Enhancement of learning experiences and outcomes during the crisis – An opportunity for curriculum modernisation – Abraham Wai
Rapid advancement in medical knowledge and development in clinical practice drives continuous development of medical curriculum so as to prepare students for postgraduate training and future practice. Moreover, we are facing an expanding student population from highly diversified backgrounds, explosion of medical knowledge and changing societal needs and expectations.
In response to all these challenges, the Emergency Medicine Unit underwent the modernisation of the undergraduate teaching – to modernise the content to make it relevant and forward-looking; to modernise the pedagogical approaches to make them efficient, effective and sustainable for a class of 300 students; and to modernise the assessment methods to help ensure that we produce competent doctors for future practice.
Modernising the content
Rapid advancement in medical knowledge and innovations requires us to renew the content in the medical curriculum if it is to produce graduates with sufficient competency for the one-year internship in a public hospital before full registration in Hong Kong. Our teaching prepared students with resuscitation skills and provided the nature of emergency care in public hospitals through clinical attachment.
The suspension of clinical attachment during the early phase of the pandemic forced us to develop a core curriculum from which we redesigned the teaching programme on Emergency Medicine across the clinical years. We shifted from a knowledge-based to a competence-based curriculum which includes early recognition and treatment of common medical emergencies that interns will encounter. In addition to knowledge, students are expected to perform the actual treatment skills satisfactorily to patients with emergencies.
The complexity of health care processes reinforces the importance of teamwork among health professionals. Interdisciplinary collaboration in healthcare settings is also emphasised. Important crisis team skills, such as communication and team member collaboration, briefing and debriefing, situation awareness and assertiveness, and decision-making, are incorporated in the Emergency Medicine curriculum. These concepts would be repeatedly illustrated in different teaching activities.
Modernising the pedagogical approaches
The existing way of teaching before the pandemic was no longer sufficient for our expanded student population. We extensively adopt blended learning for most sessions. Students are advised to view online videos in their own time and review high-quality clips of recoded ‘lectures’. Each video session ends with five to ten multiple-choice questions on the related topics, which also form part of the continuous assessment. This is followed by a face-to-face session in which teachers will help reinforce concepts through case discussion or clinical skills through clinical simulation. Concept / Clinical skills checklists are available so that students may refer to them during class preparation and revision.
Our students are in senior years in the medical curriculum. As such, the delivery of teaching and learning transit from didactic to experiential. Students are encouraged to learn from reflection and debriefing processes to improve clinical competence after each session.
Since the pandemic, we have introduced more clinical simulation sessions to enhance students’ clinical experience in hands-on skills and team-based patient care. The skill development process starts with individual skills in our earlier classes (Junior Clerkship), from airway patency assessment and treatment, manual ventilation support to cardiopulmonary resuscitation. These skills are then applied in critical care scenarios such as patients with shortness of breath, poor circulation and altered mental status, in which students apply the knowledge from previous classes and clinical skills developed to manage a patient with emergency conditions. Instructor-led debriefing facilitates their learning and concept reinforcement.
Students will return to Emergency Medicine in Specialty Clerkship after rotation to other specialities. At this stage, students will acquire advanced skills through discussion of more complex cases and simulated practice. We introduce peer teaching and peer-assisted debriefing so that students may learn from both teaching and learning.
Supported by Teaching Development Grants, we developed and evaluated innovative teaching activities through clinical simulation. We evaluated students’ attitude and clinical performance in teamwork education. Comparing blended teaching that comprises a didactic tutorial and a clinical simulation with debriefing, we found that clinical simulation with debriefing alone is effective enough to enhance students’ teamwork skills and clinical performance in medical emergencies. A further project evaluated students’ perception and clinical performance through peer scenario design and peer-assisted debriefing, in which students rated the experience superior to existing clinical teaching activities such as clinical attachment or case-based tutorials.
We believe that real-life clinical experience in resuscitation is of crucial value to medical students. Even though student attachment to the emergency department has not yet resumed, we develop real time live streamed classes connecting students with clinician teachers in resuscitation room so that students observe patient evaluation and management in real life. Since this allows close observation of the process at the patient side, students find it a better experience than before, during which students used to observe remotely from the back of health professionals.
Modernising the assessment
Assessment drives learning and medical students’ learning activities are particularly prone to focusing more on the assessments. To ensure that students are competent according to the competence set in the curriculum, students are evaluated through both continuous and summative assessment. While summative assessment is managed centrally, we develop team-based open-book continuous assessment in which students are encouraged to learn through deliberate practice of team-based patient care. Instead of personal excellence, we advocate team excellence with individual contribution. Capable students should be able to perform well and help team members learn and perform well. This design ensures safe and ethical clinical practice during internship, specialist training or any forms of practice, irrespective of rank, experience and field of practice.
Learner empowerment
While the above initiatives shall remain under professoriate oversight, students who have experienced the existing emergency medicine curriculum will serve as a valuable source of guidance and advice, and will be actively engaged in the process of curriculum design through taking part in a formalised and supervised working group. Our modernisation process will therefore take into consideration students’ perspectives and what they think are conducive to learning. Students will have to undergo a recruitment and selection process for appointment to the working group, and their contributions will be recognised as appropriate.
Conclusion
The pandemic posed a challenge to clinical education. However, through team collaboration in the Li Ka Shing Faculty of Medicine, we introduced major curriculum reform, which renews teaching content, enhances teaching and learning experience and improves clinical performance. A challenge became an opportunity in our education development.
Acknowledgements
The author would like to thank Teaching Development Grant (TDG) for the unfailing support of the innovative education projects; and Professor Gilberto Leung, Professor Timothy Rainer, Dr Gordon Wong, Dr Julie Chen and Professor Julian Tanner for their support of TDG projects and modernisation of emergency medicine teaching.
