Covid-19 Summer Term 2020

Summer term 2020 was special. Most universities start their summer term in April and thus, with the onset of the Corona outbreak in March, their preparation time given the circumstances was reduced drastically. One of the major challenges was that face-to-face lectures had to be planned online. In a very short amount of time, new online conference systems were established, and the necessary technical support was partially organized with the help of student tutors. Even though people who work on international projects are already used to video conferencing solutions, the amount of potential technical difficulties is still high and bandwidth issues can destroy all previous efforts.

Instruct, as an e-learning provider, observed a strong increase in online lectures and virtual patient usage in our system. Even institutions that already use our system CASUS and offer numerous online courses outperformed their previous numbers (Graphic 1).

Graphic 1: Comparison of completed virtual patient cases by students from one exemplary university from April to July 2019 and April to July 2020.

The peak in July is the result of exam preparation. We also registered slightly more support requests, however, these were still easily manageable.

In the media, both researchers and newspapers made online learning one of their central themes, especially regarding possibilities on how the current circumstances will impact e-learning in the future. Their findings are not necessarily novel, as can be seen in an article from the New York Times (, “[…] students tend to learn less efficiently than usual in online courses […]. But if they have a facilitator or mentor on hand, someone to help with the technology and focus their attention — an approach sometimes called blended learning — they perform about as well in many virtual classes, and sometimes better.”

In an article from the German newspaper, Sueddeutsche Zeitung, called „Schluss mit dem Digitalgejammer!“ (“Stop complaining about Digitalization!”) ( ), the author highlights the discrepancy between educators moaning about a lack of personal interaction, exchange and dialogue in e-learning, while in reality seminars and lectures are quite often overcrowded permitting no interactivity whatsoever, not to mention dialogues and conversations are rarely feasible. The author states that students might miss pre-Corona campus life, but educators believe and hope that various other reasons also play into this.

It’s exciting to see how this transformation will shape the future, and it seems as though we have a special winter term in store for us, too – this time we will have slightly longer to prepare. One thing is for sure: it’s time for more and better blended learning solutions.

A look back on an eventful first half year

by Felicitas Wagner & Sören Huwendiek, Universität Bern

The first phase of the DID-ACT project (January – June 2020) was a very intense and insightful time. The main goal of the first project phase was to conduct a needs assessment among different stakeholder groups regarding a longitudinal clinical reasoning curriculum for students and a train-the-trainer course for teachers. Also, barriers for the implementation for such a curriculum and course as well as potential solutions were investigated.

At the first meeting of the project-team in Augsburg in January, the foundations were laid for the following work. In the next months, we carried out surveys and interviews. The data collection unfortunately collided with the onset of the Corona crisis, which made it a challenging task to recruit participants in the health sector. Nevertheless, we were able to conduct a considerable number of interviews and almost 200 people took part in the survey. During these difficult times, our bi-weekly online-meetings were especially valuable to keep the project on track, coordinate and support each other with the ongoing tasks.

DID-ACT team meeting in zoom

The analysis of the needs for the student curriculum showed that cases and simulations are seen as especially important in the teaching of clinical reasoning while oral and written exams are seen as most useful to assess clinical reasoning. For the train-the-trainer course, a blended-learning approach is favored. Results on barriers are described in our blog entry “Barriers for a clinical reasoning curriculum“. More detailed results can be found in the D1.1a report and the D1.1b report.

After finishing the data analysis regarding needs and barriers for the planned longitudinal clinical reasoning curriculum and the train-the-trainer course, solutions to overcome the identified barriers were sought. We analyzed the answers from our interview partners and conducted an online ideation workshop with the team members to develop further solutions (described in our blog entry “Online ideation workshop”). More details on solutions are described in the D1.2 report.

After this exciting first phase of the project, we are now looking forward to the next months where a curricular framework with learning goals and educational methods for the student curriculum and the train-the-trainer course will be developed.

Barriers for a clinical reasoning curriculum

As part of the DID-ACT project we conducted over 40 interviews with educators, students and clinical reasoning experts asking them among other questions, what barriers they see for developing a clinical reasoning curriculum for students and a train-the-trainer course for teachers. Interestingly, one of the most important barriers mentioned by the interviewees were cultural barriers. This includes aspects such as a lack of collaboration among educators, no culture of reflection, no culture of dealing with errors, and a resistance to change. A second category of barriers was related to the teaching process. Interviewees identified obstacles such as a lack of awareness that clinical reasoning can be taught, a lack of qualified educators to teach students, and also a lack of guidance and standards on how to teach clinical reasoning.

The results of the interviews can be found in the D1.1b report.

As already started in our ideation workshop we are now discussing solutions to overcoming these barriers – the results will be published by the end of June!

Online ideation workshop

In our specific needs analysis we have identified a wide range of barriers and needs for the implementation of a clinical reasoning curriculum in a survey and semi-structured interviews. As a next step we had planned a face-to-face design thinking workshop on May 5th in Krakow, Poland, to develop solutions to overcoming these barriers and addressing the needs. Due to the travel restrictions we decided to try something new and do the workshop in a synchronous online meeting after an asynchronous individual preparation phase.

For the preparation phase we setp up a course in our learning management system and the team members had time to familiarize themselves with the identified barriers and needs. They were asked to submit at least five (better ten) ideas on how these needs and barriers could be addressed including at least one crazy/absurd idea.

In our online meeting on May 5th we divided the 18 participants into four small groups (using the zoom break out rooms) in which they had to present their ideas and clarify any questions. After 20 minutes we met in the plenary in which each group presented their ideas and we documented and clustered those (using the integrated whiteboard). Finally, each particpant was asked to identify three solutions that are easy to do / hard to do / have a high impact.

Overall, the online workshop worked very well, only the simultaneous presentation of ideas and clustering on the whiteboard was tough, and could be better done in two phases with first collecting the ideas and then clustering them.

During the next weeks we will continue the discussion and refinement of the solutions and publish a final version as D1.2 report by the end of June.