An intravenous injection simulation using improvised materials.
Trisha Denise D. Cedeño1, Ian Christopher N. Rocha1, Kimberly G. Ramos1, Noreen Marielle C. Uy1
doi: http://dx.doi.org/10.5195/ijms.2021.908
Volume 9, Number 1: 77-79
Received 11 01 2021: Rev-request 06 02 2021: Rev-recd 11 02 2021: Accepted 17 02 2021
As of February 10, 2021, coronavirus disease 2019 (COVID-19) has spread across 219 countries and territories around the world, with 106,321,987 confirmed cases worldwide1 and 541,560 confirmed cases in the Philippines,2 since it was initially identified in Wuhan, China on December 31, 2019.3 Due to increasing cases, many countries have imposed preventive measures to contain the virus which include the closure of schools, colleges, and universities.4–7
Our online learning classes started 11 months ago when the Philippine government imposed a community quarantine on March 10, 2020.7 Due to the continuous rise in number of cases, an Enhanced Community Quarantine (ECQ) was imposed after one week.8 Under the ECQ, residents were not allowed to leave their homes except in cases of emergency and essential reasons.8 Because of this preventive measure, almost all educational institutions shifted to online education. Despite the class suspensions, students were advised to fulfill their educational requirements during the ECQ period.
Our institution opted to use online platforms to facilitate continuous learning processes. This abrupt shift to an online curriculum has enabled creativity, innovation, and adaptability among students and professors alike.9,10 However, it has also increased stress and, possibly, the toll on mental health and financial burden among the school community. Various contributing factors include difficulty in adjusting learning strategies, the need for new laptops, smartphones, and tablets, having to perform responsibilities at home, poor internet connectivity, and other unexpected events such as natural calamities.11–15
Our institution employed various strategies and innovations to accommodate for the loss of face-to-face encounters, especially those that need to be in the hospital setting. Training materials were not easily accessible and available, thus giving rise to various improvisations. For instance, in Pharmacology, we were required to perform the various parenteral routes of drug administration. Due to the strict ECQ implementation, a student resorted to using a towel to simulate a patient's arm, ballpen refills to simulate blood vessels, and a makeshift cotton holder using pens, cotton, and tape Figure 1. Meanwhile, other students used stuffed toys to serve as their patients Figure 2.
Figure 1An intravenous injection simulation using improvised materials.
A clinical skills simulation on the preparation and administration of parenteral medications on stuffed toys as simulated patients.
As incoming senior students, we were excited to practice the theoretical knowledge we learned in school by undertaking rounds and meeting actual patients. In the context of this pandemic, we were caught up in the uncertainty of when we would go back to school and the possibility of being the next front-line workers in the hospitals. Despite the challenges, the Filipino spirit of resilience persevered as we adapted to the constant changes, completed all the academic requirements, and we were promoted as clinical clerks in May 2020. In the Philippines, a 4-year Doctor of Medicine program consists of 3 academic years and 1 clinical year, which is the clinical clerkship.16
Our clinical clerkship, or final year, formally started on June 1, 2020. Had it not been for the pandemic, the usual setup for clinical clerks was supposed to be done in community and hospital settings. The cohort one year ahead of us spent their time at a tertiary level teaching hospital. However, for our cohort, everything was conducted online. We spent the first half of our clerkship in the comforts of our own homes as it would be dangerous to deploy us into hospitals due to risks of infection and/or transmission of COVID-19.
For the first half, our clerkship syllabus included online rotations among the major departments, namely, Internal Medicine, Obstetrics and Gynecology, Pediatrics, and Surgery, and the minor departments, namely, Family and Community Medicine, Psychiatry, Radiology, Orthopedics, Otorhinolaryngology, and Ophthalmology. This entailed small group discussions (SGDs), presentation of assigned topics, and webinars held online. For the second half, which began in December 2020, the focus was on clinical skills among the major departments. At present, clinical clerkship in the hospital remains uncertain. In the meantime, while compromises are being made in hospitals, online adjustments and leniency are in place.
Online rotation activities include clinical case discussions and conferences, patient encounter simulation scenarios, interactive SGDs, and reporting sessions via Zoom and/or Google Meet. For patient encounter scenarios, students are tasked to make a video recording of simulated clinical history taking and physical examination with their family members as their patients, which is subsequently presented during SGD sessions Figure 3A. Some rotations do not require videos but discuss real-life written clinical cases virtually Figure 4. The most unforgettable experiences include a virtual patient encounter with a real patient in our Family Medicine rotation Figure 3B, and a virtual episiorrhaphy workshop on a chicken as a simulated reproductive organ of a postpartum patient during our Obstetrics rotation Figure 5. Some mobile applications, such as Touch Surgery and Docquity, are also useful.17,18 Meanwhile, quizzes and exams are completed at the end of rotations via Google Forms, Microsoft Forms, and/or Edmodo.
Figure 3(A). Patient encounter simulations during our rotations in Internal Medicine, Obstetrics and Gynecology, and Surgery, (B). Screenshot image of a real virtual patient encounter during our Family and Community Medicine rotation via Facebook Messenger (photo posted with consent from the patient)
Screenshot images of interactive SGDs with preceptors via Zoom meetings during our Internal Medicine rotation.
Virtual workshop and simulation of episiorrhaphy on a chicken during our Obstetrics and Gynecology rotation.
It seems easy to handle learning online until you get to the point where actual skills have to be tested and practiced. Online learning has limitations on medical skills which require things to be felt, heard, and seen – all things that need to be tangible to practice the clinical eye. Despite all the challenges, there are also benefits. For instance, it is easier for preceptors to monitor attendance as well as for everyone to hear each other speak since voices are magnified through headphones, earphones, or speakers. Students can now easily go back and review the live online lectures since some professors allow the recording of online classes. The preceptors also give ample time for the students to prepare for their classes and exams. The pandemic blessed everyone with a deeper sense of understanding and consideration of individual struggles and personal life matters.9,10,12,19
It cannot be denied that the past 11 months was an uphill climb with constant struggle to study and stay on track to become physicians. Nonetheless, this pandemic has brought medical school to our homes and has given us more time to reflect on the pressing national issues affecting the health of the Filipino people. It is also a great opportunity to find a deeper meaning on our chosen career path and a strong motivation to become better physicians in the future.
We would like to thank Rachel Anne J. Tinio, Gianne D. Lontoc, Shannon Jean R. Roque, and Aya Grace D. Matsunaga for sharing their photos during their online classes and virtual clinical clerkship.
None.
Conceptualization: TDC, ICR, NMU. Data Curation: TDC, ICR, KGR. Supervision: TDC, ICR. Writing – Original Draft: TDC, ICR, KGR. Writing – Review & Editing: TDC, ICR, KGR, NMU.
1. World Health Organization. WHO coronavirus disease (COVID-19) dashboard. Geneva: World Health Organization; 2021 Available from: https://covid19.who.int. Cited Feb 10 2021.
2. Department of Health. COVID-19 tracker [Internet]. Manila: Department of Health; 2021. Available from: https://doh.gov.ph/covid19tracker. Cited Feb 10, 2021.
3. World Health Organization. Listings of WHO's response to COVID-19 [Internet]. Geneva: World Health Organization. Available from: https://www.who.int/news/item/29-06-2020-covidtimeline. Last updated: Dec 28, 2020, cited Feb 10, 2021.
4. Buonsenso D, Roland D, De Rose C, Vásquez-Hoyos P, Ramly B, Chakakala-Chaziya JN, Munro A, González-Dambrauskas S. Schools closures during the COVID-19 pandemic: a catastrophic global situation. Pediatr Infect Dis J. 2021 Jan 12.
5. Vlachopoulos N, Smyrnakis E, Stachteas P, Exindari M, Gioula G, Papa A. Medical students during COVID-19 pandemic: lessons learned from response teams in Greece. Int J Med Students. 2020 14 May-Aug;8(2):191–193.
6. Thomas A, Shenoy MT, Shenoy KT, Suresh Kumar S, Sidheeque A, Khovidh C, Pillai JP, Pillai PM, Sherin CH, Mathew A, Zakkir T, Dileep S, Mekha V, Raju S, Junaid K, Sivendu P. Survey among medical students during COVID-19 lockdown: the online class dilemma. Int J Med Students. 2020 May–Aug;8(2):102–106.
7. Presidential Communications Operations Office. Gov't imposes community quarantine in Metro Manila to contain coronavirus. Manila: Presidential Communications Operations Office. Available from: https://pcoo.gov.ph/news_releases/govt-imposes22community-quarantine-in-metro-manila-to-contain-coronavirus/. Last updated: Mar 13, 2020, cited Jan 11, 2021.
8. Merez A. Luzon quarantine: a breakdown of implementing guidelines. ABS-CBN News. Available from: https://news.abs-cbn.com/news/03/17/20/luzon-quarantine-a-breakdown-of-the-implementing-guidelines. Last updated: Mar 17, 2020, cited Jan 11, 2021.
9. Pacheco Carrillo AM. The utility of online resources in times of COVID-19: a Mexican medical student point of view. Int J Med Students. 2020 Jan–Apr;8(1):58–59.
10. Seymour-Walsh AE, Bell A, Weber A, Smith T. Adapting to a new reality: COVID-19 coronavirus and online education in the health professions. Rural Remote Health. 2020 May;20(2):6000.
11. Baticulon RE, Sy JJ, Alberto NRI, Baron MBC, Mabulay REC, Rizada LGT, et al. Barriers to Online Learning in the Time of COVID-19: A National Survey of Medical Students in the Philippines. Med Sci Educ. 2021 Feb 24;1-12.
12. O'Doherty D, Dromey M, Lougheed J, Hannigan A, Last J, McGrath D. Barriers and solutions to online learning in medical education: an integrative review. BMC Med Educ. 2018 Jun 7;18(1):130.
13. Adebisi YA, Agboola P, Okereke M. COVID-19 pandemic: medical and pharmacy education in Nigeria. Int J Med Students. 2020 May–Aug;8(2):162–163.
14. Medina-Gaona LA. Clinical skills abilities development during COVID-19 pandemic in Mexico City. Int J Med Students. 2020 May–Aug;8(2):175–176.
15. Maharaj S. South Africa and COVID-19: a medical student perspective. Int J Med Students. 2020 May–Aug;8(2):186–187.
16. Commission on Higher Education. Policies, standards and guidelines for the Doctor of Medicine 2 (MD) program [Internet]. Quezon City: Commission on Higher Education; 2016. Available from: https://ched.gov.ph/wp-content/uploads/2017/10/CMO-18-s.-2016.pdf. Cited Feb 3, 2021.
17. Mandler AG. Touch Surgery: a twenty-first century platform for surgical training. J Digit Imaging. 5 2018 Jun;31:585–590.
18. Pante JL. Docquity app now available for local medical professionals. Manilla Bulletin 7. Available from: 8 https://mb.com.ph/2018/05/13/docquity-app-now-available-for-local-medical-professionals/. Last updated: May 13, 2018, cited Feb 10, 2021.
19. Garman JC. COVID-19: turning a pandemic into a learning opportunity for senior medical students. Int J Med Students. 2020 Sep–Dec;8(3):307–308.
Trisha Denise D. Cedeño, 1 Medical Student, School of Medicine, Centro Escolar University, Manila, Philippines
Ian Christopher N. Rocha, 1 Medical Student, School of Medicine, Centro Escolar University, Manila, Philippines
Kimberly G. Ramos, 1 Medical Student, School of Medicine, Centro Escolar University, Manila, Philippines
Noreen Marielle C. Uy, 1 Medical Student, School of Medicine, Centro Escolar University, Manila, Philippines
About the Author: Trisha Denise D. Cedeño, Ian Christopher N. Rocha, Kimberly G. Ramos, and Noreen Marielle C. Uy are clinical clerks and 4th year medical students of Centro Escolar University, Manila, Philippines of a 4-year Doctor of Medicine program.
Correspondence: Ian Christopher N. Rocha, Address: 9 Mendiola St, San Miguel, Manila, 1008 Metro Manila, Philippines. Email: rocha1750018@ceu.edu.ph
Editor: Francisco J. Bonilla-Escobar Student Editors: Nicole Katherine Conners Student Editors: Andrew Thomas Copyeditor: Leah Komer Proofreader: Ciara Egan Layout Editor: Sajjad Ali
Copyright © 2021 Trisha Denise D. Cedeño, Ian Christopher N. Rocha, Kimberly G. Ramos, Noreen Marielle C. Uy
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Medical Students, VOLUME 9, NUMBER 1, April 2021