The Covid-19 pandemic: Provoking thought and encouraging change

During my new and increasingly regular habit of standing in the queue outside the supermarket, and despite standing the regulation two metres apart, I could not help but hear the conversation ahead of me. An elderly lady was telling the gentleman ahead of her how bad the Covid-19 pandemic was and how nothing had been this bad since the last world war! His response was to agree; I suppose he had heard it several times before and wondered how to respond. After making further small talk, he finished his part off the discussion with the comment ‘Oh yes, but it has made me think!’

Think what? I wanted to ask him what he meant by this, but the queue was moved on and unfortunately, I never had the opportunity.

This short but true story stayed in my head as I walked home and has certainly made me think subsequently. The Covid-19 pandemic has caused much disruption, social, political, educational, and personal. While there must be very few corners of the world that have not felt even minor disruption, some countries appear to have been less affected than others, for which there must be many reasons. It has caused fear and fracture, loss and grief, and has even coined the phrase—the new normal, referring both to the present time and the future. There is little doubt that it is making countries and communities think and hopefully learn, politically, socially, and educationally. All elements of society have been affected, health professions education specifically. The pandemic has created a necessary change culture in all aspects of education; it has brought forward and accelerated new development, much that we all thought would happen, but probably later! Accepted and well-practiced methodologies in teaching, learning, and assessment have come into question, and despite their longevity and perceived importance, they have become inappropriate or even impossible to do; they have been taken over by innovative methods of on-line teaching and assessment. With most UK medical schools closing their doors to students, graduating students early and creating a new form of supervised internship has become the new normal for the immediate future in the UK (General Medical Council 2020). Social distancing in hospitals and clinics has become their new normal but has resulted in a worrying decrease in attendance at hospitals for other illnesses (Lazzerini et al. 2020).

So, has this pandemic really made us think? Are we expressing a knee- jerk reaction to an immediate need or are we creating a new world of healthcare and health professions education? Are we rapidly advancing to the present those ideas and actions that we thought would slowly evolve over time but never really believed in? Are we lost in a sea of innovations that are lacking in theory and researched evaluation? Will we in fact just return to our previous educational practices once it is all over? All reasonable questions that require deeper thought and resolution.

Over the last two months and together with many other institutions and associations, the Association for Medical Education in Europe (AMEE) has responded to its wider community in addressing some of the many difficulties we all face as a consequence of the pandemic. The biennial Ottawa Conference held in Kuala Lumpur during February 2020 had to react only days before starting with the implementation of on-line learning, with surprising but very positive results (McKimm et al. 2020). The popular AMEE annual conference has now become a live virtual conference (The Association for Medical Education in Europe 2020a), with the possibility that we will never return to the usual, much loved conferences of the past.

Recently AMEE has run a series of webinars of how faculty are coping with education during the Covid-19 pandemic (AMEE 2020b). The webinars have covered best practices in online learning and assessment, student and faculty stress and wellness, professional and unprofessional behaviour and a look into the future of assessment, post Covid-19. The apparent importance of these subjects has been reflected in the number of webinar attendees, at both the live and through the archived versions.

Both of the AMEE journals, Medical Teacher (www.medicalteacher.org) and MedEdPublish (www.mededpublish.org) have seen an almost three-fold increase in submitted papers, with some outstanding and practical papers receiving high ratings and many views (Eachempati and Ramnarayan 2020; Boursicot et al. 2020; Sandars et al. 2020); all related to the pandemic and all trying to apply logic to the way forward.

If there can be anything positive that results from the Covid-19 pandemic, it will be as a result of the need to advance to what was in the educational melting pot of the future; we have been made to think, to innovate, to practice, to evaluate and research. This Special Edition of Medical Teacher provides just a few examples from the numerous academic outputs resulting from the pandemic, many of which will become our future- our new normal.

The well-known American author, Dale Carnegie¹ was quoted as saying ‘Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all.’ Although it is unlikely that many of us have reached that hopeless stage as yet, the authors of these selected papers have brought together the who, the why, the where and the what of our new normal.

Despite disruption and confusion, Covid-19 will push educational institutions to change attitudes to the curricula, the methods of teaching, learning and assessment, our approaches to the students, and the psychological care for faculty and students. As Tolsgaard and colleagues point out in their commentary, we are presented with sacrifices to make and choices to take (Tolsgaard et al. 2020). The sacrifices will result in major change; their enactment will be a delicate balancing act from which the new normal will develop. This commentary is supported by the letter from Amini and colleagues, from Iran, who reflect upon the absences from their curriculum of public health and disaster management competencies (Amini et al. 2020). Sun and Su from Harbin in China, in their letter to the Editor, suggest that the Covid-19 pandemic can add quality to the curriculum by cultivating the moral quality and social responsibility in their students (Sun and Su 2020). Sydney Harris², another American journalist, was quoted as saying, ‘The whole purpose of education is to turn mirrors into windows;’ what we see in the mirror may not always be to our liking but it is there, it is real and we need to see it through a new window.

It was Gheihman and her colleagues who presented in their paper published prior to the pandemic, the issues related to clinical uncertainty (Gheihman et al. 2020). This uncertainty has now become real, and was apparent in the webinar that Cleland and colleagues described in their paper ‘Adapting to the impact of Covid-19: Sharing stories, sharing practice.’ The uncertainty of what the pandemic brings and what effects will last are clear from the questions their audience shared. The authors asked all colleagues to record and evaluate their educational innovations, given that ‘their actions will probably shape the future of health professions’ education and training forever and in doing so, could just lead to real transformative and transformational learning for all of us’ (Cleland, McKimm, et al. 2020).

The closure of many health professionals institutes has called for a dramatic change in their organisational management. The future of these institutions relies upon a throughput of students, with many institutions relying on home and international students to maintain their annual income. Travel restrictions will cause a drop in these international students with perceived catastrophic changes in the financial stability of many institutions, but what of their home students; how will they be selected now the travel restrictions exist? Cleland et al., provide a selection approach they have designed through conducting on-line multiple mini-interviews (MMIs) to interview potential students, exploring the challenges they faced and possible solutions (Cleland, Chu, et al. 2020). Whilst they express an opinion that new innovations such as theirs have the potential to inform and transform future medical school selection, they call for a cooperative approach and a sharing of ideas to overcome the present selection issue, as well as re-shaping the future of the selection process.

Health professions institutes have responded in different ways to the pandemic. Ashokka and colleagues from Singapore describe their school’s coordinated response to both sustaining education while minimising transmission of the virus (Ashokka et al. 2020). Recognition is given that their school is highly organised, well-coordinated and well resourced, such a response may not be afforded to one in less well-resourced areas, but their main principles may still apply. Hall and colleagues, who provide some useful tips on maintaining competency-based medical education, further express the effects upon curricula in their paper (Hall et al. 2020). While mainly referring to postgraduate education, many of their useful tips can be applied to other educational levels.

The pandemic has brought out the best in both faculty and institutions. The response in China to controlling the virus to mainly one Province has been remarkable. Yang and faculty colleagues were members of the ‘China response’ (WHO-China Joint Mission 2020) who travelled to Hubei Province to provide medical support (Yang et al. 2020). While not describing all their noble activities in combating the virus, they draw attention that such activities can highlight some major deficiencies in their curriculum- theirs could be a new normal.

Assessment is a major difficulty related to the pandemic. The placing of examinations on-line, the difficulties with running an OSCE during the pandemic (Boursicot et al. 2020), the inability of arranging clinical assessments and the possibility of unprofessional behaviour and cheating all add to the difficulties facing faculty. The personal views of a 4th-year medical student about to embark on his first experience of an open-book approach are well described in the personal view from Jervis and Brown (Jervis and Brown 2020). While not negating the value of open-book examinations, the paper does draw attention to the need for or indeed the purpose of examinations during such a disruptive time; a time when they suggest that medical students may be more constructively engaged.

Fuller and colleagues took a wider perspective on assessment in their paper (Fuller et al. 2020). Their opinions drew attention to the linking of frameworks, drawn from theory, which can guide the strategic decisions we all have to make; the questions of the who and why, the what, when, and how in developing our new approaches to assessment. They draw attention to the myths of assessment that we can now explore, evaluate, and implement in a collegial and cooperative manner, in order to change the landscape of assessment; their new normal in assessment.

As the novel coronavirus pandemic continues to spread, directly affecting everyone’s lives and testing the resilience of our health care systems, it is more important than ever to prioritise health and well being (Lau et al. 2008). Self Determination Theory (SDT) suggests that all human beings require fulfillment of three basic psychological needs for optimal health, resilience, and well being—autonomy, competence, and relatedness, all acting in an integrated way (Deci and Ryan 2008). The paper by Wald provides several practical tips, together with extensive references, for an integrative approach to dealing with resilience and wellbeing during the pandemic (Wald 2020). The shorter personal paper from Orsini and Rodrigues supports the work of Wald and suggests that the Covid-19 pandemic has been a catalyst to teamwork and working together supports motivation and improves psychological well being (Orsini and Rodrigues 2020).

To the authors of all these papers and all those papers that have both preceded and the many that will follow this Editorial, congratulations on your thoughts and ingenuity, long may they continue. We have no doubt entered into our new normal, a time of innovation, exploration, and application. We will certainly not return to the old normal and perhaps Covid-19 is our catalyst to change in health professions education.

“It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.”³

Disclosure statement

The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.

Notes

Additional information

Notes on contributors

Trevor Gibbs

Professor Trevor Gibbs, MD, SFHEA, DA. FAcadMED, MMedSc, FRCGP, FAMEE, is President of AMEE. His interests lie in curricula and faculty development, particularly in resource-constrained countries.

Notes

1 Dale Breckenridge Carnegie (1888–1955) American writer and lecturer and the developer of famous courses in self-improvement.

2 Sydney Harris (1917–1986) American journalist and novelist.

3 Charles Darwin (1809–1882) English naturalist, geologist and biologist, best known for his contributions to the science of evolution.