High fidelity simulation as an alternative to traditional bedside teaching during COVID-19 and literature review (Preprint)

UNSTRUCTURED Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, it’s usage within medical education has been declining and additional challenges have been added during the COVID-19 pandemic. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the utilisation of online learning, social media platforms, virtual consultations, and simulation. Simulation based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with standardisation of cases. Several studies have been described in the literature, predominately using the Harvey simulator. The results demonstrate simulation-based training can increase student’s confidence, increase the rates of correct clinical diagnoses and improve retention of skills and knowledge when compared with traditional teaching methods. In order to mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School, a high-fidelity simulation based model of traditional bedside teaching was designed and implemented. The teaching sessions focused on asthma and aortic stenosis with all students having the opportunity to perform history taking and a focused cardiorespiratory clinical examination using SimMan 3G. Key aspects of the pathologies including epidemiology, differential diagnoses, investigation and management were summarised using an interactive powerpoint presentation, followed by a debriefing session. Overall feedback was highly positive with 91% of students feeling more confident in their clinical examination skills following the teaching session, all students recommending the session to a colleague and implementation of regular simulation being frequently requested amongst the responses.

685 Implementation of Education Fellows on General Surgery Medical School Rotations Facilitates Student Learning and Improves Learning Experience

Aim A UK teaching hospital expanded their established education fellow programme to the General Surgery department to assist with departmental teaching of third-year medical students from the affiliated medical school on clinical placement. Teaching on ward rounds, bedside teaching and clinical tutorials were three areas identified as requiring improvement based on previous student feedback. Observation of Upper and Lower Gastrointestinal (GI) malignancy multi-disciplinary meetings (MDMs) via Microsoft Teams was also introduced as a new teaching initiative. Method Four post-foundation training education fellows were allocated on alternating weeks to supervise third-year medical students on upper and lower GI ward rounds and during GI MDM observation, conduct bedside teaching and facilitate blended-learning clinical tutorials in accordance with the 2020 GMC Medical Licensing Assessment curriculum. A mixed-methods survey was sent to students after surgical placement and the results compared to student feedback from previous years. Results 31 out of 52 students (60%) on placement responded. 100% rated the fellow-led clinical tutorials as “excellent”. 87% of respondents rated the upper and lower GI ward rounds as either “excellent” (52%) or “good” (35%). All respondents rated the implementation of education fellows as either “very helpful” (94%) or “helpful” (6%) for their learning. Most students rated the MDM observation initiative as “good” (36%) or “average” (36%). Conclusions Implementation of education fellows on third-year medical student placements in General Surgery facilitates self-reported student learning and is associated with a drastically improved student learning experience. More work is required to develop GI MDM-based teaching to improve student learning experiences from MDMs.

995 Bedside Teaching from A Distance; Surgical Education in The COVID Era

Introduction The COVID pandemic resulted in a shutdown of facilities and resources globally. With drastic changes in the provision of services available in the health sector, so too were medical students’ provision of learning. With the onslaught of COVID and the need for ongoing learning resources for students, novel methods to maintain adequate surgical patient exposure and student interaction on a platform amenable to the interactive format required was devised using a virtual platform to compliment current pedagogical approaches. Method This was a randomised control trial to evaluate the perceived use of remote learning in place of surgical bedside teaching in the COVID-19 era. Medical students in a regional hospital were recruited and randomised to undergo the bedside teaching in person or receive the teaching virtually through a Xpert eye, smart glasses to facilitate connections remotely. Feedback questionnaires and exit interviews carried out following each session. Content analysis of transcripts was performed to evaluate the presence and quality of perceived learning, benefits, and limitations. Results Feedback demonstrated greater engagement, satisfaction, involvement, and learning (p < 0.01) in the bedside teaching group. Content analysis yielded three main themes: Interpersonal content, technological features, and provision of content. Students reported the virtual teaching was an acceptable alternative in the current climate of social distancing and reduced patient access. Conclusions The current pandemic poses a risk to adequate patient exposure to patient centred learning. Teaching sessions received remotely are an acceptable alternative in the current climate of reduced clinical access, however bedside teaching remains the preferred method of learning.

Video-based reflection on neonatal interventions during COVID-19 using eye-tracking glasses: an observational study

ObjectiveThe aim of this study was to determine the experience with, and the feasibility of, point-of-view video recordings using eye-tracking glasses for training and reviewing neonatal interventions during the COVID-19 pandemic.DesignObservational prospective single-centre study.SettingNeonatal intensive care unit at the Leiden University Medical Center.ParticipantsAll local neonatal healthcare providers.InterventionThere were two groups of participants: proceduralists, who wore eye-tracking glasses during procedures, and observers who later watched the procedures as part of a video-based reflection.Main outcome measuresThe primary outcome was the feasibility of, and the proceduralists and observers’ experience with, the point-of-view eye-tracking videos as an additional tool for bedside teaching and video-based reflection.ResultsWe conducted 12 point-of-view recordings on 10 different patients (median gestational age of 30.9±3.5 weeks and weight of 1764 g) undergoing neonatal intubation (n=5), minimally invasive surfactant therapy (n=5) and umbilical line insertion (n=2). We conducted nine video-based observations with a total of 88 observers. The use of point-of-view recordings was perceived as feasible. Observers further reported the point-of-view recordings to be an educational benefit for them and a potentially instructional tool during COVID-19.ConclusionWe proved the practicability of eye-tracking glasses for point-of-view recordings of neonatal procedures and videos for observation, educational sessions and logistics considerations, especially with the COVID-19 pandemic distancing measures reducing bedside teaching opportunities.

Experience of a Final Year Medical Student: Pre- and Post-COVID-19 Era

Medical education provides both knowledge and clinical skills to students. Clinical skills program including bedside teaching is considered an irreplaceable part of the undergraduate medical curriculum. COVID-19 pandemic has halted the delivery of effective clinical skills to medical students which has especially affected the final year students. So, we need to find an alternate approach to teach clinical skills to medical students in this era of COVID-19. This public health crisis has also demonstrated the significance of resilience and adaptability in the medical education system and the need to inculcate these values in our generation of medical students. This will help the students to complete their transition from a ‘student’ to a ‘doctor’. This article highlights the experience of a final year medical student in the pre- and post-COVID-19 period, problems faced by final year medical students during this crisis, and effective ways to cope up with them.

Medical Students and Patients Perspectives on Bedside Teaching

Objective: To evaluate perspectives of medical students and patients on bedside teaching. Study Design: Cross-section survey Place and Duration of Study: Department of General Surgery/Pediatric Surgery Unit-ll, DHQ Teaching Hospital, Dera Ghazi Khan from 1st April 2019 to 30th June 2019. Methods: Two hundred students from 4th year and final year MBBS class were included and 100 patients from general surgery and general medical wards who stayed for at least 48 hours and had at least 2 case presentations and 2 consecutive morning rounds were enrolled in the study. Their perspectives about bedside teaching were assessed with two separate questionnaires. Results: The mean age of medical students was 23 years (20-26) and 35% were male and 65% were female. The mean age calculated for patients was 55.5 years (18-75). Fifty two percent were females and 48% were males. Fifty eight percent of medical students stated that the time of bedside teaching is not enough and it should be increased. Majority of patients were satisfied with the bedside teaching techniques and 82% of patients believed that through bedside teaching. No significant difference of responses among students and patients was observed. Conclusion: Teaching on the bedside provides unique opportunities to incorporate the learning skills for direct benefit of the patients. It provides a unique learning triad consisting of patients, students, and teachers and creates clinical simulation as a learning tool. Key words: Bedside teaching, undergraduate, medical students