Application of virtual simulation in clinical skills and operation courses.

Aim: This study investigated the effectiveness and prospect of applying virtual simulation operation (VSO) as a novel teaching tool in clinical skill and operation courses. Methods: A comparative test and survey study on the teaching effect of VSO was conducted with the clinical skill and operation course as the test course. The test group students received offline courses combined with online VSO practice. In contrast, the control group students received offline courses combined with instructional video review. The two groups were assessed using the Chinese medical school clinical medicine professional level test and a questionnaire survey. Results: The test group students scored significantly higher than the control group in the skills test (score difference: 3.43, 95% CI: 2.05-4.80) (p < 0.001). Additionally, a significant increase in the percentage of high-and intermediate-score ranges and a decrease in the percentage of low-score ranges was observed (p < 0.001). According to the questionnaire survey, 80.56% of the students were willing to continue using virtual simulation in their subsequent clinical skill and operation learning. Further, 85.19% of the students believed that the VSO is superior because it is unrestricted by time and space and can be performed anywhere and anytime compared to traditional operation training. Conclusion: VSO teaching can improve skills and examination performance. An entirely online operation that does not need special equipment can break through the spatiotemporal limitations of traditional skills courses. VSO teaching also suits the ongoing COVID-19 pandemic situation. Virtual simulation, a new teaching tool, has good application prospects.

The Impact of COVID-19 on Radiological Science Students and Interns at King Saud bin Abdulaziz University for Health Sciences: Cross-Sectional Study.

Introduction: The impact of the coronavirus disease (COVID-19) outbreak on many parts of our lives cannot be overstated. This study aimed to identify the psychological, physical activity, and educational effects of COVID-19 on radiological sciences students and interns at the three campuses of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Jeddah, and Alahsa. Methods: A cross-sectional study was conducted between November and December 2021 among Saudi-108 radiological sciences students and interns using non-probability convenient sampling at King Saud bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Jeddah, and Alahsa using a validated questionnaire. Statistical analyses were conducted using Excel and JMP statistical software. Results: 102 out of 108 completed the questionnaire resulting in a 94.44% response rate. The percentage of the overall negative psychological impact was 62%. For the physical activity effects of COVID-19 among students and interns, 96% reported a decline in their physical activities. 77% of participants reported a fair impression that the students were able to achieve some of their academic goals and acquired new skills during the pandemic, and 20% reported a good impression. They achieved all their goals and developed new skills, whereas 3% reported bad impressions and needed to achieve their goals or improve their skills. Conclusion: COVID-19 had a negative psychological and physical activity impact on RADs students and interns at the three KSAU-HS campuses in the Kingdom of Saudi Arabia. Despite technical difficulties, students and interns reported positive academic outcomes from COVID-19.

Demise of the USMLE Step-2 CS exam: Rationalizing a way forward.

The COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection risk for examinees, standardized patients (SPs), and administrators, soon became permanent cancelation in January 2021. Expectedly, it triggered debate in medical education circles. Positively, however, the USMLE regulatory agencies (NBME and FSMB) saw an opportunity to innovate an exam tainted with perceptions of validity deficits, cost, examinee inconvenience, and worries about future pandemics; they therefore called for a public debate to fashion a way forward. We have approached the issue by defining Clinical Skills (CS), exploring its epistemology and historic evolution, including assessment modalities from Hippocratic times to the modern era. We defined CS as the art of medicine manifest in the physician-patient encounter as history taking (driven by communication skills and cultural competence) and physical examination. We classified CS components into knowledge and psychomotor skill domains, established their relative importance in the physician process (clinical reasoning) of diagnosis, thus establishing a theoretical framework for developing valid, reliable, feasible, fair, and verifiable CS assessment. Given the concerns for COVID-19 and future pandemics, we established that CS can largely be assessed remotely, and what could not, can be assessed locally (school/regional consortia level) as part of a USMLE-regulated/supervised assessment regimen with established national standards, thus maintaining USMLE's fiduciary responsibilities. We have suggested a national/regional program for faculty development in CS curriculum development, and assessment, including standard setting skills. This pool of expert faculty will form the nucleus of our proposed USMLE-regulated External Peer Review Initiative (EPRI). Finally, we suggest that CS evolves into an academic discipline/department of its own, rooted in scholarship.

Telesimulation: students' satisfaction with a program to develop clinical skills

Introduction: COVID-19 prompted alternative strategies for teaching clinical skills. Telesimulation uses telecom-munication resources to provide learning environments at distant sites. At Westhill University School of Medicine, practices with telesimulation were designed to develop clinical skills in medical students. This study assessed student satisfaction. Objective: To know students' satisfaction with a telesim-ulation program to develop clinical skills. Method: This is a descriptive and cross-sectional study. A survey was answered voluntarily and anonymously by medical students who participated in a telesimulation program from September 2020 to September 2021. The survey was designed based on the "Satisfaction with Simulation Experience Scale” and, was sent to 225 medical students through Google Forms™ to measure satisfaction with the program. Results: 143 students answered the survey. On a scale of 1 to 5 (Likert format), the students' satisfaction was 3.89 ± 1.21. 80% claimed they were able to actively par-ticipate in patient care simulation. 76% said that physi-cal examination, presented by multimedia resources and telemedicine, was sufficient to integrate diagnosis. 69% agreed that telesimulation adequately complements clinical rotations in real clinical environments. Conclusions: Students appreciate telesimulation. In the current educational context, telesimulation is an effective tool to develop some clinical skills. © 2023, Universidad Nacional Autonoma de Mexico. All rights reserved.

The impact of pandemic disruptions on clinical skills learning for pre-clinical medical students: implications for future educational designs.

BACKGROUND: Pandemic disruptions to medical education worldwide resulted in rapid adaptations to clinical skills learning. These adaptations included moving most teaching to the online environment, decreasing the accepted "hands-on" methods of teaching and learning. While studies have shown significant impacts on student confidence in skills acquisition, there is a paucity of assessment outcome studies which would contribute a valuable perspective on whether measurable deficits were incurred. Here, a preclinical (Year 2) cohort was investigated for clinical skills learning impacts that could influence their transition to hospital-based placements. METHODS: A sequential mixed methods approach was used on the Year 2 Medicine cohort, including: focus group discussions with thematic analysis; a survey derived from the themes observed; and a cohort comparison of the clinical skills examination results of the disrupted Year 2 cohort, compared to pre-pandemic cohorts. RESULTS: Students reported experiencing benefits and disadvantages of the shift to online learning, including a decrease in confidence in their skills acquisition. End of year summative clinical assessments showed non-inferior outcomes when compared to previous cohorts for the majority of clinical skills. However, for procedural skills (venepuncture) the disrupted cohort had significantly lower scores compared to a pre-pandemic cohort. CONCLUSIONS: Rapid innovation during the COVID-19 pandemic provided the opportunity to compare online asynchronous hybrid clinical skills learning with the usual practice of face-to-face synchronous experiential learning. In this study, students' reported perceptions and assessment performance data indicate that careful selection of skills suitable for online teaching, supported by timetabled "hands-on" sessions and ample practice opportunities, is likely to provide non-inferior outcomes for clinical skills learning in students about to transition to clinical placements. The findings can be used to inform clinical skills curriculum designs that incorporate the virtual environment, and assist with future-proofing skills teaching in the case of further catastrophic disruptions.

Using Active Learning to Evaluate Student Competency Beyond Clinical Skills

Active learning methodologies support the development of higher-order thinking and knowledge application necessary for modern health care environments. Through active learning, nurse practitioner students apply their understanding of population-specific competencies while developing critical thinking and reasoning skills for safe and effective care. Myths regarding student-centric learning, such as cost, time, and design, may create barriers for faculty to incorporate competency-based methods into didactic curricula. This article provides evidence-based strategies and exemplars for active learning as a method to evaluate student competency beyond clinical skills.

Medical Trainees' Attitudes about the Value of Simulation in the Obstetrics and Gynecology Program of King Abdulaziz University, Jeddah, Saudi Arabia

Objective: Simulation was introduced as an educational method in the Obstetric and Gynecology (OB-GYN) to enhance the quality of trainees' medical education, knowledge, and skills acquisition. This questionnaire-based study aimed to assess types of simulation used and satisfaction with simulation-based education (SBE) among medical trainees in the OB-GYN program of King Abdulaziz University in Jeddah, Saudi Arabia before and during COVID-19. Method: A total of 1131 undergraduate and postgraduate medical students were registered in the OB-GYN programs and participated in the SBE activities utilizing KAU-CSSC from 2018 through 2020. total, 581 requested to participated in questionnaire, only 300 students completed the questionnaire.Results: Simulations were used most frequently for skills training (91.3%), followed by mannequin-based scenarios (63.0%), virtual reality (41.3%), standardized patients (34.0%), and tissue-based scenarios (32.1%). OB-GYN simulations can help trainees and instructors overcome problems in conducting intimate-area examinations and improve their gynecological history-taking skills. Trainees recommended mandatory establishment of simulation skills centers in every hospital and medical college and the use of online simulation tools after COVID-19. The mean of total score for simulation use was 49.63 out of 60 points. A total of 218 trainees (72.7%) had a positive attitude toward simulation use and 82 (27.3%) had a more neutral attitude.Conclusions: The study results revealed the usefulness of low and high-fidelity SBE among OB-GYN medical trainees in concerning their teaching, training, and objective assessments. The cumulative mean score suggested that the trainees were satisfied with simulation-based modules and practical learning. SBE provided a valuable alternative opportunity for exposure to clinical cases during COVID-19, allowing interactive virtual demonstrations of simple clinical examinations and procedures while attending to infection control concerns relating to COVID-19.

Redefining Clinical Skills in History Taking in Association With Epidemiological Assessment of Risk Factors, and Diagnosis of Patients With Cardiovascular Diseases With a Special Emphasis on COVID-19.

Cardiovascular diseases were the leading cause of death in the world prior to the COVID-19 pandemic. A wide range of risk factors may precipitate a cardiovascular disease and therefore multiple aspects of the patient's history may lend a hand in the diagnosis of the specific stage of cardiovascular disease that is presented by the patient. This article will give a general review of the knowledge and skillsets needed by a clinician to distinguish and at the same time correlate the different presenting symptoms and the potential cardiac issue associated with them. History taking is a very essential and critical clinical skill that is of paramount assistance in diagnosing and treating the patient with the right management therapies to find a cure for the disease. Basic approaches in the evaluation of the physical condition and cardiac assessment are important skills in healthcare that help decrease mortality in everyday life and therefore are needed to be learned efficiently. Lifestyle changes and modern standard of living especially in a developing country like India contribute majorly to the evolution of this disease in the population as well as the eating habits and addictions which play a vital role in the progression of the disease. The aim of this article is also to give an outline of various risk factors and recent etiological agents by analyzing the epidemiological variation and patterns that can be ruled out or considered associated with the cardiovascular related-symptomatology and relevant history of the patient to confirm a diagnosis by investigations which will direct the clinician towards specific treatments and recovery of the patient. A special topic of understanding would be the COVID-19-associated cardiovascular complications which have been recently discovered and studied as a result of the pandemic.

Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students.

BACKGROUND: During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. METHODS: Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. RESULTS: Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. CONCLUSION: The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.

The effect of COVID-19 on medical student clinical skill practice and self-perceived proficiency.

Background: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted medical education. This study aimed to determine how COVID-19 affected students' opportunity to practice core clinical skills across specialty rotations and their self-perceived proficiency at performing these. Methods: Routinely administered surveys of fifth year medical student' experiences and perceptions of medical training from 2016 to 2021 were analysed. Number of times core clinical skills were performed and self-perceived proficiency of each skill were compared pre- (years 2016-2019) and during-COVID (years 2020-2021). Results: Data from 219 surveys showed a reduction in the opportunity to perform "a cervical screen test" (p<0.001), "a mental health assessment" (p=0.006), "assess the risk of suicide" (p=0.004) and "bladder catheterisation" (p=0.007) during-COVID. Self-reported skill proficiency was also less during-COVID for performance of: "a mental health assessment" (p=0.026) and "an ECG" (p=0.035). Conclusions: The impact of COVID-19 on mental health skills was greatest, potentially due to a shift toward telehealth services and consequent reduced ability for students to engage in consultations. In a time of potential long-term change in the healthcare landscape, it is imperative to ensure adequate opportunity to practice all core clinical skills during medical training. Inclusion of telehealth earlier into the curriculum may benefit student confidence.

Students' perceptions on shadowing during COVID-19 and an exploration of innovative solutions for clinical exposure.

PURPOSE/OBJECTIVE: The objective of this project was to evaluate the perceptions of predental students' shadowing experiences during a pandemic and further, explore innovative solutions that can be implemented to ensure that shadowing opportunities are equitable and accessible. METHODS: Data was collected via the Web 2.0 social media platform, Instagram (owned by Meta Platforms, Inc.) from 122 participants attending college in North America and are on the predental track: freshman (N = 11), sophomores (N = 25), juniors (N = 30), seniors (N = 34) and recent college graduates (N = 22). Participants completed a survey consisting of 20 questions. RESULTS: Results showed that the pandemic disrupted traditional shadowing methods; students turned to various virtual platforms, such as YouTube and Zoom, to obtain shadowing experiences. There was an increase in the number of students who shadowed virtually during the pandemic versus pre-COVID-19. The majority of the respondents (80%) agreed that dental schools have not provided sufficient guidance on how to approach shadowing during a pandemic. CONCLUSION: Innovative shadowing platforms should be implemented in order to help college students explore careers within dentistry and beyond. The development of a standardized virtual shadowing program with clear guidelines can increase equity and accessibility.

Impact of COVID-19 pandemic on medical education

Background: Medicine is one of the few academic disciplines that cannot be taught in the distance education mode. Hands-on practice for clinical skills and competency is critical in medical education. Although this pandemic has offered new learning modes such as teleconsultation, videoconferencing, virtual simulations, and digital podcasts, how much actual knowledge transfer and skill gain will be achieved, is unanswered. Aims and Objectives: The present study has been planned to understand the impact of COVID on medical education and to identify the factors which promoted or hindered learning during COVID-19 pandemic. Material(s) and Method(s): This cross-sectional study was conducted among 261 willing MBBS students from various colleges of Tamil Nadu after obtaining Institutional Ethical committee clearance using a pre-validated structured online questionnaire through Google form link in online social platforms through "Voluntary opt in" method of sampling. Result(s): About 22.6% of the study participants were affected by COVID-19. About 46% of the participants family members suffered from COVID and all of them accepted that it significantly affected their academics. About 71.6% experienced anxiety/depression. About 93.5% were addicted to social media during class hours. About 88.1% welcomed "flipped/blended learning". More than 90.8% reported that they missed skill-based learning/Primary health care training. About 80.8% positively felt that they got more duration for preparing exams. About 89.3% found that practical exams were challenging. Conclusion(s): Not only have we witnessed the importance of having a robust health-care system, but the pandemic has created a critical need to transform various aspects of medical education especially to a model of blended learning of online and offline methods to enable a better academic environment so as to reflect the changing medical landscape.Copyright © 2023 Jeevithan Shanmugam, et al.

Sustained clinical knowledge improvements from simulation experiences with Simulation via Instant Messaging-Birmingham Advance.

BACKGROUND: Simulation via Instant Messaging-Birmingham Advance (SIMBA) delivers simulation-based learning through WhatsApp and Zoom, helping to sustain continuing medical education (CME) for postgraduate healthcare professionals otherwise disrupted by the coronavirus (COVID-19) pandemic. This study aimed to assess whether SIMBA helped to improve clinical knowledge and if this improvement in knowledge was sustained over time. METHODS: Two SIMBA sessions-thyroid and pituitary-were conducted in July-August 2020. Each session included simulation of various real-life cases and interactive discussion. Participants' self-reported confidence, acceptance, and knowledge were measured using surveys and multiple-choice questions pre- and post-simulation and in a 6- to 12-week follow-up period. The evaluation surveys were designed using Moore's 7 Levels of CME Outcomes Framework. RESULTS: A total of 116 participants were included in the analysis. Significant improvement was observed in participants' self-reported confidence in approach to simulated cases (thyroid, n = 37, P < .0001; pituitary, n = 79, P < .0001). Significant improvement in clinical knowledge was observed following simulation (thyroid, n = 37, P < .0001; pituitary, n = 79, P < .0001). For both sessions, retention of confidence and knowledge was seen at 6-12 weeks' follow-up. CONCLUSIONS: SIMBA increased participants' clinical knowledge on simulated cases and this improvement was retained up to 6-12 weeks after the session. Further studies are required to explore long-term retention and whether it translates to improved real-world clinical practice.

A smartphone-based online platform for clinical skills training and assessment with standardized patients: platform development and pilot study outcomes.

There are limitations and difficulties in the management of traditional in-person standardized patient (SP) practice. The latest developments in online communication tools and the COVID-19 pandemic have promoted the needs for online clinical skills training objectively. However, existing commercial online platforms may not meet the requests for SP-based medical simulation. This paper described the methodology applied to develop a smartphone-based online platform for the management of clinical skills training and assessment with remote SPs, and aimed to determine whether this new platform is acceptable or useful through a pilot run in September 2020. The post-run survey including questionnaire inspired by technological acceptance model and determinants of the perceived ease of use was used to assess the acceptability and usefulness of the platform. Twenty four-year students of clinical medicine participated in the pilot study with twenty SPs and ten faculties. Data from the post-run survey showed that there was a general recognition that the platform is easy to use among all the users. Two questions regarding the usefulness of the platform showed significant differences between the SPs/faculties and the students. More SPs found the platform useful as a training method than the students did. The faculties showed more attempts than the students to use this platform for clinical skills training in the future. This smartphone-based online platform was widely accepted among the tested students, SPs and faculties, which meets the requests and challenges of the new era. It provides an effective approach for clinical skills training and assessment with remote SPs.

Using simulation to train clinical providers in the effective use of telehealth.

With the onset of the COVID-19 pandemic, telehealth became a widely used method to provide patient care. Providers had to quickly learn how to adapt traditional clinical care to the virtual environment. The existing literature focuses on the technological aspects of telehealth with only a few publications addressing optimization of communication, with even fewer looking at the use of simulation to fill the knowledge gap in this area. Simulation training is one such avenue that can be used to practice virtual encounters. This review outlines how to effectively use simulation as an educational method to teach clinical skills needed for effective telehealth communication. The experiential nature of simulation provides learners with an opportunity to adapt their clinical skills to a telehealth encounter, and an opportunity to practice challenges unique to a telehealth environment, such as patient privacy, patient safety, technology disruption, and performance of an examination virtually. The goal of this review is to discuss how simulation may be used to train providers for best practices in telehealth.

Nursing students' experiences of using flipcharts as a learning tool during the COVID-19 pandemic.

BACKGROUND: Building mastery of clinical skills is essential for nursing students to ensure readiness for clinical placements. During the coronavirus disease (COVID-19) pandemic, limited face-to-face teaching and student access to campus facilities, along with the rapid adoption of online methods, increased the need to develop innovative teaching tools to support students. OBJECTIVE: This study aimed to explore nursing student perceptions and experiences of using Flipcharts for learning clinical nursing skills during the COVID-19 pandemic. DESIGN: This study used a qualitative descriptive design. METHODS: Second-year nursing students were invited to participate at the end of the semester to share their experiences of using Flipcharts in their clinical simulation laboratory. A total of 12 nursing students participated in individual semi-structured interviews conducted between December 2020 and February 2021. Data were analysed using Braun and Clarke's six-step method of thematic analysis. RESULTS: The findings of the study demonstrated that students considered Flipcharts to be beneficial in developing their clinical skills and were additionally valuable in supporting students with English as a second language. Three major themes were identified: the perceived value of Flipcharts during limited face-to-face teaching, the role of Flipcharts in supporting skills acquisition across learning domains, and the practicality and accessibility of this learning resource across different mediums. CONCLUSION: Students perceived the use of Flipcharts to be valuable in achieving mastery of clinical skills during COVID-19. The students' experience of using Flipcharts was positive overall and found the learning tool practical and accessible in supplementing learning.

Curriculum Interventions and Pedagogical Approaches for Virtual Care Delivery: A Scoping Review

The onset of the COVID-19 pandemic has accelerated the adoption of virtual care as a modality for home-based care delivery to individuals and cohorts who might not otherwise have access. While a number of positive outcomes have been reported, rapid growth has occurred without critical consideration of clinician education and training. Little is known about the curricular and pedagogical requirements for educating current and future clinicians in virtual care provision. This review was informed by Arksey and O'Malley's five-stage methodological framework for scoping reviews, first published in 2005. Using a clearly articulated search strategy and reporting process, over 4000 pieces of literature were analysed to inform this review. A final 17 papers were included. Common themes emerging in relation to curricula content include the basics of virtual care, cultural awareness, interprofessional collaboration/training, telepresence, encompassing non-verbal, verbal and environmental considerations, and virtual care clinical skills. Standalone modules are recommended for delivering ‘the basics' of virtual care, while the interactive/participative approach is endorsed as an appropriate method of instruction. The reviewed literature reviewed offers a set of core inclusions and pedagogical approaches for a virtual care education program, although these are often mentioned in general terms and are not always well described. Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a consistent and cohesive approach to curricula and pedagogies. These approaches should be rigorously evaluated as part of a continuous quality improvement process.

Clinical Competence of New Nurses: Challenges to the Impact of Online Learning During the Covid-19 Pandemic

Introduction: The Covid-19 pandemic demands education adopt e-learning as a mandatory learning method. Discontinuation of learning at the clinic provides challenges in achieving new nurse candidates' clinical while caring for the patients. However, the description of online learning's impact on the clinical competence of new nurses is still limited. Purpose: To identify the clinical competence of new nurses after following the online learning system throughout the Covid-19 outbreak. Methods: A sequential explanatory mixed-method study. This research conducted quantitative and qualitative data collection by using online forms. The purposive sampling technique involved 120 new nurses. As quantitative respondents, seven new nurses, seven senior nurses, and seven head nurses as qualitative participants. The quantitative and qualitative data were analyzed by performing a chi-square test, and the Colaizzi method was, integrated into the result to get a complete understanding. Results: Online learning significantly impacted new nurses' clinical competence (p-value 0.031). This study results formulated seven main themes, including quickly learning to run digital medical devices, making good reports, lack of confidence in performing nursing implementation, being late in making decisions, lack of empathy, rarely communicating therapeutic, hard in building close relationships. Online learning positively impacts knowledge and administrative skills;the opposite occurs in attitudes, nursing procedural skills, values internalization, and communication. The integrated result shows that the online method is inappropriate for nursing clinical competency learning. Conclusion: Various online learning components shape nursing students' clinical competence. It recommended modifications to the orientation program for new nurses. © 2022 UPM Press. All rights reserved.

Utility of the online YouTube on physical examination in surgery module during COVID-19-pandemic

To analyse the perception towards using YouTube videos in clinical examination in surgery module during COVID-19 pandemic, a cohort study included sixth year medical students of two consecutive batches in their surgery course at the college of medicine, university of Ha'il, throughout the academic years 2019- 2021. Suitability of YouTube was predetermined, all unsuitable were excluded. Clinical sessions were initiated as distance e-learning. Then after, data were collected using a predesigned online questionnaire. The informed consent as well as ethical clearance were obtained prior to conduct the study. Gathered data were examined by SPSS version 25.0. A-151 responses (79 females and 72 males) were recruited in the final assessment (93.2% inclusion rate). The participant's perception was significantly more positive than negative. They agreed/strongly agreed that YouTube enhances the learning process, and increases interest and understanding in 66.2% (P=0.000) and 70.8% (P=0.000) respectively. In another view, they agreed/strongly agreed that it increases the depth of understanding the content of clinical examination and helps them to get more deeply involved with the clinical examination in 68.2% (P=0.000) and 66.3% (P=0.001) respectively. About 72.8% preferred the combination of both videos and in person teaching of clinical examination Hybrid" (P=0.000). Short videos of less than 15 minutes were preferred by 72.8% (P=0.000). Gender has no impact on the perceived values. In conclusion, the obtained results may support the inclusion of online video-supported resources that may be useful for medical students to strengthen and gain surgical clinical skills.

Teaching Clinical Skills Using Online Modality through Modified Peyton's Framework: An Experience from a Medical University in Pakistan.

Introduction: Medical institutions worldwide faced an unprecedented situation during COVID-19 of identifying alternative strategies to sustain the continuum of learning process. This led to several innovations in the traditional medical curriculum. This study explored the effectiveness and feasibility of using the Peyton's framework modified for a virtual platform (Microsoft Teams) for teaching clinical skills to first and second-year medical students at The Aga Khan University, Karachi, Pakistan. Methods: In 2020-2021, the modified Peyton's framework was integrated in the clinical skills (CS) curriculum for all first- and second-year students (N=200). For evaluation, a mixed-method design was used, with pre-and post-session questionnaires. Students' satisfaction was obtained through the standard session evaluation tool of the university. For the qualitative arm, to explore the instructors' experiences, purposive sampling was used (n=8) and a focused group discussion (FGD) was conducted. Finally, performance of the students at the end of year summative Objective Structured Clinical Examination (OSCE) was compared with the students of previous year. Quantitative data were analysed using STATA® version 15.1, using paired t-test to compare the differences in OSCE scores in selected CS stations. A p-value of <0.05 was considered significant for all tests. The FGD was transcribed and analysed through manual content analysis. Results: Nine clinical skills (that included history and examination skills) were taught using the virtual platform. There was a significant improvement in post-session questionnaires in seven of these skills (p value <0.01). Session evaluations showed that most students were satisfied with the learning experience. The instructors showed that the online teaching offered a promising platform for teaching history taking skills. The OSCE scores showed mixed results, with significant improvement in two out of four repeated stations by using paired t-test [abdominal exam (87.33 ± 8.99, <0.001); and precordial examination (88.45 ± 8.36, 0.001)]. Conclusions: Modifying Peyton's framework to a virtual platform allowed us to sustain the continuum of clinical education during the COVID-19 pandemic. The results support the use of a blended learning environment for teaching clinical skills.