Filling the lockdown learning gaps with pub quizzes

by Giselle Green

Newly qualified junior doctor Seb Casalotti has been using pub quizzes to teach medical students missing out on hospital-based learning.

After seven years of studying medicine at Cambridge and University College London (UCL), Seb Casalotti was due to head off to Italy for his elective, the medics’ equivalent of an eight-week hands-on internship. He’d been brushing up his Italian ahead of his work experience in Sienna. On his return, he was looking forward to finally graduating and starting work in August as a junior doctor.

But COVID-19 struck. Seb went into lockdown with his family. No elective, no official completion of his medical studies. And no graduation – apart from a homemade ceremony involving his dog and an online event staged by UCL.

Like the thousands of final year medics who had qualified as provisional junior doctors and were hurriedly dispatched to the frontline ahead of time, Seb too was keen to help the NHS. But unlike many of his peers, Seb lives with a close family member who is shielding (clinically extremely vulnerable’). That meant if he wanted to join the NHS frontline, he would have been forced to make a difficult choice: “I could have taken up a volunteering role in a hospital, but I would have had to move away from my family and that wasn’t something I wanted to do at this stage.” 

Instead, he decided to turn his focus on how to help medical students, his juniors, at UCL who were missing out on vital hospital-based learning. 

COVID-19 brought an abrupt end to the hospital rotations that are a crucial part of training for medics across the country. Consultants understandably had other priorities on top of delivering lectures and attempting to make their teaching accessible online. And the prospect of thousands of students circulating around hospitals was no longer safe. So, in collaboration with four other newly graduated medic friends – Aman, George, Izzy and Salina – Seb set out to create an online learning resource.

It’s ended up growing into something he’s hoping could be incorporated into the university’s mainstream medical curriculum with its innovative way of teaching medical students. At its heart is a somewhat unexpected model: the pub quiz. 

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Session topic: Gynaecology. I commend anyone who gets all correct. Hats off to you! Tag your friend to see if they know their histology!

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Every week from April to July, Seb and his team have been hosting live, online pub-style quizzes for Year 5 medics (in their penultimate year as medical students) to supplement their teaching on the modules they’ve missed because of COVID-19. The questions, definitely not the sort that would be heard in a regular pub quiz, cover all 29 topics on their syllabus, from adolescent medicine to maternal infections to bladder cancer. 

Seb explains how they effectively gamified the curriculum: “The sessions have three parts. First, true or false questions that are answered in teams and get the students discussing problems. For example: Doctors have a legal duty to disclose information about a patient if it’s deemed in the public interest. True or false? The answers to these types of questions aren’t obvious. We wanted to promote deliberation. Then there are bonus questions which bring in a bit of fun alongside aspects of the history of medicine and current affairs and go wider than the core curriculum.  We make up cryptic crosswords, use dingbats and linkees, and odd-one-outs.

One week we got students to guess the type of thought/language disorder demonstrated by pop-song lyrics! And finally, there’s a knockout-style case study where we use polls to make students think about what to do next in a clinical scenario.”

They added a competitive element to the tried and tested case format to see which student would still be (metaphorically) standing by the end of the scenario. The questions and answers were delivered MC-style to the Year 5 medics who grouped themselves into 36 teams with names like ‘Don’t Cry For Me Quarantina’, ‘Beyoncé Know-Alls’ and ‘Livin Covida Loca’.

Honestly, these sessions have been SO useful and really passed my expectations on what I thought they were going to be.

Seb and his medic mates ran three back-to-back 90-minute sessions every Friday for different cohorts within the year group. But here’s the clever part. The teams didn’t just answer questions. They also helped set them.

Different streams of students missed different clinical placements as they’re normally taught in three rotating cycles. But between them, they’ve covered them all.  So, each week Seb and his colleagues set the students a task to generate questions based on placements they’d just completed in the preceding term to put to fellow students who hadn’t done those placements. In creating the questions, the medics end up revising the topics themselves.

It’s a win-win: the students did serious learning in a fun and collaborative way by either thinking up clever questions for others or wracking their brains for an answer. Seb describes this as “a student mutual aid scheme that acts in solidarity with clinicians as it supplements their educational provision.”

Seb and the SOLViT team (student-led online virtual, team-based learning) picked the best questions, weaved in their own and added the explainers. They also made sure to incorporate plenty of questions using their own ward-based experiences as the students had missed out on these. “Textbook medicine isn’t always like real-life medicine,” Seb points out.

Seb has long been an advocate of what’s known as ‘peer-led, team-based learning’. He says: “I’ve always thought medical schools should encourage more peer-to-peer learning, that they should be a platform for students to teach something they feel confident in. I wanted to take a grassroots approach. SOLViT has shown medical students can produce useful educational resources in innovative, non-traditional ways. Hopefully, this project can demonstrate new avenues of student-led education for universities.”

Credit must go to the medical teaching staff at UCL for having the vision to back the project and the support offered. Seb says they benefited from the fact that UCL’s Head of Medical Education, Jonathan Cartledge, was himself an advocate of team-based learning. “He provided us with lots of insights and finessing to make sure the project would work. For example, we originally overestimated what students could contribute, so we had to scale that down. He’s been pivotal in keeping us realistic.”

And knowing how much pressure the staff were under, Seb and his team did all they could to keep their involvement to a safe minimum. “Once we’d compiled the questions in each topic, we’d run those past the relevant specialist in that field. That way they could select the most appropriate ones and ensure the content was correct and appropriate but without it creating too much extra work for them.  And we always had a doctor present during the sessions so they could engage with students who have questions or intervene when necessary. We feel very well supported.” 

The SOLViT team. © SOLViT

But what does success look like? Can it be measured? 

The final session was a couple of weeks ago. In terms of reach, around half of the UCL year group of 300 medics regularly took part every week. Some watched it online afterwards as they had been volunteering or living in different time zones. Others preferred to work alone.

Students were asked to fill out feedback forms every week and then complete a final, more comprehensive one. Seb says this showed “the vast majority of students who participated felt the sessions positively impacted their learning. Furthermore, the overall sentiment was that one of the strongest elements was how the project was student-led.”

Ahead of final exams, which have just been completed, Seb is pleased those who’ve taken part in the SolvIt sessions felt better prepared – although he admits it will be hard to quantify the precise contribution of the sessions. “We won’t have any hard data on what this has meant for exam performance.” 

But the weekly pub quizzes haven’t just helped fill the learning gap; they’ve been filling a social one too.

“Medical school is usually very interactive and social,” says Seb. “But COVID-19 put a stop to that. People have enjoyed getting together through these weekly sessions and appreciate the work that’s gone into it. Doing it on a Friday has given it a good vibe as in normal times we might be going for a drink. Aside from the serious learning, I hope they’ll think it’s been a worthwhile socialising experience and it’s contributed to boosting their mental health during the lockdown.” 

The comments on the feedback forms certainly back this up:

>“Honestly, these sessions have been SO useful and really passed my expectations on what I thought they were going to be. I’d previously have found group learning challenging so I assumed doing the same online would be even harder. But each Friday I looked forward to them -as sad as that sounds!” 

>“The sessions have provided structure to the week and also reduced my sense of isolation from my peers. It has had a very positive impact on my motivation to revise and mental health.”

Another unexpected benefit, says Seb, has been around the positive impact of online learning:

“Whilst online learning will bring up issues in terms of access to technology which are important to consider, there are ways in which online learning may be able to improve equity of student involvement by reducing the need for travel (and the associated costs) and by breaking some of the barriers seen in face-to-face teaching. We have found that the online platform has allowed some students who may have been less confident in contributing vocally have been able to do so more freely on an online platform.”

Seb has also been encouraged by the medical staff’s positive attitude and willingness to get involved, by the relationships that have been built with the students and the skills sharing between different faculties. 

The feeling is mutual. UCL’s Head of Medical Education for Year 5, Jonathan Cartledge, was impressed by the project. 

“Seb and the SOLViT team maintained a fun atmosphere which was a really important component given the isolation and fear experienced during lockdown by many. The team approach was employed to offer a social aspect to the experience, and this was greatly enhanced by the light-hearted and supportive peer-led nature of SOLViT. The peer-led aspect generated a more cheeky atmosphere with some banter and jokiness that is less prominent in faculty-led team-based learning. 

But he wasn’t ready to give the SOLViT team a free hand.

“I felt that many of the questions students had generated were harder than those I would have developed and tended towards more niche rather than core aspects of the topic. I think the faculty input in selecting those questions for use was therefore important in enabling this experience to be appropriately pitched. On the plus side, the creation of questions is likely to have benefited the learning of the question writers as well as the intended audiences.”

So does he think this pub-quiz style learning has a future?

“Looking to the future the faculty are really keen to find ways to continue this collaboration but there are challenges to this. The SOLViT team were students post-finals but pre-foundation posts [when they start work as junior doctors] who had time to help develop, deliver and moderate the sessions. This took a lot of work, leadership, innovation, determination and commitment.

We may struggle to replicate this, particularly when the equivalently placed final year students next term will be working to catch up on the clinical experience they missed during the lockdown and will be preparing for their final assessments. However, faculty are keen to collaborate again if students are also interested in doing so.”

Even without COVID-19 casting uncertainty over the future of face to face learning, Seb believes the project itself has a promising future. He’s been made an Honorary Clinical Teaching Fellow at UCL and is up for helping next year’s students:

“This project shows that team-based learning can be integrated into different parts of the medical curriculum and can be a great way to promote peer to peer learning. The process has been a great experience for the whole team, and we’re keen to help the next year of medics take the project forward for future years.”

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