A total of 48 out of 82 medical schools in Japan responded to the survey (a response rate of 58.5%). Table 1 presents the characteristics of medical schools. Participation levels in the study were 42.9%, 77.8%, and 74.2% among national, public, and private medical schools, respectively, with responses from public and private medical schools tending to be higher than those of the national faculties of medicine. The data revealed that deans faced a variety of challenges and, in the absence of clear guidelines, made their own interpretations and took action. Thematic analysis of survey data reveals the involvement of multiple stakeholder groups, including medical students, parents of medical students, medical schools, and government. Table 2 presents the themes and representative quotes. The authors observed no obvious differences in responses between geographic regions.
General Process of Japanese Curriculum Adaptations
Japanese deans said they had guided online teaching based on their universities’ learning environments and the national government’s declaration of a state of emergency. The deans mentioned that during this process they also adopted policy changes from other universities and referenced the discussions of the Association of Medical Education Departments as a guide for changing policy at their individual universities. . Before making changes to the policy, they paid close attention to numerous inquiries, not only from medical students and faculty members, but also from parents of medical students. Finally, the deans stressed the importance of aligning the policy with that of neighboring medical universities.
Although the pandemic required quick decisions, especially in the beginning, the Japanese deans did not act too hastily and took a trial and error approach. They first integrated the opinions of the different stakeholders and examined various possibilities. Rather than simply changing policies, deans have looked for ways to support their medical students. During this process, the deans thought deeply about how, as leaders, they could also ease the burden on teachers and the concerns of parents.
Certain themes, identified during the thematic analysis, revealed the clues that the deans perceived in their environment, then recognized as important and relevant to effectively deal with the pandemic. We present these themes below, organized by stakeholders.
The deans acknowledged that medical students had to adapt to clinical clerkship with less direct contact with patients to comply with infection control measures in hospitals. In addition to compromised clinical experience, deans have expressed concerns about the development of medical students as professionals and their transition from undergraduate education to postgraduate clinical training. Regarding the tendency to adjust standards on the length and content of clinical placements to avoid postponing promotion or graduation, respondents expressed concern that such changes could lead to insufficient skills. . Other student concerns include the financial burden of medical students and related issues.
Respondents raised the challenge of dealing with widespread criticism from parents of medical students regarding the resumption of classes and clinical rotations, especially in geographies where COVID-19 was more prevalent. In these areas, parents complained that clinical placements started just before the end of the emergency declaration. Although many medical schools have established strategies around codes of conduct, such as stay-at-home policies, parents have continued to criticize their effectiveness in keeping their children safe. Deans were also concerned about media coverage of the pandemic and how it might influence the perceptions of medical students and their parents about the value of the medical profession.
Faculties of medicine
Deans have been challenged by their faculties potentially facing excessive workloads due to COVID-19. Additionally, they were concerned about the potential burnout and stress of faculty members working in clinical areas. Deans expressed hesitation about the ability of faculty members to adequately adapt to the process of rapidly transitioning to an online educational environment. Specifically, deans were struggling to allocate budget and staff to deal with changes in the environment caused by COVID-19. They recognized the difficulties in creating an adequate educational environment in the current circumstances.
There have been many considerations about government policy in response to the pandemic. The government has advised universities to operate resiliently without considering the special features of medical education emphasizing experiential learning in clinical settings. Medical school leaders are responsible for operationalizing the general guidelines at their discretion. In the survey, the deans expressed concerns about the excessive restriction of learning opportunities that may be required by infection control measures. The deans also acknowledged the frustrations expressed by faculty members regarding the need for smooth policy changes.
This section demonstrates the role of action in creating meaning. Themes related to what deans are doing within their faculties of medicine in the context of the pandemic will be presented by category of speakers.
Medical schools have revised their educational objectives for lectures and clinical rotations in response to the trend of moving the learning environment online. Deans instructed counselors to provide detailed individualized attention to prepare students for classes, in addition to using textbooks when transitioning to online classes. If students were unable to attend a course or internship due to illness, they could study later. Deans and faculty members, together with medical students, established a task force to solicit medical student input on educational policies. They aimed to prevent students from being excluded from this cooperative approach. As part of the above process, faculty members who reviewed the curriculum and the medical students themselves discussed the skills to be acquired throughout their curriculum.
Each medical school has developed means, through electronic media, to communicate information to students and parents and to ensure full dissemination and accountability of information. A new committee has been formed within the medical school to review student and parent responses. With the extended period of distance learning, the deans aimed to consider the concerns of students as well as their parents, and the new committee was an essential part of this process, including responding adequately to the various complaints from parents.
Faculties of medicine
Deans were aware of the need for faculty development in the process of rapidly transitioning the educational environment to digital. There was a tendency to look for ways to reduce the burden on professors while developing effective online training modules. Medical school deans relied on the cooperation of other medical school deans as they developed new educational policies to be implemented in their own medical schools. Deans used a trial and error approach, first implementing something new and then making corrections based on feedback and lessons learned. Deans also reminded faculty and supervisors that they are role models for medical students and therefore their actions are important.
Deans ensured the importance of infection control and, based on their own consensus, decided on student personal protective equipment options, attendance standards and educational choices. They planned what to do if ongoing clinical placements had to be halted due to local infection rates, and each had several options regarding learning methods. Deans respected the discretion of faculty members in teaching clinical placements and solicited input from faculty members in each department in determining responses to general government policies.