Message from Our Staff: The big question: To keep online learning or resume face-to-face?

By Associate Professor Tham Kum Ying, Assistant Dean for Year 5, LKCMedicine

Enough has been said about how well our students, faculty and staff have pivoted quickly and adapted well to online learning, teaching, and working in the past two years of COVID-19. With the progressive lifting of pandemic-related restrictions, the question is not whether we should keep these online activities but how much to keep online and how much to resume face-to-face (F2F)? As in most things in life, the answer is “It depends!”

As a content expert for several Year 1 online Team-Based Learning (TBL), the absence of the buzz, noise, energy, and dynamism is real. Pre-pandemic, the active construction of knowledge especially during the Application Exercise stage is exciting and fun. For example, a student asks, “Why is the patient’s pain referred to his abdomen?” After my reply, another student will follow up with an equally good question, “Does this mean that other patients with a similar diagnosis will also experience such referred pain?” Such questions illustrate powerfully that learning is socially constructed – a distinct advantage of TBL – and content experts are very delighted by such student engagement. All these hardly happen during the online TBLs. 

On the other hand, my experience with the Year 5 students is different. We created Extended Case-Based Learning (ECBL), which is an online activity with two parts: (a) one student is in the “hot seat” for a mock-OSCE case (Objective Structured Clinical Examination e.g., take a history from a standardised patient, followed by questions from the assessor) and (b) the assessor-clinical tutor gives feedback to the student, and shares key points on the case with the entire class. The senior students do not hesitate to unmute or type in the chat their questions about the case and history-taking techniques. The quality and quantity of questions are good, and many tutors enjoy the student engagement during these EBCLs. 

Why the difference? 

Perhaps for the current Year 1 and 2 students who have only experienced online TBLs, the essential stages of forming-storming-norming-performing (Tuckman, 1965) to become effective teams are not facilitated by the virtual environment. The Year 5s, who are now working as Postgraduate Year 1 doctors, learned how to be effective team members in Year 1 and 2, and replicate this behaviour even in the virtual environment. TBL material in Year 1 and 2 has clearly defined boundaries such that students with individual effort can study and be confident in passing the year end written exams. Year 5 material on the other hand, makes the students realise that the more they share and co-learn with peers, the better they get, and the higher their chance of passing the final exams! There are probably other reasons that are worth exploring, and I hope someone will take this up as a research study.   

A hybrid model that combines the best of online and F2F is probably appropriate and preferred. The convenience and efficiency of online learning, teaching, and working are undeniable. The liveliness and energy during F2F sessions facilitate learning, and more meaningful interaction between student and patient, and among students, faculty, and tutors. Which brings me back to the original question: how much to keep online versus resume F2F? The answer is worthy of serious consideration by our education leaders, and I am certain it will change our culture. 

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Bibliography:

Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384–399. https://doi.org/10.1037/h0022100