I have completed one academic year of online teaching paediatrics to year 4 medical students of the Clinical School Johor Bahru, Monash University Malaysia. All institutions of learning were closed with the implementation of the Control Movement Order (MCO) and its various permutations. All teaching has to be done online. Campuses are closed as are hospitals teaching wards. Medical students are not allowed to go the wards in the hospitals and to interact with patients. Monash students are lucky in that the university has the foresight to create an excellent and well equipped online library a few years ago, so the students never lack for reading resources. There is, of course, always the Internet. Online teaching, in a way, is not new to me. I have been involved in moderating online courses in evidence-based medicine, and healthcare for Monash year 4 students for the last 10 years. The changes are in teaching clinical paediatrics which we used to do in small groups in the campus and on the bedside of patients in the hospital. It is a challenging exhausting year. Yet, in many ways, it has been a fruitful year in the many lessons I acquired while teaching online clinical medicine.
Firstly, I have to rework most of my teaching materials. Without face-to-face interactions, lectures needed to rework into smaller, captivating, and digestible chunks. It is not realistic to expect students to sit through an hour lecture watching you speak on a computer screen. I cannot do that, so I do not expect this younger generation that is used to sound bites and shorter demand to their attention span. So instead of giving a lecture, I have uploaded my revised lectures to the university Moodle. I expect the students to view these lectures on their own time before we come together in our face-to-face Zoom sessions. Then the Zoom sessions will only be used to highlight certain main points I want to emphasis.
Reformatting my teaching materials mean, not only my delivery but also considering how students will learn their clinical contents. I teach case-based tutorials. In previous years, the students will clerk a patient in the ward and present it in our weekly sessions. Now, I have to prepare clinical case studies. When I describe a patient to the student, I am sure without the nuanced previous encounter with patients, the students cannot fully grasp the significant of what we are discussing. It becomes just an intellectual exercise, abate an interesting one. Talking about a child with congestive heart failure due to an enlarged heart is different from standing at the bedside of a small emaciated child, gasping to breathe, and seeing the movements of the heart beneath the thin ribcage. None can forget such an experience. The closest I can do is to search Youtube for video of a child with a similar condition.
Secondly, we usually meet on Zoom which is an excellent platform for watching disembodied digital spirits. The technology is advanced enough for us to see each other in real time, share our screens, and break out into small groups. “You are muted” became our greeting cry! I have spent an entire academic year interacting with students who are digital images. I have yet to meet them in real life. I guess, I am to them, another digital image too. I love teaching because I can interact with real life students. I get to know these students. Over the years, they have become, in some ways, my extended family. I believe that more of medicine, or in my case, paediatrics is caught than taught. It is my hope that I convey to my students through my presence who a good doctor should be (or should not be, as my faults will illustrate). This I cannot do through Zoom. I sense I am just another interactive avatar in a game to them.
I am not saying Zoom is bad. As a teaching tools, it is useful to convey information. Transfer of information, as most educator will highlight, is only a small part of learning. It is high tech, but low touch. Medicine is high tech and high touch. It is the human touch aided by technology.
The technology is here but the telecommunication infrastructure in Malaysia is lacking in many areas. All the students are back at home as the campus is closed. Internet connectivity is excellent in some areas, spotty in some areas, and non existence in others. Zoom is an Internet-based application. Some students have Wifi networks while others try to login using only their phone networks. Hence some students are dropping in and out (often not willingly) during a Zoom session. To preserve their connectivity, they often switch off their video. I appreciate their reason for doing so, but with video and sound off, I often wonder whether they are there at all!
Thirdly, going online made us global teachers and students. We are awakened to the fact that there is so much resources in this digital space. There are so many lectures, clinical photos, case studies, videos of surgeries, and information available not only on the Monash website but in the Internet. As a teacher, I realized that I do not have to reinvent the wheel. I can point students to resources by better teachers and institutions. They, in turn, point me to resources I find useful for my own learning. This vast treasure on the Internet is both a blessing and a curse. It is a blessing because there is much information available, a curse because it does not engage the mind in independent critical thinking.
In Zoom session, I often divide the students into small breakout rooms and give each a topic to research and present in 10 minutes. I am often amazed at how much these students can do in 10 minutes. They come up with very impressive PowerPoint presentations. The students are experts in finding information and in ‘cut and paste’. However, they have problems when it comes to sieving through the information to come to a diagnosis for a patient, or to see the underlying medical principle. They lack the deductive logical thinking skills essential for medical practice. They are slave to the algorithms of clinical guidelines.
Finally, in this academic year of living online, I wonder how the students interact with one another. The clinical school is a temple of learning. This learning comes not only from the formal learning but also by informal and the null curriculum. Online teaching helps to fulfil formal learning but not so much in the others. Learning occurs in interactions between teachers and students. It also important between students themselves. We learn from one another. The clinical school is actually a village. For clinical students, the chief ‘enemies’ are the teachers and the university system. They need each other to prove themselves worthy to their enemies. This builds comraderies and relationship. Students’ relationships teaches them how to work as a team, be resilient in stormy times, and be self-directive. All these are part of the system of clinical education.
The pandemic gives me an opportunity to teach medical students online for one academic year. There are advantages and disadvantages of teaching online especially using Zoom. It also offers an opportunity to re-examine the way of teaching and learning in teachers and students in general. We do not know what the following year will bring. Perhaps another academic year of learning online. Or perhaps not. Let us never forget the lessons we learnt this year. Perhaps it is a good year, after all.