Leeds Institute of Medical Education, Leeds School of Medicine, University of Leeds, Leeds, UK.
Leeds Institute of Health Sciences, Leeds School of Medicine, University of Leeds, Leeds, UK.
Med Educ. 2024 Sep;58(9):1032-1041. doi: 10.1111/medu.15392. Epub 2024 Apr 12.
Medical education relies on real patient learning (RPL) to provide medical students with essential clinical experience. However, growing demand for clinical placements continues to be a challenge in providing sufficient RPL opportunities. The COVID-19 pandemic forced academic institutions to rethink the delivery of traditional clinical training and innovations in online clinical learning experiences, specifically livestreamed clinical experiences, have emerged which show promise in addressing the capacity limitations of traditional placements. Although previous reviews have explored the use of livestreamed clinical experiences during the pandemic, there is a lack of rigorous theoretical framing to support these innovations.
The aim of this review is two-fold: to examine the effectiveness of livestreamed clinical experiences through an experience-based learning (ExBL) theory perspective and to provide practical recommendations to optimise and implement these innovations.
A review of literature was conducted to identify journal articles published between September 2019 and January 2023 reporting on innovations relating to livestreamed clinical experiences. The search focused on undergraduate and postgraduate medical education but relevant evidence from other healthcare professions were also included due to a limited evidence base. Strengths and weaknesses were derived from the literature and analysed in relation to ExBL components.
Principal strengths of livestreamed clinical experiences included expanded access to RPL opportunities and medical specialties, enhanced standardisation of learning experiences and positive perceptions from students regarding convenience. Clinical educators found these innovations enabled teaching at scale. Patients did not perceive such innovations to negatively impact their standard of care. Limitations included the inability to practice physical examination skills, challenges in ensuring learner engagement and connectivity issues.
Livestreamed clinical experiences have the potential to effectively expand placement capacity and provide high-quality educational experiences for medical students. Although certain limitations exist, technological and pedagogical adaptations can help overcome these challenges. The application of theoretical frameworks to future online innovations will be fundamental to ensure effective clinical learning.
医学教育依赖于真实患者学习（RPL）为医学生提供必要的临床经验。然而，临床实习机会的需求不断增长仍然是提供足够 RPL 机会的挑战。COVID-19 大流行迫使学术机构重新思考传统临床培训的交付方式，创新的在线临床学习体验，特别是直播临床体验，已经出现，并有望解决传统实习的能力限制。尽管之前的综述已经探讨了在大流行期间使用直播临床经验，但缺乏严格的理论框架来支持这些创新。
本综述的目的有二：从体验式学习（ExBL）理论的角度检查直播临床体验的有效性，并提供优化和实施这些创新的实用建议。
对文献进行了综述，以确定 2019 年 9 月至 2023 年 1 月期间发表的报告直播临床体验创新的期刊文章。搜索重点是本科和研究生医学教育，但由于证据基础有限，也包括了来自其他医疗保健专业的相关证据。从文献中得出优势和劣势，并根据 ExBL 组件进行分析。
直播临床经验的主要优势包括扩大了 RPL 机会和医学专业的获取渠道、增强了学习体验的标准化以及学生对便利性的积极看法。临床教育者发现这些创新使教学规模化成为可能。患者不认为这些创新会对他们的护理标准产生负面影响。局限性包括无法练习体检技能、确保学习者参与的挑战以及连接问题。
直播临床经验有可能有效地扩大实习容量，并为医学生提供高质量的教育体验。尽管存在某些局限性，但技术和教学方法的调整可以帮助克服这些挑战。将理论框架应用于未来的在线创新对于确保有效的临床学习至关重要。
