Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
TUM Medical Education Center, School of Medicine, TUM, Munich, Germany.
BMC Med Educ. 2022 Jan 31;22(1):73. doi: 10.1186/s12909-022-03141-z.
The COVID-19 pandemic poses a huge challenge for clinical teaching due to contact restrictions and social distancing. Medical teachers have to balance potential risks and benefits of bedside teaching, especially in course formats intended to foster practical clinical skills. In this context, we aimed to address the question, whether presence-based teaching formats without patient involvement are suitable to teach practical skills.
In this quasi-experimental study, presence-based teaching formats with and without patient contact were retrospectively compared regarding their effects on medical students' theoretical knowledge and practical skills, i.e. the performance and clinical interpretation of the neurological exam. To this end, evaluations from 102 students and their lecturers participating in a neurological bedside teaching course at a German university hospital between October 2020 and April 2021 were obtained. Students were initially randomly assigned to course dates. However, 53 students assigned to courses in November and December 2020, were not able to go bedside due to contact restrictions. These students formed the interventional group and the remaining 49 students the control group. The primary outcome measures were students' overall grading of the course (school grades, 1-6) as well as ratings of knowledge and skills provided by the students themselves and their lecturers on a numerical rating scale (0-10). Comparison between groups was performed using frequentist and Bayesian t-statistics.
The teaching format without patient contact received a significantly poorer overall grade by the students (p = 0.018). However, improvements in the students' self-ratings of knowledge and skills did not differ between the two formats (all p > 0.05, BF = 0.42). Moreover, especially practical skills were even rated significantly better in the group without patient contact by the lecturers (p < 0.001).
Teaching formats without patient contact are less well-received by the students. However, they are able to teach practical skills regarding the performance and clinical interpretation of examination techniques. Still, the evaluations obtained might not adequately capture the importance of bedside teaching in preparing future physicians for their practice. Perspectively, hybrid teaching approaches including flipped-classroom concepts hold considerable potential to enhance effectiveness of bedside teaching in the present pandemic situation and in the future.
由于接触限制和社会距离，COVID-19 大流行对临床教学构成了巨大挑战。医学教师必须权衡床边教学的潜在风险和收益，特别是在旨在培养实践临床技能的课程形式中。在这种情况下，我们旨在解决一个问题，即没有患者参与的基于存在的教学形式是否适合教授实践技能。
在这项准实验研究中，回顾性地比较了有和没有患者接触的基于存在的教学形式，以了解它们对医学生理论知识和实践技能的影响，即神经检查的表现和临床解释。为此，我们获得了 2020 年 10 月至 2021 年 4 月期间在德国一家大学医院参加神经科床边教学课程的 102 名学生及其讲师的评估。学生最初是随机分配到课程日期的。然而，2020 年 11 月和 12 月被分配到课程的 53 名学生由于接触限制而无法进行床边教学。这些学生组成了干预组，其余 49 名学生组成了对照组。主要的观察指标是学生对课程的整体评分（学校评分，1-6）以及学生和讲师在数字评分量表（0-10）上对知识和技能的评分。使用频率主义和贝叶斯 t 统计对组间进行比较。
没有患者接触的教学形式得到了学生的整体评分明显较差（p=0.018）。然而，两种形式之间学生自我评估的知识和技能的提高没有差异（所有 p>0.05，BF=0.42）。此外，讲师甚至对没有患者接触的组中检查技术的表现和临床解释的实践技能评价更高（p<0.001）。
没有患者接触的教学形式不受学生欢迎。然而，它们能够教授实践技能，即检查技术的表现和临床解释。尽管如此，获得的评估可能无法充分捕捉床边教学在为未来医生准备实践方面的重要性。展望未来，包括翻转课堂概念在内的混合教学方法具有很大的潜力，可以提高大流行时期和未来床边教学的效果。
