Toward Sustainable Teaching: Staff Perceptions of the Delivery of a Rural Medical Program during the COVID-19 Pandemic

Abstract

What can be learned through teaching and learning in crises, such as bushfires, floods, and the global COVID-19 disruption? How can insights gained be applied to prepare for inevitable future disruption to normal operation, especially in regions identified to be prone to natural hazards? In 2021, focus groups and individual interviews were conducted with academics, clinical tutors, and professional staff members to explore staff perceptions in a regional medical school in eastern Victoria, Australia, about their experiences of teaching and learning during the COVID-19 pandemic. Strategies are suggested to sustain teaching in times of crisis or natural disaster to future-proof against inevitable change including protocols, policy, staff checklists, and staff continuing professional development.

1. Introduction

A social constructivist approach to research seeks to understand the effects of a range of discourses operating within society—events, realities, meanings, and experiences—on the perceived reality [1]. Qualitative approaches to uncover these connections share the goal of seeking to understand lived experience [2]. Teaching through a global pandemic provides a salient opportunity to explore the lived experiences of staff involved in persevering with the delivery of tertiary learning opportunities during a time of rapid change [3, 4].

In response to the pandemic and to contain the spread of COVID-19, many countries around the world temporarily closed educational facilities [5]. In Australia, the duration and extent of restrictions that impacted education varied across the nation [6], with Victoria experiencing some of the longest restrictions. Medical education was similarly impacted, with the sudden cessation of in-person classes and clinical placements. COVID-19 necessitated many changes to teaching and learning in higher education. In our study, adaptations to teaching delivery are needed to accommodate the location of students across Australia and the world and in different time zones. A large study of medical students in the United Kingdom showed that students spent significantly more time using online learning platforms during the pandemic and appreciated the flexibility that online learning offered [7]. However, barriers to using online teaching modalities included poor internet connection and family distraction [7].

The sudden lockdown of educational facilities necessitated rapid transition to online teaching. Under normal circumstances, transition to online delivery is met with barriers that delay the development and implementation of the quality online learning environment in medical education [8]. The nature of the barriers was duly amplified during the COVID-19 pandemic due to factors such as isolation from the campus, lack of infrastructure in the home office, and absences of key support staff due to illness.

Online learning and flipped classroom strategies were implemented to continue curriculum delivery of medical education during the COVID-19 pandemic [9]. In medical education, restricted access to the clinical context precipitated a move to simulation-based learning environments. Simulations were also presented in the virtual context. Virtual clinical placements support the continuation of clinical teaching and the development of student competencies and confidence [10].

A study was undertaken in 2021 to explore the perceptions of staff working in a regional medical school about their experiences of teaching and learning during the COVID-19 pandemic. The geographical region in which the research occurred is known for its emergency and disaster profile, including floods and fires [11]. The rationale was to explore strategies implemented to maintain teaching in times of crisis or natural disaster.

2. Methodology

Qualitative research seeks to ask open-ended questions leading with “Why?”, “How?”, and “What?”, to learn about the experiences of participants regarding a given situation, leading to the potential of a multiplicity of findings [12, 13]. The most common methods of qualitative data collection are flexible strategies such as focus groups and in-depth interviews, suitable for identifying unanticipated aspects of a social phenomenon, wherein the participants start to discuss various topics or themes and engage with each other [14]. Video technologies, such as Zoom™, have transformed these methods of data collection, reducing the need to travel [15]. This technology has been particularly useful in conducting research during the global COVID-19 pandemic and in a distributed education context.

This study was considered low risk; the research was approved by Monash University Human Research Ethics Committee ID# 24441. With targeted recruitment, participants were involved in the delivery and support of preclinical and clinical medical training across the region of Gippsland, eastern Victoria, Australia. A list of semi-structured questions was prepared to prompt discussion [12] and to ensure consistency across the different data-gathering sessions. The focus groups and interviews took place via Zoom™, running between 45 and 90 minutes, and were conducted by an independent facilitator. Eleven staff participated: six academics, three sessional clinical staff, and two professional staff members (Table 1).

Participants by job description	Numbers
Permanent/Fixed term Academic	6
Sessional Clinical	3
Professional	2

Table 1.

Research participants.

Participants were advised that the sessions would be recorded and sent to a Monash-approved professional service for transcription. As part of the transcript “cleaning” process, the participants have ascribed a code for anonymity. This code was a letter followed by a number “P” for professional staff, “A” for academics, or “S” for sessional staff.

The process of analysis began during the data collection phase as the facilitator conducting the interviews and focus groups began to see patterns emerging [16]. Inductive approaches to data coding and analysis allows codes and themes to derive from the data, not from preconceived ideas [1]. Coding of the raw data was an iterative process, defining the different thematic levels. The code book development was based on handwritten field notes and through the qualitative data analysis software, NVivo™. Rigor was enhanced by using a constant comparison approach [17].

3. Findings

Four themes were identified:

• Rapid transition from face-to-face to online teaching

• Transition from working in a professional/public to a personal/private space

• Re-transition and the “new normal”

• Readiness for inevitable future transitions

An overview of each theme, with representative participant quotes, follows. Under each theme and sub-category, the positives and negatives of the experiences are listed, noting that not every transition experience was negative.Theme 1: Rapid transition from face-to-face to teaching online.The traditional context of medical education is face-to-face. There were challenges across the board in moving to online teaching, including learning the appropriate and necessary technology. Staff stress across transitions was apparent.Adapting to change“Change” was mentioned by many participants alongside the urgent and rapid timeframe:

And there was no time; we, I think it was a Monday, and then it was a Wednesday that we were teaching online. So, there was no time, really, to go “what’s what?”. (S3)

Others spoke of the rapid change with disbelief

I’ve worked for the (university) for 20 odd years; never, ever had I worked from home. So just getting into that routine of going from one end of my house to the other to go to work, that was in itself was weird. (P1)

Learning the technologies

There were some positives to be found in adapting to the new technology:

I guess this time last year I probably didn’t know what Zoom was and I’m much more computer literate and feel much more comfortable in this format which has been a good thing for me and so I guess that’s a positive that I’ve learnt new skills that I wouldn’t otherwise have had to learn and I’ve had to communicate with people in this sort of setting. (S1)

There were also challenges:

… we had to put in place systems to enable that delivery that we’d never used before. So, we all did have to learn Zoom, obviously … I hadn’t had time to have any training yet, so I had to train myself in order to set-up Zoom meetings and work through all the glitches that we had. (P2)

The new technology was recognized as having the potential to enhance teaching and learning, but also created challenges.Adapting to online teaching

Many staff spoke about the “trial and error” approach:

The thing was adapting the class teaching to the online environment and, although we had our materials from previous years that we could draw on, we needed to make sure that it worked in an online environment and it was a bit of trial and error to see what would work, what wouldn’t work. (A1)

Fatigue, in particular Zoom™ fatigue, was noted by the participants, and became a catalyst for change:

I think (management was) getting feedback that (the students) didn’t want to be on Zoom for too long and so then we were getting it filtered down to us that we needed to cut out half an hour or make the sessions shorter. I think that happened a few weeks into the online teaching, we had to cut things and change things around into shorter time frames. (S1)

However, reducing student load increased workload for staff:

… reducing the student load meant that the staff load increased (because) you had to. You were doing it at hours where you normally wouldn’t be working or you were repeating things more than you normally would or stuff like that; so, we learnt a little bit, but I think that some of those compromises: good for the students; not so good for the staff. (A3)

Staff related to student fatigue:

Oh, it was fatiguing, and I can absolutely relate to student fatigue when you’ve had seven hours of Zoom meetings in a day. You can almost not talk; your brain, you’re just fried. And so, I guess undergoing that meant we could absolutely relate to student fatigue. (A1)

Physical fatigue was also a consideration:

I found the eye-strain not as bad as the sitting. Long periods of sitting …So the sitting was what, we would normally teach standing up; I would normally teach walking around, not sitting in a room. So, I found that, and actually, just sitting a lot was very tiring. (A3)

Communication

Communication processes needed to be improved. Disparate information from multiple sources was identified as a problem:

I guess the big challenge for my role was trying to get the information we needed to tell the students. So, communication was the most important part of last year … As it turns out, … the day-to-day challenges were in communication. And that was pervasive. (A4)

Online communication behaviors and “soft skill” development for future clinicians were also highlighted:

I’ll just echo … the importance of communication skills, not only in clinical fields but in scientific fields. Certain students tend to use Zoom as a crutch because even more so in the Zoom environment, if they’re afraid to participate or they don’t want to participate, it’s much easier for them to disconnect and even if they do want to participate but they’re scared to, in real life they would be forced to talk and participate in a group environment but in the Zoom environment they can just hide behind a chat function which I’ve noticed quite a lot in my classes (and) it’s not really teaching students how to communicate with their voice or with their body actions. (S2)

Teamwork

Teamwork was a positive feature, with many praising collaborative efforts in adapting to online learning:

… we’re small and we are very supportive of our students. We (have) a small group of staff and everybody tends to know everybody and when the students have an issue, they know who to ask or they will get support …. (S1)

The stress of constant change

The pivot of transition between workspaces—that is between working from home, returning to the office, then back home—was problematic for staff. Initially the disruption was anticipated to be a one-off event, yet it was protracted and has led to a “new” normal. One example was timetabling:

… (It) was extremely time consuming. We ended up having four versions of the timetable last year (2020). Pretty much March, when we first started to go into lockdown, the timetable was set for the year. (Usually, there’s) just tiny little alterations, normally, that happen … So, it can still take the odd time, every now and again, but not to the degree of what happened last year. We ended up doing, when we went into lockdown we did fully online. And then we had that tiny glimmer of hope that we’d come back to campus for two days, so we adjusted a couple of weeks based on that and then we … we only came back for a couple of days and that’s when … we went back into lockdown after that. So, after that we went back to fully online. (P1)

Catalyst for change

Staff saw value in the pandemic-invigorating change. There was an opportunity to reflect on past practice and the rationale for this:

I think re-looking at how you teach … and how you interact with students is probably the main stuff I got out of it …. (A5)

Theme 2: Transition from working in a professional/public to a personal/private space.

Social distancing measures and/or lockdowns changed work locations from public professional spaces to the private personal sphere. Work intruded into home lives; personal and professional boundaries blurred.Setting up workspaces

Setting up a home office spanned from:

I had everything I needed. I’m a tech person and so I’m probably an outlier. (S2)

… to …

Yeah; I had to get a couple of cables; a keyboard; a mouse; I need(ed) to get a proper chair. And I had an old TV monitor that was modified to be an extra screen. ‘Cos with the work I do, I can’t do it on a laptop; it’s just not viable. (P2)

…and…

… I was on a fold-out camp table from Bunnings¹; it was on chocks ‘cos it was the wrong height and the table rocked and the keyboard rocked on the table and so … I didn’t want to spend money because I didn’t know how long. But then, as we went on, it became, I actually need a proper chair and I need a proper desk and all those sorts of things because we are going to stick to it. (A3)

Setting up to work from home was expensive and defining a workspace could be a challenge:

… you need a place where you need to know your internet is capable; you need to have a desk; you need to have screen and computer. A quiet space because it’s very hard to have concentration and teach when there’s too much noise going on and some, in some respects … some noise is okay, but not for students; I think that that’s not very fair, so … having time to set that up …. (A3)

It was important to establish workspaces that would not interfere with the operations of the household:

I set up really quickly in what I thought was probably going to be the best location in the house, that wasn’t going to upset everyone else. It didn’t really work, so I did in the end have to change it. And obviously, we went into winter too and it was the coldest part of the house so I was like “I can’t do this; I can’t be wearing a blanket all day”. And … the set up definitely wasn’t what I have now; I wish I had done this in the beginning, but I guess we didn’t know how long we were going to be here. (P2)

Extra domestic disruptions

For staff with partners and/or children working from home, there were further disruptions:

… ‘cos you’ve got (children) at home and they’re trying to adapt to a new environment as well; they’ve not got any social activity happening and they come out of their (room) during their break and then they’re disrupting what I’m doing and that’s not an intentional thing, but they’re trying to adapt to their new environment to suit themselves and it didn’t necessarily suit the whole household. (P2)

Internet accessibility and stability

Location was often influenced by internet stability but this was not always reliable. In a rural setting this can be an additional problem. Internet accessibility was a big issue in the transition to working from home:

The big (issue) for probably everyone is the internet and the way that we connect. I live in quite a rural area and I’m not in a town and our internet is not always great and so I don’t know how you fix that …. (S1)

Work often took longer to complete at home. One of the professional staff members described challenges in uploading teaching resources to Moodle:

I didn’t notice this until I went back into the office; I thought my home internet was pretty okay; never had any dramas with it … It wasn’t until I went back into the office and I could upload a document to Moodle in about three minutes that at home was taking hours. (P1)

Internet and technology access were also a consideration for student equity:

I suppose making sure that the students have adequate internet is the big one … Making sure that they have access to support if they need internet help or funding is important. And making sure that they have devices and access to a computer which you assume they do have. But maybe some of them who are rural students are from underprivileged backgrounds and may need (more) support than others …. (S1)

Reduced travel time

Reduced travel time was recognized as a time and economic saving:

In terms of personal positives, in terms of travel time, there’s no real need for the vast majority of my work to actually travel and so I feel like my work has become somewhat more efficient in terms of the amount of actual work that I get done for my role. (S2)

Work-life balance

One participant summed up the challenge of work-life balance:

… for all of us, (it) was a rapidly evolving situation that didn’t just affect your working life; it affected every part of your life including personal life, so you couldn’t go “oh, it’s a difficult day at work; I’ll just go home and do my usual relaxation …”. (A5)

Pandemic home-schooling

Juggling other personal roles, for example, parenting and home-schooling, was raised as a major issue across the staff cohorts:

The people that I have spoken to, everyone’s story sounds reasonably similar … I was home schooling … It was not much fun, I can tell you. (P1)

An extended response from another participant covers the main issues experienced:

… the thing that I found hardest was with the home schooling … I found, locally, within my local team and my supervisor, there was lots of understanding … But I found that (the larger university) was depressingly under-helpful … so, the home-schooling is happening and then you’ve got this program and this work that you need to deliver for your students; it’s not (the university) that suffers; it’s the kids that suffer. (A3)

Some participants described how they coped:

I just had to nick between the rooms at times or we would chat. If I was in a meeting, I would chat with him on an iPad and say “I can’t talk right now; … move on to the next one; we’ll worry about it later”. (P1)

Theme 3: Re-transition and the “new normal”.

Further disruption emerged as the virus mutated. University and site-specific orders and lockdowns overlaid this. For example, clearances to return to work came on numerous occasions. Some staff thought that the first lockdown in Victoria, Australia would be a short-term event; others anticipated far-reaching consequences:

I was getting it from everyone (and) I think it gave me a greater understanding of the impact of COVID and some of the things we could start predicting. I was going to meetings … “it’s going to get bad; international travel will stop” (so) I could have those conversations with my other colleagues … knowing it was going to not go well … for our international (students) when they started to go home. (S3)

Blended learning

Students advocated to continue blended and flexible learning opportunities:

A lot of students have given me feedback that … dictating their own learning time is more beneficial … “the fact that COVID has given me the option … to listen to my lecture at 2am is a good thing.” … but again, you lose that interaction of in-person. (S2)

Flexibility for staff

Staff also hoped to continue flexible working:

I think I like the flexibility of being able to work at home a little bit; I certainly saved a lot of time in commuting. (A3)

Other gains

Other considerations related to assessment and marking student presentations:

… I’ve had to mark student presentations and when you’re doing that in real life you can get quite panicky, but because with Zoom you can record it, you can go back and view over the student presentation more efficiently …. (S2)

Increased agency was recognized:

… I sort of feel now that nothing could be on the scale of what we had and I think that we can pretty much do anything. (P1)

This reflection highlighted the aspects that staff and students did not want to lose in the “new normal” teaching and learning context.Theme 4: Future readiness.

The final theme emerging from the data related to preparations for sustainable teaching into the future, capturing the essence of why future-proofing ensures the continuation of quality teaching in inevitable emergencies:

… we’re responsible for educating people who are going to be doctors one day and in positions where if they make mistakes or haven’t been taught properly then there are devastating consequences and so the staff dealing with the course need to feel that they’re valued and well-supported all the way through. (S1)

Good workplace culture

Teamwork was key to success:

… one of the reasons that it went so well is that we … all get on really well as colleagues and we can have the discussions … . Paramount, it was: “COVID’s here; we can’t change that and we have to do the best by our students plus, also, the best by our team”. (S3)

The issue of resilience

Some staff picked up on the notion of resilience and its complexity:

I think resilience is tossed about too much now … I think framing it as “how can staff manage these issues into the future?” rather than “get resilience” … So, framing it in a way that is “we just need to do the best we can with what we have; that’s all”. (A5)

Considerations for uncertainty

The to-ing and fro-ing of being in and out of lockdowns was a challenge for staff, and related vacillation between teaching face-to-face, hybrid or online, led to consideration of uncertainty in future planning:

… I think that back and forwards until we called it was actually quite hard. At one stage, we went back for one day and you then had to go back to “okay; it’s back to online; all the students (go) home” and then we never went back for the rest of the year. (S3)

The constant alternations led to staff exhaustion:

… I think that’s actually magnified the issue because people have come in to 2021, we had great hopes; we thought “we’ll be sort of semi-normal” but it’s not, and I think people have come in not having had a good break to refresh because we just had to start all over again at the start of the year. Lots of extra requirements; staff shortages. (A1)

The continuous change of regulations was challenging for students too, as related by one of the professional staff members:

… there were a number of students I was dealing with and I’d maybe need to get in contact and say “can you; you need to get this done by a certain date” their immunization. But then they would say “I’m in Melbourne”. “No worries; just look into it when you come out of lockdown” and that sort of thing. They didn’t need the extra pressure of trying to do more things when they couldn’t even leave the house. (P1)

Protocols and policies

There were suggestions to develop a “toolkit” while the adaptations to the pandemic were implemented:

… I think whatever the transition is, it’s probably going to be fast; … being able to say “we have the resources ready to go to roll out in an online environment” and the transition that we’ve had has done a lot of that preparing. So … I think it would be good to review the things that worked and to put them into a toolkit … (A3)

These suggestions would provide a framework for the DISPLAN.² One staff member spoke about the flow chart that they put in place:

So (another colleague) and I wrote a protocol … So now we’ve got that in place … . We should have done that last year …. (A4)

Others were also keen to capture details while they were fresh in the minds of those who worked during this crisis:

… it doesn’t matter what you teach, you can do it, as we’ve seen. But having some sort of plan of “if we’re shut, what are we going to do?” … So I think a bit of a thought about “how long do you shut before you convert to a new style of program?” And I think, most of the time, it’s not going to be an issue. If we have a bushfire, it’s rare that we’d be closed for more than a week at a time … so I think that while it’s fresh, there should be a short document … of how do you frame it? What’s the experience with what’s been done before? … a very basic (document) to help people who may not have been around during those times. (A5)

A key issue to consider during crises is in and around clinical teaching, along with exposure to the clinical workplace and real patients:

… a very big problem that we identified in the scientific field (was) that we were literally graduating an entire cohort of undergraduate students who had never stepped into the lab and so … we’re getting a bunch of students who have never touched a pipette …. (S2)

The clinical educators highlighted the potential for students to evade the practical elements of medical training and the impact this might have:

… (the students) sort of had to teach themselves the physical examinations through videos and online content that was posted, and then they had to videotape themselves doing the physical examination of someone which often were their parents if they were at home … In some cases it was a pillow because some students were by themselves and didn’t have anybody to practice with … and we had to watch the video and then critique it on a paper based form as well as we had to video ourselves giving them some feedback which we then had to send back to them which was a hugely complicated process. It was good in theory but it wasn’t great in reality and it meant that that group of students never really learnt proper physical examination. (S1)

Maintaining clear communication and connection

Communications challenges were highlighted:

It’s been quite messy this year. Messaging from central faculty has been a bit ordinary in places, and so, yeah, I think they really need to do a better job in terms of getting information out there. It’s not good; … we sort of get mixed messages or we don’t get messages and stuff that they’re saying is happening doesn’t happen. (A6)

Maintenance of clear communication in times of crisis was considered essential. This is related to seeking information:

But one thing I have realised, and I’m sure everyone else would agree, is sometimes it takes longer to get answers when you’re at home. So instead of knocking on a door or picking up the phone, one thing can take fifteen emails that could have been resolved a bit easier. (P1)

Novel approaches arose to support students:

What was better last year because of this Zoom and technology environment, it’s very easy to organise mentor meetings with this group of students at quite a regular basis. We used Microsoft Teams as well and so what that allowed … it’s really good and the students can set up their own messaging system and if the students had any problems then they just threw it into the Microsoft Teams and a student could help them if the student was feeling generous. And because I was their mentor, I could also help with their queries. So, it gave them a sense of connectivity where there might not be connectivity already. (S2)

This comment supports the notion of virtual casual communication opportunities to help overcome some of the experienced challenges. Another major consideration was finding ways to support student safety, both physical and emotional:

… many who were isolated from their support systems … we had so many depressed, anxious, teary, some self-harming, unsafe students who, because our hospitals went above and beyond the health department, as far as restrictions go … (were) more restricted than the healthcare workers. Who weren’t allowed to leave … Or the hospital said they wouldn’t be allowed on the wards … as time went on, being more creative about what we said to enable students to stay mentally safe. (A4)

Another academic staff member also commented on the pastoral care issues that were potentially lost with the rapid transition to fully online learning:

By the time they’ve hit fourth year it’d be rare for them to have an academic issue; but I’ve encountered a few personal issues and mental health problems. And it seems to be something that’s increasing … And I guess seeing them face-to-face is a much better way to actually see how they’re going and they’re much more likely to just drop in and sit in my office and have a bit of a chat if something’s going on they’re worried about something … I think, for me, that was the biggest issue. Just that feeling that I didn’t connect with them …. (A6)

For this participant, establishing virtual office hours and having regular check-ins with students online, could provide opportunities for open communication around pastoral care issues, overcoming the tyranny of distance.Dedicated funding

Having a pool of money to access in order to help staff deliver teaching during crises was also a useful suggestion:

… the ones who control the budget, so if they put budget money associated with … (technology) to support staff that could come in during a time of transition … “Find me a solution; great; and I’ll keep working on the content”. I think the central university has a budget role. (A3)

Ongoing professional development for all staff

Continuing professional development of staff for future readiness to continue teaching through emergencies and disasters cannot be under-estimated. A key issue raised by participants was around learning technology, knowing the options available, and how to use these:

I’m not great with technology, so I had to learn to work things that people probably take for granted. Chat bars and stuff like that. But anyway, I got the hang of it. Just boring things like sharing screens and stuff; I’d never had to do it because … I’d done everything face to face. (A6)

Beyond basic technology use, other challenges included:

… trying to work out ways that I could video myself and make a small enough file to send back to the student and often my internet was struggling with that, and that part nearly drove me insane. It was all good in theory, but the practicalities were difficult … (S1)

Ongoing staff professional development was suggested as a solution:

… in hindsight, we probably could have had quite a number of different training sessions, but now, look, there’s still things with Zoom and Moodle, I’m sure, that I could know about. Especially Moodle, because Moodle’s highly temperamental, I find. (A4)

This unreliability was noted by another participant:

And that’s a bit of staff upskilling in different types of software or programs that might allow the students to collaborate with each other in slightly different ways … Platforms where, like I said, where if you’re doing an online lecture or whatever, you can engage with them in a more visual way … so that they know who you are and they have a better personal connection with you. (A3)

This knowledge cannot be assumed, so needs to be developed. A “Skills Check” for professional development opportunities might be a possibility.

In summary, the unprecedented COVID-19 pandemic demanded that clinical and academic staff rapidly transition to fully online instruction. The ramifications for educators and the units’ support teams were widespread. Challenges ranged from technical, logistical, and financial hurdles to program design and delivery, the pastoral support of students, through to more personal impacts on work-life balance. Positive outcomes were also noted including improvement in teamwork amongst the faculty, flexibility in work arrangements, reduction in commute time to work, and a sense of achievement and better preparedness for dealing with future disruptions to educational delivery.

4. Discussion, recommendations, and further research

The recognition of how crises can create opportunities for structural change in the education space for the better, can lead to considerations of what can be done to optimize that opportunity [18]. There is much that can be learned from past experiences of teaching and learning in crises, from the current COVID-19 global disruption, and the preceding acute management of other crises such as bushfires and floods in regional settings. These insights can be applied to prepare for the future and further possible crises, whether these be climate or virus-related or imposed by the Government.

Despite the flexibility of online learning, educators experienced various challenges in applying this teaching mode during the pandemic, including readiness, technology literacy, access to technology, financial difficulties, and health risks [7]. The participants suggest both financial support and the enhancement of professional development activities for staff, alongside access to reliable educational resources beyond the pandemic [19].

While policy and protocols are two elements of the solution when operating in crisis mode, management cannot rely solely on the creation of crisis prevention strategies [18]. What is also required to future-proof educational spaces, is a strategy of holistic resilience [20, 21]. What would a shared understanding fostering resilience in crises look like? Systematic work is required to identify ways that provide for resilient communities, and this also applies to teaching and learning in times of crisis [22].

In Christchurch, New Zealand, the category 7.1 earthquake of September 2010, was followed by another of 6.3 magnitude in February 2011. The second earthquake while of a lesser magnitude was catastrophic, leading to 181 deaths and triggering a state of emergency in the region. This in turn impacted the delivery of education at institutions of higher education, such as the University of Canterbury in Christchurch. Learning from our colleagues’ experiences in higher education across the ‘ditch’², key factors in sustainable teaching were the ability to respond swiftly and continue delivering teaching and learning without the physical place, due in turn to the infrastructure, pedagogy and capability supporting blended learning that was already in place [23]. These learnings are applicable to our context wherein there are implications for short-term management of crises such as fires and floods, versus long-term chronic management such as COVID-19. Investment in such approaches is likely to result in sustainable practice, such as a mix of flexible and hybrid delivery rather than a simple return to face-to-face as the default. While a decade old, the advice offered by Mackey et al. [23] is still relevant and can help institutions of higher education plan and sustain equitable experiences for students in times of disaster or crisis. For staff and students, this advice involves different lenses and questions.Staff:

• How well prepared are staff to implement blended or online strategies independently within a short timeframe?

• What professional development and support are required to ensure staff has the technological capability and the pedagogical understanding to work predominantly in an online or blended mode should the need arise?

• Do staff know how to access files, applications, and other resources remotely?

Students:

• How well-prepared for independent learning would students be if the institution had to shift all teaching and learning into a distance, flexible or online mode at short notice?

• What additional supports or resources might students need to continue their learning activities independently?

• Could students complete alternative location-independent assessment activities if necessary?

• To this we would add in the context of medical education:

  • How would such adaptations be credentialed to support progression to the next stage of learning or to join the workforce?

  • How may these adaptations simulate or substitute clinical placements?

Communications:

• What channels including social networks are ready to be used to communicate with staff and students?

• Do staff and students know about and feel confident accessing these channels?

• Are these channels likely to remain viable in disaster or emergency conditions?

• Is there access to simple technologies that could be used to create instant communications and resources for students (e.g., flip-videos, podcasting)?

Resources:

• In the event of a sudden and extended evacuation from workplaces, how will staff access the materials required to continue teaching?

• How many of these resources are electronic?

• How might cloud computing be utilized to ensure continued access should the institution’s infrastructure and servers be damaged?

• Are there adequate off-site backup and disaster recovery plans for electronic material?

• What physical resources are needed to digitize or arrange alternative access (e.g., off-site copies, and mutual arrangements with another institution) for staff and students?

In anticipating crises, not as one-off extraneous events, but rather perceiving them as inevitable and preparing staff for them, by using this list, and from the responses of the participants in this study, we also add what management and leadership might consider.Management:

• Are disaster management policies and protocols in place for staff, students, clinical placements, and resources?

• Are there funds that can be kept in reserve and deployed on an “as needs” basis?

• How might this reserve of funds be distributed? Who are the most vulnerable staff and students in times of crisis?

• What professional development strategies can be implemented to support staff in “transitions”?

In reflecting on the four “Ss” that influence how an individual copes with transitions [24]—situation, self, support, and strategies—most of these considerations are covered in the above list, the final consideration is in and around fostering not only resilience of individuals, but holistic resilience more broadly conceptualized [20, 21, 25]. The final recommendation, therefore, is around the element of resilience.Fostering holistic resilience:

• Does the organization consider resilience as an individual responsibility or is it committed to fostering a broader understanding of resilience that views this as not an individual responsibility, but a quadripartite one [25] reflecting the four Ss?

• How is resilience being fostered in a broader sense across the school and its sites?

• Are staff being given opportunities to participate in professional development to ensure that they are equipped for delivering teaching and learning in a crisis?

• What steps will be put in place to explore how resilient the teaching community is, and what can be done to better promote this?

This list of recommendations may also be the basis of future research on the preparedness of staff to plan and sustain equitable experiences for students in times of disaster or crisis, in terms of dynamic individual and organizational checklists. It would certainly serve to highlight espoused rhetoric versus theory in practice.

Much more systematic work needs to be done on the identification of mechanisms that provide for resilient societies [22]. Further research will help in understanding the fragile relationship between crisis and change. Finally, it would be prudent to follow up reflectively with staff through the lens of the four “S’s” [24] that influence how an individual copes with transitions in crises.

The study was limited for several reasons. First, it only explored the experiences of staff across regional sites in Gippsland, Australia. Second, the study was conducted at a time when staff had already experienced COVID-19 lockdowns in 2020 and were anticipating a “return to normal”. With subsequent lockdowns in the state of Victoria, Australia, in 2021 due to new viral variants, it became clear that there would not be a “return to normal”, but a switch to a “new normal”. Of this, a hybrid approach rather than a return to fully face-to-face teaching and learning may become the reality, especially with the program delivery for offshore (international) students, and students in the subsequent clinical years given their need for workplace placements. As such, it would be useful to follow up with staff on the main themes elicited in this study. It would also be useful to investigate considerations of the need for students to contribute to surge workforce efforts.

5. Conclusion

This study chronicled the experiences of staff at a regional medical education provider of the modality shifts required by the COVID-19 pandemic. Their experiences reflected the renewal and transformation of curriculum delivery, and the move toward sustainable teaching and learning in a region known for its vulnerability to natural hazards and disasters. In so doing, the research explored some of the barriers and challenges experienced in adapting from face-to-face teaching and clinical placements to an online/hybrid modality. Some outcomes were positive in terms of sustainable practice and equity of access to learning opportunities for students and will be an integral part of moving forward. The findings reinforce the need for checklists to assess program robustness, to harness technology, and for continuing professional development to ensure adaptability of students and staff.

At the point of writing this chapter, the pandemic is ongoing and continues to impact the medical program. There are cohorts of students who are entering and progressing across medicine with very different learning profiles to those that existed pre-pandemic. Considerations of preparedness for, and progression toward practice, are necessary for moving forward. With this in mind, we must not simply prepare for the inevitable rapid challenges that occur during crises, and any related shifts to online and hybrid teaching modalities; we must also be ready for a transformation of mindset [26]. Sustainability of teaching and learning in crises relies on responding to the challenges that arise, as well as recognizing the opportunities that arise.

Acknowledgments

We would like to acknowledge the academic, sessional, and clinical, and professional staff members who contributed their time during the pandemic to participate generously in this research. We would also like to acknowledge the team in the broader project: “Impacts, innovations and implications relating to the delivery of the Monash BMedSc/MD program across Gippsland sites during the COVID-19 pandemic.” These were Professor Shane Bullock, Associate Professor Margaret Simmons, Dr. Adelle McArdle, Associate Professor Marianne Tare, Dr. David Reser, Dr. Sean Atkinson, Dr. Kris Gilbert, Dr. Julie Willems, Ms. Caroline Rossetti, Ms. Meagan Presley, Associate Professor Cathy Haigh, Ms. Casey Stubbs, Dr. Annette Connelly, Dr. Deidre Bentley, Dr. Warrick Pill, Dr. Amie Gillett, Dr. Paul Brougham, Ms. Marnie Connolly, Ms. Prue Berry, Ms. Jennie Casey, Ms. Deborah Hewetson, and Mr. Bill Haigh.

Conflict of interest

There are no known conflicts of interest in this article.