Conversion to Online Teaching of a Clinical Clerkship during the Covid - 19 Pandemic

The Faculty of Medical Sciences at the University of the West Indies, Mona Campus, has been training medical doctors for over seventy years. The undergraduate programme comprises a clinical aspect that is divided into fiveand ten-week clerkships in the final three years. The orthopaedic clerkship is a five-week programme which is offered in year four and introduces the students to musculoskeletal conditions. In this five-week clinical rotation, students are taught in the hospital clinics, wards and operating rooms across several hospitals.


INTRODUCTION
The Faculty of Medical Sciences at the University of the West Indies, Mona Campus, has been training medical doctors for over seventy years. The undergraduate programme comprises a clinical aspect that is divided into five-and ten-week clerkships in the final three years. The orthopaedic clerkship is a five-week programme which is offered in year four and introduces the students to musculoskeletal conditions. In this five-week clinical rotation, students are taught in the hospital clinics, wards and operating rooms across several hospitals. 1 The key element is student to patient contact for the development of clinical skills. The students were assessed at the end of the rotation via a computer-generated multiple choice (MCQ) exam and a digital objective structured clinically exam (OSCE), consisting of videos and images with short answer questions to be completed within a fixed time. A procedure card was also completed which contributed to the final grade.
Appreciating the importance of student perception of their clinical rotations and the delivery of content at different sites, a previous study, looking at the comparison of the grades obtained at each site, showed that there were no significant statistical differences in end of clerkship grades amongst medical students who did the clerkship at different sites. 2    There were 4 stations which each lasted 5 minutes for a total of 20 minutes per student.

RESULTS
Twenty 23 students were examined by this process. Extra time was needed in 3 (13%) exams due to audio issues and in one exam a WhatsApp call was necessary to complete the exam.
There was a 95.6% pass rate with only one student failing the clerkship and this student failed both parts of the exam (Figure 1). The overall average score for the group was 61% (B score) with the average OSCE score being 59% and the average MCQ score 62%. Thirty percent of students scored 65% (B plus) or greater on the OSCE exam.

Feedback
The examiners commented that the lack of clinical experience was evident compared to previous groups.
There was also a sense of disconnect with the students during online teaching sessions and many felt that only few students actively participated in class compared to face to face teaching. A survey of the online class was done at the end of the rotation and 88% of students rated the online classes as good to excellent (Figure 2).
Students were generally satisfied with the teaching process and most preferred the structure of the online teaching but felt they lacked the experience and skill of participating in patient care

DISCUSSION
The COVID-19 pandemic, a global health crisis, has influenced many countries to close the doors on traditional classroom education at schools, colleges and universities. The pandemic has caused policymakers to reduce the contact between students in order to save (BBC) was used to encourage online discussion, participation and learning by the students. 6,7 Prior to the start of the pandemic, weekly online tutorials were held with all students to facilitate the delivery of the same course content to all students irrespective of hospital location. In addition, a student-related feedback system was established on our VLE to track and address any issues that may arise during the clerkship. 1 The usual examination process, before the pandemic, consisted of MCQs, procedure cards, case presentations and an OSCE.
Over the years of delivering these assessments to approximately thirty students per clerkship, an average score in the B range is usually obtained with 1-2 failures for each 5-week rotation. With this modified approach to include online teaching our results show that the students scored similarly to what obtained previously with the average score being 61% ( B range) and the OSCE score being 59% compared to 62% and 59% as reported by Final approval for submission was given by both authors.
Funding statement: There has been no funding granted to support this work