Now, I find myself speaking to physicians who are stressed out both from their careers and from their imploding personal lives.  While I won’t stop hearing from my scientist colleagues anytime soon from exploring alternative career transitions, I anticipate connecting with more medical doctors in the next few years. Many of these doctors no longer recognize the profession they used to love amid the increasingly hostile healthcare environment.

What worries me more is that many of these doctors no longer know who they are.

When you have invested years of your life: about two decades worth of yourself and your life to schooling to become a physician, your career decision has been deeply ingrained (i.e. family heritage) or deeply personal (i.e. personal value around making a difference as a healer). After all, it takes courage and commitment to choose a career where, when you’re finally ready to “start”, most of your peers in other professions are in their mid-career journey.

No wonder, for doctors, it can be harsh and hard to walk away from an identity that has been decades in the making.

If you are a physician, try this: describe yourself without making reference to your profession; without saying “I’m a doctor” or what clinical tasks you perform on a daily basis.

What are you left with?

If you don’t like the answer, make a plan to create one that you can live with and be fulfilled by for the rest of your life. Too often physicians settle for a role (“doctor”) as their identity, and when that role becomes threatened, they find that their identity becomes threatened. They feel out of control with who they are, what they stand for, and how they live their lives.

Now is the time for physicians to start facing this consuming identity crisis before they no longer recognize their lives or worse – themselves.

To me online learning of clinical skills almost sounds like an abomination or contradiction in terms. You learn them knee deep in blood, saliva, urine you name it but not behind a computer screen.

Recently an article was published about the experience of developing an online learning resource that supplements the learning of basic clinical skills for undergraduate medical students. Supplements, so it doesn’t replace the learning of clinical skills completely. This got me interested about their experience with this kind of online learning resource. Mind you, this is not a randomized controlled trial but just some wise advice and clear instructions on how to make a video to be put online for e-learning.

But first the wise advice, The bottom line from the Belfast Experience:
Online learning (Clinical skills) is best placed in conjunction with other traditional forms of clinical teaching, in a blended approach. Educators must be sure that online learning augments the students learning experience. It must not inadvertently promote learner isolation or a reduction of patient-centred teaching.

Especially this last warning is very important. Ah, we have a beautiful comprehensive online learning program so we can sit back and wait for skillful clinicians to be delivered.

Concerns that the uptake of such educational mediums may be influenced more by novelty than by pedagogical evidence, has driven the need for educationalists to share their experiences of e-learning

Sequence of events when producing an online clinical skills video from the discussed article:

• Preparation and planning
• Identify the clinical skill
• Establish any funding requirements (for example, simulated patients and audio-visual fees)
• Ensure that there is a clear understanding of the learning outcomes and relevance to the curriculum
• Produce a storyboard
• Hold a meeting with audio-visual specialists, clinicians and educationalists to approve the story board
• Co-ordinate a date and book a location for filming (ideally at a quiet time)
• Book the audio-visual and relevant clinical equipment
• Book a simulated patient
• Practice the skill to be filmed
• Day of filming
• Brief team on filming sequence
• Gain written consent from simulated patient(s) and participating clinician(s)
• Set up scene, including lighting and sound checks
• Perform a dry rehearsal of the skill
• Film the complete skill
• Film any further specific takes (for example, close-up shots, etc.)
• Debrief on video, and consider re-filming any sequences (difficult to undo after the film has been edited!)
• Post filming:
• Record audio narration, if required
• Edit film, with the addition of text and ? or graphics, if required
• Project team and clinical experts approve final version
• Place on website for streaming

Learning clinical skills is a two phase process in this curriculum. First students learn basic clinical skills such as history taking, clinical examination and simple procedural skills, with the use of mannequins, simulated patients and peer examination. In this first phase they have a website at their proposal. From the home page, students can select a number of options: for example, information and contact details, an updated news section, a ‘Frequently asked questions’ page and a general student support area.

However, the main focus of the website is on the pages and videos of the basic clinical skills taught. The students can review a step-by-step online guide of how to perform this skill by means of text, relevant images and videos. Built into the learning material are links and connections that help to vertically and horizontally integrate this new knowledge.

Advantages of this online learning of clinical skills:

• Students can access learning material whenever and wherever they choose
• Access to online videos are particularly useful for visually intensive clinical skills
• Allows for greater transparency of learning outcomes for both students and teachers
• Facilitates improved communication between teachers and students over a large geographical ‘clinical campus’
• Allows both students and teachers to make wider connections with other aspects of the curriculum
• Promotes greater standardisation of teaching
• Complements traditional methods of clinical skills learning in a blended fashion
• Promotes interprofessional education and sharing of reusable learning objects

They arrive better prepared to the next phase of the teaching of clinical skills: attend in small groups clinical ‘bedside’ attachments, where they have the opportunity to progress these clinical skills on
real patients. They can also rehearse their instructions online on PC or PDA.

What do you think, or do you have experience with this kind of online teaching?

Gerry Gormley, Ian Bickle, Clare Thomson, Kate Collins (2009). Online learning in clinical skills: the Belfast experience The Clinical Teacher, 6 (1), 46-50 DOI: 10.1111/j.1743-498X.2008.00253.x