The transnational virtual classroom as a learning environment for Family Medicine residents in Palestine: residents’ perspectives

Problem

The residency programme for Family Medicine (FM) in the West Bank has been running since 2014. Geopolitical complexities hinder knowledge exchange and cause professional isolation. An online tutorial programme (OTP) has been running since 2016 as a means of British GPs supporting FM residents in the first two years of training to meet learning needs around clinical complexity and patient-centred skills. The OTP is a unique virtual learning environment (VLE) incorporating case-based teaching with online presentations in real-time, patient simulation and small group work, and uses a chat-based platform with synchronous peer-to-peer and resident-to-tutor discussions that cross geographical borders.

The aims of the study are

1) To examine the perspectives of Palestinian FM residents on using a VLE with transnational support from UK tutors

2) To devise a framework for assessing impact on learning

Approach

A virtual focus group was conducted in English using a chat-based platform with a group of five third-year FM residents in the West Bank, facilitated by one UK and one Palestinian faculty member. The data was downloaded in its chat-form and independently coded by two authors (one Palestinian and one British) who also performed the content analysis. Key themes were identified and a framework analysis used which was modified in light of themes grounded in the data. A novel framework was devised, E-QUaL, synthesising and adapting four frameworks used in technology-enhanced learning; Evaluation, Quality, Usability and Learning, where the SCOT framework for evaluation (strengths, challenges, opportunities, threats) was used as a meta-framework for systemising the data.

Findings

The biggest strengths of the programme were connecting FM residents with UK tutors to learn about FM practice in an established setting, learning the “art of FM”, learning a new way of approaching patients, and the positive collaboration between UK and Palestinian faculties. The challenges included content, cultural context, residual unmet learning needs, and technical issues such as the fast pace, preference for more multi-media resources, and mixed opinions around group work and simulated patients. As the course moves to a new platform with enhanced media features, this study provides opportunities to improve the educational experience for the next cohort of residents. The threats include the new cohort adapting to a different mode of teaching, and the constant challenge of balancing clinical knowledge and professional skills in content development.

Consequences

The transnational virtual classroom is a useful and supportive learning environment for trainees in countries transitioning to FM, especially under challenging geopolitical circumstances. It can support the development of patient-centred skills and critical thinking and address professional isolation. Virtual focus groups can be conducted to overcome spatial and geographical barriers and the E-QUaL Framework can be used to assess experiences and impact on learning in a virtual learning environment.