The aim of this study is to review the literature on known barriers and solutions that face educators when developing and implementing online learning programs for medical students and postgraduate trainees. An integrative review was conducted over a three-month period by an inter-institutional research team. The search included ScienceDirect, Scopus, BioMedical, PubMed, Medline (EBSCO & Ovid), ERIC, LISA, EBSCO, Google Scholar, ProQuest A&I, ProQuest UK & Ireland, UL Institutional Repository (IR), UCDIR and the All Aboard Report. Search terms included online learning, medical educators, development, barriers, solutions and digital literacy. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed with inclusion/exclusion criteria. A consensus was drawn on which articles were included. Data appraisal was performed using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist and NHMRC Appraisal Evidence Matrix. Data extraction was completed using the Cochrane Data Extraction Form and a modified extraction tool. Of the 3101 abstracts identified from the search, ten full-text papers met the inclusion criteria. Data extraction was completed on seven papers of high methodological quality and on three lower quality papers. Findings suggest that the key barriers which affect the development and implementation of online learning in medical education include time constraints, poor technical skills, inadequate infrastructure, absence of institutional strategies and support and negative attitudes of all involved. Solutions to these include improved educator skills, incentives and reward for the time involved with development and delivery of online content, improved institutional strategies and support and positive attitude amongst all those involved in the development and delivery of online content. This review has identified barriers and solutions amongst medical educators to the implementation of online learning in medical education. Results can be used to inform institutional and educator practice in the development of further online learning.

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Barriers and solutions to online learning in medical education – an integrative review

The closure of educational activities in the Kingdom of Saudi Arabia due to the ongoing COVID-19 pandemic resulted in an unplanned shift from traditional learning to a setup that exclusively involves digital teaching and learning. Within this context, the present study aimed to explore undergraduate medical students’ perceptions regarding the effectiveness of synchronized online learning at Unaizah College of Medicine and Medical Sciences, Qassim University, Saudi Arabia. A qualitative study was conducted using virtual focus group discussions synchronously with the help of a discussion guide consisting of seven open-ended questions. Overall, 60 medical students were recruited using a maximum variation sampling technique; these students then participated in eight focus group discussions. All interviews were recorded, transcribed verbatim, and analyzed for thematic contents using the standard (Mayring, Kiger. M. E. and Braun.V) content analysis framework. A thematic content analysis yielded four core themes: (1) educational impact, (2) time management, (3) challenges encountered, and (4) preferences for the future. The online modality was well-received, and all participants agreed that online sessions were time saving and that their performance was improved due to enhanced utility of time; however, they indicated that they encountered some challenges, including methodological, content perception, technical, and behavioral challenges during sessions and online exams. Most of the preclinical students preferred online learning for the upcoming academic years. Synchronized online classes were well-accepted by the medical students. This represents significant and promising potential for the future of medical education. The principles of the online learning model and learning outcomes should be rigorously and regularly evaluated to monitor its effectiveness.

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The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students' perspectives.

ContextEvidence-based practice (EBP) is the integration of the best research evidence with patients' values and clinical circumstances in clinical decision making. Teaching of EBP should be evaluated and guided by evidence of its own effectiveness.ObjectiveTo appraise, summarize, and describe currently available EBP teaching evaluation instruments.Data Sources and Study SelectionWe searched the MEDLINE, EMBASE, CINAHL, HAPI, and ERIC databases; reference lists of retrieved articles; EBP Internet sites; and 8 education journals from 1980 through April 2006. For inclusion, studies had to report an instrument evaluating EBP, contain sufficient description to permit analysis, and present quantitative results of administering the instrument.Data ExtractionTwo raters independently abstracted information on the development, format, learner levels, evaluation domains, feasibility, reliability, and validity of the EBP evaluation instruments from each article. We defined 3 levels of instruments based on the type, extent, methods, and results of psychometric testing and suitability for different evaluation purposes.Data SynthesisOf 347 articles identified, 115 were included, representing 104 unique instruments. The instruments were most commonly administered to medical students and postgraduate trainees and evaluated EBP skills. Among EBP skills, acquiring evidence and appraising evidence were most commonly evaluated, but newer instruments evaluated asking answerable questions and applying evidence to individual patients. Most behavior instruments measured the performance of EBP steps in practice but newer instruments documented the performance of evidence-based clinical maneuvers or patient-level outcomes. At least 1 type of validity evidence was demonstrated for 53% of instruments, but 3 or more types of validity evidence were established for only 10%. High-quality instruments were identified for evaluating the EBP competence of individual trainees, determining the effectiveness of EBP curricula, and assessing EBP behaviors with objective outcome measures.ConclusionsInstruments with reasonable validity are available for evaluating some domains of EBP and may be targeted to different evaluation needs. Further development and testing is required to evaluate EBP attitudes, behaviors, and more recently articulated EBP skills.

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Instruments for Evaluating Education in Evidence-Based Practice: A Systematic Review

https://www.researchsquare.com/article/rs-41178/v1.pdf?c=1631860051000

Students' perception of online learning during the COVID-19 pandemic: A survey study of Polish medical students.

A fundamental goal of medical education is the active, constructive, transformative process of professional identity formation (PIF). Medical educators are thus charged with designing standardized and personalized curricula for guiding, supporting, and challenging learners on the developmental professional identity pathway, including the process of socialization. The author of this Commentary provides an overview of foundational principles and key drivers of PIF supporting the being, relating, and doing the work of a compassionate and competent physician. Key elements of PIF including guided reflection, use of personal narratives, integral role of relationships and role modeling, and community of practice are viewed through various lenses of PIF theory and pedagogy. Questions informing the PIF discourse are raised, including interprofessional identity considerations. Central emergent themes of reflective practice, relationships, and resilience are described as supporting and reciprocally enhancing PIF. Overarching lessons include attending to learners' and faculty's PIF within a developmental trajectory of the professional life cycle; process and content within PIF curricula as well as learners' individual and collective voices; curricular/extracurricular factors contributing to socialization, self-awareness, development of core values, and moral leadership; integrating PIF domains within pedagogy; faculty development for skilled mentoring and reflective coaching; and implementing resilience-promoting skill sets as "protective" within PIF. Outcomes assessment including the impact of curricula on learners and on patient-centered care can be challenging, and potential next steps toward this goal are discussed.

Professional identity (trans)formation in medical education: reflection, relationship, resilience.

There has been increasing emphasis on professionalism in medical education over the past several decades, initially focusing on bioethical principles, communication skills, and behaviors of medical students and practitioners. Authors have begun to discuss professional identity formation (PIF), distinguishing it as the foundational process one experiences during the transformation from lay person to physician. This integrative developmental process involves the establishment of core values, moral principles, and self-awareness. The literature has approached PIF from various paradigms-professionalism, psychological ego development, social interactions, and various learning theories. Similarities have been identified between the formation process of clergy and that of physicians. PIF reflects a very complex process, or series of processes, best understood by applying aspects of overlapping domains: professionalism, psychosocial identity development, and formation. In this study, the authors review essential elements of these three domains, identify features relevant to medical PIF, and describe strategies reported in the medical education literature that may influence PIF.

Professional identity formation in medical education: The convergence of multiple domains

Background: Faculty who want to develop e-learning materials face pedagogical challenges of transforming instruction for the online environment, especially as many have never experienced online learning themselves. They face technical challenges of learning new software and time challenges of not all being able to be in the same place at the same time to learn these new skills. The objective of the Any Day Any Place Teaching (ADAPT) faculty development program was to create an online experience in which faculty could learn to produce e-learning materials. Methods: The ADAPT curriculum included units on instructional design, copyright principles and peer review, all for the online environment, and units on specific software tools. Participants experienced asynchronous and synchronous methods, including a learning management system, PC-based videoconferencing, online discussions, desktop sharing, an online toolbox and optional face-to-face labs. Project outcomes were e-learning materials developed and participants' evaluations of the experience. Likert scale responses for five instructional units (quantitative) were analyzed for distance from neutral using one-sample t-tests. Interview data (qualitative) were analyzed with assurance of data trustworthiness and thematic analysis techniques. Results: Participants were 27 interprofessional faculty. They evaluated the program instruction as easy to access, engaging and logically presented. They reported increased confidence in new skills and increased awareness of copyright issues, yet continued to have time management challenges and remained uncomfortable about peer review. They produced 22 new instructional materials. Discussion: Online faculty development methods are helpful for faculty learning to create e-learning materials. Recommendations are made to increase the success of such a faculty development program.

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Online Faculty Development for Creating E-learning Materials

Among its many facets, the field of medical informatics encompasses the use of technology to access and manage scientific information. The Association of American Medical Colleges (AAMC), through the Medical Informatics Objectives of the Medical School Objectives Project (MSOP) has identified five informatics-related roles of the physician and has established objectives for each of these roles. The lifelong learning role incorporates skills relating to information retrieval, evaluation, and reconciliation. Without activities specifically targeting these skills, it is an act of faith that students will graduate with adequate preparation in these areas. To explicitly address these curricular goals, second-year students in Endocrinology and Reproduction Course at the University of Texas Medical Branch in Galveston were required to participate in debates on controversial topics in these fields. This exercise provided a structured task for developing and improving skills in literature searching, critical thinking, including evaluation of the quality of studies, reconciling results of conflicting studies, teamwork, formal presentation and communication, and spontaneous scholarly discussion. A search of the Medline database produced only one article describing the use of student debates for acquiring content and developing critical thinking and communication skills in health science education. The paper describes a first-year pharmacy curriculum that incorporated debates on socioeconomic topics relevant to pharmacy practice. While these debates required critical analysis of issues, the primary focus was on content rather than cognitive or informatics-related skills. Published accounts of debates in a college chemistry course and business school provide qualitative descriptions of the beneficial effects of such exercises on critical thinking, updating knowledge, and communication skills. In a more quantitative approach, Allen et al. conducted a meta-analysis of the impact of formal instruction in communication skills (including debates) on critical thinking ability. Such training resulted in 44% increase in scores on tests of critical thinking. Compared with training in other communication skills, participation in ‘‘forensics’’ (i.e., competitive debates) produced the greatest improvement, although the differences did not achieve statistical significance. Finally, Johnson et al. performed a meta-analysis of the effects of a method they call ‘‘academic controversy’’ on a variety of cognitive outcomes. This method, which shares many features of the debates described in the current report, has produced ‘‘increased achievement and retention, higher-quality problem-solving and decision-making, more frequent creative insight, more thorough exchange of expertise, and greater task involvement’’ by students. The current report describes the implementation of structured debates and the evaluation by students and faculty of the degree to which the informatics objectives were accomplished. Method

The impact of structured student debates on critical thinking and informatics skills of second-year medical students.

This article reviews the formation of the Frontera Collaboration, a coalition of health sciences librarians serving clinicians and public health personnel in the U.S.-Mexico border region. Based on findings from an assessment of the target populations’ learning needs, the Frontera Collaboration participants developed a shared set of training materials that have been used in pilot training sessions. The Frontera Collaboration's participants learned several lessons related to collaborative health information outreach and increased their understanding of the concerns and needs of clinicians and public health personnel serving border communities.

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Julie M. Trumble

Papers

Professional identity formation in medical education: The convergence of multiple domains

Online Faculty Development for Creating E-learning Materials

The impact of structured student debates on critical thinking and informatics skills of second-year medical students.

The Frontera Collaboration: A Preliminary Report of Health Sciences Librarians Promoting Evidence-Based Practice in U.S.-Mexico Border Communities