The law of unintended consequences has recently played a huge part in shifting emphasis in adult teaching from face-to-face ‘in the classroom’ (ICR) learning to virtual and self-directed (VSD) educational programs across the board. Air medical transport and retrieval training was certainly no exception, after the rollout of Covid-19 lockdowns across most of the world in 2020. From many accounts it appears that this particular unintended consequence is serendipitous, and one which may well have permanently changed our preferences.

Since 1996, CCAT Aeromedical Training has created and developed ICR study days and short courses around the world and, until 2020, firmly believed that patient transport and retrieval topics were so practical, that only face-to-face training would be suitable. In retrospect, this was a self-defeating oversimplicity that somewhat restricted our ability to teach flexibly, and to high numbers of students, in the past. Only by being forced into the situation, by the closure of our university venues in the UK and Thailand, were we encouraged to study how best to teach the syllabus under the constraints of VSD learning.

Now that universities have reopened and the world has learned that remote working and VSD teaching from home is convenient and effective, it’s a good time to take stock and make comparisons of the different teaching methods. CCAT Aeromedical Training has collected post-course feedback since 1997, with this data being used to improve not just the student’s learning ability, but also their degree of success and experience of the learning process. Part of the post-course activity is the essential analysis of all student evaluations and feedback, followed by decisions on how that can be used to improve each subsequent course or study day. However, this is the first occasion where all the data from the past three decades has been analyzed, in order to modify the very mode and methods of our teaching programs. From our data set (n=106 training courses and study days in 25 years), we have identified key characteristics that help compare and contrast ICR and VSD modes.

Now that universities have reopened and the world has learned that remote working and VSD teaching from home is convenient and effective, it’s a good time to take stock and make comparisons of the different teaching methods.

‘Face-to-face‘ learning
ICR refers to the traditional real classroom/teacher experience, where all students/ trainees are physically located in one venue, sharing the same educational experience at the same time with the same teachers/lecturers/instructors. It is a synchronous method and Table 1 shows, in our setting, the benefits of ICR learning.

To balance the argument, there are also a few potential drawbacks noted in Table 2:

VSD learning
Formerly, distance learning relied on teaching materials being physically mailed to the students, but there has been significant development of eLearning since the turn of the century. The terms ‘virtual’, ‘online’ and ‘eLearning’ describe any type of learning on the internet, but there is a distinction between traditional distance learning – now referred to as asynchronous – with webinar style (synchronous) learning that aims to emulate the face-to-face mode, albeit in the virtual domain.

Asynchronous learning enables students to engage with online educational materials remotely, from anywhere with an internet connection. The materials are available on any day, at any time, and students can usually study at their own pace – except in tests or other academic challenges. This is true selflearning, because the instructional material is not presented directly by a live, performing instructor. Video presentations of teachers taking a lecture may be used, but they don’t offer the advantages of the teacher being present and able to answer questions, give explanations and facilitate discussions.

Virtual synchronous learning, on the other hand, is a mode in which students and trainers all log into a virtual space at the same time (synchronicity) for a webinar that may comprise formal lectures, case studies, workshops and so on. This requires all participants to be online and attentive during each teaching session at the pre-arranged times and dates.

This is true self-learning, because the instructional material is not presented directly by a live performing instructor.

Evolution of CCAT Aeromedical Training courses
After reviewing the evidence and defining lists of essential and nice-to-have features of the new training regime, it was decided that with fresh thinking and an innovative approach, the best option would be to blend three modes into a Hybrid Learning Model:
A. For knowledge, understanding and reasoning –
    1. Virtual synchronous learning (live webinar)
    2.Traditional self-directed learning (modified for email postings)
B. For practical/hands on activities and demonstrations –
    3. Multi-modal approach (webinar, ICR learning and placements).

The Hybrid Learning Model
This takes advantage of the opportunities of both ICR and VSD, as well as both synchronous and asynchronous learning styles. The following steps were taken:

1. Complete review of curriculum and syllabus in order to modify and add content for appropriateness during the lockdown-induced need for remote learning scenarios.
2. Ensure that all teaching sessions have appropriate lesson plans and objectives.
3. Adopt a competency-based approach towards all outcome             
    measures and objectives.
4. Focus on strengthening memory retention by manipulating the       
    syllabus to include Ebbinghaus principles (Table 3).

Conclusions
By the application of adult learning principles and the adoption of modern theories of targeted delivery of learning materials, CCAT Aeromedical Training converted its package of educational materials in order to optimize the learning experience – while maintaining educational standards for current and prospective flight medical personnel worldwide.

Valuable lessons were learned in the first two Hybrid CCAT courses, and student feedback evaluations have remained high, providing good evidence of client satisfaction. And the future? Aeromedical Training will return to ICR courses at the University of Surrey (UK) in February, and Rangsit University (Thailand) in September this year. Also, due to the growing popularity and demand for the Hybrid webinars, we’ll be running those throughout the year too.

Finally, that law of unintended consequences is more common than you might think. The decision to develop the Hybrid Learning Model gave rise to a refreshing new approach to making ‘competency’ a central tenet of the training, and a major objective of the syllabus for each training package. The circle is complete!