Restructuring an internal medicine rotation to take on a fully virtual experience in a resource-limited setting: A mixed-methods study

Abstract

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, medical schools in the Philippines accelerated the adoption of virtual learning. Course developers were challenged to provide equal opportunities for clinical exposure given the differential access of students to technology. This study describes the modifications in the course design of an internal medicine rotation for third-year medical students and the perceptions of the faculty and students toward these changes. MATERIALS AND METHODS: Course evaluations by students and faculty were reviewed. Using a concurrent mixed-methods approach, we analyzed the quantitative and qualitative responses and triangulated the results of the faculty and student surveys. RESULTS: Shifting to a virtual learning platform decreased the number of student–patient interactions. Observing a telemedicine consultation done by faculty substituted for real patient encounters. In consideration of students with limited Internet access, synchronous activities were made nongraded. The survey response rate was 51% (93/181) for students and 34% (32/94) for faculty. Survey participants indicated high overall satisfaction toward the virtual course with a general agreement between students and faculty respondents in most domains. Recurrent themes were the demand for more patient encounters, more synchronous activities, and better evaluation tools. Only the faculty were critical of technical issues, such as audibility and Internet connectivity. CONCLUSION: The experiences of a single institution in redesigning and implementing an undergraduate medical course in internal medicine for a fully virtual platform were described. Strategies for augmenting patient exposure and tailored clinical assessment tools are needed to improve stakeholder satisfaction. In resource-limited settings, access to appropriate technology must be considered to ensure equitable learning.