Changes to clinical education during the COVID-19 pandemic: Challenges and opportunities.

The COVID-19 pandemic has caused widespread disruption to communities worldwide, and it is not surprising that health professions education was also affected. Changes have occurred at all levels of medical education: from undergraduates and doctors-in-training through to continuing professional development for established professionals. Educators had considered some of these changes for a long time, and the pandemic gave the final impetus to act. Other alterations were made simply to manage the crisis. With the shift to remote learning and the removal of students from clinical placements, we are only likely to fully understand the impact on training for the next generation of health practitioners in the years to come. In my workplace, our clinical students were unable to attend the hospital for months at a time during 2020 and faced significant limitations to patient access in 2021. Our response included casebased discussions to make didactic learning more clinically oriented, ‘meet the expert’ sessions run via videoconference and pre-recorded lectures for students to watch in their own time. Given the need to transform teaching programmes to virtual delivery as quickly as possible, it is unclear whether the change decisions were made based on educational merit rather than necessity. It is incumbent on educators to reconsider those choices in light of best practice learning theory and curriculum design principles to ensure that suitable modalities are chosen to match the intended learning outcomes. Any teaching that might best be delivered in-person should return to that form of delivery as soon as the pandemic allows. One method likely to become more prominent is the ‘flipped classroom’ model. This form of teaching requires learners to access learning materials before the scheduled session with the teacher. The in-person session becomes an opportunity to clarify misunderstandings and extend knowledge using active learning strategies such as case studies, simulation or debate. Materials developed for virtual or asynchronous use during the pandemic could be utilized as the ‘pre-reading’ for the classroom session. A novel strategy is virtual patient encounters, whereby the educator brings a videoconferencing device to the patient, and learners access the session remotely. This mitigates potential infection risks while still allowing students some semblance of real patient interaction. The literature supporting this technology-enhanced learning technique is still evolving. As many of the students most affected by the restrictions to clinical teaching are still to complete their studies, we cannot yet know whether their preparedness for practice has been affected. New graduates face a variety of learning and professional development challenges, some of which are difficult to measure before they begin their careers. We might only discover some deficiencies once they start work on our teams. Later stage doctors in specialist training programmes have also faced disruption to their progression. Professional bodies have enjoyed varying levels of success in adapting their education and assessment delivery to the requirements of social distancing and minimizing non-clinical patient contact. Media reports of failures are frequent, and one must think of the experience of our trainees with concern. The validity of assessments conducted virtually rather than inperson must also be considered. They are not a ‘like for like’ replacement—each has its strengths and weaknesses—and it is critical to understand this when planning assessment. Workplace-based assessments have also become more complex to administer due to the need to reduce crossinfection risks, and evaluation of procedural skills is challenging without face-to-face interaction. Virtual supervision using task checklists is one way to standardize this process and remove potential sources of bias; however, many of these tools have not been developed or validated for the remote assessment of skill performance. There are publications describing strategies for remote skill assessment; however, this remains a nascent area of the literature. Continuing professional development is now more challenging for clinicians used to attending in-person meetings to present their research, network and learn from their colleagues. Virtual conferences have taken the place of traditional gatherings, and one imagines conference planners face the future with uncertainty. There have always been barriers to attending major scientific meetings, including time away from work and family and travel and accommodation costs. These barriers might disproportionately affect potential attendees in earlier career stages or from lower socioeconomic backgrounds. A hybrid option that allows for both in-person and virtual registration might encourage participation by those who would otherwise be unable to attend. If professional societies wish to make hybrid conferences as accessible as possible, however, the platforms they adopt to deliver their sessions will need to improve. Caps on Received: 14 December 2021 Accepted: 21 December 2021