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Innovation Reports

Learning During and From a Crisis: The Student-Led Development of a COVID-19 Curriculum

Kochis, Michael EdM; Goessling, Wolfram MD, PhD

Author Information
doi: 10.1097/ACM.0000000000003755
  • Free

Abstract

Problem

The speed and scope of the upheaval that COVID-19 inflicted on medical education made innovation a necessity. While the disruptions imposed by physical distancing would be challenging for medical school faculty and students in any scenario, the urgency of a global pandemic and the simultaneous mobilization of academic medicine’s clinical and research enterprises escalated the situation to a crisis. Among medical students who were abruptly pulled from their clinical activities, demand for high-quality, consolidated educational resources on COVID-19 was exceptionally high. The volume and variety of related media generated each day made it difficult for students to feel like they could stay up to date on the latest information. Fourth-year students especially were trying to prepare for their upcoming clinical roles as soon-to-be residents. Meanwhile, the medical school faculty who typically produced such resources were increasingly burdened with a host of new responsibilities. Instructors of nonclinical courses scrambled to adapt to virtual formats while also responding to unexpected clinical, administrative, and personal commitments. Clinical educators focused on equipping their colleagues with the protocols and therapy-relevant evidence needed for COVID-19-related patient care activities.

Students at many medical schools began responding to the pandemic by providing services to their communities in their own ways. At Harvard Medical School (HMS), students sought to address the widespread lack of clarity about what was going on and what lay ahead.1 Just as medical students were well suited to serve as educators for the patients, friends, and family members who were frequently calling on them for information about the pandemic, so too were they capable of creating instructional materials to help their peers prepare for those roles.2 The rapidly evolving body of information about COVID-19 resulted in a comparatively small knowledge differential between students and faculty. The pandemic was an ideal test case for a student-driven curriculum development initiative.

Approach

In mid-March 2020, we recruited 15 third- and fourth-year HMS students enrolled in a medical education elective to create an accurate, comprehensive, and pedagogically rigorous independent learning resource for medical students trying to stay abreast of all that was happening around them. After self-dividing into teams based on areas of interest and inviting additional collaborators, we synthesized the key facts and collated the best existing educational materials about the COVID-19 pandemic. Working around the clock with this “divide and conquer” approach allowed us to write, secure faculty review, and peer test the first version of the curriculum in less than a week. The curriculum grew to 8 modules (see List 1) and is now available online at https://curriculum.covidstudentresponse.org. In addition, our team has expanded to 70 student authors and 30 faculty reviewers.

We originally shared the curriculum with our peers at HMS and other medical schools. Less than 2 weeks later, the Association of American Medical Colleges created the Clinical Teaching and Learning Experiences without Physical Patient Contact collection in iCollaborative, which provided us with another opportunity to disseminate the curriculum to interested audiences.3 Beyond these efforts, awareness of our curriculum spread via social media and several local and national news outlets.

Accessibility

Our team realized early on that, even if there is nothing people can do to change their current situation, access to information can itself be empowering. Although students at HMS were fortunate to have information about COVID-19 in the form of clinical guidelines and Grand Rounds from HMS-affiliated hospitals, we understood that our curriculum would be particularly useful for learners elsewhere who did not have access to these alternative sources of information. For this reason, we prioritized broad availability of our materials to anyone who might want to read them. We elected to make the materials free online and did not require users to create accounts or complete a pretest, which may have served as barriers to actually reading the content. Given the variety of circumstances in which medical students found themselves during the pandemic, we decided that the most versatile resource would be one they could read through alone on their own time.

Iterative improvement

We recognized that the ever-evolving knowledge base around COVID-19 would require an ever-evolving resource, and we quickly established a workflow in which the curriculum is updated on a weekly basis. In general, groups of 5 to 10 students work on relatively independent module teams revising their content as needed throughout the week. Editor representatives from each team then convene to ensure cohesion across modules before posting their team’s updates each weekend. These regular check-ins have allowed us to optimize resource allocation among teams while planning larger updates.

Throughout the development of the curriculum, we embraced a “rapid prototyping” mindset and never let aspirations for a perfect product hold us back from sharing a good one. For example, we initially published the curriculum on the same Google Docs platform that we used to write it. Once we had the technical support, we migrated the curriculum to a website with greater functionality. Most importantly, we strove to include our users in our iterative improvement cycles by soliciting feedback via easy-to-complete online forms. Despite initial concerns that allowing anonymity would degrade the quality of the comments, the editors who monitor the forms have not found this to be an issue. The suggestions we received—especially from users with backgrounds different from our own—helped us identify content areas we initially overlooked and led to the addition of several new sections and modules. For instance, after learning that many of our users were from low- and middle-income countries, we created a module highlighting collaboration and innovation occurring around the world.

Effective pedagogy

Our curriculum is a reminder that even uncomplicated resources can be remarkably effective if they incorporate sound educational principles. While technologically complex approaches like concept videos and virtual reality have their benefits, we focused on doing our best work within the constraints imposed by our platform and production capabilities. Many of us were able to draw on the formal instruction in adult learning theories we received in the medical education elective, and we leveraged our proximity to students. We wrote specific learning objectives to focus our content, developed realistic case vignettes to help students connect abstract principles to real-life narratives, and interspersed thought questions throughout the modules to promote higher-order thinking and the application of the material to students’ lives.4,5

Outcomes

As of August 2020, nearly 80,000 users from 132 countries have accessed the curriculum. While we had envisioned that it would primarily serve as a self-study resource for medical students, the curriculum’s reception by learners and educators alike at the local, national, and international levels indicates that it is serving a larger audience. Within HMS, the modules have been referenced in several courses and are the core readings for a new COVID-19-specific elective held in spring 2020 that had more than 160 students enrolled. Students and faculty from more than 30 medical schools across the country also have incorporated the curriculum into similar new courses at their own institutions.

Furthermore, about 40% of visitors to the curriculum website are from outside the United States, and users have translated components into 28 languages. In addition, our work has spurred a number of educational initiatives among medical students around the world, from a group in Philadelphia, Pennsylvania, who converted the curriculum into a podcast series to those in the Philippines who developed a similar online curriculum appropriate to their context. Interestingly, medical students account for fewer than half of the entries in our guest book; users range from interested middle schoolers to department chairs at major U.S. medical centers. While medical students will remain our primary audience, this variety of users aligns well with our initial goal of providing broad access to this information and speaks to the benefit of democratizing medical knowledge.

Looking inward, the project has also served an important role for all of the students involved with its creation. Even though we were spread across the country, our regular meetings and shared sense of duty provided much-needed community and solidarity during this time of social distancing. As much as we benefitted from and truly enjoyed the opportunity to pursue our unique areas of interest, the understanding that our efforts provided a much-needed service made the work all the more meaningful. The comments of appreciation in the guest book also connected us to thousands of users from all walks of life and provided a powerful motivation to continue this work.

Next Steps

Given our constantly changing understanding of the COVID-19 pandemic, our immediate goal is to keep the curriculum up to date in the months to come. In addition to continuing our current weekly update protocol, we are taking steps to ensure the continued participation of our student authors and a smooth transition to the next student leaders after this academic year. In thinking about how we can supplement the online materials, we also are working to develop more labor-intensive content like graphic summaries and concept videos. To support the medical school faculty who are using the curriculum in formal courses at their institutions, we are sharing learning assessment questions that can be used to measure student engagement with the modules. Finally, we plan to maintain existing partnerships with student groups around the world and support as many new efforts as we can to provide education and build community in this challenging time.

In summary, the exceptional nature of the COVID-19 pandemic provided a unique opportunity for innovation in medical education that might have otherwise never occurred. Our curriculum development illustrates the incredible promise of medical students as cocreators with medical school faculty of curricular materials designed to address areas of educational need. Fostering lifelong, self-directed learning is a goal of the medical education system.6 This experience is a direct outgrowth of that educational philosophy and an exemplar of how those efforts can serve broader audiences. Students and educators alike should leverage student-driven education efforts to benefit other learners both within and, importantly, beyond their institutions.

List 1

Modules in a Medical Student COVID-19 Curriculum, 2020a

  1. From Bench to Bedside: Evaluate how emerging understanding of COVID-19 pathophysiology translates to evolving diagnosis, treatment, and prevention efforts.
  2. Epidemiology Principles: Introduce the epidemiological principles underlying the current public health interventions related to COVID-19 and evaluate how these interventions could influence the impact of the pandemic.
  3. Health Disparities, Policy Changes, and Socioeconomic Effects in the United States: Appreciate the complex and rapidly changing landscape of the COVID-19 pandemic as it stands in the United States as well as the changing responses of the health care system and society as a whole.
  4. Mental Health in the Time of COVID-19: Assess how the COVID-19 pandemic affects the mental health of patients and identify basic tools for responding to these changes in the clinical setting.
  5. Communicating Information about COVID-19: Prepare to productively communicate information about COVID-19, especially with a nonmedical audience that may have varying attitudes toward the pandemic.
  6. Training for Potential Clinical Roles: Develop technical know-how in preparation for roles that medical students may play in the clinical setting.
  7. Global Innovation and Collaboration: Explore collaborative innovation and shared experiences regarding optimizing “staff, stuff, space, and systems” between countries of all income levels as they relate to COVID-19.
  8. Medical Ethics in Relation to COVID-19: Discuss various ethical controversies related to COVID-19 and apply ethical frameworks to examine the impacts of personal, medical, and governmental decisions related to the pandemic.

aAll modules are available at https://curriculum.covidstudentresponse.org.

Acknowledgments:

The authors acknowledge the dedication of the dozens of Harvard Medical School students and faculty members involved with the creation and maintenance of this curriculum, as well as the other collaborators from both within and beyond Harvard whose contributions have enriched this work beyond measure. They also thank Dr. Edward Hundert, Dr. David Jones, Dr. Andrea Schwartz, and Dr. Henrike Besche for their advice on the manuscript.

References

1. Soled D, Goel S, Barry D, et al. Medical student mobilization during a crisis: Lessons from a COVID-19 medical student response team. Acad Med. 2020;95:1384–1387
2. Rose S. Medical student education in the time of COVID-19. JAMA. 2020;323:2131–2132
3. iCollaborative. Clinical teaching and learning experiences without physical patient contact. https://icollaborative.aamc.org/collection/covid19-alternative-learning-experiences. Accessed August 28, 2020
4. Adams NE. Bloom’s taxonomy of cognitive learning objectives. J Med Libr Assoc. 2015;103:152–153
5. McLean SF. Case-based learning and its application in medical and health-care fields: A review of worldwide literature. J Med Educ Curric Dev. 2016;3:JMECD.S20377
6. Fong SF, Sakai DH, Kasuya RT, et al. Medical school hotline: Liaison Committee on Medical Education Accreditation, Part IV: Pre-clerkship education. Hawaii J Med Public Health. 2016;75:48–51
Copyright © 2020 by the Association of American Medical Colleges