Embracing uncertainty: medical student perceptions of a pediatric bootcamp developed in response to mandated changes during the pandemic | BMC Medical Education

Embracing uncertainty: medical student perceptions of a pediatric bootcamp developed in response to mandated changes during the pandemic | BMC Medical Education


Four main themes were generated following our analysis: clinical relevance, timing, teaching strategies and learning resources.

Clinical relevance

Participating medical students, who had finished preclinical work but not yet started clinical rotations, described being pushed to think about problems in a new way. With limited clinical experience, they reported occasional difficulties interpreting what was clinically relevant while identifying that they were being asked to apply the knowledge they had learned as preclinical students to more case-based scenarios. They also acknowledged the bootcamp was an opportunity to consolidate their preclinical learning into more clinical scenarios.

Transition to thinking clinically

Participants recognized that the bootcamp required them to think and use their knowledge differently in preparation for transitioning to clinical rotations. Students identified that the bootcamp provided a low-stakes environment where they were able to practice these skills.

I think that is one of the great parts of this bootcamp is they really did put an emphasis on clinical reasoning and learning an approach to common presentations, I guess. Like it was instead of, for example, just giving a lecture on bronchiolitis, it was more. Here’s an approach to a child in respiratory distress or things like that. And they also, they added on this team-based learning, where they allowed us to practice clinical decision making in this environment where it didn’t really matter… it felt new and uncomfortable at first, but I think that it’s going to be beneficial not only for the pediatric clerkship rotation, but all rotations beyond that.” [Interview #8]

“You know, antibiotics always get all mixed up in my head, right. So once you can kind of use them a few times and connect them to different experiences it’s a lot easier. Or even, … knowing which which labs to choose for a given presentation when you’ve never, ever ordered labs was challenging. You know, I did my best and I did well, but I wasn’t confident in that component especially.” [Follow-up Interview #1]

Clinical reasoning

The students reported a clear difference in how they were taught in the bootcamp compared with how they had learned during preclinical courses. They acknowledged that clinical reasoning is a difficult skill to develop with limited clinical experience. They also emphasized the importance of learning these skills in a low stakes setting.

“I also really loved the CDM [clinical decision making] questions. I think that’s what they were called. I really liked that they gave us those in again, a very low stakes environment just to see how things are asked and how they’re tested and how you have to think about things. … I think it just gave good preparation and just like a good idea of like, how to think about questions and how to think about even just medicine in general I guess.” [Interview #1]

“ …sometimes in preclerkship, we just kind of throw everything at the wall and see what sticks and I think maybe you start to see what’s left on the wall once you actually get on the floor and start doing that. So there were definitely lectures where … you could see that the active clerks were more engaged in the chat and at the same time, you’re hoping that they’re actively involved because they’ve had more exposure. And it’s not just you deficient in that knowledge area. But I expect that that explains part of it, it’s just kind of our maybe lack of complete exposure to all of this.” [Interview #5]

Right time for consolidation

Completing bootcamp between preclinical and clinical rotations allowed participants to consolidate their knowledge before the start of their clinical rotation. Participants found this timing helpful as it facilitated a better understanding of the pediatric content they had covered in preclinical courses.

“But just a lot of the material we actually did cover in our first two years. But again, it was kind of in those one or two peds lectures per block kind of scattered throughout. So it was nice having a kind of consolidated review of everything at this bootcamp, while also teaching us a few new things as well as some kind of clinical pearls here and there as well.” [Interview #8]

“I think it gives us kind of a stepping stone to better understanding clinical concepts or content, I think definitely the most learning is still going to be when we’re doing our clerkship rotation. But this was kind of a good bridge between pre clerkship and clerkship if that makes sense.” [Interview #9]

Timing

Participants described various perspectives related to the timing of the bootcamp. Given our students had just completed their second year of study and would not start their core clinical rotations until four months later, there were key issues related to the unanticipated addition of the bootcamp at the completion of their second year.

Competing interests

Some students described having had other planned commitments during the period of time that limited their ability to participate fully in the scheduled learning sessions, or, contrarily, that were compromised because they chose to participate in learning.

“…not convenient for doing other things and I ended up basically those three weeks, I wasn’t able to do my research and wasn’t able to do other things.” [Interview #2]

“I think a big part of it, too, was just that we hadn’t really known what the bootcamp would entail before. So like, we had other things going on in the summer, too. So just me personally, I was moving in the midst of it, too. Which if I had known, just kind of how structured the schedule was, and how much there was, then I probably wouldn’t have moved mid bootcamp.” [Follow-up Interview #3]

Furthermore, some students were frustrated by the impact on their planned summer break, while others appreciated having the learning opportunity to fill the time in advance of their rotation.

“You know, we didn’t get a very long summer. So I was kind of bummed. And that’s part of why it got pushed off was because I’m like, I don’t want to give up three weeks of my two months of summer to work on this.” [Interview #7]

“I think that, especially given that there were not really other learning opportunities at the time. That like, both the, like, being able to accomplish something, and knowing that accomplishing that task would lighten the load later on, I think, was the main reasons.” [Follow-up Interview #2]

“…a lot of the lectures were focused, like in a section of the day it kind of let us Yeah, kind of have a little bit of a summer or enjoy some of the nicer weather as it approached, while still kind of accomplishing some learning.” [Interview #5]

Feeling not mentally prepared

Many students describe struggling with an unanticipated change in schedule, causing them to feel less motivated to participate and learn. The timing of the bootcamp resulted in extending their learning into what would have otherwise been a break from studies. Students also describe the mental stress of balancing the pandemic with their studies and other commitments.

“I feel like in my situation, like I was interested in it, because I had that pediatrics elective canceled and this was coming up. But also I felt sort of done for the school year. So I felt I wasn’t giving my full hundred percent effort for it because it was sort of something that we just tacked on to the school year.” [Interview #2]

“It was one week after we finished our competency exam in the middle of a global pandemic. And it was just way too much to handle to also do pediatrics at the same time. …I had a summer research position lined up that’s a full time position. So I really had no time to do it. No headspace to do it.” [Interview #6]

Interval between learning and application

Students identified the interval of time between the bootcamp and their future pediatric clinical rotation as a potential challenge. Students would experience an interval of 4 to 12 months between the end of the bootcamp and their scheduled pediatric clinical rotation; for some they felt the ability to apply their learning to real patients would be difficult and that they would have to relearn the material once they were in the clinical environment. Others appreciated consolidating pediatric content after their first two years.

“Well, I think pediatrics is so different from adult medicine as they always say just because, you know, even vital signs for different age groups are completely different. So I think, you know, when you’re seeing, when I’m seeing kids one day for my pediatric rotation, it’s unfortunately not till next summer, so I’m gonna have to study all of this again.” [Interview #1]

“…it’s a while before my pediatrics block, it’s not till next year sometime. So, I don’t know, things that make information stick for me are like, seeing cases for sure in real life…” [Interview #2]

Teaching strategies

Participants identified numerous efforts to foster interaction in the virtual bootcamp format. Students recognized successes and challenges associated with these strategies and the variety of platforms and techniques.

Facilitating interaction

Students noticed the teaching staff trying their best to create an interactive environment, with the use of audience response systems like PollEverywhere, online game-based learning platforms, like Kahoot, polling functions within the video conferencing design or the chat box functions. Students appreciated different methods to reply, notably that the polling options/audience response systems allowed for anonymity as their username would be attached to the comments whereas comments in the chatbot recorded their username and remained in the chat history. Having an additional facilitator monitoring the chat box allowed medical students to have their questions answered promptly and engage with the ongoing content in real time.

“I think [multiple platforms] facilitated more discussion, especially for many of us who were using Zoom for lecture style things for the first time. It was always like the same handful of people kind of speaking up and stuff like that. But when they introduced PollEverywhere, and Kahoot I think it helps people participate more without like seeing their name displayed on the on the Zoom chat or whatever it might be.” [Interview #4]

Challenges with interaction

Sharing perspectives or answers to the questions with the chat function required the students to have confidence in their answers. This was, at times, a barrier to their participation as there were multilevel learners with varied experiences with pediatric medicine, and they were hesitant to be wrong.

“Yeah, the chat box only if I was like really confident in my answer would I say something. Just because it’s not anonymous, so if I answer wrong, like everyone can see that I answered wrong. Which I know like most people don’t care, but it’s just like, you know, you don’t want to be wrong.” [Interview #1]

Students also noted some norms from in-person lectures. Typically, there would not be a place for 100 people to answer a question, so if one person responded with their planned answer in the chat box, they were more reluctant to add their response. Yet, they would answer on the audience response/polling systems. There were also times where the use of additional technology/modalities to participate was distracting or prohibitive to learning.

“The polls required opening the app too and by the time I’d put in the kind of code for it, and then input an answer, I found that I was missing some of the other things that were being said, whereas with the chat box, it didn’t take away from learning what was still going on as well.” [Interview #9]

“…but when they had too many platforms going all at once. It felt like the lecture wasn’t really happening. It was just like us trying to manage the things that were happening on all the different platforms.” [Interview #4]

Active learning strategies in large group sessions were commented on, but the students did miss in-person interactions and the frequent, in-person, small group, team-based or problem-based sessions they were accustomed to from their first two years of undergraduate medical education:

“I think the biggest barrier just has to be that it was over zoom. And I know there were some positives like I’d mentioned earlier about the chat function, etc. But, again, it is a little harder to be totally focused all the time. If you’ve got four hours straight of zoom lectures, and I know I can just stand up and go grab a coffee or whatever and it’s just it that is a little bit harder not having that face to face discussion and interaction with everyone.” [Interview #8]

Learning resources

Another major theme that emerged from our data was related to learning resources. Our participants reported that the bootcamp created virtual learning resources all in one place for students who could use them at their convenience.

Curated and accessible resources

This rotation not only allowed students to have exposure to resources that they could access at any time when needed but also provided core knowledge for pediatrics.

“I guess just having those three weeks dedicated to pediatrics made me feel or it makes me feel more comfortable going into my peds rotation this year because I have those notes I can refer to and they gave us a lot of great resources that I know I can turn to as well.” [Interview #8]

“it gives a lot of kind of, I would say foundational knowledge for pediatrics. Which, if we didn’t have that, I assume we’d be learning a lot of this stuff on our own. I’m not really sure how like the pediatrics rotation worked before COVID. Like it was nice just to have this as a resource as to common problems in pediatrics.” [Interview #9]

Additionally, students also reported that the content of bootcamp were not only accessible but also curated and easy to navigate.

“…And actually I just reminded myself of the, there was a few resources that I found a little more maybe user friendly or or I don’t know, bright is the right word to use, but like the PedsCases podcasts, I think you call it were, yeah, I guess, maybe a little bit more concise and easy to explore.” [Interview #5]

What learners developed for themselves

Further, the virtual nature of the pediatric bootcamp created an opportunity for learners to develop their own resources. Study participants reported that the bootcamp enabled them to create personalized resources that they could use and refer to when needed.

“I think it’s great because now I have all that information. You know, on my computer, I’ve made the notes I’ve gone through, so it’ll come back quicker.” [Interview #7]



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