Undergraduate medical education amid COVID-19: a qualitative analysis of enablers and barriers to acquiring competencies in distant learning using focus groups

ABSTRACT

Due to comprehensive social distancing measures related to the COVID-19 pandemic, medical faculties worldwide have made a virtue of necessity in resorting to online teaching. Medical faculties grapple with how to convey clinical competencies to students in this context. There is a need for research not only to map but also to explain the effect of these secondary measures on students’ learning and mental wellbeing. During a period of ongoing comprehensive social distancing measures in Germany, we translated a competency-based curriculum including obstetrics, paediatrics, and human genetics to an e-learning course based on online patient and teacher encounters. In our qualitative study on students’ and teachers’ views, we identify potential enablers and drivers as well as barriers and challenges to undergraduate medical education under lockdown. In summer 2020, we conducted six focus group interviews to investigate medical students’ and teachers’ perspectives, experiences and attitudes. All focus groups were videotaped, transcribed verbatim and coded. To guide our deductive and inductive analysis, we applied the theoretical framework of Regmi and Jones. Content analysis was performed in a multi-perspective group. We identified five major themes contributing to a successful use of clinical competency-based e-learning under lockdown: Communication (with teachers, students, and patients), Mental wellbeing, Structure and self-organization, Technical issues, and Learning and commitment. We discuss enablers and potential barriers within all themes and their overlap and link them in an explanatory model. In our setting, students and teachers find e-learning holds strong potential and especially in times of COVID-19 it is greatly appreciated. We broaden the understanding of the impact of distant learning on acquiring competencies, on attitudes, and on mental wellbeing. Our model may serve for a thoughtful, necessary transition to future e-learning and hybrid programs for a competency-based medical education with ongoing social distancing measures.

KEYWORDS:

• COVID-19 pandemic
• e-learning
• clinical competence
• qualitative research
• mental health

Acknowledgments

The authors wish to thank Prof. Dr. Matthias Schneider and Prof. Dr. Ulrich Decking (Vice Dean and Deputy Vice Dean for Teaching and Study Quality) as representatives of our Medical Faculty for mediation of the new curriculum, Dr. Judith de Bruin (Head of Evaluation) for data of the online evaluation, and Christian Michalek (Deputy Managing Director Curriculum Development) and Patrick Bergman (e-learning office) for the central coordination of assignment of students and teachers to teams and channels. We wish to thank Prof. Dr. Stefan Wilm and Dr. Thomas Kaleta for curriculum advice, design and course organization in geriatrics, and obstetrics/gynaecology, respectively. The authors wish to thank Ruan van Rendsburg for language editing of this manuscript. We are grateful for the pre-editing of the manuscript by Christoph Nikendei.

Disclosure of potential conflicts of interest

No financial interest or benefit has arisen from our research.

Ethical approval

The study received a favourable opinion by the Ethics Committee of the Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany (2020-1089).

Trial registration

This study was registered in the German Clinical Trials Register, DRKS (DRKS00022251).

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The authors have no funding to report.