Narrowing expansive horizons: Experiences of first-year medical students and teaching faculty in a new multidirectional digital classroom for three- and four-year medical school programs

Introduction:  To address the country’s shortage of primary care physicians and increasing medical student debt, the Medical College of Wisconsin matriculated students into accelerated 3-year campuses in Central City and Packer City, while maintaining its traditional 4-year campus in Brew City, Wisconsin.  To ensure consistent content delivery within the basic science curriculum, students at all three campuses simultaneously participate in daily learning activities, utilizing distributed learning through a multidirectional digital classroom incorporating video-conferencing and audience response systems.     Methods:  To best uncover and understand the perspectives and attitudes of faculty and medical students, qualitative and quantitative research methods were employed framed within constructivist grounded theory.  This framework is rooted in social processes of the participants lived experiences and views these experiences as paramount to the analysis and presentation.  Prospectively, data was acquired regarding individual experiences from first-year medical students and medical school teaching faculty across the three campuses.  Beginning in the 2015–2016 academic year, nine semi-structured focus groups were conducted with concluding surveys.  These focus groups were separated by campus location: medical students at Brew City, medical students at Packer City, and faculty who taught at either the three-year regional campus or four-year campus.  In winter 2017, the study expanded including one additional student-centered focus group in Central City.  Each focus group was recorded using a hand-held device, transcribed, and analyzed using the constant comparative method.  This inductive approach required close examination of the transcriptions and line-by-line analysis to assign codes that captured the emerging themes.  To triangulate the data and further understand the medical student and faculty lived experiences, a concluding survey was distributed to participants.  This survey included eight, seven-point Likert-scale questions to further ascertain experience and overall satisfaction with the new learning environment.  Numerical data was analyzed with IBM® SPSS® 24.  This study was approved by the institutions review board. Results: In 2015–16, Packer City students rated their overall learning experience significantly (d=0.74, p<.050) higher (mean (sd)=7.6 (0.6)) than students in Brew City (6.7; 1.6) and significantly higher (d=1.21, p<.034) than the faculty (6.0 (1.0)). During 2016–17, overall learning experience scores did not differ from those of the previous years for Packer City (D=0.0) or Brew City students (D=0.0). A comparison of scores across all three campuses in 2016–17 yielded a significant change (d=1.28, p<.037) between the Central City campus (mean (sd)=7.8 (1.1)) and the Brew City campus (6.7 (0.5). No significant changes were reported between Packer City and the other two campuses.  Three overarching themes emerged from both the students and faculty throughout the study: (1) The construction of a knowledge-based community of practice, (2) responsiveness to diverse learning preference, and (3) how participants negotiated teaching and learning within the multidirectional digital classroom. Conclusion: These findings have the capacity to provide guidance when re-designing and facilitating medical school curricula and for learners who engage in new multidirectional digital environments.  Regardless of teaching site, all educators must be mindful of students’ learning needs and recognize how the overall learning experience is influenced by faculty, physical environment, and the ways in which students interact with one another daily.