Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 70

The novel coronavirus disease was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplace-based clinical learning in response to the pandemic. The objectives were to synthesise what adaptations/innovation were implemented (description), their impact (justification), and ‘how’ and ‘why’ these were selected (explanation and rationale). The authors systematically searched four online databases up to December 21, 2020. Two authors independently screened titles, abstracts and full-texts, performed data extraction, and assessed the risk of bias. Our findings are reported in alignment with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance. Fifty-five articles were included. Most were from North America (<i>n</i> = 40), and nearly 70% focused on undergraduate medical education (UGME). Key developments were rapid shifts from workplace-based learning to virtual spaces, including online electives, telesimulation, telehealth, radiology, and pathology image repositories, live-streaming or pre-recorded videos of surgical procedures, stepping up of medical students to support clinical services, remote adaptations for clinical visits, multidisciplinary team meetings and ward rounds. Challenges included lack of personal interactions, lack of standardised telemedicine curricula and need for faculty time, technical resources, and devices. Assessment of risk of bias revealed poor reporting of underpinning theory, resources, setting, educational methods, and content. This review highlights the response of medical educators in deploying adaptations and innovations. Whilst few are new, the complexity, concomitant use of multiple methods and the specific pragmatic choices of educators offers useful insight to clinical teachers who wish to deploy such methods within their own practice. Future works that offer more specific details to allow replication and understanding of conceptual underpinnings are likely to justify an update to this review.

2020年3月，新型冠状病毒病被认定为全球大流行疫情，这使得医学教育必须做出适应性调整。本系统综述整合了已发表的相关研究报告，聚焦于疫情背景下将基于职场的临床学习转向在线学习的医学教育发展与创新举措。本研究的目标在于：整合已实施的适应性调整与创新举措（描述层面）、这些举措的实施效果（合理性佐证），以及相关举措的选择依据与落地路径（解释与理论基础）。研究团队于2020年12月21日前系统性检索了4个在线数据库，由两名研究者独立完成标题、摘要与全文的筛选、数据提取以及偏倚风险评估工作。本研究的报告严格遵循STORIES声明（医疗教育证据总结报告结构化方法，STructured apprOach to the Reporting in healthcare education of Evidence Synthesis）与BEME指南（医学教育最佳证据，Best Evidence in Medical Education）的规范。最终纳入55篇文献，其中多数来自北美（n=40），近70%的研究聚焦于医学本科教育（undergraduate medical education, UGME）。核心发展举措包括从基于职场的学习向虚拟空间的快速转型，具体涵盖在线选修课程、远程模拟教学（telesimulation）、远程医疗（telehealth）、放射学与病理学影像库、手术操作的直播或预录视频、医学生顶岗支援临床服务、临床就诊的远程适配方案、多学科团队会议与病房查房等形式。本次综述识别的挑战包括：人际互动的缺失、标准化远程医疗课程的匮乏，以及对教师时间投入、技术资源与设备的需求压力。偏倚风险评估结果显示，纳入文献对研究的支撑性理论、资源配置、实施场景、教育方法及教学内容的报告质量普遍偏低。本综述聚焦医学教育工作者针对疫情开展的适应性调整与创新举措的实践响应。尽管多数举措并非全新，但举措的复杂性、多种方法的协同应用，以及教育工作者的务实化具体选择，可为希望在自身临床教学实践中应用此类方法的临床教师提供有益参考。未来若有研究能提供更具体的实施细节，以方便其他研究者复刻相关实践并明晰其理论基础，则可为本综述的更新提供佐证依据。