Could postgraduate medical education look different after Covid-19?

The Covid-19 pandemic led to rapid changes in the way things are done throughout the NHS and delivery of postgraduate education is no exception. Almost overnight we moved from predominantly lecture-based teaching to online platforms such as Zoom. In the face of a global pandemic where clinicians have appropriately prioritised frontline clinical care, there was a risk that postgraduate education would be temporarily suspended. Fortunately, this was not the reality in paediatrics and the pandemic has led to many opportunities for trainee education which could transform training in the future.

As a senior paediatric trainee (ST8) in Mersey, I have been through almost the entire three level regional teaching programme which includes monthly all-day teaching sessions mapped to the RCPCH curriculum for each training level (ST1-3, ST4-5 and ST6-8). Attending these sessions can be challenging due to shift patterns, need for clinical cover and, for less than full time trainees, the sessions occurring on days they don’t work. Paediatrics has many rota gaps with 14.6% of tier 1 (ST1-3) and 23.4% of tier 2 (ST4-8) slots unfilled in 20171; this leads to increased pressures on trainees to provide clinical cover over accessing educational opportunities. Additionally, I have attended teaching sessions in all the hospitals I have rotated through. At Warrington Hospital, we have twice weekly teaching sessions and additional educational MDT meetings. I have had to work from home for the duration of the pandemic and in the first few weeks I had no access to teaching either locally or regionally. However, very quickly local educators have worked on providing postgraduate teaching in many forms which has given all regional paediatric trainees access to a wealth of resources which were not available to us previously, and which can be accessed at convenient times around our clinical commitments.

Moving regional teaching sessions to Microsoft Teams (with a future plan to move to Panopto) has allowed the sessions to be recorded and an archive of previous sessions made available. We have also been given access to webinars and invited to teaching sessions from other departments or hospitals that we would not previously have been able to attend. For example, a recent Mersey Paediatric Endocrinology Group teaching session was virtually attended by many trainees and consultants who are working throughout the region. Specialty specific teaching sessions are no longer limited to only those who are working in Alder Hey Hospital or the number of people that can fit into a specific room. We also have access to a wider range of experts from all over the country who can teach using online platforms, giving us access to teaching on conditions that are managed in specialist centres outside our region. Archived sessions will particularly benefit those sitting examinations as they could search for the topics they need to learn at the time they need them.

While the pandemic has caused a rapid shift to online training it is important to consider how to use this to optimise learning both now and in the future. Online teaching requires good IT infrastructure, including internet access, as well as adaptation to the new format. Participants find online teaching more stressful than face-to-face sessions2 and adapting to an online learning environment can be a challenge for both facilitators and students3. Educators need to bear in mind the need for engaging the learner and promoting interactivity, which can be more challenging through a screen2, and avoid cognitive overload. Attending regional teaching sessions provides opportunities for networking and peer support which has been lost in the move to online teaching. Consideration of this needs to be made when planning delivery of postgraduate teaching, e.g. by having a hybrid of virtual and face to face sessions or using virtual discussion groups or facilitator-supported networking during break times.

Finally, the Royal College of Paediatrics and Child Health (RCPCH) is working hard to ensure education and professional development courses and teaching continue. They are making plans for virtual learning as a short-term measure so that quality of training is not affected.

The Covid-19 pandemic has changed how postgraduate medical education is delivered at the moment and the benefits this has brought can be sustained and even improved upon when it is over. Training for educators in how to teach using different technology is needed4 and consideration needs to be made as to how technology can be used to enhance learning with ongoing feedback and evaluation of current practices3,5. While there is no substitute to learning using patients in clinical settings, synchronous and asynchronous learning utilising online methods can be used in addition to this to overcome some of the challenges of accessing educational opportunities in the post-EWTD era of postgraduate training. Perhaps one of the lasting legacies of Covid-19 will be improvement in the delivery of postgraduate medical education?

References
Royal College of Paediatrics and Child Health. Paediatric Rota Gaps and Vacancies 2017 [Internet]. Available from: https://www.rcpch.ac.uk/sites/default/files/2018-02/paediatric_rota_gaps_and_vacancies_survey_wingsan_final.pdf [Accessed 04.06.20].
Taha M, Abdalla M, Wadi M, Khalafalla H. Curriculum delivery in Medical Education during an emergency: A guide based on the responses to the COVID-19 pandemic. MedEdPublish 2020; 9, [1], 69. https://doi.org/10.15694/mep.2020.000069.1
Gillett-Swann J. The Challenges of Online Learning: Supporting and Engaging the Isolated Learner. J Learn Des 2017; 10 (1), p 20-30.
Fawns T, Jones D, Aitken G. Challenging assumptions about “moving online” in response to COVID-19, and some practical advice. MedEdPublish 9, [1], 83. https://doi.org/10.15694/mep.2020.000083.1
Sandars J, Correia R, Dankbaar M, de Jong P, Goh P, Hege I et al. Twelve tips for rapidly migrating to online learning during the COVID-19 pandemic. MedEdPublish 2020; 9, [1], 82. https://doi.org/10.15694/mep.2020.000082.1

Elinor Thomason1 is an ST8 Paediatric Trainee in the North West.

Satish Hulikere2 is a Paediatric Consultant and Clinical Director of Paediatrics at Warrington and Halton Teaching Hospitals NHS Foundation Trust. @SatishHulikere

Competing interests: None declared.

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