The Covid-19 pandemic disrupted education of students all over the world. However, for students in their final stages of medical studies, the change was more worrisome, as they feared that they would not receive the optimal clinical training they aspired to with the movement to virtual learning.
“The pandemic definitely impacted our direct patient care and physical examination skills,” Bruno Pacheco, a sixth-year student at Weill Cornell Medicine–Qatar, said over the phone. “You can run simulations but you can’t develop tangible clinical skills that are needed in a physical examination through virtual training only.”
Medical students in other parts of the world share the disappointment experienced by Pacheco.
In an American study of the effects of the Covid-19 pandemic on medical students, most respondents (nearly 75 percent) agreed that the pandemic had significantly disrupted their medical education, and a majority (61 percent) believed they should continue with normal clinical rotations during the pandemic. Moreover, more than 80 percent were willing to accept the risk of infection with Covid-19 if they returned to the clinical setting.
Egon Toft, dean of the College of Medicine at Qatar University, said that it was challenging to transform clinical skills training to a virtual learning environment, but as some hospital departments were closed during the peak of the pandemic in Qatar last year, the college had to find ways to adapt.
To make it up for the lost days, the College of Medicine planned training sessions for students over the summer holidays when hospitals could receive them again. (See a related article, “Afraid of Infection, Medical Students in Egypt Want to Postpone Exams.”)
Experimenting With Virtual Platforms
Toft said that the pandemic pushed online learning forward faster. He expects to see more remote teaching at medical schools everywhere in the future.
“Students had more control over their schedules with virtual education,” he said. “Moreover, as they search online and find the right information to develop their medical knowledge, they will acquire skills to become lifelong learners after they leave the university.”
When face-to-face education stopped, the college chose five skills to test the possibility of teaching them via virtual platforms. According to Ayad Al-Moslih, head of pre-clinical education at the College of Medicine, the institution sought feedback from faculty members, students and physicians at local hospitals to further develop the virtual program.
“The pandemic definitely impacted our direct patient care and physical examination skills. You can run simulations but you can’t develop tangible clinical skills that are needed in a physical examination through virtual training only.”Bruno Pacheco
A sixth-year student at Weill Cornell Medicine–Qatar
Al-Moslih said that after trying several platforms and receiving training from the computer science department at the university, the college moved everything that does not require manual skills to virtual educational platforms. It used video demonstrations for clinical situations and anatomy classes.
For other clinical skills that require a hands-on approach, students attended in person, but the timing and the number of students in each group was cut in half.
Plans to Keep Some Virtual Elements
Weill Cornell Medicine–Qatar followed a similar approach. The university kept the majority of clinical learning and clinical assessment face to face while maintaining proper precautions. At the same time, large lectures and small group discussions were held remotely. The university used a mix of video conferencing, calling tools, self-assessment and gaming tools to enhance interaction during lectures.
Amal Khidir, an associate professor of pediatrics at Weill Cornell, said that moving forward, she would like to keep some of these changes.
“I don’t think we will get rid of all that we learned from the Covid-19 situation,” she said. “I like the virtual format for the classroom time and I am planning to maintain it. I feel it helps the students focus more, save time and become more productive.”
Khidir is responsible for the Cornell Stars program, an annual event that gives trainee doctors in the third year of the medical program an opportunity to get comfortable with examining young children, under the supervision of experienced pediatricians.
Now under lockdown conditions, the event was held online for the second year in a row. Khidir said that this provided a chance for students to practice virtual consultations that have become very common during the pandemic.
Thurayya Arayssi, a professor of clinical medicine and senior associate dean for medical education and continuing professional development at Weill Cornell Medicine–Qatar, said that consultations with students was another change brought by Covid-19.
“Many decisions were made in collaboration with students and one elective was co-developed by students and faculty members,” she said, “That was a very important theme for us that started during Covid-19 and I anticipate it will continue moving forward.”
Challenges for First-Year Students
While students in the final stages of their medical education were worried about clinical skills and training at hospitals, new students had their own set of challenges.
“Starting medical school is hard, but starting medical school in a pandemic doesn’t sound like a great idea either,” Maryam Al-Quradaghi, a first-year medical student at Weill Cornell, said by email. “It was very hard to ignore what’s going on all around the world, at times it did seem like we are helpless and that the world is collapsing. Yet we still had a quiz to study for or an assignment to submit. It was soul-crushing at times, but a motivator at others.”
Al-Quradaghi said that the lack of routine and structure and the absence of social interactions made studying much more challenging for her.
She and her classmates were also worried about not being able to ask for help as they used to do in offline school.
“Prior to the pandemic, asking for help was as easy as going up to your professor after the lecture and asking them right away. This was obviously much harder to do during online education,” she said.
A Learning Curve for Professors
Virtual teaching was a learning curve for professors as well.
Suhad Daher-Nashif, an assistant professor of behavioral sciences at the College of Medicine at Qatar University, said that when teaching moved to the virtual world she had a challenge keeping her lectures interactive.
“I began to discover games that could stimulate interaction and thinking among students,” she said. “Perhaps I will not use it later, but I think that the future lectures will be a hybrid of our old methods and what we learned during the pandemic.”
“I began to discover games that could stimulate interaction and thinking among students. Perhaps I will not use it later, but I think that the future lectures will be a hybrid of our old methods and what we learned during the pandemic.”Suhad Daher-Nashif
An assistant professor of behavioral sciences at the College of Medicine at Qatar University
To help maintain students’ attention for longer, Nashif divided the lecture into a recorded theoretical part and an unrecorded discussion part to encourage students to focus and participate more freely.
Al-Moslih said that overall students at the College of Medicine maintained the same level they had before the pandemic, which indicates that the changes to the training process did not affect their acquisition of the required skills. However, he said there are questions that remain unanswered.
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“Were the nonverbal skills of students affected?” he asked. “When communicating with a patient, doctors pay attention to body language and other nonverbal hints, but we think that these skills were nonexistent online.”
A Maturing Experience
Arayssi agrees that despite all the advantages of virtual learning, “there’s nothing better than face to face, whether for teaching, learning or patient care.”
“Our clinical curriculum is designed to make students responsible for taking care of patients from day one, under supervision,” she said. “That is a piece that cannot be done at all virtually.”
Still, Arayssi thinks that studying during the pandemic was a great maturing experience for medical students.
“I think this new generation of physicians is going to be different,” she said. “I think they are going to be more accepting of uncertainty, more compassionate and kind, more aware of inequities in this world and more aware of the effect and importance of globalization and the connection between the global north and global south.”
To read more about the novel coronavirus in the Arab region and how it has affected education, research, culture and the arts, see a collection of articles from Al-Fanar Media