Pediatric basic course goes virtual: transition from face to face to hybrid learning in pediatric critical care

The transition to virtual education models during the COVID-19 outbreak has been well described in the scientific literature over the last two years [6]. This course has demonstrated the flexibility and feasibility of transitioning to a hybrid model. In addition, no significant differences were found using a number of different evaluative methods between the two modes of course.

We suggest that these findings support the rationale that because the course contents are highly standardized, they are perceived by students in the same way regardless if presented face-to-face or virtually. At the end of both courses, the skills stations and simulated scenarios were highly appreciated and individually described as one of the most interesting parts of the course. The request for more time for practice is understandable, underlying the value of experiential sessions. Experiential learning entails a hands-on approach compared to more frontal instruction, making simulation a more personal and engaging way of learning. Although there was no significant difference in the pre and post-survey confidence levels reported by participants for most items, students of the face-to-face course reported a general shift in confidence compared to the hybrid course.

Conversely, the hybrid group had higher rates of self-confidence compared to the standard group, especially in emergency procedures. Maybe this is because there was a strong presence (22%) of anesthesiologists in the hybrid group, which was the only difference in the group’s composition. Probably this difference among the participants composition is also responsible about the higher pre and post assessment scores of the HC group compared with the FC (Table 2). This difference in a deeper perspective can be also responsible about the shift in pre and post assessment variability shown in Fig. 3. But despite the difference between the two starting groups, after the course in both FC and HC groups most of the attendees achieved a score > 80% correct in the post-course MCQ. This basal differentiation among groups affect the final scores, but we have to consider that anaesthesiologists, paediatricians and adult emergency physicians are all professional categories part of the target of BASIC course itself and the composition of the groups of attendees can have high variability in each course for several reasons. Possible implications of these findings have not been studied due to the small size of both groups. This comparison between FC and HC as part of a pilot experience represents a starting point for more accurate consideration for example in the group constitution and related educational offers. The possibility to study a larger sample of participants will provide a more precise statistical analysis on this topics.

To better define the difference reported for these specific items, a larger sample from a greater number of courses would be required.

The faculty reported a progression in the engagement and interaction of the attendees during synchronous virtual meetings in the hybrid format, probably due to the increasing confidence of the attendees with this approach and also with the faculty members. We used the “flipped classroom’’ approach, one of the models of virtual learning, where lectures are delivered through recordings that students view outside of class, thereby saving (virtual) in-class time for individual or group virtual practice and exercises, with the instructor present to assist and answer questions [7]. That means that our theoretical pictures required the students to prepare themselves for face-to-face practical sessions and engage with the material beforehand [7, 8]. In this sense, they were considered not as ‘homework’ but essential groundwork for productive class time [9]. Studies in different fields, such as law and psychology, suggest that distance learning may not increase benefits compared to traditional in-class instruction but are as effective [10]. This is an important point in terms of feasibility and effectiveness for designing new learning formats and also in the perspective of diffusion of specific learning content to a larger audience. Furthermore, online or blended courses allow the participation of students from all over the world, bringing together diverse people, cultures, and communities outside our physical location. This also offers the possibility to lower costs for building teaching modules and to provide more equal access to learning opportunities.

The pre-recorded lectures on the virtual platform represented an advantage for non-native English speakers since it was possible to listen to and review the theoretical lessons for a period of time sufficient to ensure adequate understanding by all the students. Unlike their face-to-face counterparts, online courses are predominantly asynchronous, where both faculty and students manage this themselves to a large extent. Asynchronous courses present an advantage to adult learners who need a flexible schedule. The diverse global faculty provided the candidates with opportunities to compare multiple perspectives from colleagues from all over the world, as the pre-recorded lessons and virtual meetings involved professionals from more than ten highly specialized training sites. Despite the progressive increase over the pandemic period to virtual and online teaching, some of the instructors noted the time-consuming aspect of using and implementing new technologies and the need for both students and faculty to be comfortable with the platform. On the other side, gaining familiarity with this virtual material can make it progressively easier to use and allowed the faculty to create a pool of lectures and recorded material that can be used repeatedly for many courses. Another challenging aspect of the hybrid course was the online workshops and simulation scenarios conducted locally but supervised and debriefed remotely using the online format. Conducting these sessions in English was challenging and highlighted the importance of having local facilitators involved in all sessions to support participants if language impeded the conduct of the session. The application of remote simulation as a practice for distance training is now increasingly widespread [11‐13]. This necessarily requires a high degree of preparation and engagement on the part of the instructors [11]. However, the participants considered these experiences just as favorably as the same skill stations and simulated scenarios in the face-to-face format. In face-to-face learning, the instructors encourage the students to connect with others and share their experiences. If virtual and blended learning are delivered appropriately, the instructor can maintain this role with the same aims and scopes. This can be a challenge as it can be difficult to maintain a high attention level of students in the virtual context and manage the complexity of the learning environment.