learn as well or better outside the classroom than in it. Making lecture attendance mandatory is the individual decision of each medical school. Online lectures the potential to eliminate wasted travel time of outside lecturers, who until now had had to travel to the campus, which is relatively remote. In all small-group activities, clinical skills workshops, simulations, anatomy dissections and laboratories attendance should remain compulsory.
Our Faculty, being at a peripheral geographic location and societal position, has stressed physical attendance and participation. This has been a disincentive to some excellent students whose priority is a central location. Now that we have strong preliminary evidence for the success of on-line learning for certain major components of medical education, it is unclear whether we can maintain insistence on physical presence in pre-clinical course studies.
Students expressed satisfaction with interactive online lectures with developing clinical cases, although the mixture of students from different years of study in the same online lecture was found to adversely affect the ability of faculty to meet the needs of all students. It is possible that some clinical experience is required in order to benefit from online clinical lectures.
Some lecturers felt isolated from students during online lectures and found that interaction was limited. This feeling was exacerbated by students deactivating webcams during lectures. At a later stage, the use of a webcam was made compulsory in all online small-group activities.
Assessment of students’ learning presented a special challenge. Research has shown that assessment is one of the most powerful determinants of student learning behaviors 19–21, and assessment has been described as “the tail that wags the curriculum dog” 22. With the outbreak of COVID-19, a review of the assessment methods of all current courses was conducted. In the case of long-term limitations, especially with high-stakes examinations, students would have to be brought into the faculty in small groups for proctored examinations.
Small-group activities can be continued online, although there are some significant limitations. The demonstration and practice of physical examination and communication skills was severely limited. No anatomy dissections or OSCEs were planned during the initial stages of the pandemic. In the case of long-term limitations, students would have to attend small-group lessons while maintaining social distancing. This could potentially cause significant difficulties, especially with limited availability of clinical teachers.
There was wide agreement that online lectures cannot replace traditional clinical rotations. This was stated repeatedly by both students and faculty at all levels. Online lectures with developing clinical cases were seen as a partial and temporary measure. The authors believe that, in the spirit of the declaration of the Medical Schools Council in the UK 7, in the case of a long-term pandemic, clinical students will have to be designated essential workers, and clinical teaching an essential function of physicians. This is also a unique learning opportunity for medical students, and a vital contribution to the formation of professional identity.
Limited availability of clinical learning sites should lead to careful preference of more essential rotations, for example in the case of final year students who are supposed to graduate in the near future. During clinical rotations, students can be divided into smaller groups or capsules, with each capsule attending the clinical ward at different times of the day or different days of the week.
This preliminary study has some potential limitations. The response rate of medical students to online surveys was not high. We have no data regarding the population that elected not to participate in the surveys. Results represent the experience of one medical school in one country, and therefore might not be generalizable to a wider population.