Online classrooms enhance clerkship small group teaching

Abstract

Context and setting The pressures of the modern health care environment have negatively impacted the teaching forums of traditional clinical clerkships, including small group teaching seminars. Why the idea was necessary Faculty pressured by market forces and increasing regulation have less time to meet face-to-face with students in small groups and are less likely to encounter their students in the clinical realm, damaging the faculty−student relationship and faculty members' ability to appropriately evaluate students. Students also have less opportunity in the clinical environment to observe the continuity of patient care, use of evidence-based medicine and clinical decision making by faculty. Online classrooms that supplement small group teaching sessions have the potential to not only offset these deficiencies but to enhance clinical reasoning and sophistication by creating a forum where students can work collaboratively with faculty facilitation in addressing an issue or working through a patient case. What was done We developed a web-based cyber classroom that hosts classrooms for individual tutorial groups. Students discuss 1 case each week in the classroom. Each student is assigned to serve as the discussion leader for 1 week of the classroom, providing an opportunity to build leadership skills. Faculty facilitators talk offline with discussion leaders at the start of the week to determine the case and review the discussion leader's responsibilities. Students work collaboratively in the classroom to assess the patient and develop a differential diagnosis, thus building the teamwork skills needed in clinical practice. Faculty members act as facilitators to guide, rather than lead, discussion. Cases presented in the cyber classroom are in addition to the standard tutorial curriculum reviewed in weekly face-to-face meetings. Each classroom is analysed to assess the pattern of the conversation. The quality of students' posts is also assessed on a 4-point scale, based on the sophistication of students' reasoning, use of evidence-based medicine, integration of material learned in different clinical scenarios or educational environments, and discussion of non-biomedical issues, such as ethical or cultural issues. Evaluations of the cyber classroom are correlated with other quantitative and qualitative assessments of the students, such as their performance on objective structured clinical examinations (OSCEs), shelf examinations and faculty evaluations. Evaluation of results and impact We analysed 8 classrooms, 4 each from 2 8-week clinical clerkships, including 70 students and 8 faculty facilitators with 8−9 students per classroom. We sampled weeks 3 and 6 of each classroom, analysing the differences in quality and discussion patterns between weeks 3 and 6 of each classroom and across classrooms. Based on this small sample, we expect to see a measurable increase in quality and a progression from faculty-centred to student-centred discussions from weeks 3–6 across the academic year's 6 rotations. In addition, faculty report an improved ability to differentiate among students and to assess students' knowledge and reasoning skills.