Ces projets, qui exploreront les effets négatifs et positifs de la pandémie sur l’éducation en sciences de la santé, ont récemment été lancés grâce au fonds d’amorçage pour la recherche et l’innovation de l’Institut d’éducation en sciences de la santé (IÉSS). Découvrez les projets dirigés par le Pr Sean McWatt (sur l’apprentissage de l’anatomie), la Pre Maryam Wagner (sur la formation en chirurgie) et la Dre Ilana Bank (sur l’usage de la simulation pour peaufiner les protocoles en salle d’urgence).
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Code COVID: Adapting emergency room protocols to pandemic realities
As a pediatric emergency physician at Montreal Children’s Hospital (MCH) and an associate professor of pediatrics at the ±«ÓăÖ±˛Ą Faculty of Medicine and Health Sciences, Dr. Ilana Bank is well-versed in the complex training that informs a hospital’s response to emergency situations. Doctors, nurses, respiratory therapists, and other healthcare staff carefully study and practice how to be in the right place at the right time. It’s all part of Dr. Bank’s ongoing research, “Flipping the Classroom in Simulation: An Analysis of Mixed-Modality Simulation-Based Training in Continuing (Inter)professional Development in the Time of COVID-19.”
Dr. Bank’s study centers around simulations, or mock scenarios, of whole hospital emergency procedures and codes to refine patient and provider safety needs. Through continuously reexamining protocols, a hospital can work toward providing care that is efficient, effective, and holistic.
“Healthcare is not just about textbook knowledge,” says Dr. Bank. “Anyone can look up anything in a book. The key to these simulations is understanding human dynamics: our ability to effectively communicate with and trust our team members in high-stress situations.”
When COVID-19 first sent Canada into lockdown last March, hospital staff had to redevelop safety protocols for everything from intubation and CPR to trauma responses and transporting patients between units. For two weeks, Dr. Bank and her colleagues studied every unit procedure, troubleshooting for potential challenges that might result from government-issued COVID-19 guidelines for hospitals.
When the time came to put these ideas into practice, the team utilized a flipped classroom approach. “We put together a tabletop simulation, which we could broadcast on Zoom, to run through the new protocols as they developed,” Dr. Bank explains. “We walked through every step: who’s wearing full PPE, who’s on first response or standby, which hallways to take when we have to socially distance, and so on. This stage allows us to iron out the bigger challenges before attempting an in-person scenario, where we can focus on fine-tuning spacing and communication.”
In one problem-solving simulation, Dr. Bank and her colleagues found they couldn’t fit a crib through a doorway, requiring either a different mode of transport or alternative pathway. In another, they identified the need for communication devices connecting the inside and outside teams for the trauma bay, since the handling team was considered “dirty” with potential virus exposure while the outside team was considered “clean.” “These were issues we didn’t always have before COVID,” Dr. Bank notes. “Now, when these scenarios happen in real time with real patients, we’re prepared to keep everyone safe while providing the best care we possibly can.”
Although the in-person component was put on hold for several months while the government limited in-person education, Dr. Bank’s research team looks ±«ÓăÖ±˛Ą to continuing simulations in the fall. They’re grateful for the support they’ve received from the Institute of Health Sciences Education Innovation and Research Seed Fund’s “Special Call: IHSE Research Grants on Educational Advancements or Innovations in Response to COVID-19,” which has allowed them to take their research beyond local and pediatric applications.
“The COVID-19 Seed Fund grant gives us the means to share and disseminate our insights at the national and international levels,” Dr. Bank affirms. “We have no way to predict what new crisis we’ll face a decade or century from now. These types of funding sources open the door to apply our findings in new contexts, both in the present and future.”
The anatomy of learning
While disruptive in many ways, the COVID-19 pandemic presented a rare opportunity to explore student approaches to learning in ±«ÓăÖ±˛Ąâ€™s anatomy labs. Facing social distancing requirements and a lower number of cadaver donors, anatomy faculty were forced to divide the class between in-person and virtual labs. “It set up the perfect environment to compare virtual and in-person learning because we had equal groups of students in both cohorts,” describes Dr. Sean McWatt, an assistant professor of anatomy at the ±«ÓăÖ±˛Ą Faculty of Medicine and Health Sciences.
In an ongoing study supported by the Institute of Health Sciences Education Innovation and Research Seed Fund’s “Special Call: IHSE Research Grants on Educational Advancements or Innovations in Response to COVID-19,” titled “Evaluating the Experiences of Students and Instructors During In-person Versus Remote Laboratory Education in Human Anatomy,” Dr. McWatt has gathered qualitative data from both faculty and students in the lab, examining how their experiences differed between virtual and in-person environments. He also collected survey data from students in both cohorts that measured their ability to adapt to new learning contexts using two metrics: surface learning, which requires just enough memorization to pass a class; and deep learning, which comes from actively applying course material beyond tests and exams.
Dr. McWatt and his team discovered that students whose first lab was conducted in person favoured deeper approaches to learning than those who began with remote labs, with many instructors and students citing the value of the “transformative learning experience” that comes with hands-on exploration. But there were other students who thrived while learning remotely, and a large part of the study provides quantitative data, such as class size, exam format, and time, that may explain their success.
“Ultimately, it comes down to how much our students feel supported in their work,” Dr. McWatt explains. “For example, small breakout rooms online can provide a more personalized lab experience, giving students increased one-on-one time with their instructor. But engagement in the learning community can be difficult to maintain in solely remote environments, and dissection is the gold standard of anatomy education. We want to explore potential best practices, such as blended learning models, to better meet student learning needs.”
Recognizing the potential for other universities to utilize this research in their own blended learning environments, Dr. McWatt and his team are also seeking to translate their findings into transferrable quantitative data. But learning development depends heavily on context, and every student comes from a slightly different background. When it comes to cost analysis; time, money, and resources also determine how and when learning happens in the lab.
“There are countless metrics we could use to measure learning and even more contextual factors that need to be accounted for, which makes it difficult to compare methods,” Dr. McWatt acknowledges. “So we’ve simplified our cost-analysis to only compare the money and time spent in both virtual and in-person environments. This provides a starting point for other universities to then take these numbers and apply them to their specific student contexts and budgeting needs.”
As a new faculty member, Dr. McWatt is particularly grateful for The Institute’s Innovation and Research Seed Fund, which has been instrumental in moving the project ±«ÓăÖ±˛Ą. With this funding source, he was able to purchase a subscription to a virtual Q-methodology platform that was used to obtain qualitative feedback from students, since in-person interaction continues to be limited. The Seed Fund also allows Dr. McWatt to provide gift card incentives to encourage students to participate as research subjects and to pay a current medical student, Jobanpreet Dhillon (MD’22), to assist him in his work.
“It’s key to let students know through compensation that their work is valuable,” Dr. McWatt says. “I’m honored to help them gain research experience and learn from them through this project.”
Advancing surgical education during a pandemic
For Dr. Maryam Wagner, one of the most rewarding aspects of her research career at the ±«ÓăÖ±˛Ą Faculty of Medicine and Health Sciences has been the opportunity to collaborate with researchers and healthcare professionals from across the university system.
Wagner, an assistant professor of health sciences education and an assessment lead for the Health Profession Schools, is currently co-leading a project titled “Disruption as a Positive Force: Leveraging the COVID-19 Pandemic for Educational Advancement in Surgical Postgraduate Education.” The project focuses on investigating the impact of the pandemic’s disruption on surgical residents whose hours in the operating room (OR) have been drastically curtailed. The findings will be used to inform educational initiatives aimed at improving and advancing surgical training.
The inspiration for this project emerged from a conversation between Dr. Wagner and two of her colleagues, Drs. Paola Fata and Carlos Gomez-Garibello. “Dr. Fata shared about some of the challenges faced by surgical residents as a result of the pandemic, and we wanted to find ways to help,” Dr. Wagner recalls. “Alongside Dr. Kevin Lachapelle, we were able to leverage the Institute of Health Sciences Education Innovation and Research Seed Fund’s “Special Call: IHSE Research Grants on Educational Advancement or Innovations in Response to COVID-19,” to better understand these challenges and collaborate to discern best practices or alternatives to traditional learning models as surgical training continues to develop.”
Historically, surgical residency training has relied heavily on an apprenticeship model, with learners engaging in hands-on, real-time education alongside experienced surgeons in the OR. Due to health and safety measures adopted by provincial health authorities, including the cancellation of non-essential surgeries, opportunities to teach residents using traditional models have been limited.
To begin to gauge the effect of the pandemic on surgical residents, Dr. Wagner’s team spells out the different competencies that surgical residents acquire throughout their education, such as surgical knowledge, acquisition and refinement of technical skills, and effective communication with patients and their families. The team then examines how the pandemic has impacted the development of these learning objectives, while considering the impact of decreased time in the OR on residents’ perceived ability to learn effectively.
“The pandemic has proven to be an unpredictable time for everyone,” says Dr. Wagner. “But despite the circumstances, the Seed Fund project has allowed us to take this opportunity to meaningfully contribute to enhancing the learning experience of our trainees through a scholarly approach. A large part of accomplishing that goal is learning to adapt interpersonal and academic methods in the face of ever-changing contexts.”
She also notes that the COVID-19 pandemic is just one of many possible disruptions to education. As the project advances, Dr. Wagner and her colleagues hope to expand their reach beyond the Faculty of Medicine and Health Sciences. “We’re still in the data collection phase, so we have yet to move on to best practices or potential solutions,” Dr. Wagner explains. “But we are already pursuing new projects in the field of surgical education with scholars in ±«ÓăÖ±˛Ąâ€™s Faculty of Education and other Canadian institutions. We hope the results of this study will be helpful as we continue to navigate the pandemic’s ebbs and flows and advance surgical education in Canada.”