Community Medicine Clerkship amidst COVID-19 Pandemic: Re-designing, Implementation, and Evaluation

Clerkship on primary care and family medicine is multi-elemental and was very challenging during the COVID-19 pandemic. Some medical students postponed their graduation because the clerkship at the health center could not be carried out in a pandemic situation. This article aims to describe the community medicine clerkship (CMC) module and its implementation amidst the COVID-19 pandemic. This module was delivered by online and offline activities from 10th August to 13th September 2020. A total of forty students, twelve faculty mentors, and fifteen Primary Health Care (PHC) preceptors from ten PHCs in the Tangerang District, Indonesia were involved. Students could carry out activities and fulfil assignments given in the midst of a pandemic with a re-designing of the CMC module. The one-sample t-tests were employed to compare the difference between the study values and the values before the COVID-19 pandemic. The study showed that the scores of students participating in CMC module during the COVID-19 pandemic were significantly different from the scores before the pandemic in terms of both individual and group scores. The findings of the study clearly indicated that all clinical clerkship modules must be redesigned to suit the current conditions. Modifications and variations of various learning methods, guidance techniques, monitoring and coordination are all factors that must be considered in implementing changes to these modules. © 2023 Dwi Tyastuti, Risahmawati Risahmawati, Marita Fadhillah, Fika Ekayanti, Sity Kunarisasia & Ahmad A. Habibi.

Time Does Matter: Reduced Internal Medicine Clerkship Clinical Experiences Due to COVID-19.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected medical education in many ways. The Association of American Medical Colleges (AAMC) temporarily suspended clinical student rotations, calling for a transition to remote learning. Unfortunately, due to the heavy impact of COVID-19 in our South Florida community, medical students were not able to return to in-person activities for a significant time. During this period, students had remote clerkship learning activities, didactic sessions, narrative projects, and small-group learning sessions, which were front-loaded using Zoom technology (Zoom Video Communications, Inc., San Jose, California, United States) and web-based learning tools. Once in-person clinical experiences resumed, the duration of all third-year clerkships for the remainder of the year was reduced to five weeks to allow for timely graduation. The Herbert Wertheim College of Medicine (HWCOM) Internal Medicine (IM) clerkship has traditionally been an eight-week-long rotation. Other clerkships that varied from six to eight weeks were similarly reduced to five weeks. We hypothesized that the shortened duration of the IM clerkship would have negative impacts on National Board of Medical Examiners (NBME) exam performance and clerkship clinical experiences would likely be affected. Methods We compared the NBME subject exam results and end of clerkship evaluations from the Class of 2021 (CO2021) which had the traditional eight weeks of patient care, with the CO2022, which had only five weeks of in-person patient care. A T-test analysis was performed comparing performance on the NBME medicine clinical subject exam between students who completed the usual eight-week rotation versus those who completed a five-week rotation. We also evaluated the IM clerkship course evaluation and analyzed student responses and ratings to assess any areas that were statistically significant when comparing the traditional eight-week IM clerkship to the shortened five-week clerkship. Results There was no statistically significant difference (t=0.68, p<0.4951) in mean NBME subject exam performance between cohorts. Students who completed the shortened five-week IM clerkship indicated there was limited volume and diversity of patients, which consequently affected their ability to complete all the required clinical experiences for the IM clerkship. These results indicated a statistically significant difference between the two cohorts (t =3.33, p<.001). Conclusion Students with shortened IM clerkship clinical care time (five weeks) were found to have no significant statistical differences in NBME subject exam performance compared to the traditional eight-week cohorts. However, students felt there was a decreased volume and diversity of patients, and they reported greater difficulties in completing the required clinical experiences, with diminished clinical confidence. Time does matter, and clinical time is very valuable for a student's undergraduate medical education. If another pandemic were to arise, the duration of different clerkships should be carefully assessed and individualized, and methods to assess and reclaim lost clinical time during the advanced clinical and postgraduate years should be considered.

Evaluating Live Virtual Chalk Talks as a Teaching Tool for Medical Students on a Dermatology Clerkship.

The COVID-19 pandemic has highlighted a continued need for innovative virtual teaching methods. Chalk talks, or brief illustrated interactive talks, are easily made virtual with an online whiteboard. We evaluated the efficacy of a live virtual chalk talk curriculum for medical students on their dermatology clerkship. A curriculum of one to three 1-h chalk talks was designed on the following topics: papulosquamous diseases, erythroderma, and immunobullous diseases. Talks were delivered monthly via Zoom to dermatology clerkship students. Pre- and post-talk surveys were administered to assess knowledge, confidence, and satisfaction. Compared with pre-talk, students (n = 18) achieved a greater percentage of possible points on knowledge assessment questions after the talks (41.0 ± 27.7% versus 90.4 ± 18.4%, p < 0.001). As assessed on a Likert scale (1 = not at all confident, 5 = extremely confident), students became more confident in differentiating conditions within each disease group and working up the conditions (2.02 ± 0.53 versus 3.53 ± 0.55, p < 0.001, and 2.09 ± 0.44 versus 3.76 ± 0.89, p < 0.001, respectively). Qualitative responses showed that students appreciated the student-teacher interactions. In conclusion, we found that live chalk talks are an effective and engaging way to teach dermatology to medical students in the virtual setting. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01781-4.

Medical Education during the COVID-19: A Review of Guidelines and Policies Adapted during the 2020 Pandemic.

The novel coronavirus disease (COVID-19) pandemic has dramatically changed education systems as most governments around the world closed schools to prevent outbreaks on campus. Medical education was not immune from these policies, and medical students were deprived of opportunities, particularly in clinical training. To determine how countries worldwide have responded to the pandemic, we conducted a literature review of the policies and guidelines of four countries: Japan, the United States (USA), the United Kingdom (UK) and Australia, as well as case reports of faculty and medical students up to September, 2020. Although the methods of implementation were unique to each country, the concept of "returning medical students to live education as quickly and safely as possible" was common. However, the extent to which students and faculty members became engaged in the treatment process of COVID-19 varied. While some countries endorsed students to work as members of medical staff to treat COVID-19, other countries took measures to ensure the safety of both medical students and patients. We await further reports worldwide in order to better understand the strategies employed by different nations in preparation for future possible infection outbreaks.

Reflections on medical student evaluations of a public health clerkship.

Introduction: The COVID-19 pandemic demonstrated the need for skilled medical practitioners in public health, and outbreak investigations. The College of Medicine and Health Sciences at the United Arab Emirates University (UAEU) introduced a clerkship in public health constituting theoretical and practical sessions to 5th year medical students in 2015. The aim of this study is to explore the satisfaction of the students with the public health clerkship which is crucial for the assessment and reformation of the taught curriculum. Methods: A cross-sectional, post-evaluation analysis was conducted from the period 2015-2022. The evaluation questionnaire was conducted via an online university system. The survey contained 5 themes: pre-course instructions, structure of the clerkship, academic staff, activities, and learning outcomes. Ethics approval was secured from the Social-IRB of the UAEU. We used SPSS version 26 to analyze the data using independent t-test and ANOVA. Results: One hundred and seventy four students (27.4% response rate) participated in the study. Overall, the students had an average satisfaction score of 2.86 out of 4. The majority of the students reported having a good understanding of public health (93.7%), improving their oral presentation skills (91.2%), and developing new skills (87.2%). Furthermore, more than 9 in 10 students (96.1%) reported that the program expanded their knowledge, skills, and confidence. The mass (90.2%) of students agreed that the clerkship content was covered in sufficient depth, majority of the students agreed that they had received enough information about the clerkship before it started (74.6%), majority of the students agreed that the faculty were interested in their personal development (86.1%) The students who completed the clerkship prior to the COVID-19 pandemic had a statistically significant (P = 0.02) higher average rating (72.8%) than students who completed the clerkship during the pandemic (71.1%). Discussion: Medical students at the UAEU were satisfied with the activities and delivery of the public health clerkship and found it rewarding. Conducting needs assessment and proposal writing provided them with the knowledge, skills, and confidence to conduct research in their career. These findings may be useful in helping and support other institutes to plan and develop a clerkship in the public health.

A qualitative assessment of medical students' readiness for virtual clerkships at a Qatari university during the COVID-19 pandemic.

BACKGROUND: This study aims to qualitatively examine the readiness of medical students to change to virtual clerkship (VC) during the pandemic, from both the faculty and students' perspectives. METHODS: A qualitative study was conducted based on the framework of readiness to change. Focus group discussions with students, and semi-structured interviews with clinical faculty members were done using appropriate online platforms. Transcripts were then analyzed using inductive-deductive approach. RESULTS: Twelve themes emerged which are (1) Perceptions about the university's decision and its communication to students, (2) A Perceived lack of clinical experience, (3) Students' role as members of the medical team facing the pandemic, (4) Student safety, (5) Quality and design of VC and the skills it offered, (6) Belief in own ability to succeed in the VC, (7) Confidence that VC would reach its goals, (8) New enhanced learning approaches, (9) Preparing students for new types of practice in the future (10) Acquired skills, 11) Academic support and communication with faculty and college, and 12) Psychological support. Medical students showed limited readiness to undertake a virtual clerkship and not play their role as healthcare professionals during the pandemic. They perceived a huge gap in gaining clinical skills virtually and asked for a quick return to training sites. CONCLUSION: Medical students were not ready for virtual clerkships. There will be a need to integrate novel learning modalities such as patient simulations and case-based learning in order to meet future demands of the medical profession and enhance the efficiency of virtual clerkships.

Effects of Recorded versus Live Teleconference Didactic Lectures on Medical Student Performance in the Surgery Clerkship.

OBJECTIVE: Due to the COVID-19 pandemic, numerous institutions converted medical education didactics to electronic formats including both live teleconference didactics and recorded faculty lectures. This study aims to compare the effect of recorded versus live teleconference didactic lectures on medical student examination scores during the surgery clerkship. DESIGN: Medical students completing the Surgery Clerkship received a weekly series of didactic lectures taught by faculty via a teleconference (2020-2021 academic year) or recorded format (2021-2022 academic year). Performance outcomes included weekly quizzes, National Board of Medical Examiners (NBME) Surgery Shelf Exam, and clerkship Objective Structured Clinical Examination (OSCE) scores. SETTING: University of Miami Miller School of Medicine. PARTICIPANTS: All second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over two academic years (n = 312). RESULTS: Students who received live teleconference lectures (n = 156) demonstrated higher average scores on weekly quizzes (89%) and the NBME shelf exam (76%) compared to those receiving recorded lectures (n = 156; 71% quiz, 70% shelf exam), both p < 0.001. There was a significant association with performance in the highest quartile (Q1) of weekly quiz scores and receiving live lectures (40% vs. recorded lectures 1%, p < 0.001). Comparing only MS3 students, mean weekly quiz scores and Q1 achievement were significantly higher (both p < 0.001) in the teleconference cohort with no significant difference in NBME shelf exam performance (p = 0.971). No difference in OSCE performance was observed between groups. CONCLUSION: These results suggest that synchronous teleconferences may be more effective than recorded lectures for achieving institutional learning objectives on the surgery clerkship without any negative impact on NBME shelf exam or clinical evaluation parameters. This information should be used to inform future institutional clerkship design and educational initiatives.

LIC in the time of COVID: experiences of LIC tutors during the COVID-19 pandemic in Scotland.

In March 2020, due to the escalating global coronavirus (COVID-19) pandemic, clinical placements for most medical students in the UK were suspended. A phased resumption of clinical placements started at the beginning of academic year 2020/2021. For the Scottish Graduate Entry Medicine programme (ScotGEM), 2020/21 was the first year that Dundee School of Medicine's comprehensive LIC was extended to all 54 students in the penultimate year of the ScotGEM programme. This cross-sectional qualitative study explored aspects of tutors' experiences of supporting LIC students in their practices. Thematic analysis of the data identified significant themes relating to the effects of the coronavirus pandemic on the organisation of the LIC placements and the experiences of the tutors, and the ways in which they adapted placements to the rapidly changing clinical and social landscapes. The changes necessitated by the pandemic posed significant challenges for practice-based tutors in ensuring that students had valuable educational experiences despite the constraints of social distancing requirements and the reduction in face-to-face consultations. However, tutors also identified several positive aspects of the changes which will be of interest to those involved in the organisation and delivery of both LIC and shorter General Practice based clinical attachments. Positive relationships between LIC students and practices enhanced the success of LIC placements. We will discuss how lessons learned from the experience of tutors in the pandemic could be used in the longer term to enrich the LIC experience and General Practice placements more generally.

Transition to online teaching and learning for clerkship activities during COVID-19 in Malaysia

Prior-to the COVID-19 outbreak, undergraduate PharmCare II Clerkship activities consisted of two phases. The first phase requires pharmacy students to clerk infectious disease and endocrine-related cases of patients admitted into wards at a teaching hospital, whilst in the second phase, the students are required to present the clerked cases in front of their group members with a thorough assessment by lecturers at Universiti Sains Malaysia. Due to sudden outbreak of COVID-19, presentations at hospitals and face-to-face learning were no longer feasible;therefore an online methodology was executed. Each student was assigned a real completed case clerked by a previous Master's in Clinical Pharmacy graduate. The students then critically evaluated any pharmaceutical care issues (PCIs) in each of the cases, recorded a video presentation for assessment by the lecturers and discussed each case with other group members in a synchronous online session via web-conferencing software. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

Ethical Aspects of the Guidelines for Medical Education for Students in their Clerkship Year at the Schulich School of Medicine and Dentistry During the COVID-19 Pandemic

Guidelines for clerkship training at one Canadian medical school - Western University's Schulich School of Medicine and Dentistry - did not state the ethical principles associated with the decision to suspend and eventually resume clinical training during the COVID-19 pandemic. The absence of stated ethical principles was notable considering the impact these decisions had on various stakeholders, and since ethics plays a large role in the practice of medicine. This study assessed these guidelines using an ethical lens approach to identify ethical principles and tensions implicit in the guidelines. Clerkship is defined as the third year of training at this medical school, which consists of clinical rotations. While ethical principles were not documented, it was hypothesized that these could be identified within the guidelines. A literature search was conducted, which yielded a gap in knowledge concerning ethical considerations of clerkship clinical training. The guidelines were analyzed and ethical principles and tensions between conflicting principles were identified. The most prevalent principles were beneficence and non-maleficence. It is recommended that in the future, the ethical principles associated with guidelines responding to significant issues affecting undergraduate medical education be stated, in order to increase transparency to all parties involved, enhance communication with students, and to serve as an example of how ethics is applied in a medical education setting. One limitation of this study was the use of internal guideline documents, which were circulated internally but are not published.

The impact of the transition from flipped classroom to online lectures on learning outcomes and student satisfaction in a rehabilitation medicine clerkship during the COVID-19 pandemic.

BACKGROUND: The flipped classroom (FC) is a well-known active learning module that activates the prior knowledge of students and promotes their cognitive skills during in-class activities. However, most on-site teaching during the COVID-19 pandemic had to be conducted online. The FC in our rehabilitation medicine clerkship curriculum was also shifted to online asynchronous lectures (OLs), without real-time interactions. There is no previous comparison of effectiveness between these two methods. Therefore, this study aimed to compare learning outcomes and student satisfaction in both FC and OL models. METHODS: The study design was a historically controlled study. A physical modality was chosen for the content. The FC group (n = 233), in the academic years 2018 and 2019, was assigned to perform a pre-class activity consisting of reading study materials. Thereafter, the in-class activity comprised a small-group case-based discussion. The OL group (n = 240) in the academic years 2020 and 2021 followed an online model during the COVID-19 lockdown. They were also asked to read the online materials and then watch a self-paced recorded lecture video on Learning Management Systems. The learning outcomes, including their multiple-choice questions (MCQs) scores, final exam scores, grade points, and letter grades, were evaluated. Their overall course satisfaction ratings were also collected. RESULTS: The OL group had an overall higher MCQ score for the physical modality portion than the FC group (p = 0.047). The median (lower quartile, upper quartile) of the total 50-MCQ scores were 34 (31, 37) in the OL group and 33 (29, 36) in the FC group (p = 0.007). The median final exam scores of the OL and FC groups were 69.5 and 68.3, respectively (p = 0.026). The median grade points and the letter grades were not significantly different between the groups. The proportions of satisfaction were significantly higher in the FC group than in the OL group. CONCLUSIONS: The OL group revealed significantly higher learning outcomes than the FC group. However, the FC group showed more satisfaction with interactivity than the OL group. The authors are of the view that a combination of both FC and OL methods will likely result in better outcomes.

Community Medicine Clerkship Implementation in a COVID-19 Pandemic Era: The Students' Perceptions

Introduction: COVID-19 pandemic has changed the life condition in various sectors. Numerous students in our faculty who should graduate in 2020 must be delayed. This clinical clerkship performed offline in the pandemic era shall be perceived as a crash program to pass the students. This study aimed to evaluate the implementation of a community medicine clerkship (CMC) amidst the pandemic by referring to students' perceptions. Methods: This research was a mixed methods study involving 40 students from Universitas Islam Negeri Syarif Hidayatullah, Indonesia. Students were placed in groups in the ten health centers in Tangerang Regency from August to September 2020. The open-ended question via online form was distributed at the beginning of the activity and the fourth week of the clerkship. Results: The study revealed that students' concerns increased from week one to week four, but the difference was not statistically significant (p>0.05). The participants identified as the causative factors were insufficient availability of personal protective equipment (PPE), unsynchronized coordination between faculties, preceptors and practice fields, many assignments, and frequent changes in schedule and activities. Conclusion: The implementation of CMC was affected by four factors, namely the faculty, the preceptors, the practical field, and the student itself. Asynchrony within the entire factor results in and contributes to students' concern for practice in the field. © 2022 UPM Press. All rights reserved.

The "new normal" for medical education during and post-COVID-19.

After outbreaks in more than 110 countries, the World Health Organization declared COVID-19 a global pandemic on the March 11, 2020, heralding unprecedented challenges in medical education. Our aim is to provide a descriptive overview of the impact of COVID-19 on medical education worldwide and to assess its future repercussions. Worldwide, medical students were removed from clerkship training. Clinical skills and practical procedure training transitioned to being online, and in some cases, postponed. Medical educators scrambled to convert the curriculum into online formats. Access to Internet, technology, and computer education posed resource allocation challenges in developing countries and further widened the disparities in medical education. Even in countries where the framework and funding were available to support the online transition, debatably, this arrangement can lead to disparities in clinical skills, bedside manner, and field experience among pre- and post-COVID-19 medical graduates. Challenges extend beyond undergraduate medical education to include the medical licensing process of international and national postgraduates. The international community of medical educators needs to collaborate to drive the future of medical education, as the world adapts to the "new normal."

Medical student exam performance and perceptions of a COVID-19 pandemic-appropriate pre-clerkship medical physiology and pathophysiology curriculum.

BACKGROUND: Medical schools were compelled to abruptly transition pre-clerkship curricula to remote learning formats due to the emergence of the Coronavirus Disease 2019 (COVID-19) pandemic. We evaluated student perceptions of remote learning, exam performance, and utilization of third-party learning resources to assess the implementation of a newly developed pandemic-appropriate physiology curriculum. METHODS: This was an observational study based on a survey conducted in the Spring of 2021 at the University of California, Irvine, School of Medicine (UCISOM). This study aimed to assess first (MS1) and second year (MS2) medical students' perceptions of satisfaction, support, academic performance, and connectedness before and during the COVID-19 pandemic. The MS1 class began medical school during the first year of the COVID-19 pandemic, whereas the MS2 class did so prior to the start of the pandemic. A survey instrument was developed and validated to identify the impact remote learning had on student self-perceptions of the Medical Physiology and Pathophysiology course. Surveys were distributed to all students and responses were collected on a voluntary basis. Exam scores on a customized National Board of Medical Examiners (NBME) physiology shelf exam were also compared to objectively identify how the remote curriculum during the pandemic impacted academic performance. RESULTS: Of 204 students enrolled, 74 responses were analyzed, with 42 MS1 (40% of MS1s) and 32 MS2 (31% of MS2s) responses. Overall, MS1s and MS2s were satisfied with the curriculum they received (95 and 97% respectively) and the school's support of their concerns (86 and 100% respectively). Notably, only 50% of MS1s felt connected to their peers, compared to 94% of MS2s. Lecture attendance and self-perception of their academic performance were similar between both classes. Interestingly, the intra-pandemic class's NBME exam average in 2020 (60.2% ± 8.9, n = 104) was significantly higher than the pre-pandemic class average in 2019 (56.8% ± 11.3, n = 100). Both classes primarily used course materials over third-party learning resources. An additional set of survey questions distributed only to the MS1 class found that the majority of MS1s reported minimal barriers with regards to accessibility, including internet connectivity, study-conducive environments, and balancing family commitments. Overall, pre-clerkship medical students had positive perceptions of the newly developed pandemic-appropriate physiology curriculum. CONCLUSIONS: Changes to the pre-clerkship physiology curriculum during the COVID-19 pandemic were met with overall satisfaction from the students and an increase in NBME scores. More attention to student connectedness is needed to improve how remote learning can be best optimized into future curricula development.

Otolaryngology-Head and Neck Surgery clinical electives in undergraduate medicine: a cross-sectional observational study.

BACKGROUND: Otolaryngology-Head and Neck Surgery (OHNS) electives provide medical students opportunities for knowledge acquisition, mentorship, and career exploration. Given the importance of electives on medical student education, this study examines OHNS clinical electives prior to their cancellation in 2020 due to the COVID-19 pandemic. METHODS: An anonymous 29-question electronic survey was created using the program "Qualtrics." Themes included elective structure and organization, elective clinical and non-clinical teaching, evaluation of students, and the influence of electives on the Canadian Residency Match (CaRMS). The survey was distributed through the Canadian Society of Otolaryngology e-newsletter and e-mailed to all OHNS undergraduate and postgraduate program directors across Canada. RESULTS: Forty-two responses were received. The vast majority of respondents felt that visiting electives were important and should return post-COVID-19 (97.6%). Most said they provide more in-depth or hands-on teaching (52.4% and 59.6%, respectively). However, there was great variability in the feedback, types of teaching and curriculum provided to elective students. It was estimated that 77% of current residents at the postgraduate program that responders were affiliated with participated in an elective at their program. CONCLUSIONS: Prior to the cancellation of visiting electives in 2020 due to the COVID-19 pandemic, electives played an important role in OHNS undergraduate medical education and career planning for students wishing to pursue a career in OHNS. Electives also provide the opportunity for the evaluation of students by OHNS postgraduate programs.

Innovation and Missed Opportunities in Internal Medicine Undergraduate Education During COVID-19: Results from a National Survey.

BACKGROUND: COVID-19 disrupted undergraduate clinical education when medical schools removed students from clinical rotations following AAMC recommendations. Clerkship directors (CDs) had to adapt rapidly and modify clerkship curricula. However, the scope and effects of these modifications are unknown. OBJECTIVE: To examine the effects of the initial phase of COVID-19 on the internal medicine (IM) undergraduate clinical education. DESIGN: A nationally representative web survey. PARTICIPANTS: IM CDs from 137 LCME-accredited US medical schools in 2020. MAIN MEASURES: Items (80) assessed clerkship structure and curriculum, assessment in clerkships, post-clerkship IM clinical experiences, and CD roles and support. The framework of Understanding Crisis Response (Royal Society for Encouragement of Arts, Manufactures, and Commerce) was used to determine whether curricular modifications were "amplified," "restarted," "let go," or "ended." KEY RESULTS: Response rate was 74%. In response to COVID-19, 32% (32/101) of clerkships suspended all clinical activities and 66% (67/101) only in-person. Prior to clinical disruption, students spent a median of 8.0 weeks (IQR: 2) on inpatient and 2.0 weeks (IQR: 4) on ambulatory rotations; during clinical re-entry, students were spending 5.0 (IQR: 3) and 1.0 (IQR: 2) weeks, respectively. Bedside teaching and physical exam instruction were "let go" during the early phase. Students were removed from direct patient care for a median of 85.5 days. The sub-internship curriculum remained largely unaffected. Before the pandemic, 11% of schools were using a pass/fail grading system; at clinical re-entry 47% and during the survey period 23% were using it. Due to the pandemic, 78.2% of CDs assumed new roles or had expanded responsibilities; 51% reported decreased scholarly productivity. CONCLUSIONS: Curricular adaptations occurred in IM clerkships across US medical schools as a result of COVID-19. More research is needed to explore the long-term implications of these changes on medical student education and clinical learning environments.

Adaptations of Clinical Teaching During the COVID-19 Pandemic: Perspectives of Medical Students and Faculty Members.

Background: The COVID-19 pandemic had serious implications on medical schools' programs that necessitated lots of adaptations of teaching, learning, and assessment to guarantee continuity of education in medical schools. Our study aimed to evaluate perspectives of clerkship students and faculty members regarding clinical teaching adaptations implemented during the COVID-19 pandemic. Methods: A descriptive, cross-sectional, survey-based study was conducted and targeted 5th and 6th year clerkship students and full- and part-time clinical faculty. The survey explored (1) perception of the degree of contribution of implemented adaptations to student achievement of expected clinical competencies, (2) degree of confidence regarding students' achievement of expected clinical competencies through such adaptations, and (3) perception of the effect of implemented educational adaptations on students' learning. Descriptive statistics were used, and statistical significance level was set at p < 0.05. Results: The survey exhibited high internal consistency. Both students and faculty members felt that most of the adaptations had moderate to high contribution to student achievement of expected clinical competencies. On a 5-point scale, the highest score was given by faculty members to "Interpretation of investigations" (3.93±0.84) while the lowest scores were given by faculty members (3.10±1.21) and students (2.57±1.36) to "Performing clinical procedures". Students and faculty members agreed that the adaptations had positive effect on students' learning except for the statement "Students were able to easily monitor their academic progress" where students gave less scores than faculty members, with a statistically significance difference (p=0.029). Conclusion: Students and faculty members had similar perspectives regarding the implemented adaptations and their impact and contribution to student learning and achievement of the basic clinical competencies. Both of them agreed on the need for and importance of the implemented adaptations. Our findings recommend such adaptations during the times of crises, which can be conducted through integrating online teaching with face-to-face teaching.

Feasibility of a Vertically Integrated Teaching Strategy during a Surgical Clerkship Event—Learning Methods Matter

Sound foundational knowledge improves disease conceptualization and clinical diagnosis. Vertical integration (VI) is an appealing educational strategy to refresh relevant pre-clinical information during clinical rotations. However, an optimal learning approach for this has not yet been established. We hypothesized that a small group collaborative discussion format might serve as an appealing learning method to deliver integrated material and increase retention. During AYs 2018/2019 and 2019/2020, our multidisciplinary team utilized a Colorectal Cancer workshop incorporating pre-clinical material for Y3 students on Surgical Clerkship. In search of an optimized way to deliver vertically integrated content, we alternately presented the workshop material either in a small group (SG) case-based collaborative format or as a standard-sized group (StdG) exercise. We achieved this by testing immediate and late (4-week post-event) recall and assessing student satisfaction with the VI strategy in both physical settings (StdG and SG). A total of 93% of participants considered VI-based training worthwhile, 96% reported an increased knowledge base and 93% would welcome similar VI events in the curriculum. Significantly more SG students than StdG (52% vs. 31%, p = 0.014) enthusiastically endorsed their event and would prefer to have future VI events delivered in the format they experienced (88% for SG vs. 42% for StdG) (p < 0.0001). Combined (immediate + late) recall scores were significantly better in SG versus StdG (p = 0.007), while the rate of attrition at 4 weeks did not differ significantly (p = 0.81). VI strategy successfully reactivated pre-clinical concepts, achieving both high content retention and learner satisfaction during this workshop. Students endorsed future VI events, especially when delivered in a case-based, interactive SG setting. Although resource intensive, a VI strategy employing a small-group collaborative learning method may be considered for broader curricular use in undergraduate medical education.

Return to the Reading Room: Implementation of a Hybrid Radiology Clerkship Model after Emergent Conversion to Remote Learning in the COVID-19 Pandemic.

RATIONALE AND OBJECTIVES: The COVID-19 pandemic prompted the virtualization of historically in-person radiology rotations for medical students. As students return to in-person clinical education, there is an opportunity to reevaluate teaching strategies and incorporate best practices from the pandemic. We describe our experience with the conversion of a four-week radiology clerkship from an in-person (IP) to remote learning (RL) to hybrid model (HM) and its impact on student performance and satisfaction. MATERIALS AND METHODS: Stratified by curriculum (Group 1 IP, Group 2 RL, Group 3 HM), student standardized final examination scores, final grades, lecture evaluation scores, and satisfaction scores were compared. Additional analysis was performed for Group 3 clinical divisions in which IP or RL models predominated. RESULTS: A significant decrease in mean final exam score was noted in Group 2 (p < 0.0001). Average lecture rating decreased in Group 3 compared to Group 1 (p < 0.001). Group 3 students reported improved faculty (Group 1: 59, Group 2: 61, Group 3: 82; p < 0.001) and resident (Group 1: 76.5, Group 2: 68, Group 3: 90; p < 0.001) teaching effectiveness. Student-reported quantity and quality of formative feedback were also highest for Group 3 (Quantity; Group 1: 60.6, Group 2: 74, Group 3: 93; p < 0.001) (Quality; Group 1: 59.1, Group 2: 77, Group 3: 97; p < 0.001). Group 3 subanalysis demonstrated increased student-perceived usefulness of activities within IP divisions (p < 0.01) and a decrease for RL divisions (p < 0.05). CONCLUSION: A hybrid curriculum resulted in improved student satisfaction and preserved student performance after an emergent conversion to remote learning.