Voss Miranda, Geniets Anne, Winters Niall
Department of Education, University of Oxford, Oxford, UK.
Harris Manchester College, Mansfield Road, Oxford, OX1 3TD UK.
Med Sci Educ. 2023 Nov 15;34(1):219-235. doi: 10.1007/s40670-023-01894-w. eCollection 2024 Feb.
Widespread "lockdowns" during the COVID pandemic in 2020-2021 restricted medical students' access to patients. We used a scoping review with exploratory thematic synthesis to examine how reports of digital clinical teaching during the first year of the COVID pandemic could inform digital clinical teaching in the post-pandemic world. We looked at strategies used and outcomes reported, lessons learned about how best to use digital methods for clinical teaching, and learning theories used. The eighty-three articles included in the final review fell into four groups. These were telehealth interventions; virtual case-based teaching; multi-modal virtual rotations; and a small group of "other" strategies. Telehealth reports indicated that COVID has probably accelerated the adoption of telehealth, and these skills will be required in future curricula. Engagement with virtual case-based teaching was problematic. Virtual rotations were particularly valued in specialties that relied on visual interpretation such as radiology and dermatology. For general clinical specialties, digital clinical teaching was not a satisfactory substitute for real clinical exposure because it lacked the complexity of usual clinical practice. Sixty-seven articles reported students' reactions only, and 16 articles reported a change in knowledge or skills. Demands on instructors were considerable. Few studies were theorized and none tested theory, which limited their transferability. While telehealth teaching may be a valuable addition to some curricula, digital clinical teaching is unlikely substantially to replace exposure to real patients outside of specialties that rely on visual interpretation. High demands on instructors suggest little potential for new, scalable digital clinical offerings after COVID.
2020 - 2021年新冠疫情期间广泛实施的“封锁”措施限制了医学生接触患者的机会。我们采用了一项带有探索性主题综合的范围综述，以研究新冠疫情第一年期间数字临床教学的报告如何为疫情后世界的数字临床教学提供信息。我们考察了所使用的策略和报告的结果、关于如何最好地利用数字方法进行临床教学的经验教训以及所使用的学习理论。最终综述纳入的83篇文章分为四组。分别是远程医疗干预；虚拟案例教学；多模式虚拟轮转；以及一小部分“其他”策略。远程医疗报告表明，新冠疫情可能加速了远程医疗的采用，未来的课程将需要这些技能。参与虚拟案例教学存在问题。虚拟轮转在依赖视觉解读的专业（如放射学和皮肤病学）中尤其受到重视。对于一般临床专业而言，数字临床教学并非真实临床接触的令人满意的替代方式，因为它缺乏常规临床实践的复杂性。67篇文章仅报告了学生的反应情况，16篇文章报告了知识或技能的变化。对教师的要求很高。很少有研究进行理论化阐述，也没有研究对理论进行检验，这限制了它们的可转移性。虽然远程医疗教学可能是某些课程的一项有价值的补充，但除了依赖视觉解读的专业外，数字临床教学不太可能大量取代对真实患者的接触。对教师的高要求表明，新冠疫情后新的、可扩展的数字临床教学内容潜力不大。
