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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 33-37

Coronavirus disease 2019: the role of telemedicine and teleteaching. A review


1 Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India
2 Periodontology and Implantology, Ex Pg Student, H.P Government Dental College and Hospital, Shimla, Himachal Pradesh, India
3 Department of Oral Medicine, Private Practitioner, Patna, Bihar, India

Date of Submission18-Aug-2020
Date of Acceptance12-Jul-2021
Date of Web Publication15-Sep-2021

Correspondence Address:
MDS Rohit Singh
Department of Oral Medicine,Private Practitioner, Patna, 800 001, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tdj.tdj_30_20

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  Abstract 


Beginning from late December 2019, this spring of 2020 has been a testing time globally for every individual. Especially impacted are the health care educators of both medical and dental communities. New coronavirus disease 2019 or severe acute respiratory syndrome-CoV-2 is a highly contagious and lethal virus that has drastically influenced students, health care teachers, patients, and clinicians similarly. Numerous dental and medical schools/colleges have temporarily put on hold all clinical postings and placements along with classroom teaching to counter this virus's transmissibility. The onset of this disease may have profound and drastic consequences as colleges and universities have begun to conduct remote assessments while few are even considering deferring fresh students' related courses due to the inability in carrying out teaching and clinical postings. As health care systems shall be further stretched with an increasing burden of new coronavirus disease 2019, disruptions in medical education are expected across all countries and continents. Hence, necessary arrangements have to be made so that learning students can maintain their clinical skills as well as knowledge. Teleteaching or remote teaching technologies can potentially substitute in-person lectures and clinical training, particularly during the current pandemic era. These replacement approaches may be necessary as effective measures in the current medical education dilemma during this current health care crisis and shall also aid in laying the future foundation for teaching during similar confounding situations. In this review article, we shall discuss various modes of remote teaching that are available at this time.

Keywords: coronavirus disease 2019, dental, education, medical, modes, teaching


How to cite this article:
Kulkarni MD, Kadam H, Mahajan A, Singh R. Coronavirus disease 2019: the role of telemedicine and teleteaching. A review. Tanta Dent J 2021;18:33-7

How to cite this URL:
Kulkarni MD, Kadam H, Mahajan A, Singh R. Coronavirus disease 2019: the role of telemedicine and teleteaching. A review. Tanta Dent J [serial online] 2021 [cited 2021 Oct 19];18:33-7. Available from: http://www.tmj.eg.net/text.asp?2021/18/2/33/326038




  Introduction Top


The currently ongoing new coronavirus disease 2019 (nCOVID-19) pandemic is caused by the severe acute respiratory syndrome (SARS)-CoV-2 coronavirus [1]. The outbreak and faster diffusion of SARS-CoV-2 which is responsible for COVID-19, has caused an emergency in the health and education system worldwide [2]. Four known human coronaviruses primarily cause mild to moderate degree of upper respiratory tract diseases which include alpha-coronaviruses and beta-coronaviruses. The SARS and Middle-East Respiratory Syndrome (MERS) are the recent viral strains that caused pandemic disease. The coronaviruses responsible for human diseases are the beta corona strains. These viruses possess great ability to undergo mutations therefore; posing more challenges [1]. The COVID-19 infection spreads from human to human transmission mainly through fomites and droplet infection [3].

Health care academic institutions are centers for conducting research that can aid in saving countless human lives. These institutions are also known as 'academic health care or medicine systems' where knowledge and expertise are provided to students both to undergraduate as well as postgraduate students and residents to practice medicine, surgery, dentistry, pharmaceutical sciences [4].

This review aims to ensure the impact on outcomes related to the education and health sector since this is not just a pandemic state but also, an infodemic. At present, health literacy is very important as all socio-ecological model levels which include – individuals' health-associated behaviors, interpersonal and family relationships, organizational behaviors, state policies, and their drafting, state, and national level mortality statistics and global economy within few weeks' spans.

Teleteaching and telemedicine

Academic health institutions such as medical and dental colleges or hospitals have a central mission which largely focuses on providing education. In the present COVID-19 times, both the infrastructure along with resiliency is under the scanner. Also, the residency programs have been severely impacted due to social distancing norms and limited supply of personal protective equipment. Thus, hands-on training programs have been affected worldwide. Apart from training schedules, even written followed by oral examination have also been postponed. Under these circumstances, both flexible behavior and creativeness are required to continuously enable the learning process. Since hands-on training is affected, the majority of the education system has largely tilted towards the didactic part of the academic curriculum.

Utilization of various on-line web-based platforms may be sufficient for undergraduate students' teaching in preclinical learning years while senior year health care students training in clinical section requires absolute patients' contact as face-to-face communication and clinical examination of patients is requisite for the learning process and building of a diagnostic clinical process. Sir William Osler had famously opined that 'the one who studies medicine with-out any books sails upon un-charted seas, but the one who studies medicine without patients does not go to sea ever.'

Hence, web-based online platforms that include lectures, teleconferencing, etc., have taken major procedures to continue with the academic process. For example, Tomlinson (2020) developed an online software program namely, The Neurosurgical Atlas (available as http://www.Neurosurgicalatlas.com), that is mainly focused on operative procedures and microsurgical anatomy. Its subscription has increased to greater than 20% ever since COVID-19 emerged as a major pandemic. This platform comprises a three-dimensional collection of neuroanatomical structures such as – the cavernous sinus, temporal bone, various surgical areas, or corridors like – supra-orbital, orbito-zygomatic, etc., These illustrations are preferred on two-dimensional printed images in textbooks as they can facilitate the learning procedure in complex anatomical regions [5].


  Challenges in coronavirus disease 2019 times and methods employed for teaching and training Top


The growing COVID-19 disease has led to both increasing demands on clinical and administrative aspects of running hospital services along with providing educational tools as didactic lectures, chalk, and board discussions, etc. Online web-based programs have been initiated by an email that contains a link address along with a password. After a person joins a meeting, the screen is shared and recordings are made. This virtual education platform is also provided with the option of blurring any user's background for privacy purposes. Thus, an online virtual educational training program helps in providing a platform for patient participation along with collaborating. However, the outcome of continuing education specifically for hands-on patient-based health care systems requires constant monitoring [6].

Most of the professionals imparting dental and/or medical knowledge are also working as front-line workers in the COVID-19 pandemic. Thus, following this, there is a shortage of professionals who are working on both ends especially, that in-charge of working on infected patients and also, in affected areas [7].

It is important to maintain and also, contribute to each other's mental well-being while remaining in an increasing period of isolation. This is more important for young age groups who usually remain occupied with numerous activities. For medical and dental students, this isolation period is a deterrent to the learning process. Hence, newer mechanisms of imparting knowledge have to be devised. Online platforms like WhatsApp, Zoom, and email services are few interactive handles where this can be achieved [8].

All the remote learning methods have been well received by students and residents all over the world. However, one of the greatest changes has been an emphasis on self-learning which is very important for understanding any patient. However, there might be a reduction in confidence when related to clinical applications leading to stressor development. This may be overcome by regular clinical postings on the redeployment of the education system as before [9].

Providing health literacy in these pandemic times along with routine evaluation, communication, and services has gained increasing importance. Thus, high literacy regarding this pandemic disease is very critical and important right at this moment [10]. The nCOVID-19 infection represents an unprecedented challenge in health care and associated education system. Integrated information services include the establishment of a hospital command center, creation of computerized automated dashboards alongside optimization of communication to patients and staff. Also, a tele-intensive unit along with teleconference software can aid in providing communication skills [10].

The most crucial element in imparting education in these times is the reassurance of students and their parents. Remote teaching involves asynchronous reading and learning which the functional format in assignment works is. Curriculum development should include assessment techniques for students. This shall enable teachers to focus on evaluating teaching methods and furthering any improvements. Also, a roadmap to provide adjustments to the learning trajectory of the student after the restoration of postpandemic normalcy can be devised. Since COVID-19 spread led to fast actions to curb its spread, most academic institutions did not find time to prepare themselves for remote teaching methods. However, learning via remote methods requires certain prerequisites such as – availability of ready material at home, finalization of results of terminal exams which could help in assessing students and above all, staff readiness, division of work and constantly learning updates on distance teaching methods and aids [11].

Due to COVID-19 pandemic, medical and/or dental or complete health education has undergone drastic changes mainly due to lack of face to face teaching and regular assessments. Also, affected are clinical postings and associated classes. This description requires remote assessment. Also, few universities specifically in the United Kingdom are planning to defer new admissions. Therefore, the traditional form of teaching at present has been replaced with online, electronic, or distance learning methods. Thus, this teaching method aids in guiding students based upon curriculum content and also helps in covering the course content. However, there is very limited interaction between teachers and students. There is also an underlying worrisome trend that restarting normalcy teachers and institutions might be facing empty lecture halls along with a reduction in active participation. Therefore, universities should tap into using interactive platforms that are based upon live video-conferencing. This will encourage student participation while maintaining social distancing also. Apart from preclinical patient teaching, those into clinical teaching wherein contact with patients is required, telemedicine can be practiced. Also, the use of tablets has been advocated. Herein, one tablet is provided to a patient seated in an isolated room. Followed by this, the patient communicates with the doctor with another tablet in another chamber and gets his prescription. The tablet meant for patients is cleaved using appropriate disinfectants as per protocol. Thus, both students along with physicians can effectively communicate with patients at the same time avoid risking exposure to this viral pathogen. This will also reduce the consumption of personal protective equipment. This method shall help students in clinical settings in maintaining and refining their diagnostic learning and at the same time, it will also allow them in providing aid in form of extra hands to the already stretched out health care systems by helping in reduction of COVID-19 through screening and communicating with the patients in the triage area [12].

Plancher and colleagues opined that to continue with the education specifically directed towards skills training technologies like – simulation-based training, virtual reality-based training programs, augmented reality-based software via distance learning online mode should be developed and their usage should be encouraged. The virtual learning platforms or e-learning navigates around costs involving food, lodging, and travel expenses. Also, facilitating students to learn at their own pace and time. However, enforcement of regular participation by students, both undergraduates, and postgraduate residents can be further enforced by marking virtual attendance. However, there are long term side-effects or flip side to this teaching technological method. For example, when a person participates in training programs and conferences, they become submerged in those activities as they are away from their routine distractions. Attending virtual training and conferences or seminars can impact learning. To circumvent these, various educational institutions have started to use web-based programs such as Moodle, Angle, Vista, and Blackboard. Also, organizing webinars and podcasts can be routinely employed to enhance the learning process [13].

Teleconferencing has shown positive influences in reducing the number of visits to the emergency department due to an integrated approach by all physicians which includes psychiatric counseling to alleviate anxiety and depression [14]. Since all medical and dental institutions are slowly converting into virtual learning platforms, trainee residents can also play a significant role in teaching by using images to teach gross and microanatomy along with pathophysiology of various diseases [15].

The extreme transmissibility and increase in mortality risk especially among patients with comorbid conditions. Hence, social or physical distancing has been adopted in an attempt to slow down the spread or the 'curve flattening' in commonly used terminology nowadays to depict plateauing of virus spread. Tele-health services which include virtual clinical visits and digitalization of health prescriptions have thus, gained momentum even in clinical training sessions. However, these services when extended to inter-state stakeholders (patients) require firm adherence to local practice regulations and guidelines [16].

Telemedicine services have traditionally been used for providing health care in remote, low resource, and rural settings. There is an urgent need for the expansion of these services in the present COVID-19 scenario. Thus, the use of these web-based facilities educes strain on education as well as the health care system [17].

Cancellations of class-oriented lectures have led to teaching via remote learning methods. However, there is a lack of proper guidance regarding methods of conducting them. Lipomi described the uploading of pre-recorded lecture videos which comprises theoretical content; problem-based learning and real-time applications. These lectures can take place at regular intervals twice weekly. Another advantage of distance-based or remote learning teaching programs is that any student can revisit the lectures based upon their suitability and requirements numbers of times and listen to certain portions of the lectures at ease [18].

Alsafi and colleagues reported that numerous modifications have been introduced in assessment mechanisms that vary widely among various institutions. Few universities have either delayed or expedited final examination while others have decided to complete the cancellation of terminal examinations. In this case, student evaluation shall be based upon either open book assignments or using previous performances towards the year-end and mid-term examinations based upon which outcome or result can be ascertained [19].

To ensure distance learning mode, institutions must assess their remote users' capability, software to be used, licenses requirements and limitations related to hardware and bandwidth to connect with internal computer systems to ensure that institutional computer systems can handle the influx of users and also, ensure an increased utilization of network and resources. Therefore, multiple sites with telehealth capability should be prepared as soon as possible [20].


  Conclusion Top


While considering the current state of graduate and postgraduate medical and dental education, it is no surprise that the teaching method is a predominantly traditional form of didactic teaching and learning. However, this form of teaching and learning has now challenged unlike before, especially due to the currently employed public health measures maintaining social distancing to mitigate COVID-19 spread. As a result, there is a disruption of regular educational activities. This may harm students' and trainees' mental wellness and especially, the sense of student community.

In the nCOVID-19 era, the need for effective innovative solutions for optimizing educational discourse has increased. Future online-based applications should focus on measurement of outcomes which include student and parent satisfaction, virtual attendance, and also, clinical performance. Additionally, these platforms may be utilized further for conducting board reviews and mentoring programs. Although at the same time it is equally important that online remote teaching does not replace the requirement for clinical procedures and teaching but acts as an adjunct or complementary method with the existing virtual platforms.

During the nCOVID-19 pandemic and the requirement for maintaining social distancing, all virtual learning and training platforms significantly have undergone reshaping and innovations on our methods of teaching and promoting interactions with medical and dental trainees students. Additionally, this has allowed the continuation of a need to foster community feeling among students and teachers. These measures can help attenuate trainee burnouts and promote mental and emotional wellness at a time when individual isolation has become part of day-to-day life. Thus, program-specific virtual learning training platforms have an important role to play in the learning process of medical and dental students.

Conflicts of interest

None declared.



 
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