key: cord-0703134-npvjzmyi authors: Park, Hyunmi; Lee, Young-Mee; Ho, Ming-Jung; Han, Hee-Chul title: How the coronavirus disease 2019 pandemic changed medical education and deans’ perspectives in Korean medical schools date: 2021-06-01 journal: Korean J Med Educ DOI: 10.3946/kjme.2021.187 sha: 7143da439a57da45c9614a7c5f1d41d90913ae4a doc_id: 703134 cord_uid: npvjzmyi PURPOSE: This study explored how the Korean Medical Colleges responded to the coronavirus disease 2019 (COVID-19) pandemic and the medical deans’ perspectives on what and how these adaptions influence the present and the future of medical education. METHODS: An email survey combining short and open-ended questions was distributed to all 40 Korean school deans in May 2020. Thirty-seven deans out of 40 medical schools in Korea (92.5%) participated. RESULTS: Most lectures moved online but students’ assessments were delayed and later held onsite. Clinical rotations continued except for an average of 3-week suspension during the first COVID-19 wave. The deans’ remarks on the positive influences far outweighed the negative impact of COVID-19 on medical education. Although technological adaptations caused initial hardship, the experience gained through the use of various online learning systems led to attitudinal changes on the importance of adopting new technology and a tailored and student centric curriculum in medical education. CONCLUSION: The deans’ perspective changes has shown the possibility of the deans’ generation aligning more closely with the current Generation Z medical students. They projected further innovations in teaching and learning methods, especially applying flipped learning and highlighted the need to invest in faculty development so medical educators can be equipped and competent in diverse ICT (information and communications technology) learning platforms. Also, the need for advance preparations in medical education for future similar public health crises were stressed. Unprecedented changes brought by COVID-19 positively impacted Korean medical education in parts and the Korean deans envisioned further innovations using the experiences gained during this crisis. The coronavirus disease 2019 (COVID- 19) pandemic's impact on medical education has been unprecedented and the resulting hardship has led to rapid innovation globally, but has affected the four generations coexisting in medical schools differently. The majority of the medical school deans belong to the Baby Boomer generation (born between 1946-1964) , and the specialists delivering the bulk of the education belong to Generation X (born between [1965] [1966] [1967] [1968] [1969] [1970] [1971] [1972] [1973] [1974] [1975] [1976] [1977] [1978] [1979] [1980] . The young doctors are part of the Millennials (born between [1981] [1982] [1983] [1984] [1985] [1986] [1987] [1988] [1989] [1990] [1991] [1992] [1993] [1994] [1995] [1996] [1997] [1998] [1999] [2000] and the medical students are the new Generation Z, also nicknamed Zoomers [1] . For Generation Z, computers and the internet are just part of life and they expect customized experiences which also includes how medical education is delivered [2] . Marshall and Wolanskyj-Spinner [3] state that the above characteristics may lend themselves to positive developments in the current COVID-19 situation. In Korea, the impact of the COVID-19 pandemic on medical education have been similar to the rest of the world, except for the continued face-to-face clinical clerkships in hospitals. Curricular adaptations to online education settled speedily [4] , and most students swiftly adapted to online learning and showed higher satisfaction levels than expected. Institutional change is known to be difficult and tardy across all fields, and the conservative attitudes of medical educators in Korea were no exception. However, the Korean deans' perspective changes on medical education have been remarkable amidst these enforced and challenging situations. The experiences and lessons gained during COVID-19 have consolidated the deans' perspectives towards a student-cantered education which was previously a concept rather than an actioned need. From the beginning of the pandemic, the medical academic community were able to quickly share knowledge benefitting the continuing of medical education in these tumultuous times. Many papers on innovative ways of delivering virtual clerkship [4] [5] [6] [7] , overcoming challenges [8] , altruistic opportunities [9, 10] , identification and utilization of the hidden curricula [11] , and novel assessment methods [12] Thirty-seven deans out of the 40 medical schools in Korea (92.5%) participated in this survey. Table 1 shows their characteristics. The qualitative analysis of the free text responses school management ( Table 2 ). The deans commented that the application of diverse online teaching and learning methods increased confidence in online education and students were highly Increased confidence in online education in both faculty members and students -Confirming the capability of online teaching -Increased familiarity of online teaching in both teachers and students -COVID-19 pandemic accelerated the adaptation of online learning Application of diverse online teaching and learning methods -The use of various online teaching methods including synchronous/asynchronous lectures, PBL, TBL, and other small group teachings -The use of various online platforms including Google, Zoom, Slacks, and so forth Medical students' high acceptance of, and adaptability to, online learning -Higher than expected satisfaction levels from students for online classes -Highly positive students' responses to the interactive online classes including Zoom PBL -Remedial lessons also able to be delivered online Positive influence on self-directed learning -Increased self-directed learning by repetitive study of online materials -Increased opportunity for individualized tailored learning Confirming the education effect of online education -The intended educational outcomes could be achieved by online or blended learning Student support -Implementing online student counselling/supporting system Educational system and environment Reinforcing online education systems -Development of a new online learning system -Increased development and use of various online contents and learning materials -Increase use of the learning management system -Reinforcing the pre-existing online system among campuses or hospitals in distance Pre-existing facilities -Maintenance of teaching facilities including lecture theatres, to align with online education Technical problems including internet network -Delay in solving internet or network problems as technicians were not on-site -Problems with securing internet network and slow Internet speed -Large video file sizes leading to uploading difficulties -Insufficient server capacity User inexperience of online teaching -Lack of guidance on the use of online teaching tools for faculty and students -Lack of faculty competency or adaptability for online classes -Early operational difficulty in online classes -Difficulty in providing unfamiliar teaching methods Lack of finance and human resources -Economic burden and lack of administrative staff for the operation of individual medical school servers -Too many inquiries at the beginning of online classes paralyzed the medical education department -Insufficient faculty and teaching staff available for divided classes Lack of facilities -Insufficient facilities for online teaching including equipment for video recording, and so forth -Lack of large classrooms available to allow for safe distancing Online assessment -Negative perception of online exams -Lack of measures on how to provide online assessments Difficulty in conducting small group classes -Inexperience in conducting small group lessons online (Continued on next page) non-face-to-face education curriculum or method as a future-oriented medical education system." Other benefits the deans experienced were: "Online meetings enhanced communication and increased transparency on decision making between the school stakeholders." "Experience of infection prevention management improved the schools' response and competence for future public health crisis ( Table 2) ." Negative impacts commented by the deans were mainly related to medical professionalism issues: "Medical education is not only conveying medical knowledge. There must be a rapport built through face-to-face education, but is hindered by the current social distancing." "Ethics education is possible to be given online, but its efficiency is uncertain." Others lamented the untapped educational opportunities when students were excluded from clinical work in exchange for their safety. Academic integrity issues also emerged. Some students working from home blurred their professional behavior in live classes. The major challenges faced were categorized into preclinical and clinical phases (Table 3 ). In the preclinical phase, technical problems related to the sudden shift to virtual teaching were the main concern, which included lack of guidance, support, physical and server capacity amongst others: "There were delays in solving technical problems due to the lack of personnel (Table 4 ). [6, 26] or clerkships [4, 27] , remote simulations [7] , medical student joining bedside teaching COVID-19 rounds remotely via iPad [5] , and virtual OSCEs. This study has several limitations. First, the experience in medical education in Korea may not be transferrable to other countries with more serious pandemic situations or in less resourceful conditions. Second, this study results were obtained by the deans and may not reflect the general perspective of all other teachers or students in medical schools. However, since the medical deans have been at the forefront of the response team and led the adaptations to the pandemic, they may be an ideal subject group who can represent the changes endured. The strength of this study is that it is a national-wide survey with the highest representation of medical school leaders (92.5%). The authors of this study may conclude the un- Words we're watching Is medical education ready for Generation Z? 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