Covid-19: Health Education England shares advice for traineesBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1635 (Published 24 April 2020) Cite this as: BMJ 2020;369:m1635
All rapid responses
We are pleased to read the very timely article in your esteemed journal titled “Covid-19: Health Education England shares advice for trainees” by Rimmer. The authors have succinctly described the stress and uncertainty the trainees are facing in their trainings due to COVID crisis. The novel corona virus COVID 19 is a mammoth crisis and a great challenge for humanity. All facets of life including human health, society, industry, commerce as well as medical education have been affected by this global pandemic. As we know, medical education is based essentially on pillars of development of knowledge, skills, behaviour and communication skills in medical students. While knowledge and deep learning actively require teacher-learner interaction in a conducive environment, skills, behaviour and communication are difficult to cultivate without student patient interaction in real life scenario. Without development of all these four attributes in a medical student the science and art of medicine remains incomplete. This emergent situation has given global setback to undergraduate and postgraduate medical education.
Although didactic class room teaching, presentations, demonstrations and bed side teaching learning have largely been replaced by self directed learning (SDL) and online teaching learning platforms, but the benefits of direct teacher student contact and real time two way feedback are difficult to replicate in online forums . Well structured small group online teaching during COVID pandemic can improve teacher student interaction and initiate a deeper learning experience too . Similarly conferences and student presentations which helped integration of medical students into larger medical fraternity have been replaced by online conferences and webinars. This quick transformation in the mode of imparting medical education has imposed challenges upon both - students and teachers in terms of teaching – learning methods, conducting trainings, skill based learning and competency based assessments. Adapting to these challenges in teaching learning may not be easy for students with low motivation, lower socioeconomic strata, lack of equipment and poor internet connectivity .
Here we are sharing our experience in the Indian context. At our institute we are using Web X platform for imparting online teaching to four hundred and twenty undergraduate students from four MBBS batches. The first component of online teaching is real time large group teaching for all the subjects of respective batch, each class lasting forty five minutes as per the approved curriculum. The presented lectures are posted online and are accessible to all for future reference. Students also use this platform for their presentations e.g. seminars and interesting case scenarios. The second component of online teaching is small group teaching (4 to 5 in each group) for active participation and in-depth learning. Based on their curriculu , assignments are given to students, which they upload for assessment after completion. Although some guidelines also are available to conduct student assessments, how to conduct annual assessments is open to discussion  .
There are challenges in imparting skills through online teaching learning methods as ‘‘to study the phenomenon of disease without books is to sail on an uncharted sea, while to study books without patients is not to go to sea at all’’. This statement of Sir William Osler underlines importance of student patient interaction for cultivating clinical and communication skills as well as right attitude towards the patients. In the era of social and physical distancing the real student patient interaction may not be possible but practical skills still can be facilitated by online videos on patient examination followed by students practicing on simulation and virtual reality platforms, while attributes like attitude and communication skills can be practised on in door patients maintaining social and physical distance.
With current COVID pandemic followed by second and third wave a distinct possibility, online teaching is likely to stay. So we must adapt to this mode of teaching learning and innovate programs to make student- teacher interactions better and stimulate deep learning. As development of clinical skills, attitude and communication in a medical student are integral part of medical education, we have to discuss and deliberate how these attributes can be addressed in online platforms.
1. Rimmer A. Covid-19: Health Education England shares advice for trainees. BMJ 2020;369:m1635. doi:10.1136/bmj.m1635 pmid:32332033.
2. Ferrel M N, Ryan J J. The Impact of COVID-19 on Medical Education. Cureus 12(3) :e7492.
3. Daniel SJ. Education and the COVID-19 pandemic [published online ahead of print, 2020 Apr 20]. Prospects (Paris). 2020;1‐6. doi:10.1007/s11125-020-09464-3 .
4. Joint Committee on Surgical Training. COVID-19 and trainee progression in 2020 (update I) – 1 April 2020, 2020.
Competing interests: No competing interests