The outbreak of the COVID-19 was an unpredictable emergency, which had brought unprecedented pressure to intern teaching. However, with the popularization of home computers and smart phones and development of convenient teaching software in China, it was feasible to conduct online teaching. The great challenge we faced was how to make the good use of online teaching platforms and resources, how to transform the teaching mode, and how to adjust the evaluation system to flexibly carry out the online internship teaching.
The traditional internship teaching mode in China is mostly lecture-based and teacher-centered, in which students receive knowledge passively and interaction is rarely seen. In addition, with the increase of conflict between doctors and patients in China, most of the patients lose their trust in doctors especially the interns. Therefore, the interns seldom have an opportunity to practise clinical operations on patients in China. To make up for this deficiency, we tried to use CBL teaching mode, which was originated from Harvard Business School in the United States. It is characterized by case-based discussion, interaction, sharing and thinking, in which students would participate actively. It is more effective for teaching and more suitable for current medical education. On the other hand, there are also limitations in CBL teaching method. For instance, once the students lack enough basic knowledge, the quality of teaching cannot be guaranteed. Moreover, due to the constraint of space and time, it is difficult to monitor pre-class and post-class study situation in CBL.
Due to the advantages of SPOC, we decided to use SPOC as our online teaching method in this special pandemic period. SPOC is derived from the MOOC, and is implemented on a smaller scale and has more restrictive requirements for entering the curriculum, paying more attention on the quality of teaching compared with MOOC. SPOC is suitable for internship teaching because internship teaching in China is usually conducted in small-scale in which the interns are organized and trained in groups. The characteristics of SPOC can just fill the holes of CBL for internship teaching, especially of online CBL. Therefore, we applied the SPOC-based CBL in surgical intern teaching during the COVID-19 pandemic.
Findings of the questionnaire survey showed that most of the students thought it was necessary to carry out the online internship teaching and were satisfied with SPOC-based CBL. As required by SPOC, students learned the case-related resources by their own before pre-class test, and they could study in their own rhythm, which could help to optimize their use of time. The pre-class test provided an effective way for evaluating mastery of basic knowledge related to the case, which could overcome the limitation of CBL that it couldn’t guarantee the teaching quality when basic knowledge was not well mastered by students. As it was shown in the results of questionnaire, 94.4% of students thought this teaching mode was resultful in enhancing theoretical knowledge, and 97.2% of students regarded it as a good way to improve clinical thinking.
The major challenge of online internship teaching was how to improve the capacity in clinical work, including the capability of medical history collection, physical examination, medical record writing, doctor-patient communication, and surgical operation. In this teaching mode, we combined the online training on SP with the offline training on isolators in the same house, aiming to improve the ability of medical history collection, physical examination, and doctor-patient communication. Some researches showed that video coaching and mental practice can improve the operative ability[14, 15]. So we trained students using live broadcast and videos of surgery, and tried to help them understand and remember the procedures. However, the results of final test revealed that the clinical operative skills in SPOC based CBL was significantly poorer than in traditional surgical internship teaching before the pandemic. This result is consistent with other studies, that surgical skills cannot be improved through video review alone. Because these techniques require practice in operations or at least in simulation training. Only 57.3% of students believed that online learning alone could improve surgical skills, which highlights the shortcomings of online internship teaching.