Teaching and Learning Lifestyle Medicine During COVID-19: How Has Living During a Pandemic Affected Students’ Understandings and Attitudes toward Self-Care and Population Health? A qualitative analysis | BMC Medical Education
The findings of this article provide insight into how the collision of emerging SCI, broader public health education, and a once-in-a-generation pandemic is impacting student attitudes toward sedation. learning about these subjects. Students described how their emerging understanding of health inequities, preventive medicine, and self-care supported their behavioral response to the COVID-19 pandemic, and how this impacted their attitudes and understanding of the LM. Taken together, these results suggest that Imperial’s new lifestyle and prevention medicine learning was beneficial to students and a potentially useful vehicle around which student health, LM skills, and population health education can be integrated.
While it is not possible to characterize a counterfactual scenario in which LM teaching or the COVID-19 pandemic did not occur, these participant responses suggest that LM learning provided knowledge and skills from which students can more positively engage and mitigate the negative impacts of the pandemic.
While a minority of students said their experience of the pandemic did not affect their views on the LM, the majority did. The government’s response to the COVID-19 pandemic in England included a series of lockdowns which affected all aspects of normal student life. At the same time, these lockdowns and associated social isolation seem to have highlighted lifestyle factors, health behavior and broader determinants. Themes 1 and 2 highlight the impact of this on students: time spent in this period of social isolation appears to have facilitated opportunities for students to reflect on their own health behavior; Theme 3 might suggest that this was catalyzed by knowledge of how LM and broader determinants influence health status.
Other published work has explored the impact of the Covid-19 pandemic on health behaviors and the perception of its importance . A prospective cohort study in the UK found reduced fruit and vegetable consumption, reduced physical activity and increased alcohol consumption during the spring 2020 lockdown . However, these results were tempered by a slight increase in strength training. Sleep behaviors were affected in different ways during the lockdown. In three European countries, sleep time has been shown to increase, possibly due to changes in social demands and expectations that often result in the sacrifice of sleep. Despite a reported increase in sleep time, subjective sleep quality has been shown to reduce . Similar results were found in a sample of American university students . Hand hygiene data demonstrates pandemic’s ability to drive behavior change [19, 20], although this did not hold as the pandemic progressed. This ability to catalyze behavior change is also reflected in historical experiences with other infectious diseases, such as changes in traditional burial practices and care-seeking behaviors that occurred during the Ebola outbreak. in 2013-2016. ; and adherence to public health measures such as hand washing, mask wearing and social distancing during the 1918-20 influenza pandemic . These are important considerations in this work. Considering the sub-themes identified in theme 2, some responses indicate an intention to change, rather than to change behavior, and others demonstrate recognition of the difficulty in changing behavior.
Experiencing a public health emergency can provide a new perspective through which broader issues of health inequity are more salient and applicable, as highlighted in Themes 3 and 4. The importance of translating abstract concepts into ideas more concrete is reflected in the growing importance of social responsibility of medical schools . Social accountability embeds institutions in the communities they serve and connects students to local public health challenges, allowing them to contextualize their learning.
More broadly, a shift towards experiential learning  is exemplified by medical school initiatives to incorporate clinical experience into medical degree programs at an earlier stage , replacing the traditional division between the “preclinical” and “clinical” sections of the medical degree. This experiential learning trend is also evident in public health programs [25, 26]. Efforts to integrate experiential learning are supported by pedagogical theory which describes it as “the construction of knowledge and meaning from real-life experience” . For this process to take place most effectively, the learner must have prior knowledge in which to contextualize their experience and provide a framework for critical analysis. So, in our example, the students’ prior knowledge came from the material taught during the LMAP and reflecting and analyzing their experience of confinement in the context of this knowledge allowed them to synthesize the ideas that we present in the results section. Previously published work has suggested that experiential education is a promising method for facilitating learning about health inequalities . Health inequalities are higher than ever, having been exacerbated by COVID-19 . It is imperative that medical schools redouble their efforts to not only teach the theory behind health inequalities, but also practical approaches to addressing them. Our results support the idea that experiential learning, whether through simulation or real experience, could be a promising approach to achieve this.
Our findings also suggest that experiential learning gained through lived experience of the pandemic may provide a basis for increased empathy. There has been previous work on the role of simulation teaching in developing empathy and a review of empathy education in nursing concluded that experiential learning was the most promising form of teaching for developing this trait . Additionally, in a study exploring medical students’ understanding of empathy, students expressed a preference for experiential learning as a method of developing this trait. . Experiential learning can therefore be a win-win, both as an effective method for developing empathy and as a popular method with students.
One of the primary goals of LM in the Imperial program is to improve student health behaviors. It’s clear from the data that students have changed their behavior in response to the lockdowns, and in a particularly mental health-focused way. Long-term health outcomes can be difficult to achieve for young, healthy students for whom those outcomes are a long way off. Living during lockdowns can bring some of these results closer to home. Understanding motivation is beyond the scope of these data, but thinking about what motivates positive behavior change in this context can provide useful insights into how these motivations might be internalized to promote longer-term positive change, consistent with the self-determination theories of learning. .
In terms of the strengths of this study, this is the first study the authors are aware of that examines the relationship between LM teaching and the COVID-19 pandemic on a large scale. Among its other strengths, the 71% response rate suggests that a wide range of viewpoints were represented, although the generalizability of these findings to other medical schools and other pandemics is potentially limited. Another limitation is that the data was collected as part of the module assessment, and therefore students would have been more likely to give positively biased responses than if they were responding to independent researchers. The data provides a snapshot of student attitudes, taken at a time when health anxiety was perhaps unusually high during the first UK lockdown. Importantly, the data provides no insight into how these thoughts and attempts at behavior change during lockdown affect long-term health behaviors or ongoing attitudes toward LM among medical students. These are avenues to explore further.