‘The coin’ was an excellent idea. Most other participants seemed to agree. We were attending an online workshop on Team-based learning (TBL) as part of the faculty development activities at the International Medical University in Kuala Lumpur, Malaysia. We were using the Microsoft Teams platform and following the plenary were working on an actual TBL case in small groups of five or six faculty members. We completed the individual readiness assurance test (IRAT) before joining our groups and were now working through the group readiness assurance test (GRAT). We discussed the correct answer in our group, arrived at a consensus regarding the same and now scratched the card to reveal the correct answer. It was a tense moment. An electronic coin was available to maneuver to scratch the card and reveal the correct answer. We received immediate feedback on our choice. If the choice was incorrect, the group discussed further before choosing the next option. As the marks obtained decreased with each wrong choice, we were cautious and guarded. It was a lesson on how assessment can provide immediate feedback on learning
Small group learning (SGL) sessions for large number of students using a single facilitator can be conducted using TBL. The workshop provided me with a good working knowledge about TBL and its theoretical underpinnings. I interacted with and got to know other faculty members and educational technology staff at the institution.
I had completed all formalities to join the IMU Centre for Education at the International Medical University in Kuala Lumpur, Malaysia but was not able to physically join as the corona virus pandemic exploded on the world scene in mid-March. All travel was closed and most countries were under lock-down. In the pre-internet era, the old adage ‘Out of sight out of mind’ would have been very true. In today’s world, the internet allowed me to stay in touch with my new colleagues and interact with them.
I participated in the Centre meetings and the online workshops and had a good overview of the activities of the Centre. The sudden shift to online learning at the University required a lot of support to be provided to faculty members by the IMU Centre for Education (ICE). I did not yet have access to the learning management system (LMS) and an institutional e-mail. My colleagues were kind enough to help me with material as and when required. In some ways my personal situation was similar to the King Trishanku in Indian mythology. Due to the pandemic (and the availability of modern information technology) I was suspended midway between my new job and colleagues and my present location at my parental home in Mumbai, India. I interacted with my colleagues online and participated in some of the activities and deliberations. However, I could not yet contribute fully to the activities of the center. I was not present fully in either location and felt suspended in between the two worlds. Trishanku wanted to enter heaven in his physical, mortal body. He obtained help from the sage, Vishwamitra who using his spiritual powers transported him to heaven. The Gods were alarmed and the King of the Gods, Indra pushed Trishanku back down toward earth. The sage used his powers to arrest Trishanku’s fall and he was suspended upside down midway between heaven and earth. The sage created a new heaven for Trishanku where the king resided in his mortal body.
I participated in other online learning sessions and workshops on writing cases for problem-based learning sessions, using Zoom for online sessions especially the break out rooms feature for small groups, using Articulate storyline and a session on aligning program educational objectives and program learning outcomes. The key learning point for me was not confining the measurement of learning outcomes to the conclusion of the educational program but moving forward and relooking the outcomes after the graduate has worked at a job for a few years. I felt this was a useful concept as it also considered the impact of learning on the job on learning outcomes at the time of graduation.
I also attended a mandatory workshop on the fundamentals of teaching-learning for all new faculty. The workshop was from 9 am to 5 pm and the time difference between India and Malaysia meant I had to start early. Doing a daily eight-hour session entirely online for three days was a novel experience for me, the other participants and the resource persons. Working together with faculty members from pharmacy, nutrition, dentistry, Chinese medicine and other areas provided me with an understanding of teaching-learning in these areas. We worked on aligning learning outcomes and teaching-learning methods and creating assessments based on the learning outcomes.
The ‘virtual’ small group activities were an important learning point for me as an educator. I had facilitated many small group sessions face-to-face but doing the same online was a new experience. Sharing screens, documents, interacting through audio and video and collaborating on a task was a rich learning experience. The two commonly used platforms Zoom and Teams both have the option of creating breakout rooms. The facilitator/s could move between rooms providing support and guidance when required.
The major personal impact of the pandemic was a reminder by Nature of human frailty and vulnerability. After the second world war, medicine had impressive success against infectious and communicable diseases. With antibiotics, improved sanitation and vaccination most infections were no longer the monsters they once were. The medical curriculum and the media started focusing more on chronic diseases. Investment in antimicrobial drugs declined. Many nations still had weak public health systems and did not invest enough on health. The recommendation that at least 5% of the budget should be invested on health and another 5% on education was not followed. I read about the Spanish flu and the massive death toll but like most others wrongly believed that we in the modern brave new world were immune to the ancient plagues. I was afraid especially when neighbors in our apartment building tested COVID-positive and relieved when they were discharged from treatment facilities without complications. I believe we may need to provide infectious diseases, antimicrobials, epidemic control and prevention their rightful place in the curriculum.
The lock-down had a major impact on economic activity. As academicians we often debate whether we can shift learning and assessment totally online. I think we may have to see the bigger picture. Even today economic activity cannot take place optimally without face-to-face interaction and free movement of people. For some time, we may be able to enforce movement restrictions but in the longer-term economic catastrophe is inevitable. With economic hardships funding for education will likely slow down with a serious impact on universities and colleges.
We live in a very uncertain time. For me, the pandemic and the subsequent lock-down has created a roller coaster of emotions. I feel privileged to contribute to the center for education, work and collaborate with like-minded colleagues and participate in training and education sessions but sad and concerned about the COVID-19 pandemic, the lock-down, travel restrictions, the possible collapse of an old way of life and the delay in physically joining my colleagues and taking up the new assignment. I am also certain that medical education will not be the same post-pandemic and technology and blended learning approaches will play an increasingly important role. Face-to-face lectures for large groups of students may become much less common. Scientists predict with climate change and increased population growth, the potential for pandemics is going to increase. So, their early detection and containment may be the key to human survival. Often, I think it ironic that as human beings we expend so many resources and so much time and effort on devising better ways of killing each other being oblivious of the microscopic assassins lurking all around us!

P Ravi Shankar
IMU Centre for Education
International Medical University
Kuala Lumpur, Malaysia.