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Center for the Future of the Health Professions Dec. 2020 column: The viability of hybrid education in entry-level health professions programs

Director’s note

This month, The Center for the Future of the Health Professions will be posting our third monthly op-ed column and the last one for 2020. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce, so they can effectively plan for a sustainable future and make the best use of available resources.

This month features Earla J. White, PhD, MEd, and Leonard B Goldstein, DDS, PhD. Dr. White is chair of undergraduate medical education and associate professor of health systems science within A.T. Still University’s School of Osteopathic Medicine (ATSU-SOMA), and Dr. Goldstein is assistant vice president for clinical education development at ATSU. They discuss the hybrid educational model as a viable solution to overcome an array of challenges, such as the isolation and disruptions experienced during the COVID-19 pandemic. In the last year, hybrid education has become a best-practice method for health professions education programs to bring together professionals and scholars and help them to become adept at creative new approaches to traditional classroom and clinical learning. We encourage readers to share their thoughts after reading this important piece.

By Randy Danielsen, PhD, PA-C Emeritus

Self-directed and collaborative learning through inquiry and innovation is grounded in antiquity. The triad of Greek philosophers – Socrates, Plato, and Aristotle – laid the foundations for learning through the practice of discovery and innovation.1-2 Nearly 2.5 millennia after Greek philosophy arose, another deeply inquisitive and innovative scholar, Andrew Taylor Still, envisioned wellness and founded osteopathic medicine and the first osteopathic school.3 This educational institution, now known as A.T. Still University in honor of its founder, is a progressive multidisciplinary health sciences university.4

The concept of remote or distance learning dates to Dr. Still’s lifetime in the 1800s. Handwritten correspondence courses via the U.S. Mail provided opportunities for learning when potential students lacked access to in-person instruction.5 As media platforms developed, the internet has provided a wide variety of technology options. While these e-learning systems solve some difficulties inherent with remote learning, obstacles to effective physically distant education remain, especially in entry-level health professions programs education.

The ancient Greek1-2 and pioneer American3 eras of social and political unrest, wars, and epidemics were, perhaps, not so different than the current societal, political, and COVID-19 pandemic challenges. Increasing societal demands bring endless opportunities for health professions education (HPE) reform. Review of HPE literature makes it clear that rapidly evolving populations and care systems need health professionals who possess an ideal blend of science and humanism.6-9 Like the three Greek philosophers,1-2 Dr. Still was an exemplar in living and in dying according his own well-examined beliefs despite agonizing opposition and conflicts in uncharted territories.3 The theories and care practices that these brilliant minds brought forth reveal three important lessons for advancing HPE amidst the COVID-19 pandemic and into the future.

First, the intentional return to scholars taking charge of their own learning aligns with lifelong learning principles of the Greek philosophers1-2 and the father of osteopathic medicine.3 Second, systems logic as introduced by Aristotle gave rise to systems thinking,10 which links modern health systems science (HSS) domains.11 The integration of HSS into HPE curricula better positions professionals to understand and navigate interdependent factors within complex systems and to partner with patients, families, and communities.8-9,11 Third, interprofessional education activities with emphasis on wellness and whole-person care12-13 provide opportunities for health professionals and learners to work together as a high functioning team.8-9,14

Effective interprofessional relationships and patient encounters are necessary for patient safety.8,11,15 In addition, sociologists contend that half of what students learn, they acquire through interactions with fellow students.16 Distance learning requires more self-discipline, greater time management skills, and stronger motivation and engagement in the learning process on the students’ part to overcome the physical distancing. Students lacking these skills may fall prey to distractions at home and into the doldrums of lost confidence and poor performance. Also, in the absence of peer-pressure to perform, students may feel less incentive to attend classes, and find it easier to disengage and withdraw.16

The “hybrid” education model builds upon the ancient philosophical and osteopathic foundations of inquiry, innovation, and humanistic whole-person care. Hybrid education leverages innovative technologies such as artificial intelligence and virtual learning platforms in combination with in-person, real-life clinical experiences.8-9,16-17 The hybrid model is a viable solution to overcome an array of challenges, such as the isolation and disruptions experienced during the COVID-19 pandemic. Hybrid education has become a best-practice method for HPE programs to bring together professionals and scholars and help them to become adept at creative new approaches to traditional classroom and clinical learning.8,16-17

It is an exciting time to build upon 128 years as a founding institution of healthcare13 and embrace HPE transformation. Review of the literature reveals there is much work to do for successful HPE transformation.5-9,11,14-20 Experts emphasize continuous monitoring of the external environment is necessary for successful HPE reform and alignment with evolving systems and societal needs.8-9 Leadership of academic presidents and deans is crucial for the prioritization and support of HPE initiatives.8-9,11, In addition, sincere attention must be paid to faculty development and to learners’ perceptions8-9,11,14-15,17-21 in our commitment to prepare professionals who are collaborative, compassionate, competent lifelong learners.13 The vision for HPE transformation is ripe for return to the guiding principles of ancient scholars as we continue to focus on our osteopathic heritage13 for optimal patient, population, and provider health and wellbeing.

References

  1. Stavru A, Moore C. Socrates and the Socratic Dialogue. Boston: Brill; 2017. https://brill.com/view/title/33451. Accessed November 1, 2020.
  2. Perdue SM. The big three of Greek philosophy: Socrates, Plate, and Aristotle. PennState website. https://sites.psu.edu/rclperdue/2014/09/19/the-big-three-of-greek-philosophy-socrates-plato-and-aristotle/. Published September 19, 2014. Accessed November 1, 2020.
  3. A.T. Still biography. ATSU Museum of Osteopathic Medicine website. https://www.atsu.edu/museum-of-osteopathic-medicine/museum-at-still. Accessed November 1, 2020.
  4. About ATSU. A.T. Still University website. https://www.atsu.edu/about-atsu. Accessed November 1, 2020.
  5. Challenges with distance learning. Diplomatic Language Services website. https://dlsdc.com/blog/challenges-with-distance-learning/. Published July 1, 2014. Accessed October 12, 2020.
  6. Blatt B, Plack MM, Simmens SJ. Preparing interprofessional faculty to be humanistic mentors for medical students: The GW-Gold Mentor Development Program. JCEHP. 2018;38(2):117-125. doi:10.1097/CEH.0000000000000203.
  7. Lyon L, Itaya LE, Hoover T, Booth MT, Nadershahi N. Humanism in dental education: A comparison of theory, intention, and stakeholder perceptions at a North American dental school. J Dent Educ. 2017;81(8):929-936
  8. Thibault GE. The future of health professions education: Emerging trends in the United States. FASEB BioAdvances. 2020;00:1-10. https://doi.org/10.1096.fba.2020-00061.
  9. Josiah Macy Foundation. Improving environments for learning in the health professions. https://macyfoundation.org/assets/reports/publications/macy_monograph_2018_webfile.pdf. Published December 2018. Accessed November 1, 2020.
  10. Patnaik RM. Aristotle’s thinking and systems thinking. J Ind Eng Int. 2013:VI. 
  11. Gonzalo JD, Skochelak SE, Borkan JM, Wolpaw DE. What is health systems science? Building an integrated vision. In: Skochelak SE, Hammoud MM, Lomis KL, et al, eds. AMA Education Consortium Health Systems Science. 2nd ed. Canada:Elsevier; 2020:1-20.
  12. Tenets of osteopathic medicine. American Osteopathic Association website. https://osteopathic.org/about/leadership/aoa-governance-documents/tenets-of-osteopathic-medicine/. Accessed November 1, 2020.
  13. About ATSU. ATSU website. https://www.atsu.edu/about-atsu#Mission-Vision. Accessed October 30, 2020.
  14. Gonzalo JD, Singh MK. (2019). Building systems citizenship in health professions education: The continued call for health systems science curricula. Agency for Healthcare Research and Quality, Patient Safety Network. Perspectives on Safety. https://psnet.ahrq.gov/perspective/building-systems-citizenship-health-professions-education-continued-call-health-systems. Published February 1, 2019. Accessed October 30, 2020.
  15. Kirkpatrick A. Clinical learning that overcomes pandemic barriers. Macy Foundation. https://macyfoundation.org/news-and-commentary/clinical-learning-that-overcomes-pandemic-barriers. Published July 7, 2020. Accessed November 1, 2020.
  16. Ross J. Pandemic ‘confirms face-to-face teaching is here to stay.’ The World University Rankings website. https://www.timeshighereducation.com/news/pandemic-confirms-face-face-teaching-here-stay. Published June 4, 2020. Accessed October 12, 2020.
  17. Shah S, Diwan S, Kohan L, et al. The technological impact of COVID-19 on the delivery of the future of education and health care delivery. Pain Physician. 2020: S23:S367-S380. https://www.painphysicianjournal.com.
  18. Tenison E, Touger-Decker R. Impact of e-learning or blended learning versus face-to-face learning in regard to physical examination skills, knowledge, attitudes among health professions students. Top Clin Nutr. 2018;33(3):259-270. doi:10.1097/TIN.000000000000149.
  19. Chen BY, Kern DE, Kearns RM, Thomas PA, Hughes MT, Tackett S. From modules to MOOCs: Application of the six-step-approach to an online curriculum development for medical education. Acad Med. 2019;94:678-685. doi:10.1098/ACM.0000000000002580.
  20. Venkatesh S, Rao YK, Nagaraja H, Woolley T, Alele FO, Malau-Aduli-BS. Factors influencing students’ experiences and satisfaction with blended integrated e-learning. Med Princ Pract. 2020;29:396-402. doi:10.1159/000505210.
  21. Ngan OMY, Tang TLH, Chan AKY, Chen DM, Tang MK. Blended learning in anatomy teaching for non-medical students: An innovative approach to the health professions education. Health Prof Educ. 2018;(4):149-158 doi:10.1016.j.hpe.2017.11.001

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