Cross-faculty learning and virtual observation sessions: How medical education has evolved

Professor Dr Raja Affendi Raja Ali, Dean of Faculty of Medicine at The National University of Malaysia, tells us the wider trends in medical education today, including inter-professional learning and digital learning aids

The field of medicine is evolving rapidly, and will call for different skillsets from doctors and medical professionals of the future – thus medical school curriculums need to advance in tandem to produce competent doctors ready to meet these needs, said Professor Dr Raja Affendi Raja Ali, Dean of Faculty of Medicine at The National University of Malaysia (known as UKM, short for Universiti Kebangsaan Malaysia).

One key difference will be the rise of shared decision making with patients, rather than the doctor-led decision processes of today, he said. Critical thinking skills will be an increasingly important core skillset for clinicians, in appraising relevant information and applying them into day-to-day practice.

With more focus on integrated care – where clinicians from different disciplines come together to care for a single patient collaboratively – Professor Dr Affendi shared that UKM has adopted an inter-professional learning (IPL) approach so students get used to working with peers from other fields.

“We know that doctors are going to meet a lot of other healthcare professionals involved in the managing of patients,” said Professor Dr Affendi. “For example, in managing obesity, it is important for doctors to communicate effectively with nutritionists and dietitians.”

Also, multimorbidity – where multiple chronic conditions occur in an individual patient – is on the rise, as longer life expectancy increases the possibility of chronic disease developing. Managing multimorbidity greatly increases the complexity of disease management, and requires more multi-discipline collaborations between clinicians.

While such collaborations ensure more holistic care, they may also lead to differing and sometimes contradicting opinions. It is thus important that students are taught how to found decision-making processes on evidence-based medicine.

“The traditional disease-focused approach to clinical medicine may lead to care that is fragmented and poorly coordinated, and produce treatment plans that are inefficient, ineffective, or even harmful for patients. We use UpToDate, which provides expert recommendations for complex patient conditions,” Professor Dr Affendi added.

“We receive a lot of positive and constructive feedback from the users in our faculty. It is a great alternative that we have, so users – even though they don’t see patients physically – can access and navigate UpToDate and various sources to complement the teaching and learning in the medical school. Overall, it is a fantastic resource for the evidence-based practice.”

At UKM, joint IPL sessions gather medical students together with those from Pharmacy and Nursing to discuss patient cases. Besides exposing students to the work environment they will face in the future, the dean sees this as a way to build empathy, communication and teamwork skills, starting from the first year of school.

“If you look at the medical curriculum many years ago, there is maybe a lack of empathy… You don’t put yourself in the patient’s shoes,” he said. “When our students get together with other disciplines outside the faculty, we hope that their minds will change: to treat the patient who has the disease, rather than treat the disease.”

Acceleration of digital adoption

Another key trend in medical education is the accelerated rate of digital transformation and use of digital platforms for learning, Professor Dr Affendi added.

Even before the pandemic, the faculty had introduced Zoom as one of the platforms for its classes. “The lecturers can teach virtually anywhere now… they may now choose to hold their classes after office hours or even on the weekends, and see their patients during the day,” he noted.

It was a good foundation to build upon when the pandemic drove the full shift to virtual classes. Professor Dr Affendi shared that to ensure all faculty members are brought up to speed on effective online teaching methods, a few lecturers who were particularly adept in digital teaching were nominated as teaching ambassadors. They led a video series titled “How I do it?”, where they shared with their fellow lecturers how to fully embrace the digital learning culture and how can digital can be integrated with clinical teaching.

affendiThere are also plans to have dedicated clinics for students to observe patient interactions virtually.

“We are in the process of setting up dedicated clinic rooms equipped with cameras and other tools, so doctors can see the patient as usual and students can monitor how the history taking and process is like,” he said. The school will be working out the SOPs and issues such as patient consent before rolling this out.

Digital transformation as the way forward

Feedback from faculty and students on new digital tools have been largely positive, but Professor Dr Affendi acknowledged there are some challenges. For example, some students face poor internet connectivity issues, while others have had to fork out extra for 4G data to stream their classes.

Also, in terms of virtual medical classes, Professor Dr Affendi pointed to a lack of benchmarking or evaluation on the most suitable digital clinical teaching method, how it can incorporate necessary in-person sessions on physical examinations, and how schools can shift to accommodate that rapidly. There is also the need to balance the costs and the quality of digital learning technology.

Nonetheless, he is firm in his belief that online teaching will be the main staple moving forward. He was glad that so far, students and lecturers have been agile and open to adapting to changes in teaching methods and style. “It’s important that the lecturers and students know, even though COVID-19 may subside in the coming months or years, we will still continue to have dedicated online teaching… we are not going to go back to the old ways,” he said.

In fact, he sees that digital will continue to change many aspects of education. “I can foresee the first or second year students of the future may not need to come physically to college… or maybe the Netflix of education will be introduced,” he mused.

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