Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review

Background The novel coronavirus disease (COVID-19) was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplace-based clinical learning in response to the pandemic. The objectives were to synthesise what adaptations / innovation were implemented (description), their impact (justification), and ‘how’ and ‘why’ these were selected (explanation and rationale). Methods The authors systematically searched four online databases and hand-searched MedEdPublish up to December 21, 2020. Two authors independently screened titles, abstracts and full-texts, performed data extraction, and assessed the risk of bias. Our findings are reported in alignment with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance. Results Fifty-five articles were included. Most studies (n=40) were from North America, and nearly 70% focused on undergraduate medical education (UGME). Key developments were rapid shifts from workplace-based learning to virtual spaces, including online electives, telesimulation, telehealth, radiology, and pathology image repositories, live-streaming or pre-recorded videos of surgical procedures, stepping up of medical students to support clinical services, remote adaptations for clinical visits, multidisciplinary team meetings and ward rounds. Challenges or barriers included lack of personal interactions, lack of standardised telemedicine curricula and need for faculty time, technical resources and devices. Assessment of risk of bias revealed poor reporting of underpinning theory, resources, setting, educational methods, and content. Conclusions This review highlights the response of medical educators in deploying adaptations and innovations from workplace-based to online learning during the COVID-19 pandemic in clinical settings. Whilst innovations and adaptations have ensured learning across the continuum, explicit reporting of operationalisation of education interventions requires additional focus. We would encourage future work to fully evaluate all outcomes and move towards reporting at Kirkpatrick levels 3 or 4