Dr Mostafa Ahmad, an Academic Teaching Fellow with the Internal Medicine programme, answers the question ‘Can we improve the students’ physical examination skills through online teaching alone?’ in the last blog post of the ‘Hot topic’ theme ‘Lessons from the Learning and Teaching Conference 2021′.
The fully online internal medicine M.Sc. programme has ten years of experience in distance learning. It is joined by nearly 150 students who are practising medics from 40 locations worldwide giving a diverse community that can work in very different health services and with great differences in availability of resources. So how can we teach practical skills to medics just online?
Doctors need to acquire various skills. Many of these can be taught online, like critical thinking, clinical judgment, and safe prescribing. We can’t, however, ignore the importance of bedside teaching in developing many other skills, and one of these is mastering the physical examination techniques.
High fidelity simulation is commonly used in teaching a variety of skills with the utilisation of high-end simulators. Here comes a question: What about those students who are joining from remote areas or don’t have access to these high-tech solutions?
Thinking about ways to overcome the barriers of teaching practical skills away from the bedside, we developed a method to guide the students in performing the correct technique while utilising low technology. We aimed at helping them practice regardless of the facilities available.
We designed an interactive online module teaching hand examination skills. The module explained the background knowledge and the correct technique of each step, and provided instructional videos. However, we know that not all the students will have someone to practice their examination skills with, so we showed them how to do the examination method with both a real person and a dummy hand. We suggested simple cardboard models and air/water-filled gloves that can be easily made at home to be utilised for the skills practice.
To ensure that they understood the teaching materials, we asked them to submit a short video of their technique to our online Learn platform. We followed that with staff comments as feedback to guide them on how to improve their practice.
We did a pilot study to explore how the students received this teaching model. The results provided us with an excellent insight into the potentials and challenges of such an approach.
Fourteen students participated in the pilot study from eight countries in Africa, Asia, Australia, Europe, North and Central America. Around 30% of the students recorded their examination using a dummy hand.
Overall, all the students agreed or strongly agreed that this approach increased their confidence in performing correct and smooth hand examination techniques. The feedback we provided was received positively. More importantly, the self-rating of the hand examination skills improved significantly from (poor – fair) at the baseline to (fair – excellent) after the study.
There were many learning points from this experience:
- One of the crucial aspects to consider is liaising with the IT. The students faced some technical issues when directly uploading their examination videos to the discussion boards on the Learn platform. We realised that it would have been better to upload the videos to the Media Hopper platform before sharing them on the discussion board.
2. Feedback proved vital in the online teaching of examination skills. Just watching videos or reading the study materials doesn’t guarantee the students will absorb all the information or get the examination right. Despite the great job the students did in performing the examination as per the study materials, it was evident from their submitted videos that there was still room for improvement. Guidance was essentially required to clarify specific points and to correct inaccurate examination procedures.
3. The students valued the use of distance learning of these clinical skills, but there were still some limitations. Most of the participants did feel this approach cannot replace the face-to-face training for various reasons, including the advantage of the latter giving the ability to provide real-time feedback, instant opportunities for questions and clarification, and the possibility of showing abnormal findings. Some of the students felt practising on the dummy hand was different from examining real people. Finally, there would be challenges in applying this method in teaching examination of other sensitive body parts.
Despite these limitations, almost all the students felt confident enough to examine a real person following this method.
We think that the method we developed using online module + creating a video + distantly delivered feedback is valuable and can be utilised with some modifications to significantly improve the learning experience. It shows how low technology can result in a high learning impact and the multiple learning strategies used to enhance teaching. Furthermore, it can bridge the gap to some extent between the lack of bedside teaching and reaching clinical competence for the purely online clinical courses.
You can listen to Mostafa’s talk on the Learning and Teaching Conference website.
Dr Mostafa Meshaal Ahmad is an Academic Teaching Fellow with the Internal Medicine programme. He is also a Rheumatology and GIM trainee in South East of Scotland. Mostafa graduated from Assiut University in Egypt, where he completed MSc in Internal Medicine. Dr Ahmad has a passion for teaching, and recently gained accreditation as an associate fellow of the Higher Education Academy (AFHEA).