Abstract
Background: The COVID-19 lockdown caused significant limitations in experiential learning opportunities for medical students. Experiential learning is an essential aspect of medical education which allows medical students to deliberately practice and improve upon key clinical skills such as patient consultations, physical examination, and clinical decision making. The medical curriculum disturbances during the lockdown were responded to with digital technology in a variety of methods. One method utilised by educators was the use of virtual reality simulations.
Aims: This thesis uses two studies to explore digital technology's role in medical education to solve limitations imposed by the COVID-19 lockdown. The first study uses quantitative methods to identify student readiness to engage in virtual simulation during the lockdown. This study also explores the relationship between readiness and engagement and the virtual simulation's value as a learning tool in this environment. The second study uses qualitative methods in order to assess educator opinions and attitudes regarding their use of digital technology in response to limitations imposed by the COVID-19 lockdown.
Methods: Year 4, 5 and 6 undergraduates spread across the three campuses of the Otago Medical School, University of Otago were invited to participate in Study 1 (n=874). This study involved completing online virtual simulation cases and three online surveys. The surveys assessed students' readiness to engage with the simulation, motivation, confidence, and experiences. Our assessment of readiness was developed from various measures which included the online learner readiness scale, the MUSIC model, and the Michigan virtual online learner readiness rubric. Motivation was assessed using the MUSIC model and confidence was measured using a questionnaire provided by the simulation developers.
Medical educators were selected using purposive sampling and were invited to participate in study 2 (n=6). Study 2 used semi-structured interviews to inquire about educators' use of digital technology in response to the COVID-19 lockdown limitations. The interviews were transcribed and coded using a general inductive approach. A thematic analysis was conducted on the results to develop a framework.
Results: 48.9% (419/874) of participants had responded to the initial survey, and 16% (166/874) of participants had engaged in the virtual reality simulations used in study 1. The mean total readiness score was 3.83, which indicates that students were generally ready to engage with the simulations in the lockdown environment. Students' total readiness did not show any relationship with engagement; however, dimensions of readiness, including selfdirected learning (p=0.042) and success (p=<0.001) showed a relationship with engagement. The self-directed learning dimension was associated with a direct correlation, and the success dimension was associated with an inverse correlation. The simulations had a beneficial effect on students' confidence to perform clinical tasks (p=0.002). Students' opinions suggested that this form of learning is a valuable and useful learning tool that they would choose as a method of learning.
Interviews conducted in Study 2 were analysed using the general inductive approach. Six key themes were identified, which were COVID-19 limitations, the clinical workforce impact, use of technology as a response, learning, student factors and future implications. The educators used virtual reality simulations, digital communication software, and livestreaming software to deliver experiential learning opportunities. Educators found variable success with these responses as learning tools. However, educators' opinions regarding virtual reality simulations were generally positive and highlighted its significance in enabling experiential learning and future medical education implications.
Conclusions: Virtual reality simulations become increasingly valuable as a learning tool in environments such as a lockdown where physical limitations are imposed upon students and educators due to its ability to enable experiential learning. Students are generally ready to engage and use this technology during a lockdown. Many students showed interest in accessing the virtual simulation; however, only a small number of them participated in the simulation. The low participation rates may be due to environmental factors and suggest that simply providing technology is not enough to ensure engagement with a learning opportunity. However, students and educators' opinions, student's readiness levels, and the effect of the simulation on confidence are all factors that suggest that there is significant value in virtual reality simulation as a method of experiential learning in response to limitations imposed by the COVID-19 lockdown.