A hierarchy of needs for remote undergraduate medical education: lessons from the medical student experience

Abstract

Purpose: The disruption of undergraduate medical education (UME) by the COVID-19 pandemic has sparked rapid, real-time adjustments by medical educators and students. While much is known about online teaching in general, little guidance is available to medical educators on how to adapt courses not originally designed for the online environment. To guide our faculty in this transition we conducted a needs assessment of students enrolled in virtual courses across all 4 years of UME training.

Methods: Using a mixed-methods approach, we conducted a single-institution virtual learning needs assessment in May and June of 2020. We developed and disseminated a survey to assess student experiences with virtual learning. We conducted quantitative and qualitative analysis of responses (n = 255 or 39%) to identify emergent themes.

Results: We identified six interdependent themes that need to be met for medical students to fully reach their learning potential: access to stable internet and quiet study spaces, flexible course design with asynchronous, self-paced components, clear expectations for engagement with content and each other, a sense of connectedness with faculty and peers, synchronous classes that maximize interactivity, and assessments that foster a sense of learning over performance. Interpersonal relationships with faculty and peers affected students' sense of learning more than any other factor.

Conclusions: Based on our findings we propose a hierarchy of needs for virtual learning that provides guidance on adapting existing medical school courses to the remote setting and overcoming common challenges. We highlight opportunities for how virtual elements may enrich in-person courses going forward, including in the clinical setting. Although the solutions required to meet the threshold of need at each level may differ based on the context, attending to these same fundamental needs can be extrapolated and applied to learners across a range of environments beyond the virtual.

Keywords: Flipped classroom; Online teaching; Remote learning; Telehealth; Undergraduate medical education.

Fig. 1

Effect of the remote experience on the perception of learning. Likert response options were collapsed into categories to allow for easier comparison. A Discussion-based formats (small groups or case-based collaborative learning (CBCL) were harder to translate to the remote setting compared to lectures or other formats. Overall, at least half of all students felt that the remote setting limited their learning compared to the in-person classroom experience. B In the clinical setting students were concerned about their learning across many different domains. When probed more specifically, C Aquifer cases, and D Telehealth visits provided opportunities for students to enhance the clinical skills in some domains

Fig. 2

Engaging learners virtually. Likert response options were collapsed into categories to allow for easier comparison as needed. A Zoom fatigue put a limit on the learners’ attention and engagement. Students indicated that no more than 3 hours of live virtual class per day was ideal. B Overall virtual learning was seen as less engaging than in-person. Small groups or formats including breakout-groups were rated as more engaging. C Breakout rooms, polling and chat were rated as most effective tools in engaging students virtually

Fig. 3

Schematic model for a hierarchy of needs for virtual learning and implications for course design based on Maslow’s hierarchy of needs. This model emerged organically when we synthesized qualitative and quantitative findings into one narrative. Each level of the pyramid needs to be fulfilled to a certain threshold, e.g. internet that is table most of the time, to be able to benefit from the next level of the pyramid. Course design can ensure that each of these thresholds is met for as many students as possible