|Year : 2022 | Volume
| Issue : 2 | Page : 170-174
Approach for an undergraduate surgery course teaching and assessment during the COVID-19 pandemic in Saudi Arabia
Sultan Alsheikh1, Noura Alhassan1, Yasser Alfraih1, Hamad Alqahtani1, Mona M Soliman2
1 Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||28-Feb-2021|
|Date of Acceptance||24-Feb-2022|
|Date of Web Publication||28-Apr-2022|
Mona M Soliman
Department of Medical Education, College of Medicine, King Saud University, Riyadh
Source of Support: None, Conflict of Interest: None
Background: The COVID-19 pandemic has caused a sudden shift to online education worldwide. Online education is a challenging experience in medical education. This study describes the approach toward teaching and assessment upon the sudden shift to online education in the undergraduate surgery course due to lockdown and the perception of students. It also describes the preparation for the succeeding new academic year. Methods: In May 2020, after the complete lockdown, online small group interactive tutorial sessions were conducted for the 3rd-year surgery course that included case-based discussion and demonstration of certain clinical skills. The final assessment of the course was delayed to August 2020. Forty-five faculties participated in the exam. Each had 7–6 students to examine a total of 315 students. Seven different sets for the examination were used. Seven closed-ended questionnaires were distributed to the students' online using Google surveys after the final exam students. The questionnaire assessed the students' satisfaction of the urgent arrangement in the course and exams due to the COVID-19 pandemic situations. Likert scale was used to receive students' feedback on 5-point scale. Results: All sessions recorded a participation of 71–92 students. A total of 12 lectures covering four topics and three online surgical clinical topics were conducted using zoom. A total of 288 students of 315 attended the final written exam and 287 attended the objective structured clinical examination (OSCE). A total of 144 students of 293 (49%) responded to the 7 questionnaires that were distributed. Regarding the students' agreement on their benefit from the online tutorials. Fifty-nine percent of the respondents agreed that the tutorials improved their clinical sense and developed interest in surgical skills, while 41% of the students disagreed. The majority of the students agreed on the relevance of the topics discussed in the online tutorials. The majority of students agreed that the online tutorials helped to improve their understanding and knowledge of the topic. In response to whether the online tutorials helped to improve understanding and knowledge of the surgical topics, the majority of the students agreed. Conclusion: Online medical education for undergraduate surgery courses for 3rd-year medical students is a novel and effective method for managing the urgent situation. Students were overall satisfied with the approach and reported that it helped them to achieve the designed learning objectives.
Keywords: Assessment, COVID-19, medical students, surgery, teaching, undergraduate
|How to cite this article:|
Alsheikh S, Alhassan N, Alfraih Y, Alqahtani H, Soliman MM. Approach for an undergraduate surgery course teaching and assessment during the COVID-19 pandemic in Saudi Arabia. J Nat Sci Med 2022;5:170-4
|How to cite this URL:|
Alsheikh S, Alhassan N, Alfraih Y, Alqahtani H, Soliman MM. Approach for an undergraduate surgery course teaching and assessment during the COVID-19 pandemic in Saudi Arabia. J Nat Sci Med [serial online] 2022 [cited 2022 May 21];5:170-4. Available from: https://www.jnsmonline.org/text.asp?2022/5/2/170/344206
| Introduction|| |
During the COVID-19 pandemic, the government of Saudi Arabia, as it was worldwide, have implemented multiple social distancing measures that included a complete closure of educational institutes that were implemented in the end of April 2020, followed by a complete lockdown in May 2020., The teaching process has stopped and given the uncertainties at the time, there was no clear insight of the impact and length of the pandemic.
The COVID-19 pandemic has challenged medical education worldwide., The pandemic resulted in lockdown and sudden shift to online education. Medical students were not allowed to practice clinical skills and competencies in the hospitals. Medical educators worldwide were searching for novel approaches to teach medical students clinical competencies online., The challenge for medical educators has been to adopt the medical curriculum to ensure achieving the intended learning outcomes while maintaining effective medical care delivery and applying the precautionary measures.
The department of surgery at King Saud University took approaches to design online education for medical students and utilize the online facilities available at the university. Undergraduate surgery courses are two courses in the 5 years medical bachelor's degree program in the College of Medicine, King Saud University. The first one of two surgery courses is an 8-credit hours course that spans over the whole third academic year with objectives concentrating on symptom analysis and clinical examination for surgical diseases. The course is given in lectures to large groups and in small groups teaching sessions, 3 large groups and 24 small groups.
In the academic year 2019–2020, the course had 40 lectures and 25 clinical sessions throughout the year. It meets the requirement of the medical education department which is 40 lectures and 22 clinical sessions.
This study describes the approach that was done upon the lockdown due to the COVID-19 pandemic and the sudden shift to online education in the undergraduate surgery course and the perception of students on the preparations that was implemented. It also describes the preparation for the succeeding new academic year.
| Methods|| |
The study was approved by the ethical committee at the medical education department. The study was approved by the Institutional Review Board at The College of Medicine, King Saud University, Ref. No. 21/01098/IRB. Written informed consent was obtained before the study. The study is questionnaire-based study and adhered to the ethical guidelines of the Declaration of Helsinki. IRB issued on 13.12.2021.
Analysis of the course achievement
In May 2020, after the complete lockdown in Riyadh, comprehensive analysis of the learning objectives achievement was done, including the knowledge component and clinical competencies component. The majority of the large group lectures was already conducted (36 of 40). The remaining lectures were scheduled to be conducted online using zoom. The majority of the clinical bedside teaching sessions were conducted (22 of 25). There were some deficiencies in the teaching of certain clinical competencies that needed to be addressed. Online small group interactive tutorial sessions were conducted that included clinical bedside discussion (CBD) and demonstration of certain clinical skills.
The final assessment of the course was delayed to August 2020. The written exam component was conducted in campus large halls approved by the infection control team. The students were required to fill the infection control survey form. They were placed in individual tables/chairs at least 2.5 m apart with <40 students in each hall. The rooms were cleaned and sanitized before and after each use. The students were asked to bring their own laptops or tablets. They were asked to download the program before the exam and the code was distributed and well known at the beginning of the exam. The examination program did not allow the students to open any other programs and in the attempt to exit the exam, the students were prompted to confirm the exit and examination would be locked and then send to the examination center. For the students whom their devices did not meet the program standards were given paper exams.
In preparation to the OSCE virtual exam, the faculty was given institutional access to zoom. All faculties were given instructional pamphlets on using the application and one-to-one training was conducted upon request.
The students were given instructions to have their ID card available and to show the room they are using during the exam. The students were given the zoom meeting rooms ID numbers and passwords before the examination. They were instructed to login to the zoom meeting room 15 min before the examination and stay logged in the waiting room to wait for their turn.
The examination sets were distributed in the morning of the examination. The examiners were instructed to allow the students to the meeting room one by one and conduct the examination. Once the examination had finished the student was removed from the meeting room and the next student was allowed in.
The examiners were instructed to ask for the ID card and to be shown the room before starting the examination. The examination was conducted over 15 min, 1 min for introduction and 6 min for each question/scenario. Two extra minutes were given to the examiner discretion to either add to the student time, to fill in the examination forms, or to prepare for the next student.
Forty-five faculties participated in the exam. Each had 7–6 students to examine a total of 315 students. Seven different sets for the examination were used. Each set had different history and clinical reasoning questions. Each set was conducted simultaneously. These measures were implemented to avoid leakage of the examination materials. The exam papers were either given to the course organizer or the course assistant in person or scanned and E-mailed using the university E-mails.
Preparation for the academic year 2020–2021
Anticipating that the pandemic will continue through the academic year 2020–2021, we have implemented some changes to assure that the academic process continues smoothly and minimize any interruptions. Thus, we have changed parts of the course structure to have more small groups tutorial and case base. To minimize the outbreaks, the college board mandated minimizing the hospital exposure to 3rd-year students. Thus, all clinical teaching was shifted to the Clinical Skills and Simulation Center (CSSC) of the College of Medicine using standardized patients with clinical scenarios.
The course structure was changed to include tutorials, lectures, and clinical sessions. We have decreased the number of large group lectures to 21, added 17 small group tutorials, and kept the clinical sessions at 24.
We have doubled the number of small groups to minimize possible outbreaks and maximize the benefit. The lectures were given through zoom to three large groups without major changes. The clinical sessions were more structured, with each having its unique objectives and clinical scenario. Each session had a trained standardized patient and high-fidelity manikins. Tutorials were given to each two to four small groups through zoom depending on the topic and objectives assigned.
Clinical teaching sessions have been planned to be conducted in the CSSC. Each room used was inspected by the infection control department. Each room was assigned a maximum number of attendees and chairs were placed 2 m apart, a bed, gloves, masks, and hand sanitizers. Each small group was assigned a room for all the clinical teaching. The rooms were cleaned and disinfected after each use. This was made to contain the possible spread of an outbreak. We liaised with the other course organizers to assure that we had the same groups or divided existing groups. This was another measure to contain possible outbreaks. The standardized patients we recruited through the hospital. They included nurses, allied health-care workers and environmental personnel who had institutional infection control training. They were given scenarios before the sessions and had briefings on what clinical signs to illicit.
The study was described briefly at the beginning of the questionnaire. Written informed consent was obtained. Seven closed-ended questionnaires were distributed to the students' online using Google surveys, after the final exam in August 2020. The questionnaire assessed the students' satisfaction of the urgent arrangement in the course due to the COVID-19 pandemic situations using 5-point Likert scale. All responses were analyzed using Microsoft excel.
| Results|| |
Lectures and online tutorial
All sessions recorded a participation of 71–92 students. A total of 12 lectures covering four topics and three online surgical clinical topics were conducted using zoom.
| Exam results|| |
A total of 288 students of 315 attended the final written exam and 287 attended the OSCE. The results continued to resemble a bell curve shape. Although the bell was flatter, and the average grades were higher but nonstatistically significant. The assessment score reliability (KR-20) 0.81.
A total of 144 students of 293 (49%) responded to the seven questionnaires that were distributed. In response to the question regarding the students' agreement on their benefit from the online tutorials, 17% of the total students strongly agreed on the Likert scale, 13% agree, 22% somewhat agree, and 18% slightly agree.[Figure 1]. Only 18% disagree on the benefit of the online tutorials. Fifty-nine percent of the respondents agreed that the tutorials improved their clinical sense and developed interest in surgical skills [Figure 2]. While 41% of the students disagreed. The majority of the students agreed on the relevance of the topics discussed in the online tutorials (22% strongly agreed, 6% agree, 17% somewhat agree, and 10% slightly agree) [Figure 3]. Only 6% of the students disagreed on the relevance of the topics in online tutorials. The majority of the students agreed that the online tutorials helped to improve their understanding and knowledge of the topic (29% strongly agreed, 13% agree, 23% somewhat agree, and 14% slightly agree) [Figure 4]. Fifteen percent of the students disagreed.
|Figure 2: Students' agreement on improvement in clinical sense and developing interest in surgical skills through the online tutorials|
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|Figure 3: Students' perception of the relevance of the topics discussed in the online tutorial|
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|Figure 4: Students' perception if the online tutorials helped to improve understanding and knowledge of the topic|
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Similarly, most students agreed with the importance of the topics discussed in the online tutorials (28% strongly agreed, 38% agree, 15% somewhat agree, and 10% slightly agree), while only 8% disagreed [Figure 5].
|Figure 5: Students' perception on the importance of the topics discussed in the online tutorials|
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In response to whether the online tutorials helped to improve understanding and knowledge of the surgical topics, the majority of the students agreed (19% strongly agreed, 16% agreed, 24% somewhat agreed, and 16% slightly agreed) [Figure 6]. While 24% of the students disagreed on that. Thirty-five percent strongly agreed that the online tutorials provided a safe environment to help them reach their academic objectives during the pandemic [Figure 7], 8% agreed, 15% somewhat agreed, and 12% slightly agreed. Only 8% of the students disagreed.
|Figure 6: Students' perception if the online tutorials helped to improve understanding and knowledge of the surgical topics|
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|Figure 7: Students' perception if the online tutorials provided a safe environment to help me reach my academic objectives during the COVID-19 pandemic|
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| Discussion|| |
The COVID-19 pandemic has challenged medical education globally to adopt new methods of teaching and assessment for medical students that ensure the graduation of competent medical doctors while following the precautionary measures.,, Online education has been existing in Saudi Arabia for long time. The current pandemic situation has caused educational institutes to utilize the existing facilities to the maximum. Faculty-developed training workshop has been conducted regularly before the pandemic at King Saud University to train and motivate faculty to utilize online education. Extensive online training was conducted after the lockdown to train and support faculty in the sudden shift to online education.
Upon lockdown, the department of surgery has adopted a novel approach to evaluate the undergraduate surgery course achieved learning objectives and to provide online discussion-based sessions on the deficient topics. The students' online attendance was high and highly appreciated the novel structure. The department also adopted a novel approach for assessment.
The major concern in adopting the novel approach of online education in the undergraduate surgery course was to ensure that the students mastered the core clinical competencies intended. Teaching clinical competencies and skills online is a big challenge. The preparation for the new academic year, with the ease down of the pandemic situation included clinical teaching in the CSSC. Although there will be still a deficient part of the student clinical encounter, teaching in CSSC will ensure that the medical students practice and master the essential surgical clinical skills and competencies. The present study showed an overall satisfaction of mastering the essential surgical clinical skills following the comprehensive online course that was conducted upon lockdown due to the pandemic situation in 2020.
Although simulation can be used to deliver some learning and assessment experiences, it cannot deliver all. In addition to that there are concerns and challenges that ha to be addressed carefully. Online case-based discussion is a well-known method of teaching in health professions education. Although online medical education for clinical competencies is a challenge and should be taken with caution. Keeping in mind that this time will pass hopefully and the junior medical students will have more time to practice their clinical skills and competencies.
| Conclusion|| |
A novel approach was adopted for undergraduate surgery courses for 3rd-year medical students teaching and assessment during the COVID-19 pandemic. Students' perception of the novel approach was highly satisfied. Preparation for the new academic year with the blended learning approach was highlighted.
The author would like to express sincere thanks to the Students council and all 4th-year medical students for their cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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