Implantation of Distance Learning as Strategy in Medical Internship: Challenges and Perspectives

ABSTRACT The theoretical and practical experience of medical school can be approached using virtual environment learning strategies. In this respect, flexible time and space would appear advantageous for the establishment of the teaching-learning process in the period where there is a predominance of practical activities. The virtual environment can represent a space for sharing experiences and discussions with students in different practical scenarios. This case study aims at evaluating how medical interns perceived learning in two different scenarios using the Moodle virtual environment. The first intervention consisted of discussing clinical cases of patients with infectious and parasitic diseases who had been treated or assessed in primary or secondary health care by other interns. The second intervention involved completing the reflective portfolio, with teacher feedback regarding the activities performed by the interns during their public health internship. In both cases prior expectations, subsequent satisfaction and self-perceived learning were systematically analyzed. As a result, the responses of 36 students were evaluated in the first intervention, and of 30 students in the second, accounting for more than 97% of the students invited. Most of them considered the Moodle environment suitable and reported knowledge/skill gain in both interventions. The main gains pointed to were improved skills for clinical reasoning and reflection on clinical practice in primary care. In the discussion of clinical cases, student involvement increased significantly once they were awarded marks for qualified participation in the activity. In the reflective portfolio, teacher feedback was considered an important motivating factor for the students. However, 51% of their posts received no teacher feedback. In conclusion, the virtual environment was considered useful for student learning during internship, but there remains a need to develop the tutors’ role in this process.

摘要：医学院校的理论与实践学习可依托虚拟环境学习策略开展。在实践活动占主导的教学阶段，灵活的时空条件对教学活动的推进具备显著优势。虚拟环境可作为不同实践场景下医学生共享经验、开展研讨的专属空间。本案例研究旨在评估医学实习生对两种不同场景下使用Moodle虚拟环境的学习体验感知。第一项干预措施为讨论由其他实习生在基层或二级医疗卫生机构接诊或评估的传染病与寄生虫病患者临床病例；第二项干预措施为完成反思性档案袋，并获取教师针对实习生公共卫生实习期间所开展活动的反馈意见。研究对两种场景下参与者的前期预期、后续满意度及自我感知学习成果均进行了系统性分析。结果显示，第一项干预共回收并评估了36名学生的反馈，第二项干预则评估了30名学生的反馈，受邀学生参与率均超过97%。绝大多数参与者认为Moodle环境适配本次学习活动，并表示在两项干预中均获得了知识与技能提升。学生提及的主要能力提升包括强化了基层医疗场景下的临床推理能力与临床实践反思能力。在临床病例讨论环节，当学生因达标参与本次活动获得考核评分后，其参与度显著提升。在反思性档案袋环节，教师反馈被视为重要的学生学习激励因素，但仍有51%的学生提交内容未获得教师反馈。综上，虚拟环境被认为有助于实习生在实习期间的学习，但仍需进一步强化导师在该过程中的作用。