A longitudinal Q-study to assess changes in students' perceptions at the time of pandemic.

The COVID-19 pandemic forced many universities and colleges to rapidly adopt online course delivery. As with any new foray, realizing the optimal aspects of a course to change became incredibly important for course instructors. In this study, we used a particularly sensitive method, i.e. Q-methodology, to evaluate changes based on students' perceptions from fall 2020 to winter 2021. Q-methodology is commonly used to uncover shared values, opinions, and preferences. Using Q-methodology, students participating in both semesters of an undergraduate anatomy and physiology course were surveyed in fall 2020 and winter 2021. The Q-sample included 44 statements. Data from fall 2020 were treated as the baseline and changes in students' perceptions from 2020 to 2021 were assessed. In total, 31 students completed both fall 2020 and winter 2021 course evaluations. Three salient factors emerged from the fall 2020 evaluation: Overtaxed students, Solo Achievers, and In-Person Learners. At the baseline, students were concerned mostly about the delivery of the course, then the winter 2021 evaluation showed how they were adjusting to online learning. The longitudinal Q-study proved to be robust in identifying changes in perceptions. These granular findings indicate how students might differ in viewing and evaluating online courses. This methodology can be used in redesigning and restructuring different components of an online course in higher education settings.

Using Q‐Methodology to Evaluate Student Perceptions of Online Anatomy in the Time of COVID‐19

Background Since the seventeenth century, the primary approach to teaching anatomy has involved hands‐on learning using cadaveric specimens. However, the ability to use this long‐standing tradition was curtailed in the 2020‐2021 school year due to the COVID‐19 pandemic. Many institutions closed physical classrooms entirely, launching experiential courses, such as anatomy, into the online space. Hypothesis We hypothesized that Q‐methodology could be used to uncover student perceptions of an introductory anatomy and physiology course that was offered online for the very first time. Methods Q‐methodology, considered the study of subjectivity, is an approach that statistically uncovers groups of individuals with shared perceptions within a larger cohort. Instructors can use Q‐methodology to identify groups of students with shared needs, allowing for more specific and productive course reform. In the current study, Q‐methodology was used as a means of course evaluation in the fall 2020 and winter 2021 semesters. Students were asked to sort 44 opinion‐based statements in a quasi‐normal table based on their level of agreement. By‐person factor analysis of 166 responses revealed three statistically distinct groups of students. Results The three groups were assigned the following monikers: Connected and Contented (CC), Disconnected and Disgruntled (DD), and Interconnected and Collaborative (IC). CC students (n=66) felt generally ambivalent toward course components and were comfortable with the technology skills required to participate in the online course space. DD students (n=50) were deeply unhappy with several elements of the course, including lectures, assignments, and evaluations. These students also felt as if they were teaching themselves. Finally, IC students (n=29) looked favourably upon the tutorial space and the role of teaching assistants. Analysis also revealed that some sentiments were shared across all three groups, including the preference for physical rather than virtual specimens, and the desire for more practice questions from faculty in order to prepare for bellringer exams. Interestingly, cohort opinions did not remain static across both semesters. There was a positive attitude shift as more students felt “Disconnected and Disgruntled” in the fall, and “Connected and Contented” in the winter. Conclusions These findings are useful for anatomy instructors interested in transitioning courses to an online or blended space, particularly in the face of ever evolving public health restrictions. The current study also models the wealth of information that can be uncovered using Q‐methodology ‐ useful for anyone interested in the previously amorphous study of subjectivity.

Impact of the COVID-19 pandemic on non-small-cell lung cancer pathologic stage and presentation.

BACKGROUND: It is believed that the cessation of normative cancer care services during the COVID-19 pandemic may be resulting in pathologic upstaging and higher long-term mortality rates. We aimed to understand how the pandemic has affected our patients diagnosed with non-small-cell lung cancer (NSCLC). METHODS: We conducted a single-centre retrospective analysis to assess how the COVID-19 pandemic has affected patient referrals, pathologic stage of NSCLC, mortality rates and surgical procedures at our cancer care centre in Ontario, Canada. At our centre, physicians advocated for and followed recommendations that operations in cancer patients should be among the last procedures to be delayed. Patients were included if they were aged 18 years or older, were not receiving palliative care, and had been screened, diagnosed and treated for NSCLC (primary tumours). We compared outcomes between a prepandemic period (January 2019 to February 2020) and a period during the pandemic (March 2020 to February 2021). RESULTS: A total of 695 patients were included for statistical analysis, of whom 650 underwent surgery. There was no statistically significant difference in any of the outcomes of interest between patients seen before (n = 330) and during (n = 320) the pandemic. CONCLUSION: Cancer care services at our centre were maintained during the COVID-19 pandemic, and potential adverse effects on prognosis and survival that have been seen in other countries were avoided. The results inform health care providers how the effects of future pandemics can be blunted by using proactive preservative strategies and surgeon advocacy.

Frequency of Neglect and Its Effect on Mortality in Long-Term Care before and during the COVID-19 Pandemic.

Neglect of vulnerable adults living in long-term care (LTC) homes has been well documented. It often presents first in the physical symptoms of decubitus ulcers, dehydration and urinary tract infections (UTIs). A retrospective cohort study was conducted to examine the relationship between neglect and 90-day mortality among LTC residents in Ontario. An index of neglect was created. Of 106,765 residents, more than one-quarter were found to have at least one indicator of neglect: 13.1% had decubitus ulcers, 13.5% had dehydration, 6.2% had a UTI. Residents who exhibited clinical signs of neglect had higher risks of death within 90 days, both before and during the COVID-19 pandemic.

COVID-19 excess mortality among long-term care residents in Ontario, Canada.

The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality. Residents of long-term care homes have been disproportionately affected. We conducted a retrospective cohort study to determine the scale of pandemic-related deaths of long-term care residents in the province of Ontario, Canada, and to estimate excess mortality due to a positive COVID-19 test adjusted for demographics and regional variations. Crude mortality rates for 2019 and 2020 were compared, as were predictors of mortality among residents with positive and negative tests from March 2020 to December 2020. We found the crude mortality rates were higher from April 2020 to June 2020 and from November 2020 to December 2020, corresponding to Wave 1 and Wave 2 of the pandemic in Ontario. There were also substantial increases in mortality among residents with a positive COVID-19 test. The significant differences in excess mortality observed in relation to long-term care home ownership category and geographic region may indicate gaps in the healthcare system that warrant attention from policymakers. Further investigation is needed to identify the most relevant factors in explaining these differences.

Using Q Methodology to Evaluate Online Anatomy Education: Learning in a COVID-19 Context

Introduction Anatomy education traditionally relies on in-person learning and experiential skill development. However, the ongoing COVID-19 pandemic has forced many courses to adopt online modes of delivery, and anatomy is no exception. The question now is whether anatomy education has successfully made the transition to the digital space, particularly with respect to the perception of learners. Objective The current study seeks to understand how students view an online, introductory anatomy and physiology course. Traditional methods of course evaluation include Likert scales and open-ended responses;however, such methods fail to consider both the diversity of learners and the need for course-specific feedback. Thus, we used the emerging area of Q methodology as a tool for course evaluation. Hypothesis We hypothesize that Q methodology will enable us to uncover student opinions which are specifically relevant to their online course experience. Methods Q methodology can be used to identify groups of learners with shared perceptions, allowing educators to better understand and respond to the needs of students. Studies consist of three phases: survey instrument development, data collection, and analysis/interpretation. First, a list of opinion-based statements regarding anatomy education are selected. Next, students rank statements based on their level of agreement. Finally, rankings undergo a by-person factor analysis to categorize students into distinct groups with shared perceptions. Results Data was collected from 106 students at McMaster University. Factor analysis revealed three distinct subgroups within the cohort. Group 1 (n = 45) felt they needed more time on their evaluations and lectures did not cover an appropriate amount of content. Group 2 (n = 30) did not enjoy synchronous tutorials or labs. Group 3 (n = 21) overall was satisfied with course delivery. Certain perceptions were also shared among all three groups. There was a consensus among students that they generally disliked online learning compared to in-person learning, with particular concern surrounding the use of virtual specimens and bellringer exams. Students, however, appreciated the availability of asynchronous lectures as a mode of online content delivery. Age, sex, program, education history, and anticipated grade were not associated with cohort subgroupings. Conclusion Interestingly, results of this study recognize similar course strengths/limitations noted in in-person classes (e.g., value of in-person laboratories and assessment concerns reported elsewhere), but also highlight key areas of strength (asynchronous lectures) and limitation (use of digital resources) specific to the online environment, which will be important considerations for future online offerings. Next steps for the current study include repeating the evaluation in the winter semester to see if opinions are stable across groups of learners and individual students.