LearningOutcomes inaLiveVirtualversus In-PersonCurriculumforMedicaland PharmacyStudents

LearningOutcomes inaLiveVirtualversus In-PersonCurriculumforMedicaland PharmacyStudents SedtavutD.Nilaad1,EricaLin1, JacobBailey1,CaitlynTruong1,SamvelGaboyan1,AnkitaMittal1, BrookieM.Best2,3,KamaGuluma4,AlanaIglewicz5,LinaLander6,SeanEvans7,CharlesGoldberg1,and LauraE.CrottyAlexander1,8 1DepartmentofMedicine,2SkaggsSchoolofPharmacyandPharmaceuticalSciences,3DepartmentofPediatrics-Rady Children’sHospitalSanDiego,4DepartmentofEmergencyMedicine,5DepartmentofPsychiatry,6DepartmentofFamily Medicine,and7DepartmentofNeurosciences,UniversityofCalifornia,SanDiego,LaJolla,California;and8Department ofMedicine,VeteransAffairsSanDiegoHealthcareSystem,LaJolla,CA ORCIDID:(L.E.C.A.) ABSTRACT Background:Thecoronavirusdisease(COVID-19)pandemichasbeenasourceof disruption,changingthefaceofmedicaleducation.Inresponsetoinfectioncontrol measuresat theUniversityofCalifornia,SanDiego, thehybridin-personandrecorded preclerkshipcurriculumwasconvertedtoacompletelyvirtual format.Theimpactof thisexclusivevirtual teachingplatformonthequalityof traineeeducationisunknown. Objective:Todeterminetheefficacyofavirtualcourse,relativetotraditionalhybrid in-personandrecordedteaching,andtoassesstheimpactofsupplementary educationalmaterialonknowledgeacquisition. Methods:Aretrospectiveobservationalcohortstudywasperformedtoassessan introductorycourse,heldmostlyinpersonin2019versuscompletelyvirtual in2020, forfirst-yearmedical studentsandsecond-yearpharmacystudentsat theUniversityof California,SanDiego,SchoolofMedicineandSkaggsSchoolofPharmacyand PharmaceuticalSciences. (ReceivedinoriginalformJanuary6,2022;acceptedinfinalformApril29,2022) ThisarticleisopenaccessanddistributedunderthetermsoftheCreativeCommonsAttributionNon CommercialNoDerivativesLicense4.0.Forcommercialusageandreprints,pleasee-mailDianeGern. SupportedbyDr.CrottyAlexander’ssalarywassupportedbyaVAMeritAward 1I01BX004767,NIHNHLBIK24HL155884andNIHNHLBIR01HL147326. AuthorContributions:Allauthorscontributedsubstantiallytotheconceptionanddesignof thework,thecollectionandinterpretationofdata,anddraftingandrevisingthemanuscript. CorrespondenceandrequestsforreprintsshouldbeaddressedtoLauraE.CrottyAlexander, M.D.,UniversityofCalifornia,SanDiego,9300CampusPointDrive,MailCode911J,LaJolla,CA 92037.E-mail: . Copyright©2022bytheAmericanThoracicSociety DOI:10.34197/ats-scholar.OC | Nilaad,Lin,Bailey,etal.:LearningTrendsduringtheCOVID-19Pandemic 1 ORIGINALRESEARCH ATS Scholar. Published August 31, 2022 as 10.34197/ats-scholar.OC Copyright © 2022 by the American Thoracic Society Results:Themidtermandfinalexaminationscoresweresimilarforthehybridand virtualcourses.Therewasnoassociationbetweenthehoursofrecordedlectures watchedandfinalexaminationscores foreithercourse.Inthe2019in-personand recordedcourse, studentswhodemonstratedconsistenton-timeuseofpracticequizzes scoredstatisticallyhigheronthefinalexamination(P=0.0066).Inthe2020virtual course, studentswhodownloadedquizzesregularlyhadstatisticallyhigherscoresonthe midtermexamination(P,0.0001). Conclusion:Thesimilarexaminationscoresforthehybridin-personandrecorded andexclusivelyvirtualcoursessuggest that theshort-termknowledgeacquiredwas equivalent, independentof themodalitywithwhichthecontentwasdelivered.Consis tenton-timeuseofpracticequizzeswasassociatedwithhigherexaminationscores. Futurestudiesareneededtoassessthedifferencebetweenacompletelyin-person versusvirtualcurriculum. Keywords medicaleducation;coronavirusdisease;virtual learning;preclerkshiplearning Theuniquecircumstancesof the coronavirusdisease(COVID-19) pandemiccausedbythesevereacute respiratorysyndromecoronavirus2 (SARS-CoV-2) resultedinan unprecedenteddisruptionofmedical education.Adherencetoinfectioncontrol measures ledtotheswiftcancellationof in-persondidactics (1).Withthesocialdis tancingmeasuresrequiredtoprevent the spreadofSARS-CoV-2in2020, therewas adrasticshift towardanonlineenviron ment,withanalmostexclusivereplace mentof in-personlearningbyvirtual modalities. Althougheducational systemshave traditionallyreliedonface-to-face teaching, sinceits introduction,web-based learninghasplayedagrowingrolein medicaleducation(2,3).Theadditionof technologyhasbeenadoptedbymost institutions tofacilitatelearningbytrain ees (2).Beginningevenbeforethe COVID-19pandemic,preclerkshipteach inghasshiftedtowarde-learning,as in-personlarge-grouplectureattendance hasdeclinedeversincerecordingand onlinepostingof lecturesbecamecom monplace(4).Theadditionofasynchro nous learningtothetraditionalcurriculum hasbeenviewedpositivelybylearners (5,6).Onlineteachingplatformshave beenshowntohavesimilarlyhighdegrees of studentengagementcomparedwith in-personapproaches (7). Theswitchtoacompletelyvirtual curriculumasaresultof theCOVID-19 pandemicmayhaveprofoundconsequen ces inthefuture.Althoughsmall studies haveexaminedtheefficacyofvirtual for mats (8–10), thereareminimaldataon largerscaleapplications.Assuch, thereis still limitedunderstandingof theimpactof thisnearlyexclusivelyonlineversionof medicaleducation.Somemedicaleduca torshaveexpressedconcernsabout the qualityof traineeeducation,citingvideo/ audiointegrity, social isolation, student engagement,andrelianceonlearnermoti vation(4,11).Therefore,anevaluationof knowledgetransferandacquisitionfrom onlineteachingformats isnecessary. Theaimof thisstudywas todetermine theimpactofanexclusivevirtual ORIGINALRESEARCH 2 Nilaad,Lin,Bailey,etal.:LearningTrendsduringtheCOVID-19Pandemic | ATS Scholar. Published August 31, 2022 as 10.34197/ats-scholar.OC Copyright © 2022 by the American Thoracic Society ORIGINAL RESEARCH curriculum on examination performance in comparison with traditional hybrid in person/recorded delivery. In addition, because much time and effort are spent on developing and distributing supplemental educational materials for medical trainees, we sought to understand the patterns of use of online supplemental educational resources and the impact on overall knowledge acquisition. METHODS Study Design A retrospective cohort study assessing the impact of a hybrid in-person and recorded versus completely virtual curriculum was conducted at the University of California, San Diego, School of Medicine and Skaggs School of Pharmacy and Pharmaceutical Sciences. In this study we examined the Foundations of Medicine course for a cohort of first-year medical (MS1) students (MS1) and second-year pharmacy (P2) students during 2019 and 2020. The study was determined to meet exempt status by the University of Califor nia, San Diego, Institutional Review Board. Course Specifics The Foundations of Medicine course is the first course in the MS1 sequence and P2 sequence, spanning five weeks and covering core biomedical science content including cell biology, molecular biology, and genetics. The course is divided into core lectures (40%), small-group sessions (50%), and histology and anatomy labs (10%). In 2019, this course, which consisted of 36 hours of material, was conducted using an in-person and recorded format. Specifically, lectures were taught in person, but in-person attendance was not mandatory. Students had the option to watch the recorded versions online instead of or in addition to attending lectures in person. Although exact in-person atten dance was not obtained, attendance was estimated to be high, with 75–80% of the class being present in person in 2019. This high presence is typical of the first course of the year, with in-person atten dance waning with subsequent courses. In 2020, this course, which consisted of 30 hours of material, was conducted using a COVID-19 virtual format (CVF) because of the pandemic. All lectures were per formed either remotely live via Zoom (San Jose, California) or prerecorded and posted online, with the majority being prere corded. Notably, these lectures were taught primarily in a didactic format, with the ability to ask follow-up questions during the lecture and afterward. The lecture con tent was unchanged between the 2019 and 2020 courses and consisted of