As the COVID-19 pandemic continues to ravage worldwide, educators have been required to move from in-person classes to an online setting to ensure the continuity of education [1, 2]. Some institutions were aided by their experiences from previously implemented pandemic preparation responses due to curriculum disruption during the SARS and H1N1 influenza outbreaks [2,3,4]. As the world enters the next phase of this pandemic, where many countries are going through cycles of tightening and loosening of restriction measures, there are now opportunities to allow a limited number of students to return to campus for an in-person education. However, returning to full in-person education remains a challenge for a variety of reasons. These limiting factors include the inability to accommodate the entire class size at a teaching venue due to prevailing social distancing measures, and the gradual adoption of vaccination differentiation measures, such as only allowing fully vaccinated individuals to attend in-person classes .
Why Implement Hybrid Classes Instead of Remaining Online?
Considering the concerns for resuming in-person classes, we offer a strategy to implement a hybrid arrangement of synchronous in-person and online classes, which will allow a fraction of students to resume in-person education. Such innovations that will allow the resumption of in-person education in a hybrid setting, in the short term, would provide a solution during the pandemic and, in the long term, would allow educators to rethink issues about class size and engagement strategies post-pandemic. With minimal changes in resource requirements, a hybrid class will allow educators to expand class size without the size of the physical venue being a limiting factor.
Even though the impact of prolonged online learning on the students’ development can be mitigated by different educational settings or instructional methods , we advocate for resuming some form of in-person education during the ongoing pandemic, because we have previously shown that whilst the students’ perceptions of learning were not negatively affected, they perceived that the development of their interpersonal skills was impacted in a fully online team-based learning (TBL) environment . Similarly, several other studies have found that students perceived unsatisfactory interpersonal interactions when immersed in a prolonged online learning environment [7,8,9,10,11,12], as shown by poorer ratings for teamwork interdependence in an online TBL environment, despite similar academic performances in both online and in-person TBL classes [7, 8]. The suboptimal interpersonal interaction is further compounded by the social isolation that has occurred due to the COVID-19 pandemic, which has been shown to have a significant psychological impact on students [13,14,15]. In the case of healthcare professional students, the suboptimal social interactions due to prolonged online learning lead to two other concerns: suboptimal team dynamics and delayed professional identity formation [7, 16,17,18,19,20].
Team Dynamics is Suboptimal in Online Classes
In the medical field, good teamwork has been shown to improve medical outcome and quality of patient care [21, 22]; thus, healthcare professional educators have been implementing educational methods that promote teamwork. This includes TBL, a structured educational method that requires students to complete pre-work individually, attempt in-class activities individually (termed Individual Readiness Assurance Test) and then together in teams (termed Team Readiness Assurance Test), and solve application case studies as a team . With an in-person TBL class, the benefits of a diverse team are manifested after 20–25 h of interaction . In addition, learners attending in-person TBL are more likely to have organic interpersonal interactions and team building events after lessons. Team cohesion is crucial to the TBL process, as it was shown to be a significant predictor for team academic performance . In a completely online TBL environment, social activities that promote team cohesion are likely to be limited. Indeed, we have found that most students preferred in-person over online TBL, as it supported the in-person interaction with their team members that is crucial for team building (unpublished results; Table 1). Consistent with this notion, recent studies have also reported that teamwork and team dynamics were impacted in online classes, as reflected by reduced group deliberation, which is suggestive of potential conflict avoidance that could be detrimental to the learning process and team cohesion [7, 16, 17]. Therefore, it is critical to develop ways to support in-person team building, such as hybrid classes, whenever possible.
Professional Identity Formation is Delayed in Online Classes
Professional identity formation is also an important part of physicians’ development. Professional identity is a highly dynamic and multi-faceted process achieved through socialisation with peers and mentors, and influenced by interactions with patients in the clinical setting [26,27,28,29]. Given that being part of the community of practice is fundamental for professional identity formation [30, 31], concerns were raised when medical students were temporarily removed from the clinical training environment during the COVID-19 pandemic . By extension, the social isolation due to online learning can affect preclinical students’ sense of belonging to the greater community of practice. During the pandemic, majority of online classes placed greater emphasis on the continuity of medical education, i.e. discipline knowledge, rather than on fostering communities of practice . Thus, the limited opportunities for engagement in informal observation and being part of the community of practice when immersed in fully online classes are perceived to impact professional identity formation . Recent qualitative studies also showed that students, who transited to an online learning environment, experienced various disruptions to the facets of formal, informal, and hidden curricula that are critical in facilitating professional identity formation [19, 20]. In essence, online learning had changed their interaction with faculty, role models, and peers. Students noted that real human interaction was an irreplaceable part of the socialisation process, which was important in promoting professional identity formation . Indeed, medical educators have thus called for “reimagining” of professional identity and innovative ways to support professional identify formation during the pandemic [34, 35]. Hence, to strengthen the process for medical students to “think, act, and feel like a physician” , we advocate for including some form of in-person education, even during the pandemic.