Online Education and the Post-Pandemic Transition

Online Transition and Redesigning Learning Experiences

Online learning involves interacting with instructors and peers and checking one’s understanding, alongside using technology to access learning materials. The pandemic restricted opportunities to participate in classrooms and clinical settings, prompting a review of how to structure these activities in different environments. In medical education, a key issue was how to connect online activities that support knowledge acquisition with experiences through which learners develop their roles in relation to patients, healthcare teams, and communities.

Five Guidelines for Designing Distance and Engagement in Online Learning

A review examining the foundational concepts of online learning describes the pandemic-driven transition as re-mediation (Rhim & Han, 2020). This means re-examining the time and space of existing teaching activities and redesigning learning experiences. The review presents transactional distance, community of inquiry, and learner autonomy as foundations for instructional design. The backdrop is distance education’s evolution through mail, television, and the internet. Transactional distance is the social, psychological, and relational distance between the instructor and the learner. In online instruction, the distance between the instructor and the learner varies with dialogue and the flexibility of the curriculum structure. Within a community of inquiry, cognitive presence, social presence, and teaching presence operate together. Cognitive presence involves constructing meaning through questioning and problem-solving. Social presence involves sharing emotions and thoughts with the community. Teaching presence involves designing educational experiences and facilitating participation. Learners vary in their ability to navigate materials and monitor progress. Designs that allow autonomy also include activities that support motivation and learning strategies.

The five guidelines for translating these concepts into instruction are the experiential learning cycle, a combination of synchronous and asynchronous learning, diverse interactions, online-mediated clinical experiences, and support for a learning community. Experiential learning is a cyclical process of concrete experience, reflective observation, abstract conceptualization, and active experimentation. Observing an expert’s thinking through a lecture, providing patient care, and performing anatomical dissection can all provide experiences for this cycle. Flipped learning allows learners to study recorded lectures at their own pace before testing their understanding and solving problems in face-to-face or synchronous online activities. Asynchronous discussions provide time to refine thoughts, while synchronous activities allow learners to exchange immediate feedback. Interactions are categorized as those students have with learning materials, instructors, peers, and themselves. Materials with clear outlines and summaries, individualized feedback, small group discussions, and online forums support these exchanges. Interaction with oneself includes metacognitive activities such as setting goals and checking progress.

Designing online clinical experiences creates opportunities to practice clinical thinking and work through cases that are difficult to encounter in clinical settings. The critical clinical competency curriculum introduced in the review provides a structure for deliberate practice in clinical reasoning using 144 different patient cases. This design accounts for the difficulty a third-year medical student may have encountering diverse patients or gaining sufficient practice in differential diagnosis and treatment planning during clerkships. Whenever new patient information appears in the video, the student pauses to explain the rationale for their judgment and include or exclude differential diagnoses. The student then compares their reasoning with that of an expert panel representing various specialties. This curriculum is available free of charge to medical learners. The review also examines examples of participation in virtual rounds for COVID-19 patients using HIPAA-compliant video conferencing tools. Experiences that are difficult to facilitate online, such as night shifts or interactions with members of various healthcare professions, also warrant consideration when structuring clinical education. The guideline for supporting a learning community addresses the relationships that sustain these activities. The instructor provides information, guides learners through learning materials, facilitates participation and collaboration, and engages in lifelong learning. An atmosphere in which students share difficulties and emotions and instructors disclose their own learning needs supports discussion and higher-order thinking.

Reconfiguring the Purpose of Education and Field Participation Post-Pandemic

A paper exploring the direction of post-pandemic medical education links educational changes to four questions concerning why, what, how, and whom educators teach (Han et al., 2021). The discussion originated in the ASPIRE Academy, composed of representatives from universities that received the ASPIRE-to-Excellence Award from the Association for Medical Education in Europe. Eighteen medical educators from Germany, Pakistan, New Zealand, Portugal, Slovenia, the UK, and the US participated in the online iXII Meeting, held monthly starting in March 2020, and in asynchronous collaborative reflection. The discussion of educational purpose unfolded as non-emergent care shifted to telemedicine, students were deployed to work or graduated early, and declining patient numbers affected medical institutions’ income. The paper examines educational priorities alongside community health needs in university medical institutions reliant on clinical revenue. It proposes collaborations that reward prevention and public health. Community residents participate as collaborators and co-designers in preventive activities. Telemedicine is presented as a way to reduce the time and cost of accessing care and address health issues requiring behavioral changes, such as diabetes, hypertension, and weight management. The relationship between long-term educational debt and specialty choice is also addressed. The discussion connects the costs of training the health workforce with community demand through microcredentials focused on specific medical procedures. It also considers initiatives that ensure the minimum training necessary for basic clinical competencies and licensure.

Proposals for educational content address disaster preparedness, social accountability, and approaches to handling uncertainty. Disaster management encompasses team formation and leadership, resource and supply chain management, skill development, and community communication. Cross-training prepares learners to meet clinical demands outside their specialty during a crisis. Social accountability involves identifying community needs and demonstrating outcomes that respond to them. The study proposes attention to healthcare relationships and community contexts when organizing competencies into checklists and easily measurable goals. Suggested educational topics include the health of Indigenous people, minorities, migrants, refugees, and sexual minorities, as well as poverty, rural areas, mental health, and healthcare in correctional facilities. The discussion also considers ways to incorporate humanities, social sciences, community health, and ethics into daily problem-solving across subjects from the outset of education. Participating in community residents’ activities and developing ongoing relationships are described as ways to cultivate clinical and cultural competencies. In a context where research accumulated rapidly alongside post-publication retractions, the discussion emphasizes approaching diagnosis and treatment as processes of continually reassessing problems. Suggestions also include examining perspectives from complementary, alternative, and integrative medicine—including nutrition, mindfulness, acupuncture, yoga, Tai Chi, and Qigong—in education.

The proposed educational methods include open lean medical education and place-based pedagogy. The former involves universities collaboratively developing and managing basic science materials and making education openly accessible. It involves selecting new information, organizing and standardizing common foundational knowledge, and sharing some interprofessional education. It aims to reduce duplication in producing materials and disparities in access to educational resources. The latter encompasses activities through which students learn about relationships and roles in their future working environments, such as service-learning in free community clinics and global health experiences. A proposal referencing the paid field training of firefighters and paramedics links taking on work and responsibilities under supervision to the development of healthcare teamwork skills and professional identity. The discussion also covers guidelines from the Medical Schools Council of the UK on student volunteer roles and examples of participation in pandemic responses at medical schools in Portugal and Pakistan. A Singapore study cited in the discussion of whom to educate found that one-third of medical students did not want to return to clinical settings and two-thirds were willing to return. Intrinsic motivation and professional responsibility were higher among those willing to return. Conditions that make returning difficult, such as a lack of protective equipment and health problems, are also considered. The paper suggests considering intrinsic motivation, social responsibility, and the ability to communicate with diverse communities in selection.

Reading notes

The critical clinical competency curriculum’s 144 patient cases emphasize explaining the rationale for a judgment and comparing it with expert reasoning. A research perspective combining HRD and medical education can connect online reflection activities with field assignments to examine how the roles learners acquire vary with their opportunities to participate and the support they receive. Whether sharing materials between universities through open lean medical education frees up time and resources for small group feedback or community participation is a separate research question.

References

• Rhim, H. C., & Han, H. (2020). Teaching online: foundational concepts of online learning and practical guidelines. Korean Journal of Medical Education, 32(3), 175–183. https://doi.org/10.3946/kjme.2020.171
• Han, H., Clithero-Eridon, A., Costa, M. J., Dennis, C. A., Dorsey, J. K., Ghias, K., Hopkins, A., Jabeen, K., Klamen, D., Matos, S., Mellinger, J. D., Peters, H., Pitama, S., Smith, C. L., Smith, S. F., Suh, B., Suh, S., & Zdravković, M. (2021). On pandemics and pivots: A COVID-19 reflection on envisioning the future of medical education. Korean Journal of Medical Education, 33(4), 393–404. https://doi.org/10.3946/kjme.2021.207