gms | German Medical Science

In the wake of the SARS-CoV-2 pandemic, measures were initiated in Bavaria which could change academic teaching sustainably [1]. The challenge lay in the short-term transformation of established courses into a digital format. Although the Master Plan 2020, irrespective of the current situation [2], points to the urgency of digitizing medical teaching, it was the SARS-CoV-2 pandemic that created the necessary pressure to digitize teaching and implement knowledge transfer in a creative and proactive way for participants. The following report is intended to show how general practice teaching can work digitally and asynchronously in the clinical section of the study program, thus going didactically beyond the conventional frontal classroom teaching. Interactive learning activities according to the “ICAP Framework” can be supported by the “Reflective Video Consultation” and an “Online Forum” [3]. These enable the experience of autonomy and competence as well as relatedness, which according to self-determination theory have a positive influence on learning motivation and performance [4].

At the Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), general practice is anchored in the 1^st clinical semester as a lecture with two semester hours per week (SWS). The internship is to be completed from the 5^th to the 10^th semester. (Pre-)clinical elective courses are offered. The practical elective part can be completed in the final practical year (see figure 1 [Fig. 1]). In the summer term 2020, the “Lecture General Practice” and the clinical elective course “Smart Decision-making in Clinical Practice” were offered digitally. Other elective courses could not be offered digitally due to the highly practice-oriented interactive setting (e.g., small groups, role-play), or – after suspension – were offered again in analogue form (clinical traineeship, internship, elective part).

The lecture was transformed into a solely digital teaching format. The 90-minute lectures were offered as video podcasts. Each lecture was divided into smaller thematic sections (“Segmenting Principle”) [5] and made available as audio annotated videos via ILIAS, a learning platform [https://www.studon.fau.de/]. In-depth assignments for self-study and further materials were offered to counteract the possible passivity by reduced interaction. The contents were made available one week before the actual “presence date”. At this meeting, a reflective video consultation with practical examples took place on WebEx (Cisco Systems, [https://www.webex.com/]). A forum on the learning platform, supervised by the lecturers, encouraged additional interaction. This resulted in a variant of an inverted-classroom concept with the possibility of reflexive learning in an asynchronous environment and at an individual pace [6]. To promote digital learning, the formats were held in common language, and the video lesson was conducted by two lecturers in dialogue with each other and with the students, in accordance with Mayer's “Personalization Principle” [7]. At the end of the lecture, students evaluated their learning experience. This included self-developed items for the evaluation of didactic methods, satisfaction and the desired form of presence. Items were answered, following the school grading principle (1 “very good” through 6 “deficient”). A free text answer (open wishes/criticism) was also possible.

The clinical elective course was initially established as a hybrid event (presence-digital, 2 SWS). In the summer term 2020 it was further developed as an online learning module (ILIAS, [https://www.studon.fau.de/]) and interlocked with the lecture thematically and didactically. For each thematic section, there was an activating preparation, supplemented by podcast contributions of the lecturers. A course follow-up intensified the content in self-study by means of exercises or control questions and thus informed students about the learning progress. A forum supervised by lecturers and student tutors enabled asynchronous interaction.

Evaluation results – assessment according to German school grades – of the lecture (response rate n=115/170; 67.6%, see figure 2 [Fig. 2]) showed a high level of acceptance with an average grade of “very good”. The same applies to the commented videos. Forum, reflective video consultation and teaching materials received an average grade of “good”. The most desired teaching formats were “Focus on virtual with in-depth presence phases” (n=54) and “Focus on presence phases, virtual support only” (n=37). In the free-text responses, the “very good organization” and “didactic method” were highlighted in comparison to other clinical subjects. The evaluation of the elective course has not yet been completed and will be published elsewhere.

1.

Asynchronous teaching enables students to work independently at their individual learning pace, regardless of time and place. Nevertheless, personal contact must be possible at all times. In addition to content and method, students appreciate reliable structure, organization and support in a virtual environment.

2.

Students need self-regulation strategies to ensure that online courses do not become more boring and less enjoyable than in class [8]. Self-regulation can be encouraged, for example, through portfolio work [9].

3.

Asynchronous, digital blended-learning/inverted-classroom concepts can strengthen clinical teaching (e.g. general practice) [10], [11]. The focus is shifting from passive teaching of content to interactive content handling.

4.

Evaluation differences between videos and the forum may result from a different level of activity (passive vs. interactive) [3].

5.

A further development of the evaluation is planned.

The described elective is a course for the introduction to evidence-based medicine. It is recognized as a continuing education course (DNEbM e.V.) and is funded by the German Federal Ministry of Education and Research (“QuiS II No. 01PL17017”).

PK and NL share first authorship and were responsible for manuscript preparation, data collection and analysis as well as the development of the evaluation. RK and TK revised the manuscript. MR developed the evaluation and, together with PK, was responsible for the development of the teaching idea. MR revised the manuscript, data collection and data presentation.

The present work was performed in (partial) fulfillment of the requirements for obtaining the degree “Dr. rer. biol. hum.” for NL.

The authors thank the student tutors for their support. The authors would like to thank the Medical Faculty of the FAU Erlangen-Nuremberg and the Institute for Learning Innovation of the FAU Erlangen-Nuremberg for their constructive support.

The authors declare that they have no competing interests.