Life as a MEDICAL STUDENT: MBBS Year 1 2020/21 - Teaching & Learning in NUMed with COVID-19 Pandemic

皆さん、こんにちは! Hello everyone.
In this post, I will be sharing how the 1st Year MBBS study 2020/2021 in Newcastle University of Medicine Malaysia (NUMed ) is conducted during the COVID-19 pandemic. The official dates for the first term are from 21st September 2020 to 18th June 2021. The teaching in NUMed is mainly conducted virtually online with a few practical sessions for anatomy and clinical skills throughout this year.

!! DISCLAIMER:
Please take note that the sharing might not be truly applicable for 1st Year MBBS study in NUMed without COVID-19 pandemic issues. Lots of restrictions on teaching and learning in universities in Malaysia during the pandemic based on government rules and SOP. Also,  I am a Malaysian student, who was able to attend any on-campus sessions for my first-year MBBS study held under the SOP restrictions. 

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MBBS YEAR 1 2020/2021 TEACHING & LEARNING with COVID-19 PANDEMIC

Basically, the teaching for the first two years of MBBS studies in NUMED is conducted in the form of case-led. Clinical cases stories will be used as the central topic for us to learn about anatomy, physiology, pathology etc. For example, in Case 3, the clinical case story is about a patient with kidney problem, then we will learn about the renal system including the anatomy of the system, renal physiology, relevant pathology such as kidney stones and urinary tract infection, embryology of urinary system etc.

 The general sequence is such as:
1. Anatomy + Physiology
2. Pathology / Pathophysiology ( Relevant Diseases ) 
3. Pharmacology
4. Clinical Reasoning


Simultaneously, there are topics related to epidemiology and medical ethics such as Doctor-Patient Relationship, Evidence-Based Practice, Medical Ethics etc. That's true that to be a successful doctor in the future, it is not merely about the medical knowledge, but also how we conduct our medical practice in an ethical and rational way. In addition, we also have group discussions sessions for history taking training and clinical reasoning. Usually, clinical reasoning will be held nearly the end of the case learning so that we have adequate knowledge to evaluate and analyse the example situations given. 

The lessons can be subdivided into 'Taught' and 'Self-Directed':

[A] 'TAUGHT' / SYNCHRONOUS
'Taught' refers to the synchronous lectures, discussions for history taking and clinical reasoning, and practical sessions.  These sessions used to be conducted in person on campus usually, enabling students to interact with one another. Unfortunately, due to the SOP restrictions, we only had our synchronous lectures, history taking and clinical reasoning virtually via online platforms.

[ Non-Practical Lessons ]
The main online platform used is ZOOM.
Personally, I feel that ZOOM works quite well for the lectures as it has the 'RECORDING' function, which means that these synchronous lectures are recorded and uploaded on the study portal ( we have an online study portal like MOODLE with learning materials uploaded, called MLE ). Students can rewatch the lecture at any time for revision. As for group discussions, the 'BREAKOUT-ROOM' function enables lecturers to break us into small groups of 3 to 5 people or even more to discuss privately in groups.

❌However, there are some disadvantages here:
a) Internet connection problem
    EG: Some of my peers were unable to participate fully during group discussion sessions due to poor internet connection at home or hostel, which causes frequent disconnection

b) Lack of interaction or engagement
     It actually seems very different where you got the chance to discuss a topic with others face-to-face compared to virtually where you might unable to see them if they choose to close their camera. You might not be able to see their facial expression and respond unless they talk. This makes the discussions less engaging for me. 

c) Problems with the upload of the recorded lectures
   Sometimes, the lecturers might forget to press the 'RECORD' button prior to the start of the lessons. This causes the problem of having some part of teaching not recorded or that lesson is not recorded. Yet, this can be solved by the cooperation between lecturers and students by the reminder on RECORDING the session before the teaching begins. Even if the lectures are recorded, it takes quite a long time for the recording to be generated from ZOOM and successfully uploaded on MLE. This may cause students unable to revise the lecture on the same day immediately. However, we did have some cases with lectures uploaded quickly. 



[ Practical Lessons ]

(i) Anatomy Lab Session
These sessions require students to come with preparation. There are some pre-recorded lectures and tutorials that need to be read and completed prior to the lessons. During the sessions, students are required to discuss anatomical structures based on learning outcomes using models in the lab or the 3D Complete Anatomy app on Ipad. It is then followed by a small individual/ group presentation or question-answering/ prompting session. ( randomly assigned by lecturers on the day ) For instance, describe the gross anatomical structure of the kidney. This session also serves as the opportunity for students to clear their doubts on the topics snd ask for further clarifications. The university tried to make the anatomy sessions on campus if possible.

However, if the COVID-19 pandemic is too serious, it will be conducted online via ZOOM instead. In fact, for students who were unable to turn up for the on-campus sessions EG: International students, particularly during the first two semesters, their anatomy sessions were held online.
<The drawback here is that students lose the chance to have hands-on experience on the models, yet need to make use of pictures online and 3D anatomy apps, especially during the presentation, as well as the internet connection problems >

*The sessions are not recorded instead because they may include personal discussions and ideas


(ii) Clinical Skill Session
All the clinical skill sessions were held in person since hands-on skills are required. Similarly, relevant resources including tutorials and manuals are uploaded on MLE, and students are required to be prepared for the sessions. Examples of clinical skill sessions are:
 - Handwashing
 - Examination of the cardiovascular system
 - Examination of the respiratory system
 - Examination of the gastrointestinal tract system
 - Venepuncture ( On simulator model for Year 1; On actual person for Year 2 )

During these sessions, students are divided into a group of 4 to 7 with a lecturer assigned to each group. After a brief explanation and demonstration by the lecturer with doubts-clarification, if there is any, each student will take turn to perform on a simulated patient or model, usually a male student in the group. It is a MUST that every student has demonstrated respective skill and get a sign-off from the lecturer assigned. Hence, instead of having synchronous sessions, for the students who were unable to attend the on-campus sessions, there were catch-up sessions held at the end of the semester or term to help them getting the sign-off for the missed clinical skills sessions. 



[B] 'SELF-DIRECTED'/ ASYNCHRONOUS
'Self-Directed' refers to independent learning with tutorials and non-synchronous lectures pre-recorded and uploaded on the study portal, MLE whereby students have to refer to it on their own time. These sessions are not placed in the official timetable, hence require students to be self-discipline and manage their own time wisely. Yet, there is 'NARRATIVE' released by the lecturers to provide guidance on the timeline of study the learning materials for both synchronous and asynchronous sessions to help us finish up the materials on time. It is not compulsory to follow the timetable suggested in NARRATIVE. I usually choose to modify it based on topics related and my own timetable. 
< As long as things can be done by the due date, it's fine ~ >

There is not much effect by COVID-19 on the asynchronous studies, yet somehow it tends to have more asynchronous lessons compared to synchronous lectures at the beginning of the first semester. After collecting feedback from students, the lecturers eventually tried to balance out the proportion of both types of lessons as many students prefer to have more synchronous sessions instead. 



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APPLICATIONS USED FOR MBBS LEARNING IN COVID-19 PANDEMIC:

i) ZOOM: 
For synchronous lessons such as lectures, clinical reasoning and history taking, some talks and meeting with academic mentors

ii) Microsoft Teams:
Act as a public discussion forum with lectures on studies such as anatomy topics, for some general announcements, virtual oral presentation for assignment, General Studies (MPU) lessons etc.

iii) MLE Form App:
The apps that need to be installed on phones or tablets brought to clinical skill sessions for e-signoff by the respective lecturers at the end of the lessons. 

iv) Piazza 
This is an optional application that might be used by some lecturers. It is also a discussion forum, but students can choose to post questions/ answers anonymously. 


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CHANGES ON EARLY CLINICAL& COMMUNITY EXPOSURE (ECCE) DURING COVID-19 PANDEMIC

In fact, in NUMed, an integrated approach is used in teaching, whereby students are exposed to clinical and community settings and get to learn about clinical skills ever since Year 1. One of the key aim here is to promote interprofessional education (IPE) whereby medical students get to know how other healthcare professions such as nurses and dietician like. Supposedly, clinical visits will be held to clinics and hospitals in Johor. Yet, still, the biggest issue here is the COVID-19 pandemic. Unfortunately, we don't have actual ECCE visits in the Year 2020/2021 for Year 1 students. Instead, we have it virtually. 

For virtual ECCE, it looks like a more detailed 'story' on patients' pathways during hospitals/ clinic visits with scenarios. For instance how the patient gets to the hospital through paramedics during emergency cases, what the paramedics do in the ambulance, who is/are in charge of the patient when he first arrived at the emergency department, what the healthcare provider do next and so on. Some even have the storyline on the recovery and follow-up visits. We also learnt about how consultation is conducted virtually through online platforms with patients simultaneously in the pandemic condition. Similar to the actual ECCE, a reflection is still needed to be written for virtual ECCE despite having no in-person exposure.

< I was actually quite looking forward to ECCE sessions upon getting a place in NUMed. Sadly, I didn't have the chance to pay actual visits to hospitals and clinics (KK) nearby in my Year 1 ECCE due to pandemic issues. Although the virtual ECCEs were actually quite nice and detailed as well as with the job scope of other healthcare workers introduced briefly, I personally felt that it would be a huge difference if these are exposed in my reality as it would be a great chance to interact with the patients and other professionals in real person. This was quite a great loss for me as I didn't have much experience on hospital visits in the past.  >



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Some Thoughts on the Teaching & Learning in NUMED in 2020/2021 with COVID-19 Pandemic

As a first-year MBBS student in 2020/2021, I am quite satisfied with how NUMED conduct the lessons either in a synchronous or asynchronous way. With about 9 months of (mainly) online study under the aid of a narrative guide, I started to become more and more get used to the virtual learning environment. One good thing to say is that the more asynchronous sessions, the more freedom on your own time management and attire as you are basically studying at home. You may spend more time on a particular topic if you want before proceeding to another as long as all the tasks can be finished on time. 


          On the other hand, I also faced some challenges. The main problem I encountered here was the lack of an appropriate environment for studying vibes. I tend to get distracted a lot while studying at home/hostel compared to at locations such as cafes and libraries. I used to study at the Reading Area in my hostel apartment, but it was usually closed under SOP restrictions during MCO state. Secondly, I also noticed the lack of interactions and engaging feelings during virtual discussions especially when everyone chose to close their webcam and lack of contributions to the discussions. Well, sometimes I was also one of the shy people who opt for closing video cameras. 


          For the on-campus lessons, I would say that NUMED actually did a great job in keeping on reminding and ensuring that students follow the SOP rules set by the government. For instance, during lab sessions, students will be wearing lab coats + aprons + gloves + masks + face shields, as well as maintaining social distancing even during face-to-face discussions. There were columns drawn on the labs on where to put our chairs while entering. A video on SOP restrictions and which directions to walk to the labs are attached to the clinical skills tutorials studied prior to the sessions. Bottles of hand sanitiser were placed around the campus as well. I personally think that it could be considered quite SAFE to have on-campus sessions in NUMED.


       However, imagine that you were wearing so many layers covering your face in the labs, honestly, we can't really hear each other voices very clearly during discussions with the face shield and masks. Sometimes, there would be also vision disruption due to water vapour formed on the face shield. Moreover, each time after the 2-hour (at least) practical sessions, there will be a marking left around your head due to the band of the face shield if it is too tight.


       Another thing that I would like to mention was the efforts of the lecturers in NUMED taking into account on students' end-case feedback to improve the next case teaching. Obviously, relevant modifications are made based on our requirements from Case 1 to Case 13 in order to smoothen our learning. This included the sequence of learning materials uploaded on the MLE, allocation of the appropriate number of tasks per day in case narrative etc. It actually shows that the university concerns about students ideas and continuously reflecting on the teaching approaches used. 



[ Conclusion ]
In a nutshell, I feel grateful and satisfied with my choice of getting into NUMED. The lecturers here are friendly and showing the passion to teach us more. This really boosts my eagerness to learn more and my bravery to ask questions on my doubts. Despite having the pandemic, fortunately, all the teachings and learnings for Year 1 2020/2021 were able to be completed prior to the final examination. Instead of looking it as a problem, perhaps we may look it in another way as an opportunity to increase the use of technology in our learning.  

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Here is a quote for you: 

" The real opponent in your life is not OTHERS, but YOURSELF."

Who is the main competitor in our life? -------------ME, MYSELF that is from YESTERDAY

Medical school is tough, but bear in mind that your efforts today will be paid off soon in the future.
Together we fight for knowledge, ourselves, and our future! 
がんばって！

May wish you all the best and be blessed with fortunate :)