Undergraduate medical education amid COVID-19: a qualitative analysis of enablers and barriers to acquiring competencies in distant learning using focus groups

Abstract

Due to comprehensive social distancing measures related to the COVID-19 pandemic, medical faculties worldwide have made a virtue of necessity in resorting to online teaching. Medical faculties grapple with how to convey clinical competencies to students in this context. There is a need for research not only to map but also to explain the effect of these secondary measures on students' learning and mental wellbeing. During a period of ongoing comprehensive social distancing measures in Germany, we translated a competency-based curriculum including obstetrics, paediatrics, and human genetics to an e-learning course based on online patient and teacher encounters. In our qualitative study on students' and teachers' views, we identify potential enablers and drivers as well as barriers and challenges to undergraduate medical education under lockdown. In summer 2020, we conducted six focus group interviews to investigate medical students' and teachers' perspectives, experiences and attitudes. All focus groups were videotaped, transcribed verbatim and coded. To guide our deductive and inductive analysis, we applied the theoretical framework of Regmi and Jones. Content analysis was performed in a multi-perspective group. We identified five major themes contributing to a successful use of clinical competency-based e-learning under lockdown: Communication (with teachers, students, and patients), Mental wellbeing, Structure and self-organization, Technical issues, and Learning and commitment. We discuss enablers and potential barriers within all themes and their overlap and link them in an explanatory model. In our setting, students and teachers find e-learning holds strong potential and especially in times of COVID-19 it is greatly appreciated. We broaden the understanding of the impact of distant learning on acquiring competencies, on attitudes, and on mental wellbeing. Our model may serve for a thoughtful, necessary transition to future e-learning and hybrid programs for a competency-based medical education with ongoing social distancing measures.

A Literature Review of Barriers and Opportunities Presented by Digitally Enhanced Practical Skill Teaching and Learning in Health Science Education

“…While a lack of instruction [ 28 ] incoherent or disorganised layout of online learning material [ 30 ] and difficulty identifying key information [ 35 ] are described as frustrating aspects of online learning, poor organisation of learning materials can also hinder student learning success [ 36 ]. For example, the linear progression of prognosis in virtual patients is a design element that can be criticised by students, due to a lack of comparability to a learning environment with real patients.…”

“…These issues include periodic unavailability of e-learning platforms [ 27 ], internet connectivity issues resulting in video buffering [ 38 ] and broken web links to resources [ 35 ]. When practicing communication and assessment skills with patients through video, an unstable internet connection can disrupt flow and rapport building [ 36 ]. Patient unfamiliarity or discomfort using technology can also impede skill acquisition [ 36 ].…”

Outcomes of Remote Pathology Instruction in Student Performance and Course Evaluation

“…13,14 Besides technical issues, distance learning faces additional challenges in the realms of engagement/commitment, structure/organization, and communication/mental well-being. 15,16 To that end, data are needed that determine the efficacy and evaluate the outcomes of purposefully and completely online medical teaching programs, but these are generally lacking. The aim of this study was to measure the effect of remote instruction on students, both in terms of their capacity for learning as well as their perception of course quality.…”

Medical students’ adoption and evaluation of a completely digital general practice clerkship – cross-sectional survey and cohort comparison with face-to-face teaching

“…This is in line with findings from both education and medical didactics. Video conferencing and student-teacher communication have been described to be perceived as highly beneficial [ 19 , 29 ]. It should be noted that involving GP preceptors in online teaching requires significant effort.…”