Clinical Learning in Medical and Health Professions Education amid COVID-19 Pandemic: A Literature Review of Various Methods and Innovations

BACKGROUND: COVID-19 has caused disruption to medical education and health care systems around the world. The highly contagious nature of the virus makes it difficult for educational institutions to continue their studies as usual, thus affecting the medical and health professions education which is based on face-to-face lectures, practicum, skills laboratories, and clinical practice in health facilities. AIM: This paper discovers clinical learning initiatives across the globe and highlights the contribution toward educational processes. METHODOLOGY: This study utilized an integrated literature review method. A systematic search for articles published was performed in Springer, ScienceDirect, PubMed, and EBSCOHost. Primary search monetary terms were e-learning (all synonyms) and health sciences education (all synonyms), including COVID-19. Articles published within the period of COVID-19 pandemic included in this study. For the synthesis, the 20 included studies selected were coded. In this study, data were synthesized through narrative synthesis using thematic analysis (TA). To identify the recurrent themes author followed six steps when synthesizing data using TA, for example, familiarizing with the data, developing initial (sub) codes, searching for (sub) themes, reviewing (sub) themes, compiling ideas or issues, and producing final data in line with the study aims and objectives. RESULTS: Out of records identified, a total of citations was screened, of which 20 were found to be of relevance to this study most were quantitative (14.70%) in design. Studies were published in 2020 since the beginning of COVID-19 pandemic. The geographical range of papers covered mostly the moderate-income regions. On conducting TA of the included studies, it was possible to obtain two broad descriptive themes/categories: enablers or drivers of, and barriers or challenges to, under which important themes have emerged. CONCLUSION: Study suggests that developing e-learning in effective clinical learning is needed, not only limited to moving the learning process but also needing to follow the instructional design, so that learning outcomes can be achieved by students. In addition, a learning process that promotes self-directed-learning is needed so that students have flexibility, use relevant learning styles and are able to integrate knowledge, skills and attitudes as a meaningful learning process.

Palliative and End of Life Care in Undergraduate Medical Education: A Survey of New Zealand Medical Schools

Background: In New Zealand, 34% of deaths occur in the hospital setting where junior doctors are at the frontline of patient care. The death rate in New Zealand is expected to double by 2068 due to the aging population, but many studies report that graduates feel unprepared to care for people near the end of life and find this to be one of the most stressful parts of their work. International guidelines recommend that palliative and end of life care should be a mandatory component of undergraduate medical education, yet teaching varies widely and remains optional in many countries. Little is known about how medical students in New Zealand learn about this important area of clinical practice. The purpose of this study was to investigate the organisation, structure and provision of formal teaching, assessment and clinical learning opportunities in palliative and end of life care for undergraduate medical students in New Zealand.Methods: Quantitative descriptive, cross-sectional survey of module conveners in New Zealand medical schools.Results: Palliative and end of life care is included in undergraduate teaching in all medical schools. However, there are gaps in content, minimal formal assessment and limited contact with specialist palliative care services. Lack of teaching staff and pressure on curriculum time are the main barriers to further curriculum development.Conclusions: This article reports the findings of the first national survey of formal teaching, assessment and clinical learning opportunities in palliative and end of life care in undergraduate medical education in New Zealand. There has been significant progress towards integrating this content into the curriculum, although further development is needed to address barriers and maximise learning opportunities to ensure graduates are as well prepared as possible.

Perception regarding clinical learning environment among undergraduate nursing students

Clinical experience is an integral aspect of nursing education as it transforms the theoretical knowledge into practice and the cornerstone of nursing as a health profession. The experience gained through a good and supportive clinical environment includes the atmosphere of the clinical placement unit, and the relationships shared with clinical staff supervisors (staff nurses) and mentors (Clinical instructors) that will affect the students learning. Elements like good teaching, relationship with the clinical staff and opportunity to practice, need to be assessed to have an understanding of the student’s perception regarding clinical learning environment. The aim of the present study was to assess the clinical learning environment among undergraduate nursing students of various colleges of Punjab. Materials and methods: A non experimental, descriptive research design was used to assess the perception regarding clinical learning environment among undergraduate nursing students. SECEE inventory (student evaluation of clinical education environment) by Kari Jecklin - Sand was used to determine the clinical learning environment. Five Nursing institutions were selected conveniently to select 500 under graduate nursing students randomly. Results and Major Findings: The findings of the study revealed that Majority (68%) of the study subjects were satisfied with their clinical learning environment followed by 30.8% who were moderately satisfied and only 1.2% were unsatisfied with their clinical learning environment. As per the Personal Profile of the study subjects, age and gender were found highly significant with the perceived clinical environment score at the 0.01 level of significance whereas no significant association was found out with the habitat, marital status, type of family, place of stay during study and financing during study. As per the family background, mother’s occupation was found highly associated with the clinical learning environment score whereas no association was found with the annual income of parents, education of mother, education of father, father’s occupation and number of siblings.

Analysis of the Interprofessional Clinical Learning Environment for Quality Improvement and Patient Safety From Perspectives of Interprofessional Teams

ABSTRACT Background In 2018 the Clinical Learning Environment Review (CLER) Program reported that quality improvement and patient safety (QIPS) programs in graduate medical education (GME) were largely unsuccessful in their efforts to transfer QI knowledge and substantive interprofessional QIPS experiences to residents, and CLER 2.0 called for improvement. However, little is known about how to improve the interprofessional clinical learning environment (IP-CLE) for QIPS in GME. Objective To determine the current state of the IP-CLE for QIPS at our institution with a focus on factors affecting the IP-CLE and resident integration into interprofessional QIPS teams. Methods We interviewed an interprofessional group of residents, faculty, and staff of key units engaged in IP QIPS activities. We performed thematic analysis through general inductive approach using template analysis methods on transcripts. Results Twenty individuals from 6 units participated. Participants defined learning on interprofessional QIPS teams as learning from and about each other's roles through collaboration for improvement, which occurs naturally when patients are the focus, or experiential teamwork within QIPS projects. Resident integration into these teams had various benefits (learning about other professions, effective project dissemination), barriers (difficult rotations or program structure, inappropriate assumptions), and facilitators (institutional support structures, promotion of QIPS culture, patient adverse events). There were various benefits (strengthened relationships, lowered bar for further collaboration), barriers (limited time, poor communication), and facilitators (structured meetings, educational culture) to a positive IP-CLE for QIPS. Conclusions Cultural factors prominently affected the IP-CLE and patient unforeseen events were valuable triggers for IP QIPS learning opportunities.