Teaching pre-clinical medical students remotely in Nigeria post Covid-19 pandemic: can past experiences shape future directions?

PURPOSE: Online teaching has gained popularity in recent years, but changes have been slower to implement in Lower or Medium Income Countries (LMIC). The aim of this research was to build upon educators' experiences of remote teaching during Covid-19 to inform the development of a blended learning approach for teaching pre-clinical subjects at the Faculty of Biomedical Sciences at Obafemi Awolowo University, Ile-Ife, Nigeria (OAU). METHODS: The Critical Incident Technique (CIT) was used in this exploratory study. Participants were invited to either complete an online qualitative questionnaire or take part in an online structured interview, which were hosted on Microsoft platforms. Data were obtained from eighteen educators and were analyzed using thematic analysis. RESULTS: Findings suggest that most educators (72%) continued to engage with remote teaching post-pandemic. All lab-based practical topics returned to being in-person, and teachers' experiences highlighted that a new blended learning approach should focus on asynchronized online teaching of didactic subjects. Five main themes captured educators' experiences and lessons learned regarding online teaching including: skills and training, teachers' motivation and attitudes, internet and connectivity, learners' behaviors, and socio-economic constraints. CONCLUSION: Findings provided additional evidence on the way in which educators in LMIC would like to build upon the positive aspects of online teaching and move towards a blended learning model. However, the implementation of such an approach should consider students' and faculty's needs and socio-economic constraints.

Using Qualitative Questionnaires in Medical Education Research.

Most students in Health Profession Education courses are new to the world of qualitative research. Faced with the challenge of designing a research project, they are often drawn towards using the questionnaire as a data collection method, commonly assuming that utilising open-ended questions alone constitutes qualitative research design. Designing questionnaires that meet the standards of rigour is challenging, and this common assumption reflects inexperience with and misunderstandings of qualitative ontology, as well as the lack of methodological literature on designing and developing qualitative questionnaires. This paper is written with research supervisors as well as students in mind, as it is aimed to help elucidate the decision-making process and the justification for using a qualitative questionnaire. Drawing upon examples of research conducted by our students, and the wider literature, we demonstrate how qualitative questionnaires can produce rich and meaningful findings when they (1) prioritise qualitative research values, and (2) follow a rigorous design process when the questionnaire is developed. We conclude by offering a simple framework for developing rigorous qualitative questionnaires to those who may consider using this approach.

Construction and validation of a medical career readiness inventory.

BACKGROUND: Medical students' preparedness for clinical practice is well researched, yet little is known on the extent to which students are being prepared for a medical career. This paper reports the construction of a short medical inventory titled eXploring medical sTudents' caReer reAdiness (XTRA) to measure students' career readiness based on Super's theory of career maturity. APPROACH: We designed an instrument consisting of a series of 5-point Likert-scale to identify participants competencies regarding career exploration and planning during their undergraduate studies. The instrument was completed by 348 medical students from 41 universities in the United Kingdom. We examined the validity and reliability of the instrument through Exploratory Factor Analysis, Cronbach's coefficient α and Pearson correlation. EVALUATION: Exploratory Factor Analysis revealed that 16 of the 20-items survey were aligned with the exploration stage of Super's theory: Crystallisation (Career goals), Specification (Career pathways) and Implementation (Career accomplishments). The four items that formed two separate statistical factors were specific to a current medical career in the UK. Internal reliability for Super's factor subscales were acceptable (α = 0.71 to α = 0.81). A significant positive relationship was found between students' overall rating of career readiness and the three factors, indicating construct validity. IMPLICATIONS: The XTRA Inventory is a short instrument with construct and content validity specifically designed to measure career readiness of medical students. Further work on its psychometric properties will help establish this inventory to be used as a guidance and career counselling tool by medical educators and educational institutions in developing career development programmes.

Teaching Medical Students About Kawasaki Disease: The Development and Evaluation of a Digital Educational Resource.

Introduction: The use of digital educational resources has gained widespread popularity across all disciplines in medical education; pediatrics being no exception. In this paper, we report how instructional design and multimedia principles were used to develop and evaluate an e-learning resource on Kawasaki Disease, which was primarily created as a revision aid for undergraduate medical students. Methods: The design and development of the resource was based upon the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional model. A "People, Activities, Contexts and Technologies" (PACT) analysis was initially undertaken to identify learners' needs, and the 12 Principles of Multimedia Design informed the development of the resource. The evaluation strategy was informed by the Usability Evaluation Method for e-Learning Applications and focused on the instructional design parameters of navigation, visual design and intrinsic motivation to learn. Results and Conclusion: Feedback from the seven medical students who completed and evaluated the resource showed high levels of satisfaction. Students perceived it to be beneficial to their learning and indicated a preference for an interactive digital resource over traditional modes of learning, such as textbooks. However, as this was a small-scale evaluation, suggestions for further evaluation and how this may inform ongoing development of the resource are considered in this paper.

Teaching Undergraduate Medical Students Non-Technical Skills: An Evaluation Study of a Simulated Ward Experience.

Purpose: Research suggests that medical students in the UK report a need to be better prepared for the non-technical skills required for the role of a junior doctor. A Simulated Ward Experience was developed in an attempt to address this need. The purpose of this study was (1) to evaluate the effectiveness of the Simulated Ward Experiences by examining students' reactions regarding the quality of teaching and (2) to examine the main drivers of learning and the extent to which students felt it helped them prepare for their future training. Methods: A mixed method evaluation study was conducted using a questionnaire and focus groups. Final year students who participated in the Simulated Ward Experience were invited to contribute to the evaluation, out of which 25 completed the questionnaire and 13 took part in focus group interviews. Data analysis were conducted by means of descriptive statistics for questionnaire data and thematic analysis of focus group transcripts. Results: The median Likert scores for quality of teaching Non-Technical Skills were either very good or excellent, demonstrating that students were highly satisfied with the way in which these were taught. Qualitative data provided further insights into the aspects of the intervention that promoted learning, and these were categorised into four themes, including realism of the simulation; relevance for the role and responsibilities of the Foundation Year 1 Doctor (including Non-Technical Skills); learning from and with others; and supportive learning environment. Conclusion: This evaluation study provides further evidence of the value of learning in a simulated setting, particularly when it is closely aligned to the real clinical context and creates opportunities to practice skills that are perceived to be relevant by the learner. Study limitations are recognised and suggestions for further studies are provided.

Teaching Medical Students How to Interpret Chest X-Rays: The Design and Development of an e-Learning Resource.

INTRODUCTION: The teaching of radiology to medical students has often been criticised for being inadequate and unstructured, with students reporting lack of confidence in assessing x-rays. In this paper, we describe how an e-learning resource, on how to interpret a chest x-ray for medical students, was designed and developed. The aim of the resource was to provide medical students with knowledge of how to interpret a chest x-ray in a systematic approach. METHODS: The technology used to design the e-learning resource was Xerte Online Toolkits. The design and development of the e-learning resource was based upon andragogical principles and followed Overbaugh's guidelines and Mayer's 12 multimedia principles. An instructional design model called ADDIE was used to help develop the resource and its content. These included cases of common conditions, a quiz and summary table at the end. The paper focuses mainly on the way in which instructional design, education and multimedia principles were used to inform the development of the resource. FINDINGS: A preliminary evaluation was completed by 18 medical students from year 3-5 who completed the e-learning resource. The feedback was positive with an average rating of 9/10 and 100% of students saying they would recommend the resource to a colleague. Students commented that they liked the resource as it was easy to navigate, had good visual learning and contained good explanations with relevant content. CONCLUSION AND FUTURE IMPLICATIONS: This paper demonstrates how, with the use of instructional models, educational theories and principles, an e-learning resource can be created. Preliminary evaluation showed that students were satisfied with the resource and felt it helped them acquire knowledge on how to interpret chest x-rays. This resource can be further utilized either as a standalone resource or before starting clinical placements and may prove particularly useful in the current and challenging learning environment where there is an increased need for digital resources.

Postgraduate students' perceptions of what makes for effective assessment feedback: a case study of a clinical masters course.

The purpose of this study was to examine postgraduate students' perceptions of assessment feedback. Using the Critical Incident Technique, students enrolled on a taught clinical course were asked for their perceptions of effective and ineffective examples of assessment feedback. The data were analysed using thematic analysis and nine themes emerged that capture perceptions associated with feedback content and feedback process. Students perceived effective feedback if it was specific and clear, using positive tone of language. They expressed a preference for feedback that is delivered in a standardised format, reflecting the grades given, individualised, and when the marking criteria is explicit and enables dialogue with the marker. Students perceived feedback to be ineffective when it focused on grammatical errors rather than content, when it was provided by anonymous graders and if it was too personal. Timeliness of feedback was also important to participants. Practical implications and suggestions for future research are highlighted in this paper.

Teaching Medical Students About Attention Deficit Hyperactivity Disorder (ADHD): The Design And Development Of An E-Learning Resource.

In this paper, we describe how an e-learning resource on Attention Deficit Hyperactivity Disorder (ADHD) for medical students was designed and developed. The aim of the resource was to provide students with essential knowledge and understanding about ADHD prior to their attendance at a classroom teaching session as well as to serve as a revision tool. The paper focuses on the way in which instructional design, educational and multimedia principles were used to inform the development of the resource. It also reports results of a small-scale evaluation of students' satisfaction with the resource and the way in which they believed it impacted knowledge acquisition of ADHD related concepts and principles. In addition, we consider ways in which the resource could be further utilized and evaluated, for example as part of a flipped classroom approach to learning, and whether this would be a useful model to use when teaching other aspects of Child and Adolescent Psychiatry.

Teaching undergraduate medical students Child and Adolescent Psychiatry (CAP): a Delphi study on curriculum content.

BACKGROUND: The prevalence of psychiatric disorders in children and young people is high but despite this, many doctors have difficulty identifying and managing psychiatric disorders presenting in this age group. The purpose of this study was to determine appropriate curriculum content in Child and Adolescent Psychiatry (CAP) for a Graduate Entry Medicine (GEM) course. Doctors with a background in primary care who were also involved in undergraduate teaching rated how necessary they considered a number of knowledge, skills and attitudes items were for inclusion in the CAP curriculum. METHODS: An online questionnaire study was carried out using modified Delphi methodology in two rounds. The questionnaire was derived from a list of CAP learning objectives and/or curricular content obtained from a thorough review of the literature. 23 of the 24 doctors who had agreed to participate went on to complete the round one questionnaire (95.8% response rate) with 19 also completing round 2 (82.6%). Where there was high agreement (70% or more) amongst participants, items were considered as having sufficient consensus to either accept or reject them. Mean scores were then used as a way to prioritise items. RESULTS: At the end of round two, there was consensus to consider including 26 of the 34 knowledge items, 16 of the 20 skills items and three of the four attitudes items in the CAP curriculum. The most highly rated knowledge, skills and attitudes items were depression/ suicide; communicating with children, young people and families; and rapport building. The majority (83.3%) of round two responders, considered that the current amount of CAP teaching time was "too little". CONCLUSIONS: Delphi methodology proved useful for determining consensus and the priority rankings of the CAP knowledge, skills and attitudes items can now be used to help educators determine which topics to focus upon. The study findings support the need for additional CAP teaching time in the GEM curriculum and will help to shape new CAP content. Additional formal CAP teaching time has already been incorporated into the psychiatry speciality attachment, a new clinical skills session has been developed and CAP topics have been introduced into written and clinical examinations.