Research

Background

The COVID-19 pandemic marked the first global health crisis to unfold in a highly connected digital media environment. Understanding how social and mainstream media shaped public health communication during this period is crucial for improving future pandemic responses. Early pandemic communication was complicated by rapid information spread through social media, which often outpaced official channels and created challenges for effective public health messaging.

Research question

How did social and mainstream media shape public perceptions and responses during the COVID-19 pandemic, and what were the lived experiences and understandings among both healthcare professionals and members of the public regarding social and mainstream media broadcasting months into the pandemic?

Literature

A narrative review explored three key areas: the evolution of media technologies and landscapes, communication strategies from past pandemics, and expert perspectives on initial COVID-19 coverage. The review highlighted the unprecedented nature of pandemic communication in an environment where social media enabled instant global information sharing while also facilitating the spread of misinformation.

Methods

The study employed Interpretative Phenomenological Analysis (IPA) methodology to examine the lived experiences of 40 participants (20 healthcare professionals and 20 members of the public) through in-depth, semi-structured interviews conducted 15 months into the pandemic. Analysis was enhanced through innovative use of AI-assisted tools while maintaining IPA’s idiographic focus.

Results

Analysis revealed distinct Group Experiential Themes (GETs) for healthcare professionals and the public. Healthcare professionals demonstrated more sophisticated information evaluation strategies but struggled with bridging professional knowledge and public understanding. The public showed greater vulnerability to misinformation but developed increasingly critical approaches to media consumption over time. Both groups experienced evolution in their trust of different information sources throughout the pandemic.

Discussion

The findings highlighted how modern media environments complicate traditional public health communication approaches. The research identified crucial differences in how healthcare professionals and the public processed pandemic information, while also revealing shared challenges in navigating the complex media landscape. The study extends understanding of how social media platforms can both enhance and hinder effective health communication during crises.

Conclusions

The research demonstrates a fundamental shift from a ‘deferrer society’ to a ‘referrer society’ in public health communication, necessitating new approaches to crisis communication that can harness social media’s speed and reach while maintaining message integrity. Findings suggest future pandemic responses must balance traditional authority with new forms of collaborative knowledge creation, while supporting both healthcare professionals and the public in navigating complex information landscapes.

Over the last fifty years the rate of advance within medicine has been quite remarkable (Le Fanu, 1999). With this healthcare has become increasingly complex (Rouse and Serban, 2014) and the associated risk to patients when things go wrong has also increased (Makary and Daniel, 2016). There is an interesting dichotomy in that by and large the process of medical education has remained largely unaltered for the past century (Flexner, 2002). Medicine is an inherently conservative profession based on a hierarchical structure, so when left up to the profession to introduce innovation within medical education such change has not been forthcoming.

Given the current climate within both the NHS and higher education institutions, which will be explored throughout this dissertation, a situation has arisen where medical students and patients have an increasingly powerful voice. Medical students generally are not happy and don’t feel prepared for life working as doctors, as evidenced by The National Student Survey (NSS). When they graduate and start working in what is a difficult NHS environment the situation is compounded by the fact they are not appropriately skilled to complete certain tasks. This may lead to issues with the care patients receive. When this is coupled with an increasingly pressurised working environment and patients being encouraged to publicly rate their doctors online it creates a challenging environment for doctors to work in.

This report will consider how the medical education process can be refined to better suit the needs of medical students going through the system, with the intention of maximising their time spent in medical school, in order to equip them with the skills, knowledge, attitudes and approach to learning that will help them prosper as doctors and integrate within multidisciplinary teams such that excellent patient care can be provided. With the formation of five new medical schools, this represents a unique opportunity to shape medical education in a way that leads to improvements in patient safety and quality of care in the longer term. In order to maximise this opportunity a co-ordinated approach where best practice is shared between the new medical schools would be beneficial. It is important for a collegiate approach to be fostered between the new medical schools rather than a culture of competition, hence the major recommendation of this report being the formation of a Medical Education Shared Innovation Network (MEDSIN) administered by Health Education England (HEE).

This report looks to maximise and spread that benefit, initially nationally and eventually internationally, by providing a blueprint for implementing innovative approaches to medical education. This is a blueprint which puts patients at the heart of the medical education process and equips students with the skills, attitudes and an approach to learning that serves as the foundation to the rest of their career. This is somewhat of a departure from the traditional didactic paternalistic approach to medical education. There is definitely a changing dynamic between the public and the medical profession. The rise of expert patients and their access to medical knowledge coupled with patients also generating their own health data means medical education must evolve if we are to equip medical students with the skills required for their future careers. This dissertation proposes the way to facilitate that evolution is via introducing improvements via the incorporation of innovative approaches to medical education from the beginning of students’ education in new medical schools.

Background

In recent times there has been a clamour against ‘spoon feeding’ (1) in medical education, something that has coincided with a drive to encourage medical students to participate in self-directed learning (SDL). This is all well and good; however an important variable should not be overlooked. The environment in which we are placing medical students is by no means a perfect arena for learning. The ward environment has changed dramatically since the introduction of the European Working Time Directive (2) (EWTD). The firm based structure, which supported undergraduates so well, is no longer present. The combinations of shift-working and ward-based teams have resulted in a transient workforce. Consequently there can be a lack of continuity in care for patients throughout their hospital stay. From personal experience, I have witnessed the adverse effects this environment has on educational opportunities for medical students. There is a new breed of junior doctors known as Clinical Teaching Fellows (CTFs), doctors who are specifically devoted to teaching medical students. CTFs are a fantastic resource and provide an opportunity to bridge the gap between classrooms and clinical environments.

Objectives

This dissertation will look at incorporating active learning methodologies into Small Group Teaching (SGT), and to determine if this can help prepare clinical medical students for life on the wards. This preparation will entail equipping students with core knowledge that is readily retrievable. The term I have applied to this process is (PBL-SGT)-Fusion, as I have taken elements from traditional Problem Based Learning (PBL) and Small Group Teaching (SGT) when developing this style. (PBL-SGT)-Fusion can help prepare students for life in a challenging learning environment in order to maximise their learning opportunities. The primary objective of this study was to determine if implementing active learning techniques would translate into improved student performance on a ‘Post-test’ paper. The initial cohort included Clinical Phase 3 (CP3) students. A secondary objective was looking at whether this kind of teaching could also be implemented with Clinical Phase 1 (CP1) students. Across both objectives, I wanted to ensure I developed a teaching process that was both psychometrically sound yet still enjoyed by the students. The overarching research questions therefore are as follows:

1. ‘Can a new teaching methodology incorporating active learning techniques be successfully developed and delivered?’
2. ‘Does this translate into increased student performance in a written exam?’
3. ‘Can the same method be used to deliver CP3 material to CP1 students?’

Methods

This study was performed as part of the Trauma & Orthopaedic teaching delivered to University of Nottingham Medical Students on placement at Lincoln County Hospital. A convenience sampling method (3) was used to enroll CP3 students to the study. Students were on the Musculoskeletal Diseases & Disorders (MDD) block for 8 weeks per rotation, with a maximum of 10 students per group. Due to this set up, SGT was always going to be a heavily utilised teaching methodology. The SGT environment is well suited to the (PBL-SGT)-Fusion approach as it permits incorporation of constructivist (4) approaches to learning. Students were exposed to active learning techniques including mind mapping the case and group Case Based Discussion (CBD). A total of 35 students (15 CP1 and 20 CP3) participated in this study.

A ‘Pre-test’ paper was given to students at the start of sessions to introduce the subject material. This also allowed for the activation of prior knowledge whilst identifying weaknesses and deficiencies in students’ understanding. On completion, the ‘Pre-test’ papers were handed in and reviewed by the teacher to rapidly identify the baseline level of knowledge within the group, and adjust session difficulty accordingly. Following tutor review, the tutor facilitated a group CBD between the students. This took the salient elements of the case and summarised the group discussion on to a mind map. Finally, towards the end of their placement six weeks later, students sat a ‘Post-test’ paper covering all the cases under examination conditions. It is worth noting students were not allowed to keep the ‘Pre- or Post-’ test papers, and that they were unaware the same cases would be used in the ‘Post-test’ scenario. The reasons for distributing the ‘Post-test’ paper are three fold; to assess the impact of the teaching intervention and its effect on learning, to allow students to consolidate their knowledge via recall under examination conditions, and finally, to enable the teacher to check students are not leaving the placement with gaps in their knowledge or understanding.

I used a mix of descriptive and inferential statistics to analyze the data obtained in this study. The psychometric properties of items have been calculated including item difficulty and the reliability of test scores.

Results

This study was universally well received by students of all ability and stage. Many of whom would like more teaching in this style elsewhere in their medical curriculum. CP1 students found the process enjoyable and were able to comprehend and retain material traditionally taught at CP3 level. Interestingly there was no significant difference between performances of Undergraduate (UG) students on ‘Pre-test’ papers when compared to Graduate Entry Medical (GEM) students. One might expect GEM students to out-perform their UG colleagues, given their experience doing PBL on the GEM course, this was not the case. These findings for UG and GEM students were replicated in the ‘Post-test’ paper, in that there was no significant difference between their results. CP3 students generally outperformed their CP1 colleagues. However, a particularly interesting result is the CP1 students scoring a higher median mark on their ‘Post-test’ paper than CP3 students achieved on their ‘Pre-test’ papers.

Discussion

Given the current climate (5) within the NHS, a typical ward environment is far from an optimal setting for teaching. As medical educators, the temptation can be to increase classroom based teaching to compensate, however, I would argue we need to develop innovative ways of using time with students in the classroom to maximise their learning opportunities in clinical environments. We must be mindful of the environment we are preparing students to enter and learn in, as there is often a conflict between service provision and training. (PBL-SGT)-Fusion is an example of how innovative approaches can improve student engagement and attainment. Kirkpatrick’s model has been applied when evaluating this curriculum intervention, for which the combined use of constructivist learning theory (6, 7) and implementation of active learning techniques have been central to its creation.

Conclusion

It is worth bearing in mind this innovative teaching technique so far has only been implemented by one teacher at one site with 35 students. Nevertheless, this study has proved that the introduction of active learning methodologies within SGT is both enjoyed by students and translates into improved performance in written examinations. (PBL-SGT)-Fusion has an advantage over traditional teaching methods, as active learning methodology is engrained throughout the educational process. Anecdotally students have reported a desire to alter their approach to learning having been introduced to such techniques.

An argument could be made for introducing this type of teaching earlier in students’ clinical phases, then building on it by incorporating simulation. I have termed this approach ‘Theory, Simulation, Practise’ (TSP) and is introduced in ‘Chapter 7.0) Recommendations & Suggestions for Future Research.’ The idea behind the TSP approach is creating environments where students’ learning maps with their curriculum, in a way we are actively preparing them for life as junior doctors. I believe this will lead to increased levels of engagement and satisfaction.

References

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3. Tavakol M, Sandars J. Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part II. Medical Teacher. 2014;36(10):838-48.
4. Schmidt HG, Van der Molen HT, Te Winkel WW, Wijnen WH. Constructivist, problem-based learning does work: A meta-analysis of curricular comparisons involving a single medical school. Educational Psychologist. 2009;44(4):227-49.
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6. Phillips DC. The good, the bad, and the ugly: The many faces of constructivism. Educational Researcher. 1995:5-12.
7. Hein G, editor. Constructivist learning theory. The Museum and the Needs of People, CECA (International Committee of Museum Educators) Conference, Jerusalem, Israel; 1991.