This study assesses the effects of simulated clinical practice using peer-to-peer role-playing and a COVID-19 lecture on medical students’ attitudes towards COVID-19 and the burden felt by them due to care of patients with COVID-19.
This study was approved by the Ethics Committee of the University of Chiba (Approval No. 3425). The study database has been anonymized.
CC in the department of respiratory medicine and participants
Medical schools in Japan offer a six-year curriculum, and two years are usually spent in CCs . At Chiba University, with approximately 120 students in each class, students practice in one department and then another on a rotational basis every four weeks for two years. The CC begins in December of the fourth year and ends in October of the sixth year.
Groups of 7 to 11 medical students (4th-5th year) completed four weeks of training as members of a medical team of physicians and residents in a department of respiratory medicine from December of their fourth year to November of their fifth year. A total of 82 medical students underwent CC in Respiratory Medicine at Chiba University Hospital between December 2020 and November 2021. During orientation at the start of each group’s CC, informed consent was obtained from participants for use of their data for this study.
Between January 2020 and November 2021, students who participated in both the simulated clinical practice and the lecture were included in the study. Students who did not participate in the simulated clinical practice and/or lecture, or those with insufficient questionnaire data were excluded. Additionally, medical students were not directly examining patients with COVID-19; rather, they only conducted telephone interviews and shared information at conferences when in charge of these patients. However, the seven students who practiced in September 2021, during the fifth wave of the pandemic in Japan, performed direct examination of patients after simulated clinical practice for COVID-19. Therefore, these seven students were also excluded from the study due to the possible impact of the learning effect of directly participating in the care of patients with COVID-19.
Simulated clinical practice for COVID-19 using peer-to-peer role play
Clinical practices were conducted at the Chiba Clinical Skills Center of Chiba University Hospital and included seven to eight medical students during the first or second week of the CC. Two of the authors (HK and AK) supervised the practice.
Prior to practice, students were briefed on basic IPC, such as wearing and doffing PPE and zoning (Fig. 1); they also attended an orientation session.
The students were divided into two groups of four. After their simulation center zoning practice, other practices were conducted based on different scenarios relating to the admission of patients with COVID-19. We prepared two scenarios with different patient parameters and lead lines for the hospital room, and each group participated in the practice according to the two scenarios.
For each scenario, four students were assigned the following roles: a patient, a doctor wearing full PPE, a medical staff member who assisted the doctor, and a checker who checked the doctor and medical staff (Fig. 2). In the role play, the patient and the doctor could touch each other, but they were considered contaminated and could not touch the clean area and the medical staff. Medical staff could touch the clean area (open the door, press a button, etc.) to maintain cleanliness, while they could not touch the patient and doctor. As a scenario, we created a fictional patient environment based on a real acceptance form and prepared a scenario for each role. During the practice, the students who played the role of the doctor and medical staff were supposed to practice admitting the patient to the ward appropriately without spreading the infection (Fig. 3).
During the debriefing after the practice, the controllers pointed out the problems and the students who played the roles shared their impressions.
Conference on COVID-19
A lecture on the latest literature available on COVID-19 was given to the students. It included the following topics: Comparison of Symptoms/Problems Associated with COVID-19 and Influenza, Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome, Clinical Outcomes and Treatment of COVID-19, SARS-CoV Vaccine -2 and ways to deal with information regarding COVID-19. Additionally, the lecture included Information Literacy as follows. We first presented the research data showing that fake news – which evokes fear, loathing and surprise – is more likely to spread even before the pandemic. . Following this, we provided examples of information that was later proven to be false, ranging from rumor-level information to that presented by medical professionals and heads of state. We also pointed out that drugs that show promise in basic research are rarely really useful and approved by regulatory authorities. . These examples highlighted the difficulty of properly processing medical information from all perspectives and revealed the process of medical validation using multiple drugs/vaccines . The conference emphasized the importance of not easily relying on information unless medical students experience it firsthand.
The lecture was given during the third week of the CC by two authors of this article (GS, HK).
Quantitative data collection
Quantitative data was compiled using a questionnaire to assess the effect of the education program on student responses to COVID-19. Questionnaires were created on students’ fear of COVID-19 and their burden in various situations related to the care of COVID-19 patients. Before the mock practice and on the last day of the third week of the CC, the students answered the following questions from the mock clinical practice and lecture questionnaire (Table 1): (1a) Are you afraid of COVID-19? (1b) How careful are you in your daily life to prevent COVID-19? (2) To what extent do you consider the following behaviors a burden? Questions (1a) and (1b) were scored on a five-point Likert scale, with scores ranging from 1 [(1a) Not afraid at all; (2b) Not at all cautious] at 5 [(1a) Very afraid; (1b) Very cautious]. In question 2, the following actions are listed: a. Implementation of COVID-19 prevention measures (daily life), b. General practice while taking COVID-19 preventive measures, c. Proper use of PPE, including donning and doffing, d. Management of confirmed COVID-19 patients and adoption of preventive measures, e. Processing information about COVID-19. Additionally, question (2) was scored on a five-point Likert scale, with scores ranging from 1 (not at all loaded) to 5 (very loaded). In addition to the questions above, students reported their level of satisfaction with the simulated clinical practice and presentation on the second questionnaire. The items of the questionnaire were elaborated according to the feeling of responsibility of the students in the medical treatment assumed from the teaching process.
Qualitative data collection
We conducted focus group interviews (FGI) with students to assess the effects and benefits of our program on COVID-19. The FGI also aimed to identify what students learned through our program. On the last day of the third week, students participated in semi-structured FGIs regarding the benefits of the program, and this qualitative study phase allowed us to explain the results of the quantitative data.
The students were divided into nine groups (75 student cohorts in total). The selection criteria specified that all medical students should be included, as the target population should be homogeneous to investigate perceptions regarding our COVID-19 education.
The FGIs were conducted by two physician researchers (HK and GS) and the interview responses were recorded independently using an interview guide (Table 2). Students were asked the following questions: 1) “What are the benefits of simulated clinical practice with peer-to-peer role play on COVD-19? Why do you consider this to be advantages? 2) “What are the benefits of the COVID-19 conference? Why do you consider this to be advantages? » The interview guide was validated by the two researchers (HK and GS) before data collection.
The interviews lasted no more than 30 minutes and information on the impact of work and the fatigue of the interviewees was obtained. Interview responses were transcribed verbatim.
Quantitative data are expressed as mean ± standard deviation (SD) unless otherwise specified. The Wilcoxon signed rank test was used to compare the degree of burden before and after our education regarding COVID-19. Statistical significance was set at p
Qualitative content analysis
Consistent with previous studies, qualitative content analysis was performed to analyze FGI transcripts . Such analysis includes descriptions of manifested content and interpretations of latent content . HK and CK independently read and coded all transcripts. Subsequently, they discussed, identified and agreed on the coding of the descriptors. Inter-rater reliability was measured with the Kappa coefficient (0.8–1.0 = almost perfect; 0.6–0.8 = substantial; 0.4–0.6 = moderate; 0.2–0, 4 = fair) .