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On-campus to online: 91�㽶��Ƶ adjusts to virtual educational environment

Medical students at the West Virginia School of Osteopathic Medicine (91�㽶��Ƶ) have moved from a hands-on learning approach to using their hands to type on keyboards in a virtual educational environment.

Since its beginning, when 91�㽶��Ƶ accepted the first class of students in 1974, the school has always been a hands-on institution. Over the years, some students have chosen to listen to audio recordings of lectures remotely in their homes in addition to attending traditional classroom lectures, but with federal guidelines related to the COVID-19 pandemic forcing people to work and learn remotely, 91�㽶��Ƶ students and faculty members have made the switch from on-campus to online learning for the remainder of the academic year.

The decision to do so was made by 91�㽶��Ƶ President James W. Nemitz, Ph.D., in response to the pandemic and in abiding by West Virginia Gov. Jim Justice’s stay-at-home directive for the state. 91�㽶��Ƶ classes moved to online delivery of the curriculum on March 30.

“Luckily, we were near the end of our academic calendar, but each year of medical school — from the first year, when a student is just getting started, to the fourth year, when a student is near graduation and about to begin residency — is completely different,” said Craig Boisvert, D.O., 91�㽶��Ƶ’s vice president for academic affairs and dean. “It has taken a great deal of effort among 91�㽶��Ƶ employees in various departments, who have had to adjust how we offer a quality education to our students during this unprecedented time. And it continues to evolve each week.”

PRECLINICAL EDUCATION: FIRST AND SECOND YEARS

When West Virginia’s stay-at-home order went into effect, 91�㽶��Ƶ’s administration and staff worked quickly to alter the way lectures, exams and other essential pieces of medical education were offered to students.

91�㽶��Ƶ’s associate dean for preclinical education, Roy Russ, Ph.D., said that thanks to help from other campus departments and from his own staff, the transition to online-only preclinical education took less than 24 hours. The school’s media services and information technology departments ensured lectures were livestreamed, and preclinical education staff generated calendar invitations for each lecture so that students could easily “attend” live classes using their school-issued laptops. Approval for the changes was sought and obtained from the Higher Learning Commission, the largest accrediting agency for post-secondary educational institutions in the U.S.

“In terms of content delivery, there were fewer disadvantages than anticipated,” Russ said. “First-year students had two and a half courses left. Their anatomy labs are being given virtually, and we’ve deferred their hands-on activities. For OPP [osteopathic principles and practice] labs and clinical skills, we’ve decided to include that material with their second-year courses when they come back.”

Russ explained that exams are being administered via students’ computers, as was the case prior to the stay-at-home order. However, instead of taking exams on campus, students are now permitted to take them from their home locations.

91�㽶��Ƶ’s second-year students had only one course remaining, but they face an issue for which medical schools throughout the nation are still searching for a solution. Russ said that because testing centers operated by the Prometric company are closed, students are unable to take the national board exam that’s required prior to the start of rotations that comprise the third year of medical education.

“Students can’t take the COMLEX Level 1 exam until testing centers reopen, but we don’t know when that will be,” Russ said. “Our concern is finding a way to get the exam administered so they can start the third year on time. If we delay the exam and let them start the year without it, students will be in the position of studying for a comprehensive exam while also trying to learn materials in their rotations, and that’s not ideal.”

Perhaps unexpectedly, the change to an online learning environment has actually led to increased use of one particular educational resource: office hours. Russ explained that faculty members can send virtual invitations listing times they’re available online to help students.

“The feedback I’ve gotten from faculty is that students are using online office hours more than they used the on-campus office hours,” Russ said. “If you’re at home and you have a question, all you have to do is click a button, where before you would have to come to campus to see the faculty.”

First-year student Lucas Betterton said that so far, he finds the online learning environment easy to use, and in some ways, even beneficial.

“In a classroom where there are 200 of us and somebody puts their hand up, it’s sometimes difficult to get the professor’s attention, but that doesn’t happen online,” Betterton said. “People also might be better able to articulate their question when they can write it down and have it pop up on the professor’s screen.”

Betterton said that apart from some internet connectivity issues, the transition has gone smoothly, and he thinks most students have adapted well to the temporary circumstances.

“The faculty have been amazing in keeping in touch with us, making sure that we’re all following along. And our student leadership has really stepped up and listened to our concerns,” he said. “As ironic as it is, social distancing may have brought us closer to some of the faculty and brought us closer as a class. Shared hardships can result in friendships.”

PREDOCTORAL EDUCATION: THIRD AND FOURTH YEARS

At 91�㽶��Ƶ, a student’s first two years of a four-year program are spent on campus in Lewisburg, W.Va., while the latter two years are spent on rotations in clinics and hospitals throughout 91�㽶��Ƶ’s Statewide Campus. Currently about half of the school’s total student body have had rotations placed on “pause” by the American Association of Colleges of Osteopathic Medicine (AACOM), the nonprofit organization that supports the 36 accredited osteopathic medical schools in the U.S.

“This all occurred in March when a perfect storm of things occurred,” said Robert Pepper, D.O., 91�㽶��Ƶ’s associate dean for predoctoral clinical education. “Hospitals wanted to protect their low supplies of masks, gowns, etc. and they didn’t want to expose people to COVID-19 unnecessarily.”

That meant sending home nonessential personnel including medical students on rotations. Fourth-year students preparing to graduate at the end of May had only one or two required rotations to complete before the end of the academic year. Most of those students had matched to their residency locations in March, just before social distancing guidelines and stay-at-home orders were put into place.

Third-year students, though, were in the heart of rotations, trying to complete core rotations in specialties such as emergency medicine or pediatrics. Students who had completed part of their core rotation in the hospital then completed their rotation online. Those starting their rotation online will hopefully be able to complete their rotation in the hospital. Students completing their entire core rotation online will need to complete the clinical portion during their fourth year.

“The third-year class has a lot of things going on. They are trying to complete most of the seven core rotations that are their bread and butter courses, rather than electives,” Pepper said. “We had to convert their live clinical rotations to an online format, including interactive cases, patient simulations and readings.”

In one instance, faculty worked with 91�㽶��Ƶ’s media services team to create a video about a patient encounter in which students took a patient’s history and wrote a physical — an objective often enhanced by a face-to-face encounter.

As is the case with second-year students, third-year students face the challenge of postponed national board exams. Pepper said that COMLEX Level 2 board exams, which are required before a student can begin his or her fourth year, are typically completed in June. The predoctoral education department is working to determine alternative solutions, which could include requiring students entering their fourth year to take mandatory vacation at the end of this summer rather than at a time of their choosing.

While online learning for medical students may be acceptable in the midst of the COVID-19 pandemic, it is not feasible long-term, Pepper said.

“It’s always been adjunct, but never has it been a replacement,” he said. “Nothing replaces the patient-to-patient encounter. Patients like the convenience of telehealth and video chats, and we are seeing that more and more in physicians’ practices, but for students learning something like surgery they have to be there.”

VIRTUAL TEACHING: 91�㽶��Ƶ FACULTY ADAPT TO ONLINE INSTRUCTION

Students may be on the receiving end of online learning, but 91�㽶��Ƶ faculty have had to make major adjustments in order to deliver online classes.

Jack Thatcher, Ph.D., an associate professor in the Department of Biomedical Sciences, was the director of the renal course, one of the first courses to move entirely online.

“There was definitely a learning curve,” he said. “Preparations required for online delivery were significant, requiring numerous communications and beta testing.”

91�㽶��Ƶ has heavily relied on its Cisco Webex system for the delivery of online classes. Employees in the information technology and media services departments have been available in the classroom where faculty are teaching to an empty classroom and assisting with technology problems that arise with the virtual delivery. Additionally, staff members who oversee student testing in the school’s Exam Center have had to manage the online delivery of quizzes and exams for students studying remotely. 

“One issue is delivering lectures and active learning experiences to empty classes, which is strange to say the least,” Thatcher said. “Students can submit and answer questions through the chat room, but it’s not the same as having them there. You lose all nonverbal communication and you can’t feed off their energy.”

Kristie Bridges, Ph.D., is the faculty director for the endocrinology course currently taking place. She also chairs the Department of Biomedical Sciences.

“One of the biggest differences has been my role in the classroom sessions. In the past, I would focus on the content and how it was being presented to make sure all faculty teaching the course were on the same page and to get ideas for improving the course next year,” she said. “With online classes, my role has shifted to being mainly technical — monitoring the chat function to make sure no student questions are missed and messaging students individually during the session if they’re having problems.”

Though students enjoy some advantages to the online classroom in the form of virtual office hours and chat functions during online lectures, Bridges and Thatcher said delivering medical curriculum online isn’t ideal.

“While you can show students a video on how to do a physical exam, they really need to practice doing it and get immediate feedback on that. The same applies for most interactive teaching methods such as anatomy lab and simulation. You can deliver the content without doing those hands-on activities, but students don’t get the opportunity to practice what they’ve learned in a real-life situation,” Bridges said. “Delivering content is only part of the equation. I may be old-fashioned but I still haven’t found a virtual activity that comes close to the learning I’ve seen happen when you get students in a small group, ask them to show you something or do something, and are able to give them immediate feedback. That’s when the lightbulb moments usually happen.”

91�㽶��Ƶ has no plans to make the move from on-campus to online courses permanent, but just as medical schools across the nation are adapting to new ways of teaching and learning, so has 91�㽶��Ƶ.

“This is a necessary response to a serious global situation,” Thatcher said. “One positive is that it has been an opportunity for faculty, staff and administration to set an example of dealing with a challenge in a collaborative and professional manner.”

TECHNOLOGY NEEDS: IT, MEDIA SERVICES ESSENTIAL IN SWITCH TO ONLINE CLASSES

A large part of that successful collaboration has been a result of the efforts of 91�㽶��Ƶ’s information technology and media services departments, who, together, are ensuring the livestreaming of lectures works as planned.

Kim Ransom, 91�㽶��Ƶ’s chief technology officer, said employees are striving to make it easy for faculty and students both to adjust to the realities of lectures delivered remotely.

“Faculty aren’t used to using Webex for lecturing, and students aren’t used to participating in that manner. But I think it’s going relatively smoothly,” Ransom said. “We had to very quickly make sure Dr. Russ’ staff were comfortable inviting people to Webex sessions, we worked with media services to handle lectures, and we’re trying to have some of the IT staff field Webex support within the classroom.”

Before the stay-at-home order, faculty delivered lectures to students in the classroom, and those lectures were recorded to a flash drive and uploaded to an academic management system known as E-Medley for later listening. The change to online-only learning, however, meant lectures needed to be viewable in real time.

That transition required creative solutions, said Michael Fowler, 91�㽶��Ƶ’s interim director of media services.

“We didn’t want faculty to just share their screen and talk in front of a laptop,” Fowler said. “We wanted them to be able to put on a microphone just as they would if they were teaching to a full room, providing superior audio quality for the recording and for students who are watching live. Also, our staff is now in the classroom at all times. We load the PowerPoint and we make sure the Webex session looks and sounds good. Faculty already have enough going on, so we made it so they can just come in and give their lecture.”

That wasn’t the only aspect of the lecture experience that had to change. In the classroom, students were able to answer multiple-choice questions using “clickers” that sent their responses to an audience-response system called TurningPoint. With students watching lectures from their homes, the clickers were no longer an option.

“When we stopped bringing students into the classroom, getting their responses became difficult,” Fowler said. “We spent a couple of days working with TurningPoint to find ways to allow students to respond remotely. Ultimately we worked it out so that students can respond using a mobile device or web browser, and it’s succeeding. We found that each question is getting a response rate of about 40 to 50 percent of participating students.”

In many ways, 91�㽶��Ƶ is ahead of the curve in regard to making sure students’ technology needs are met. Ransom said the department is fortunate to have ordered computers for students in the upcoming Class of 2024 in January, before the pandemic made supplies scarce. The school received the devices in March.

“We’ve always erred on the side of caution and tried to get supplies earlier rather than later,” Ransom said. “We’ve already received the devices for next year, and we’re now being told by the vendor that there’s nothing left because suddenly everybody is trying to procure hardware. Their inventory is completely depleted. But we’re ready for the Class of 2024.”

That kind of foresight also has allowed the information technology department to anticipate technological needs. Ransom explained that should a faculty member need to record a lecture from home, her team is prepared to make it happen.

“Right now we’re doing the recordings in the classroom,” Ransom said. “But let’s say we have a clinician at the Robert C. Byrd Clinic who becomes quarantined but still needs to provide a lecture. We’ve prepped everything in such a way that they can feel comfortable doing that from their home.”

EDUCATION FIRST

In the end, delivering content to students is the most critical responsibility of any medical school. 91�㽶��Ƶ is no exception, and although the school’s mission goes beyond educating tomorrow’s physicians, priorities have shifted to ensure that students continue to receive the quality osteopathic medical education for which 91�㽶��Ƶ is renowned, even in the midst of a pandemic. Fowler said that difficult times often call for difficult decisions.

“The most essential portion of my department’s role is to deliver the curriculum, and that’s where our focus has moved,” Fowler said. “We had things we wanted to do during spring break, such as upgrades, inventory and storage cleanup, but our focus has shifted solely to the classroom and to making sure the curriculum is delivered flawlessly.”

Ransom said she’s pleased with the way members of her staff are working together to safeguard the school’s commitment to its students.

“Our employees have really come together in a service-oriented fashion to make sure faculty, staff and students have the technology they need,” she said. “We’re doing our part to get through this crisis, just like everybody else.”