Jon presents a systematic scoping review that looks to map the various #meded developments resulting from the COVID-19 pandemic. The authors hope it helps educators and editors identify gaps in the existing literature and serves as a roadmap to guide future research.
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KeyLIME Session 350
Reference
Daniel et. al,. An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64 Med Teach 2021 Mar;43(3):253-271.
Reviewer
Jon Sherbino (@sherbino)
Background
Ok. So background. You’ve heard a little about this COVID thing? Any one need a primer? Well, it changed a lot of health care and health professional education. My research unit coordinated a multi-disciplinary program evaluation of how COVID changed educational practice. Punch line: lots of things changed. A lot of creativity from teachers (and learners). Learning still happened. Some efficiencies were achieved. Some past practices (mainly around social connection) are still deeply missed and not replaced. What has been your experience?
One of the savvy research moves of the past 2 years is to somehow include COVID in your grant application or publication. My google scholar search COVID + medical education had 2.9M hits ( in 0.07 seconds). And a quick scan of the first few pages speak to the impact of COVID on educational practice. Enter Daniel et al. As they attempt to wrangle the HPE literature to find how this natural experiment has impacted – for better or worse and all the spaces in between – the training of this new generation of health professionals. Early reviews in 2020 (including a review by these authors) were notable for a lack of quality and minimal program evaluation data.
Purpose
Per the authors: “The aim of the current scoping review is to map the extent, range and nature of medical education developments in response to the COVID-19 pandemic since our prior review; to summarize and disseminate current research findings of this rapidly expanding evidence base; to identify gaps in the existing literature for future research; and to determine areas of focus for future systematic reviews.”
Key Points on the Methods
This is a BEME review. More about that at the end of the show.
The study:
• ** was conducted and completed in EIGHT weeks!
• Adopts previously used search strategy
• Follows the sequence for scoping reviews identified by Arksey and O’Malley (which has a citation rate of 8.6k); and more relevantly
• Complies with the STORIES (Structure Approach to the Reporting in Health Education of Evidence Synthesis) reporting guidelines (which is also the WORST acronym I’ve seen in years).
Search of MEDLINE EMBASE CINAHL and PsychINFO from May to September 2020 . (This “new” study is already stale.)
Papers must include the:
• Education of physicians (at any stage)
• Evaluation data
Key Outcomes
7237 unique studies were identified with 127 included in the review. Interrater reliability was excellent (k=0.91).
Interestingly, the original papers and authors are only presented in the supplementary material. Aggregate data (and exemplar primary sources) are presented in the body of the paper.
Papers from the United States represented nearly half of all papers with 40% of papers regarding UGME and 33 % of papers regarding PGME. Study samples ranged from 5 to 30,000.
Educational Developments
- Pivot to on-line learning
a. Nearly half of studies
b. Majority describe exclusively synchronous learning, only 4 articles report exclusive asynchronous learning
c. CBL, PBL, TBL and flipped classroom techniques were adopted.
d. On-line learning increased attendance, flexibility, convenience, scaling and self-pacing.
e. Regional to international collaboration was made possible.
f. Disadvantages included lack of social connection, competing home priorities, passive participation, cyber threats, challenges in technical skills instruction and an increase in faculty and administrative work.
g. Few studies were informed by multimedia, social constructivism or blended learning theories.
h. Innovations in instructional methods were in the minority with virtual environments attempting to replicate previous in-person instruction. - Training for treating COVID patients
a. Focus of PGME and CME
b. Majority of studies involved IPE and involved in-situ simulation
i. One study used virtual simulation, delivered > 400 times to more than 30k healthcare workers in 5 weeks across a single region. - Assessment
a. Majority of studies focused on medical knowledge.
b. Open book exams, virtual OSCE, online clinical vignettes all described without significant impact on assessment compared to traditional practices. - Wellness
a. Interventions to address physician distress while caring for COVID patients were described.
b. Interventions to address isolation and anxiety were described.
c. Mindfulness, stress management skills, storytelling, guided reflection were commonly described personal techniques. Psychology faculty and pastoral care providers were also made available in some institutions. - Telehealth
a. Learners were integrated into existing telehealth programs to backfill lost clinical placements. - Reconfiguration of training and clinical service
a. Two articles describe early graduation to support a health system overwhelmed by COVID
b. Restructuring of clinical service to meet system needs was also described. - Admission Interviews
a. On-line adaptations to address travel restrictions led to cost and time savings without significant disruption of the interview process - Service Provision
a. One study described a resident-led initiative to dispatch volunteer residents (n=578) to French hospitals critically impacted by the pandemic.
b. The second study described the work of medical students to support clinical care via participation in call centres and diagnostic testing. - Faculty Development
a. One study described initiatives to improve facility with on-line learning, while a second provided knowledge resources relevant to COVID clinical care.
Only 10 articles reported changes in clinician behaviour or organizational outcomes relevant to their intervention. Most studies focused on satisfaction data or changes in knowledge and attitude.
Key Conclusions
The authors conclude…
“We have noted specialties that have published more extensively (e.g. surgery and surgical sub-specialties), and called on others to do more (e.g. emergency, internal, and family medicine). We have also called attention to relative areas of strength (e.g. the pivot to online learning and simulations), as well as areas in urgent need of development (e.g. telehealth, interviews and faculty development). It is our fervent hope, that educators and editors will use this review as a roadmap to guide future developments.”
Spare Keys – Other take home points for Clinician Educators
This scoping review is notable for the RAPID expanse of a completely new literature in HPE. There is a “meta” theme here worth exploring in future scholarship.
BEME guides are the “Cochrane reviews” of HPE. Started by Ron Harden and Ian Hart (shout out to a Canadian) these guides are structured with an initial registration then a publication (including a full length publication and a condensed version in Medial Teacher). The BEME Collaboration is overseen by an executive, which includes the author of the current paper Michelle Daniel. Interestingly for HPE, BEME reviews are specifically positivist in the types of review methodologies endorsed / accepted. Currently there are 70 BEME Reviews with an additional 22 registered and in process. The current review that we discussed is unusual in that it is an update of a previous review, one of the gaps in the BEME process.
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