The pandemic generated by the SARS-CoV-2 virus (COVID-19) remains a serious public health concern. The COVID-19 pandemic has compelled university teaching to prioritize the transition from in-person to remote instruction, especially laboratory teaching. As the laboratory set-up will now consist of face-to-face interactions, a curriculum that includes both virtual and hands-on phlebotomy laboratory simulations has been developed by the PHINMA Saint Jude College - School of Medical Laboratory Science in order to better prepare students for the hands-on laboratory courses that they will be taking before their actual classes. The outcome demonstrates that the students were successful in their coursework, which contributed to an increase in their level of self-assurance towards phlebotomy. As a result, the approach achieves its stated goal of reducing students' phlebotomy-related anxiety.
ABSTRACT
The pandemic generated by the SARS-CoV-2 virus (COVID-19) remains a serious public health concern. The COVID-19 epidemic has compelled university teaching to prioritize the transition from in-person to remote instruction, especially laboratory teaching (Gasparello et al., 2022). As the laboratory set-up will now consist of face-to-face interactions. A curriculum that includes both virtual and hands-on phlebotomy laboratory simulations has been developed by the PHINMA Saint Jude College - School of Medical Laboratory Science in order to better prepare students for the hands-on laboratory courses that they will be taking before their actual classes. The outcome demonstrates that the students were successful in their coursework, which contributed to an increase in their level of self-assurance towards phlebotomy. As a result, the approach achieves its stated goal of reducing students' phlebotomy-related anxiety.
Keywords: COVID-19, Laboratory Simulation, Medical Laboratory Science, Phlebotomy
INTRODUCTION
The world has been overtaken by the Coronavirus pandemic (Hiscott et al., 2020). Despite being in the early stages of a worldwide pandemic, the sars-cov2 (COVID-19) virus has killed more people than the SARS coronavirus. On January 22, 2020, the first suspected case was investigated in the Philippines, and as of March 1, 633 suspected cases have been recorded (Edrada et al., 2020). As a result of measures to contain the COVID-19 pandemic, schools were abruptly closed in more than 100 different nations. The COVID-19 outbreak poses severe issues for the world's educational systems (Onyema et al., 2020). At this time, the COVID-19 pandemic is having a significant influence on clinical education and has caused a significant disruption in clinical assessment. In the challenging environments of hospital-based educational settings, clinical mentors and students in all health professions work together (Tabatabai, 2020).
Due to the COVID-19 pandemic-related shutdown of educational facilities, distance E-learning (Remote learning or Online Learning) has become a new teaching approach to ensure the continuity of medical education (Al-Balas et al., 2020). The benefits of remote learning included comfort and accessibility (Mukhtar et al., 2020). Online modalities for faculties were applied to create course plans with less cognitive burden and more interactivity. Meanwhile, there are various drawbacks to online learning, including issues with student conduct, internet access, and social interaction that frequently provide difficulties for educational institutions and other stakeholders (Hermanto & Srimulyani, 2021). Creating (inter)active learning environments is thus an ongoing challenge. For digital learning—whether blended, hybrid, or online—a number of institutional, organizational, and administrative factors shape the more proximal influences on the teacher and student level, which then shape the effectiveness of teaching and learning (Rapanta et al., 2021). The educational institutions adopt a new educational system that is both safe and long-term (Althwanay et al., 2020).
The ability of laboratory professionals to: guarantee the quality of laboratory tests regardless of where they are performed; improve the quality of services; improve clinical outcomes; and perform joint clinical/laboratory research projects is critical in sustaining changes in the role and contribution of medical laboratories to high-quality healthcare. The recognition of the significance of the knowledge and skills required for the new role of laboratory professionals has been a key factor in effecting the change (Plebani, 2002). Online teaching had a negative impact on rural students more than on urban students; the previously existing gap between rural and urban students had widened as a result of online teaching (Feng et al., 2021). Hence, virtual laboratory simulations (VLSs) or computer-based tools with numerous applications in science, medicine, and engineering should be used prior to theoretical lectures and laboratory practices (Keleş et al., 2022). Shadow education is the term used to describe private supplementary tutoring (Zhang & Bray, 2020). Additional programs to enhance the student learning can also be defined as a form of shadow education. In the post-pandemic era, students at PHINMA Saint Jude College demonstrated poor laboratory face-to-face performance. By this, the study aims to assess the effectiveness of laboratory shadow education designed for incoming sophomores (2nd year), junior (3rd year) and senior (4th year) Medical Laboratory Science students.
METHODOLOGY
Action research combines research into substantive issues, such as how to improve the quality of children's learning in a state-run education system or how to provide equitable access to health care for all members of a community, with research into the development process in order to gain a better understanding of the enablers and barriers to change (Somekh, 2006). The PHINMA Saint Jude College, School of Medical Laboratory Science designed programs during summer as preparation to the upcoming laboratory classes. Sixty Seven (67) incoming second year students participated in Laboratory Simulation wherein the students were given an online/virtual and face to face introductory laboratory simulation for phlebotomy, microscopy and pipetting for one week. Fifty three (53) incoming third year students participated in the Laboratory Simulation, wherein the students were given an advanced online/virtual and face to face laboratory simulation for phlebotomy in different methods and microscopy for one month. While twenty (20) incoming fourth year students who will undergo internship participated in the Laboratory Simulation wherein students were given an advanced online/virtual and face to face laboratory simulation for the different professional Medical Laboratory Science subjects such as Clinical Chemistry, Clinical Microscopy, Microbiology, Hematology, Immunology and Serology, Immunohematology, Histopathology and Laboratory Management for two months.
Likert-scale survey questionnaire being graded as Excellent (5), Very Good (4) Good (3), Average (2) and Poor (1) were distributed for the online/virtual laboratory simulation, training materials and different face to face laboratory simulation.
RESULTS
Incoming Second Year
For the online or virtual laboratory simulation for incoming second year, out of 67 students who participated in the study, 57 students which are 85% of the population graded excellent the new knowledge acquired in relation to the topics discussed while 10 which are 15% of the population responded very good. Meanwhile, 50 students which are 75% of the population responded excellent for the topics that were informative, timely and relevant while 17 students 25% of the population responded very good. In addition, the 46 students which are 69% of the population responded excellent for lecture format/length suitable to content, 18 students which are 27% of the population responded very good, 2 students which are 3% of the population responded good and 1 student which is 1% of the population for average.
While 54 students which are 80% of the population responded excellent for lecture level was appropriate to audience and well understood, 11 students which are 17% of the population responded very good while 2 students which are 3% of the population responded good.
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Figure 1. 2nd Year Laboratory Simulation Synchronous Session Course Content
For the training materials for incoming second year, out of 67 students who participated in the study, 58 students which are 87% of the population graded excellent the usefulness as future reference, while 9 students which are 13% of the population responses very good. For the presentation of learning materials, 53 students which are 79% of the population responded excellent, 13 students which are 19% of the population responded very good, while 1 student which is 2% of the population responded good. For the thoroughness of content, 53 students which are 79% of the population responded excellent, 12 students which are 18% of the population responded very good and 2 students which are 3% of the population for good. For being user friendly of the materials, 57 students which are 85% of the population responded excellent, 9 students which are 13% of the population responded very good and 1 student which the 2% of the population responded good.
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Figure 2. 2nd Year Training Materials
For the face to face laboratory simulation, out of 67 incoming second year students , 52 students which are 78% of the population responded excellent for new knowledge acquired in relation to the topics discussed, 13 students which are 19% of the population responded very good and 2 students which are 3% of the population responded good. For topics were informative, timely and relevant, 53 students which are 79% of the population responded excellent, 13 students which are 19% of the population responded very good and 1 student which is 2% of the population responded good. For lecture format/length was suitable to content, 45 students which are 67% of the population responded excellent, 19 students which are 28% of the population responded very good, 2 students which are 3% of the population responded good while 1 student which is 2% of the population for average. While for Lecture level was appropriate to audience and well understood, 51 students which are 76% of the population responded excellent, 15 students which are 22% of the population responded very good and 1 student which is 2% of the population responded good.
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Figure 3. 2nd Year Face-To-Face Laboratory Simulation Course Content
The overall rating for the effectiveness of the laboratory simulation for incoming second year students, out of 67 participants, 56 students which are 84% of the population responded highly satisfied and 11 students which are 16% of the population responded satisfied.
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Figure 4. 2nd Year Overall Satisfaction for the Program
In addition, the open-ended question was asked to the incoming second year students, quoting some of the responses:
“Less kaba for the laboratory practicals and already learned the proper and basic techniques.”
“We've been indulging theoretically during the online setup and making up pre lab classes is as of great help to finally visualize and to feel what it really looks like. Just sad that we weren't able to make up the whole course due to time restraints (e. g. wasn't able to see all of the parasites available) but it's much better than not experiencing at all. Thank you for the free course”
“As a student who experienced online classes and virtual simulation of laboratory activities, this really helped me practice my skills and experience laboratory activities first hand. The knowledge I've learned during the pre-laboratory really prepared me for the following laboratory activities that my course offers.”
“Pre Laboratory helped me to be confident. This is a big help since we are students from lockdown with 0 experience about different methods of blood extraction. I Will not forget this type of laboratory experience because this is the my first time to do something like these. Such a memorable one.”
Incoming Third Year
For the online or virtual laboratory simulation: new knowledge acquired in relation to the topics category for incoming second year, out of 69 students who participated in the study 48 students which are 69% of the population responded excellent; 19 students which are27% of the population responded very good, while 3 students which are 4% of the population responded good. While for Topics were informative, timely and relevant, 49 students which are 71% of the population responded excellent, 17 students which are 25% of the population responded very good, and 3 students which are 4% of the population responded good. For the lecture format/length was suitable to content category, 45 students which are 66% of the population responded excellent, 21 students which are the 30% of the population responded very good and 3 students which are the 4% of the population responded good. Lastly, for the lecture level was appropriate to audience and well understood category, 45 students which are 65% of the population responded excellent, 19 students which are 28% of the population responded very good and 5 students which are 7% of the population responded good.
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Figure 5. 3rd Year Laboratory Simulation Synchronous Session Course Content
For the training materials: usefulness as future reference category for incoming second year, out of 69 students who participated in the study 57 students which are 83% of the population responded excellent while 12 students which are 17% of the population responded very good. For presentation of learning materials category, 44 students which are 64% of the population responded excellent, 20 students which are 29% of the population responded very good and 5 students which are 7% of the population responded good. For thoroughness of content category, 42 students which are 61% of the population responded excellent, 26 students which are 38% of the population responded very good while 1 student which is 1% of the population responded good. And for the user friendly category, 49 students which are 71% of the population responded excellent, 13 students which are 19% of the population responded very good and 7 students which are 10% of the population responded good.
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Figure 6. 3rd Year Training Materials
For the Face-to-Face Laboratory Simulation: new knowledge acquired in relation to the topics category, 54 students which are 78% of the population responded excellent while 15 students which are 22% of the population responded very good. For the Topics were informative, timely and relevant category, 54 students which are 78% of the population responded excellent while 15 students which are 22% of the population responded very good. For the lecture format/length was suitable to content while 55 students which are 80% of the population responded excellent while 14 students which are 20% of the population responded very good. Lastly, for lecture level appropriateness to audience and well understood category, 57 students which are 83% of the population responded excellent while 12 students which are 17% of the population responded very good.
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Figure 7. 3rd Year Face-To-Face Laboratory Simulation Course Content
The overall rating for the effectiveness of the laboratory simulation for incoming third year students, out of 69 participants, 52 students which are 75.4% of the population responded highly satisfied and 16 students which are 23.2% of the population responded satisfied and 1 student which is 1.4% responded fair.
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Figure 8. 3rd Year Overall Satisfaction for the Program
On the open-ended question on how the laboratory simulation helps them in their classes, the incoming third year responded:
“The prelab helped me hone my skills in blood extraction and microscopy, which were very useful in our practical examinations during the first semester's face-to-face classes. This program is also very beneficial for students like me who have only been taking online classes for the past two years in order to learn the critical skills required to be successful in the field of medical laboratory science.”
“Before Pre-lab, I never tried doing phlebotomy nor handling a microscope. Everything was new to me even though I heard it a lot from previous lessons. A lot of difference pa rin if you are actually doing the activity rather than stimulations online or learning the principles. Pre-lab is really a crucial thing to do before mag-3rd year because it was like a foundation to much more complex laboratory activities. For me, you won't be able to accomplish the lab activities in 3rd year without the pre-lab. Taking it will build your confidence and excitement again for this course na surely fading na compare nung mag-1st year pa lang”
“Nakakatuwa kasi dito ko talaga unang natutunan at na-experienced yung pag-eextract ng blood, kaya happy ako. J though I'm not really quite good at it pero atleast before nagstart yung official class, I know how to extract blood in a right way. Kaya for me, laking tulong ng pre-lab class din. <3 “
“All of the materials and learning techniques has help us a lot as incoming 3rd year student at that time. We may came from online classes which are the disadvantages of learning as an medtech student in the laboratory but pre-classes really help us to came up together and gather our full force of knowledge to get ready as a 3rd year student.”
“It helps me to become confident when handling microscope and when performing blood extraction. It made me feel like "Medtech" na talaga ako. The professors/mentors contributed the most in my activities in practicals.”
Incoming Fourth Year
For the laboratory simulation synchronous session for inkling fourth year students: New knowledge acquired in relation to the topics category, out of 17 students who participated the program, 9 students which are the 53% of the population responded excellent while 8 students which are the 47% of the population responded very good. Regarding the topics was informative, timely and relevant category, 10students which are 59% of the population responded excellent, 6 students which are 35% of the population responded very good while 1 student which is the 6% of the population responded good. In line with lecture format/length suitability to content category, 8 students which the 47% of the population responded to excellent and very good while 1 student which is the 6% of the population responded good. While, lecture level appropriateness to audience and well understood 8 students which is the 47% of the population responded excellent while 9 students which is 53% of the population responded very good.
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Figure 9. 4th Year Laboratory Simulation Synchronous Session Course Content
In line with training materials: usefulness as future reference 10 students which is the 59% of the population responded excellent while 7 students which are 41% of the population responded very good. For the presentation of learning materials, 8 students which are 47% responded excellent and very good while 1 student which is 6% responded good. Regarding the thoroughness of content, 6 students which are the 35% of the population responded excellent, 10 students which is 59% responded very good and 1 student which is 6% of the population responded good. Lastly, for the user friendly of the training materials, 8 students which are 47% responded excellent and very good while 1 student which is 6% responded good.
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Figure 10. 4th Year Training Materials
For the Face-to-Face Laboratory Simulation: new knowledge acquired in relation to the topics category, 8 students which is 47% of the population responded excellent while 9 students which are 53% of the population responded very good. Regarding the topics information, timely and relevance category, 10 students which are the 59% of the population responded excellent, 6 students which are 35% of the population responded very good and 1 student which is 6% of the population responded good. In line with lecture format/length suitability to content category, 9 students which are the 53% of the population responded excellent, while 8 students which are 47% of the population responded very good. Lastly, the lecture level was appropriateness to audience and well understood category, 9 students 9 students which are the 53% of the population responded excellent, while 8 students which are 47% of the population responded very good.
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Figure 11. 4th Year Face-To-Face Laboratory Simulation Course Content
The overall rating for the effectiveness of the laboratory simulation for incoming fourth year students, out of 17 participants, 5 students which are 29.4% of the population responded highly satisfied and 11 students which are 64.7% of the population responded satisfied and 1 student which is 5.9% responded fair.
In addition, the open-ended question was asked to the students, quoting some of the responses:
“The event prepared me to know what to expect during the actual laboratory process.”
“The pre-internship program especially the laboratory skills we learned and was taught to us was very helpful in a way that we didn't struggle in using the machines in the hospital especially when using the microscope.”
“it helped me bigtime, especially when we go to the hospital. our co-interns were shooked bc we already know things that we learned through pre lab”
“I obtained skills that a medical technologist should have.”
Conclusion
Best practices must be followed when replacing clinical or simulation with virtual encounters (Garrison et al., 2023). Students prefer virtual and online alternative inquiry-based labs because they are less likely to be sidetracked by measurement mistakes or intricate multiday processes that might lead to "failure" while rapidly generating data for reflection, enabling instructors to assess student knowledge before the hands-on laboratory. Although lab failure and problem-solving abilities are crucial, these unpleasant experiences frequently disguise the desirable student results (Alvarez, 2021). Through the combined practice of laboratory simulation and hand-on face-to face simulation, the students were able to achieve confidence, satisfaction and expertise in the phlebotomy. We underlined that simulations are fantastic learning tools that not only boost students' knowledge, but also their self-motivation and concentration.
References
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