The pandemic hit the world with a devastating force, dictating the rules of a new normality, so abnormal in everyone's perception, that led to the suspension of all face-to-face classes, as well as the cancellation of a series of activities at our Faculty. The virus forced us to rethink strategies and to implement a new distance learning methodology. The biggest challenge? To guarantee the same level of excellence and a safe, solid learning, meeting the needs and mitigating the constraints of students, lecturers and employees from multiple sectors that contributed, decisively, to the excellent results of a new pedagogical experience. Perhaps the biggest lesson from this pandemic has been expansion. Expansion of ideas and creation of possibilities which, after all, are as possible as the desire to realize them.
The new coronavirus necessarily broke with the paradigm of face-to-face teaching and launched a huge challenge to which we were able to respond, promptly. In just 24 hours and in a herculean and joint effort of the Board, Pedagogical Council, Year Coordinators, Degree Coordinators, Lecturers from all Disciplinary Areas, Course Committees, AEFML Representatives Council, and, of course, the Audio-visual Team and other FMUL non-teaching staff established a new communication structure based on videoconferences.
We reached a consensus, we experienced conditioning factors, but we overcame adversity. And in the last communiqué of the Council of Portuguese Medical Schools, the “common and consensual position” was confirmed, which was “to maintain non-face-to-face classes until the end of this academic year, considering the results achieved so far and the very positive appreciation on the part of the entire academic community”. Even though, according to “the autonomy of each School” and in “specific circumstances”, face-to-face assessments could be carried out, CEMP reports on the “commitment to give priority” to distance learning, which must, therefore, continue to be privileged.
As Albert Einstein said, the impossible exists until someone doubts it and proves the opposite. And we proved that it is possible. Progressively, what was difficult became easier and what was complicated was simplified little by little. According to Professor António Cidadão, “the situation just made an underlying will, a 'pre-existing' engine, come into operation at this very moment and that resulted in 'successful' solutions to face an urgent problem”.
But how did it all happen? We tried to find out from lecturers what the biggest challenges throughout this process were. A process that had in Lecturers and Year Coordinators the captains of a ship that ventured through unexplored seas and territories. “My concern from a professional point of view, namely with the degree, was that we could get the “boat keep sailing”, says Professor Catarina Sousa Guerreiro, who is in charge of the Degree in Nutrition Sciences, declaring that the FMUL “had a very clear and very fast strategy”. “Colleagues from other schools, at that time, had no internal guidance from their institutions. But they were also very proactive and collaborative. The situation did not allow it to be otherwise" she recalls, explaining that "the next step was to request contingency plans from all departments". “Initially, it seemed almost impossible to find a substitute for face-to-face classes, since the subjects I am responsible for are mainly clinical”, said Professor Helena Cortez-Pinto, a Gastroenterologist and Year 6 Coordinator, stating that “these classes usually have direct contact with patients, with their history collection, physical examination, and then the discussion of the various diagnostic hypotheses. With regard to year 6, it is even more difficult, given that the students are in clinical internships, with an activity similar to that of doctors.
Thus, it is all about learning based on experience and carrying out procedures. According to the Professor, and with regard to year 6, "we have succeeded, thanks to great collective effort, with the collaboration of the year 6 council. year, of the students and of the syllabus management office, to plan 128 classes of 1 hour and 45 minutes each over 14 weeks”, having already taught more than 90 classes by videoconference to year 6 students.
Catarina Sousa Guerreiro also explained that a plan was structured in three phases, the first of which ended in the Easter period, the second extending until the end of April and, finally, the third going until the end of May.
Carlos Plancha, Year 1 Coordinator and Professor at the Institute of Histology and Developmental Biology, stated that, when faced with the decision to suspend classroom activities, “agreement was immediate given the seriousness of the situation”, and, “particularly important for the success of the measure was, simultaneously, the alternative of classes by videoconference offered”.
For Professor António Vaz Carneiro, who coordinates the Year 6 clinical internship in General and Family Medicine and also all the activity of Year 3, the first reaction was “complete disaster, followed by immediate concern”, pointing to “the coordination between the technical part (AV Team), lecturers and students”, as the main difficulties in the implementation of teaching by videoconference.
The measure taken by the Faculty Board caused “a very clear feeling that it was a necessary decision and made perfect sense”, says Professor António Cidadão, who coordinates Year 3. “On the other hand, there was a feeling of challenge in tranquillity, provided by the immediate response of the Pedagogical Council", highlighting "the positions and interventions of its President". “In an exceptional situation, unknown to date, we were given the necessary conceptual support and institutional access to a set of necessary operational tools, in order to carry out a range of solutions adaptable to the specificities of the different course units of the IMDM and other FMUL degrees. Different solutions, feasible in good time, and always with the necessary quality and rigor that would make them credible in the teaching and assessment of our students”, emphasizes Professor António Cidadão.
In the case of the degree in Nutrition Sciences, “which has a reduced number of students when compared to the IMDM”, explains Professor Catarina Guerreiro, “the strategy was to try to keep the students' schedule to the maximum, as in classroom teaching, aware, however, that the teaching methodology, especially in the theoretical-practical and practical classes, would have to be changed”. The Professor also says that “there is a little added difficulty this semester, as our year 2 students have many subjects at the FF and at the FMH, requiring that lecturers external to FMUL also had to adapt”.
And with regard to the obstacles resulting from the implementation of the new teaching structure, António Cidadão considers that the exclusive model by videoconference “exacerbated the already well-known difficulties of classroom teaching.” “Unexpectedly, I must confess, I always had the feeling that I was teaching a real class. Having access to good tools helped a lot, and being able to count on excellent support for the use of the videoconference platform was essential. Getting used to distance learning tools, both on the part of lecturers and students, is an important factor, but I can testify that the learning curve is fast. Being a real time event, “live”, is a very positive factor for me”, highlights the Professor. “In fact, it is still a class in direct speech, with the feeling that the students are present. A pre-recorded lesson, regardless of its quality, can tend to present formatted information as if in written form. On the other hand, the videoconference environment enables interaction, and allows to control disturbing interaction, one of the factors that unfortunately can occur in face-to-face classes”, concludes António Cidadão, praising the“ admirable” attitude of the students throughout the semester.
In the opinion of Helena Cortez-Pinto, the biggest obstacle was “the need to prepare a class structure that could mimic, as much as possible, clinical activity”, reinforcing that year 6 students have “the need to interact, train clinical decisions, know what should be done in different situations. On the other hand, in the case of Year 6 students, we considered that it would be very useful that these classes were also a form of preparation for the National Access Test.” Thus, according to the Professor, the greatest difficulties were related to the need to create a typology of classes that most lecturers were not familiar with, “with technologies they were unaware of until then”. “In addition, the fact that they were speaking to an audience they were not seeing, and sometimes with technical problems related to the available network, conditioning image and sound problems. And everything happening at a time when many of the lecturers involved were also heavily involved in the clinical activity related to the pandemic”, she said, evoking the aggravation of the“ great emotional stress of the pandemic situation in its initial phase”.
Professor Carlos Plancha says that “in the initial phase, it was difficult to make schedules compatible between the various Disciplinary Areas, trying to fill the available hours to the maximum extent”, revealing that the technical difficulties initially encountered “were overcome by the professionalism of the Audio-visual team’s support, and the joint commitment of lecturers and students”. “As the weeks went by, the need to alternate teaching periods with periods without classes became clearer”, he recalls, explaining the importance of “students being able to consolidate their knowledge and exercise their criticism. Periods open for doubts at the end of the class and even revision or classes for queries have been progressively incorporated by some disciplinary areas, with the same objective of allowing students to exercise criticism and consolidate knowledge”, he concludes.
About what was lost and what was gained with this new pedagogical experience, the direct contact and interaction in the personal relationship that we have always taken for granted won unanimity. But in Professor Vaz Carneiro's perspective, “the freedom of students to see classes when they can” was gained, highlighting “the savings between hours of transportation and the respective stress and pollution”.
"There are always positive and negative aspects", says Professor Carlos Plancha. “The loss of direct interaction between teacher-student and student-student are important aspects that are lost. However, there is also a certain individuality in the perception of this form of teaching by students. And the questions raised by some students are more clearly perceived by all their colleagues”.
“What is lost is perhaps the most evident”, says Helena Cortez-Pinto, in a reflection on the teaching activity intrinsic to year 6. “In practical classes or internships, it is contact with the patient, including dialogue, physical examination and the possibility of carrying out procedures. In theoretical classes, it is impossible to see the students’ reaction, to ask direct questions, to have a sense of the effect that what we are saying has”. But sometimes, distance has the incredible ability to narrow connections. “Interestingly, and not expecting it, I managed to get the feeling of being closer to the students in certain circumstances, and other lecturers also confirmed this experience. As an example, when using a voting system incorporated in the classes, or the 'chat', we are immediately able to know the opinion of a large group of students”, says Professor Helena Cortez-Pinto, sharing a moment of special commotion. "I remember how moved I was, at the end of the first classes of Year 6, when the students manifested themselves on ´chat" in such a warm and grateful way that was extremely gratifying".
The students' faultless stance is recognized by the lecturers in this process, in which the students of the Pedagogical Council played a “crucial importance” role, as stated by Joaquim Ferreira, recalling that “they actively collaborated in the elaboration of the recommendations that supported all the implemented pedagogical procedures and they supervised, with great proximity and rigor, the planning of all classes and the interaction between lecturers and students”.
In an interview to Associated Press about distance classes, our students Inês Abreu and Maria José Santos reinforced the importance of avoiding the risk of contagion by the new coronavirus and shared the feeling of safety in the face of a routine marked by confinement.
The Neurology Professor and Director of the Clinical Pharmacology Laboratory of our Faculty thus gives a deep thanks “to all students who took all this effort very seriously and responded with massive participation in the videoconference classes, which proved to be extremely motivating for the entire teaching staff”, sparing no praise for the remaining elements of the Pedagogical Council. “They were exemplary regarding availability, competence, collaboration and solidarity in the multiple decisions we had to make in a context of great uncertainty. This thank extends to the Council's secretarial support”.
For Professor Joaquim Ferreira, this was a period of “great learning”. But what lessons do we learn for the future?
On the day that the Faculty of Medicine of the University of Lisbon resumes classroom activities, what will be the future of teaching by videoconference? Will there be room for this new way of teaching, will we be willing to make adjustments to our class programmes and implement a new way of practicing Medical Teaching? Professor Vaz Carneiro responds with an “absolutely” assertion, leaving no room for doubt that t we should take this path.
“We quickly concluded that it is possible to teach medicine at a distance and that the quality of classes may not be impaired in many subjects. I am totally convinced that many of the changes implemented will stay and that we will not go back to teaching in the same way”, defends Professor Joaquim Ferreira.
With the same certainty, Professor Carlos Plancha also responded positively. “When we resume face-to-face activity, we can take even better advantage of these two forms of teaching. We can reserve face-to-face activity for classes with low number of students, with practical involvement or the need for discussion, where teacher-student and student-student interaction are particularly important. And expand the activity by videoconference to much of what is called theoretical teaching. I would say that, in the future, with face-to-face activity, teaching periods by videoconference should maintain a schedule without overlapping, possibly even with an auditorium reserved for those who prefer to listen to the class there. This way, the contact period for clarifying questions presented by the students may be profitable”, states the Year 1 Coordinator.
For her part, Helena Cortez-Pinto understands that “distance learning can be used more often than it has been up to now, without it replacing face-to-face activity”. However, the Professor believes that “the voting systems incorporated in the presentations, whether ´polleverywhere´, or another similar voting system” can be used more frequently, stressing that “these systems do, in fact, allow a much deeper interaction with the students, which is advantageous for both”.
Professor António Cidadão points out that distance learning should not replace classroom teaching, considering that the first completes the second in a fusion of methodologies that had a positive mark in these first tests. “Whereas in the case of the practical component of the Histology subject, the face-to-face tutorial classes are absolutely necessary to train students to gain diagnostic capacity, essential in their future clinical activity, a typology of theoretical-practical classes by videoconference, namely, using the virtual histological preparations of the IHBD, may also be relevant”, he notes, referring concretely to the preparation of students for subsequent face-to-face classes,“ in which they will deal with the “real diversity” only present in “hands-on” histological preparations and microscopic observation.
António Cidadão also recalls that "before the pandemic, students had already secured the theoretical teaching of a topic before the said topic was addressed in the face-to-face practical classes, through tutorials". However, despite “the vast wealth of e-learning content provided by the IHBD”, the Professor says that “there was manifest difficulty to prepare students to make the most of practical classes”, and he is convinced that “future introduction of theoretical-practical classes, taught by videoconference similar to what happened this semester, will have obvious advantages”.
The tutorial practical teaching should, in the opinion of Professor António Cidadão, be used in future in the Teaching of our Faculty, saying he was positively surprised by the “videoconference environment with regard to theoretical teaching and specific models of theoretical-practical teaching”.
The success achieved with distance learning at FMUL was due, in Professor Vaz Carneiro's opinion, to the “dedication and competence of all involved” and “the enormous availability that the lecturers showed to collaborate in this new model of classes”, adds Professor Helena Cortez-Pinto.
Carlos Plancha, for his part, stresses the fact that the classes remain “interesting and useful for the students to be able to proceed, autonomously, with study and additional work”.
In the specific case of the IMDM Histology course, António Cidadão considers that the videoconference classes provided “a good solution to continue teaching year 1 students”, constituting a challenge that brought, simultaneously, an “opportunity to rethink the theoretical classes using the traditional model, which tends to be accompanied by a drop in students’ attendance throughout the semester, which unduly subtracts part of their real role in the training process of our students”.
The Director of the Gastroenterology University Clinic and of the Nutrition Laboratory of the FMUL also points out that the lecturers “managed in the very short term to create new classes from scratch, with methodologies that they had never used before, using their clinical practice, but also following the students’ request to specifically use certain bibliographic sources”. Helena Cortez-Pinto highlighted the decisive contribution of students in a complex process with marked changes, in which they revealed an “intense and proactive cooperation, ready to collaborate in the structuring of syllabi, and, once again, in the very short term" She referred as well to "the devotion of the audio-visual technicians and all the administrative staff, who worked far beyond their schedules and obligations to make this huge number of classes possible".
And if there is any secret recipe for the positive results achieved with the restructuring of teaching at our Faculty, Professor António Cidadão says that the “secret” lies “in the real value of the lessons, but fundamentally in our Institution as a whole, the Board, Pedagogical Council, lecturers, non-teaching staff, and students, obviously. There was the courage and determination to implement, and accept in real time, a set of ‘possible’ solutions, but always with guaranteed quality, knowing how to do it while maintaining the necessary rigor”.
Professor Joaquim Ferreira, who as President of the Pedagogical Council played a fundamental role in articulating the process from the first moment, points to the “capacity to anticipate the implications of the pandemic for a Medical School inserted in a large Hospital, associated with great availability and generosity of all members of our Academic Community” (highlighting the audio-visual team that supervised all classes from their homes) as determining factors for the successful implementation of distance learning.
“This enormous capacity should be even more valued when a large part of the lecturers maintained hospital activity, in a context of great demand and risk”, emphasizes Joaquim Ferreira.
Also for the Year 6 Pedagogical Coordinator, Helena Cortez-Pinto, the success of distance learning was undoubtedly due to “the Faculty's Board, the Pedagogical Council, and its directors, who stimulated all this activity and supported it minute by minute”.
António Cidadão reveals that it was an amazing experience not only “for the encouragement in the preparation of classes”, but also “for the satisfaction” that he felt teaching them, saying “I confess that a model of pre-recorded classes and subsequent availability to students, eventually in successive years, for viewing in a completely open schedule and frequency, did not seduce me and still does not seduce me. On the contrary, the model of videoconference in real time, at specific times that stimulates organization and discipline on the part of students, that allows interaction without disturbance, and that can later be revisited as if it were a library of recorded classes, is the best of both worlds. Conferences, integrated seminars, theoretical classes given by lecturers with special integrating skills, are notable and very enriching training experiences, which should be maintained in a face-to-face model, regardless of their subsequent availability in video support”.
A different kind of confession comes from Professor Joaquim Ferreira, now with the certainty of having "passed the greatest turmoil" in which "we can be more open in sharing our greatest fears throughout this period". Firstly, “we fear for the health of our students who live daily in a hospital environment”. He also expressed concern caused by “the risk of confusing the suspension of face-to-face classes with the total suspension of teaching activity”. "If it happens, it could imply the loss of a semester with the consequent implications for the legitimate expectations of students' academic progress".
Regarding the students' reaction to a new teaching model, Professor Catarina Sousa Guerreiro understands that year 1 students “felt a little disoriented”. “Under normal conditions, it is always a year of adaptation to another reality, and in our degree this semester is especially heavy in terms of workload”, stating that after the first month of distance classes, students “felt they were losing capacity for work, for production”, so “there was the need to assess whether the workload we were requesting, in an attempt to replace TP and some P classes, was higher and, eventually, out of place compared to what was initially foreseen”. This led to a“ necessary reflection among degree committees, degree directors and degree coordinators”.
Given that “we cannot always explain everything that motivates our decisions”, Joaquim Ferreira says that “the enormous degree of demand and implemented teaching weight was intended to validate the teaching that was possible to conduct this semester”. He also believes that, “together, we have achieved this objective and we can, from now on, start planning the next academic year, which unfortunately will not yet mean a return to the ‘previous’ normality”.
According to the Coordinator of the Nutrition Sciences Degree, Catarina Sousa Guerreiro, "the difficulties that arose on a daily basis were overcome with great serenity".
And regarding the assessment component, a distance model can also be a good option, says Professor António Cidadão, as “it frees up the already reduced and precious contact times”, and sets a concrete example. “In addition to continuous assessment, in the context of practical tutorial classes, the Histology subject has long used a quiz/test model of multiple choice based on images to assess the capacity of differential diagnosis and the establishment of morpho-functional correlations by the students. The question-answer dynamics in these assessments, with mandatory progression and with no possibility of returning to answered questions, mimic the situation that occurs in the context of oral assessment”.
Accordingly, it was with “great satisfaction” that the Professor saw that “the transposition of this assessment model to a remote environment was very easy, everything was done without major problems, and was reflected in a performance on the part of the students similar to that achieved in face-to-face assessment. However, given that all the questions used in the distance tests were subsequently made available to students, with feedback on the answer, it was possible to gradually build a base with several hundred self-assessment questions, an asset that will remain useful in subsequent academic years”, he states, intending to maintain this assessment system in a “remote environment ”when face-to-face classes are resumed.
“Change is never easy”, Professor Catarina Guerreiro tells us, considering, however, that “everyone's adaptation was very smooth”.
Aware that the adoption of a non-face-to-face model was facilitated by the fact that the IHBD had long invested in the preparation of a set of e-learning contents and making them available to students, António Cidadão explains that such contents were “originally designed to guide students in a hands-on tutorial teaching model” (and access to them in the present situation“ has proven to be of increased importance”). The Professor also shares a desire for the future. “I wish I had already been able to make this semester available, which I understand as a challenge for future implementation, the online availability, in real time, of the IHBD e-learning content. Due to understandable specificities of the Moodle platform, the only possible solution this semester was for students to download the contents for subsequent installation on their personal computers”.
At the moment, and engaged in the “planning and testing phase of distance assessment”, Professor Catarina Guerreiro recalls how, in the beginning, and already with “awareness of what awaited us, everything was unknown”. However, we maintained consistency and advanced towards the unknown in an uncertain reality, but with the certainty of doing our best every day.
Today, we look back and see that in this profound restructuring when, as Professor António Cidadão said, “everyone gave a lot” and demanded in equal measure, the ideas to retain are “commitment and institutional unity”, two forces of our Faculty that we are so proud of. And we sustain these forces, confident, waiting expectantly for the day when we will open the doors of our Faculty again to, together and closer than ever, overcome new challenges side by side.
Sofia Tavares
Editorial Team