Oxford-Palestine (OxPal) partnership: evaluation of an online medical research fellowship aiming to build local research capacity

Oxford-Palestine (OxPal) partnership: evaluation of an online medical research fellowship aiming to build local research capacity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Oxford-Palestine (OxPal) partnership: evaluation of an online medical research fellowship aiming to build local research capacity Kirandeep Saini, Rebecca Jurdon, Rebecca Conway-Jones, Rose Penfold, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4228949/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Innovative methods of delivering medical education across borders have the potential to further the development of healthcare capacity in austere environments. Medical students and doctors in the occupied Palestinian territory (oPt) face barriers to their education; whilst geographical, technological, and financial obstacles have limited the ability of institutions in high-income countries to share effective educational resources. We aimed to investigate the effectiveness of an international partnership in meeting the expressed educational needs of Palestinian medical students and doctors, through a locally tailored research training online course. Methods A needs assessment was used to guide the design, format, topic and content of an interactive lecture course. It was delivered to medical students in the oPt by clinicians & scientists from the U.K. and U.S.A. through an online lecture platform. The programme was evaluated through questionnaires and focus groups. Results We found students’ greatest expressed need was for supplementary teaching on medical research. Students perceived interactive online distance-teaching, delivered by utilising excess tutor capacity at educational-resource rich institutions, as equal (22%, n = 20) or superior (76%, n=71) to local in-person alternatives. Conclusions We demonstrate a low-cost, replicable method of supplementing medical education, generating engagement and building healthcare research capacity in an austere environment. Other institutions can rapidly deploy this model to upscale outreach efforts and improve global medical education. Gaza Palestine Remote teaching medical education OxPal Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background High-quality medical education is a vital component of effective and sustainable healthcare infrastructure. Globally, there is a misalignment of healthcare resource generation; whereby, regions with the greatest need to rapidly grow and upskill their healthcare workforce are those facing the most significant barriers to medical education. The role that partnerships between education-resource rich institutions and those in resource-constrained regions can play in increasing healthcare and health workforce capacity has previously been investigated and serious calls have been made for further published research on the topic(Guilfoyle et al. 2021). Studies are needed on the optimal methods of teaching delivery and nature of these educational partnerships. Further, with rapidly changing technology infrastructure worldwide, these methods need constant re-examination. The increasing availability of the Internet and improvements in reliability and bandwidth capacity worldwide have allowed partnerships to develop that rely on teaching via online distance-learning modalities. Successful partnerships have utilised these platforms to work with local students to produce interactive, location-specific courses (Bowen et al. 2012)(Frehywot et al. 2013) (Mars 2012). Their effectiveness in providing long-term benefit to local students and improvement to health care remains unclear. The current geopolitical context of the occupied Palestinian territories (oPt) results in unique challenges to healthcare and medical education (World Health Assembly) (Giacaman et al. 2009) (Horton 2009). Medical students in the oPt face a number of barriers to local medical education including but not limited to: difficulties accessing facilities for teaching both at home and abroad due to check points and denied permit applications, lack of research facilities, a shortage of clinicians with time to provide teaching, brain drain and the psychological impacts of living in occupied territory (Elessi, Aljamal, et al. 2019) (Shahawy & Diamond 2016) (Kerr Winter et al. 2015). OxPal is an educational partnership between University of Oxford clinicians, alumni and medical students and their counterparts in the oPt, founded in 2011 to respond to these barriers. This partnership aims to address the educational needs of Palestinian medical students with high-quality online courses which are free, interactive and led by the needs of local students. Tutors, in relative surplus at the University of Oxford, Harvard University and the University of London, offer their time to supplement the education of students. Evaluating whether the OxPal partnership achieves its objectives and understanding its limitations is essential for the development of distance-learning as a means of international collaboration. OxPal is part of the wave of educational initiatives and individuals championing free and open access medical education for all. Further, the COVID-19 pandemic has intensified the need for supplemental medical education but, thankfully, spurred innovation in the remote and virtual education ecosystem. The World Health Organisation has highlighted the importance of research for the achievement of universal healthcare coverage, allowing locally driven improvements in quality and accessibility whilst reducing cost (Cuervo 2013) (Dye et al. 2013) . Production of reliable evidence that can lead to locally practical clinical application requires appropriately designed investigations by local clinicians versed in both medical research methods and the local context. Here, we present an investigation of the ability of a cross-border educational partnership to uncover, design and implement means to meet the educational needs of Palestinian medical students and doctors. We evaluate the viability and effectiveness of a cross-border implemented, interactive, online medical research training course in the oPt, designed to meet expressed needs. Methods The Kern’s six step model for curriculum development (Thomas et al. 2016) was used to design the course: 1) problem identification and general needs assessment, 2) targeted needs assessment, 3) outline of goals and objectives, 4) decision on educational strategies, 5) implementation and 6) evaluation and feedback of the course. Needs Assessment We created a needs assessment questionnaire for medical students and doctors in the oPt comprising of 9 questions on demographic information and expressed, perceived educational needs(Ratnapalan & Hilliard 2002) and consent for the use of anonymised responses for research purposes. Facebook, Twitter, Linkedin and the OxPal email list were used to disseminate the questionnaire in October 2018. High-frequency answers were identified, and a course designed based on the responses. Programme design The interactive-lecture course ran from 03/01/20 – 01/05/20 (Supplementary material table 1), and was conducted on Zoom, a commercial platform. A licence for Zoom costing £120 p.a. and a ‘large room’ expansion costing £40/month for 3 months was used (Total cost - £240). The course was left open to all, including non-Palestinians. The first 8 lectures were given in Arabic and the 3 subsequent lectures were given in English. The interactive lectures lasted approximately 1 hour followed by a 15-30-minute discussion. The lectures on data analysis were taught using SPSS (IBM Corp., Armonk, N.Y., USA) with students following along on their own computers. Lectures were recorded and uploaded to YouTube (https://www.youtube.com/channel/UClmkl_oB5igJjU2-zpjjCjg) and posted on our website (https://www.oxpal.org/upcoming-programmes/) to provide an ongoing resource and to increase the number of students able to access the teaching. We analysed the feedback collected after each lecture to inform the next lecture in the series. Data collection and analysis After each lecture students were emailed a survey (via Google Forms) to collect quantitative and qualitative feedback. The post-lecture survey consisted of 12 questions (Supplementary material table 2), using binary, Likert scale and qualitative questions. We obtained post-course overall feedback comprising 28 questions collecting both quantitative and qualitative feedback (Supplementary material table 3), Students were asked to assess the course quality, its impact on their training, any technological issues they faced, and their main learning outcomes. We analysed responses for the overall course feedback and each individual lecture using descriptive statistics; data analysis was performed in Microsoft Excel. We conducted four voluntary focus groups via Zoom at the end of the lecture series (May 2020). We asked standardised open questions to help understand the impact of the program on the students, the format of any medical research teaching provided to them at their medical school and suggestions for future improvements. An OxPal member conducted the interviews, transcribed the recordings and analysed students’ responses to identify emerging themes. Results Needs assessment findings Demographic and experience of online teaching In November 2018, 121 students completed the Needs Assessment. The stages of training of respondents were 61 (50%) 4 th year students, 26 (21%) 6 th year students, 24 (20%) 5 th year students, 7 (6%) intern doctors and 3 (2%) other levels of training. 87.6% (n=106) of respondents had not received online distance-learning tutorials before. Only 1 student said they would not be able to access an online platform for weekly or fortnightly tutorials. Subject, mode of delivery and objectives Most respondents (n = 77, 62.6%) said that Medical Research/Audits skill teaching were not covered sufficiently at their medical school (Figure 1). In a single answer question 78 (63.6%) of respondents said what they most wanted from an online collaboration was to be better prepared for future clinical practice. Only 5 (4.1%) said they wanted to prepare for finals examinations. Findings from individual lecture feedback After the first lecture, 184 feedback forms were completed, this decreased over the first 5 lectures until remaining stable at a mean of 77.8 surveys filled in for lecture 6 to 11 (Figure 2). Most respondents reported that the lectures filled a gap in their medical education, ranging from 92.4% to 98.8% of respondents saying yes, per lecture. Figure 2 shows the variation in quality ratings of lectures. Overall course feedback The overall course feedback survey was completed by 93 students. Students from LMICs in the surrounding region accessed the course (Supplementary material table 4). The stages of training of those who completed the course and provided feedback were 17 (18.3%) 5 th year students, 15 (16.1%) 6 th year students, 14 (15.1%) intern doctors, 12 (12.9%) 4 th year students, 11 (11.8%) 3 rd year students, 9 (9.7%) 2 nd year students, 7 (7.5%) resident doctors, 6 (6.5%) specialist or consultant doctor, and 2 (2.2%) 1 st year students. All students reported that the course covered a gap in their medical training thus far. 71 (76%) respondents rated the method of teaching delivery as better than ‘in person teaching’ they had received (Figure 3). All respondents rated the course quality as satisfactory to excellent (Figure 4) and 67 (72%) rated the difficulty of the course as ‘About right’ (Figure 5). The reported relevance of the course to teaching in the oPt is shown in Figure 6. When asked how they had accessed the course only 15% of students reported not watching any of the lectures on YouTube. Qualitative feedback included reporting of technical issues faced by students, the most common theme was that students in Gaza had internet and electrical issues preventing them from finishing the whole lecture. When students were asked how the course could be improved the most common answers were requests for quizzes and coursework to practice what they had learnt. Students also requested mentorship on how to get involved in a research project or carrying out research themselves. When asked what the impact of the course had been on their studies 47 students reported it had had a good impact, or improved their studies or had been helpful. 22 reported it had improved their medical research skills, 5 reported improved critical thinking skills and 12 students reported feeling encouraged to become involved in research. Only 4 students said it had no effect and 0 students reported a negative effect. Focus group findings Ten medical students and four doctors volunteered to participate in a focus-group discussion, after the course. Students reported that when technical issues or timetable clashes occurred, they were able to access the rest of the lecture on YouTube, and this secondary upload process greatly enhanced course accessibility. This is in keeping with the end of course feedback showing 22% (n=20) reported internet of electricity issues affected their ability to watch at least 1 session, with most reporting YouTube viewing overcame these issues. They also provided an overview of the current teaching on medical research provided at their universities with some (Al Quds, Al Azhar) providing teaching only in the pre-clinical years, or in the first clinical year (IUG) meaning the course was helpful revision for clinical students. Some universities (Al Quds, IUG) require a graduate research project, so many students were watching to prepare for this. All students reported that the course covered topics their university teaching had not covered and were very enthusiastic to have further teaching provided on the topic of medical research. Discussion This work uncovered a strong desire for medical research teaching among medical students and doctors in the oPt, and demonstrated a successful method of meeting this need through a partnership with research-rich institutions in the form of an online lecture course. It establishes that most students rate the quality of this online distance-learning research course as comparable to or better than in-person teaching they have received. There is huge potential for educational resource-rich institutions to deliver online interactive teaching in partnership with medical students in resource constrained regions. This course had high uptake, lasting engagement and students reported that the teaching filled a gap in their medical training. This was achieved by ensuring course design was led by local students, both by conducting a needs assessment and reflecting on extensive feedback and course execution was via carefully selected tutors. Previously, there have been no studies in the literature elucidating medical research as the student-reported area of most need in the oPt. Further, we interpret the finding that 11.8% of course attendees, who filled out feedback, were from other LMICs (Egypt, Sudan, Syria, Libya) as evidence that there is a wider desire for such teaching. Further, our needs assessment demonstrated the ubiquity of reliable internet access amongst medical students even in Gaza; marking a key infrastructure development that can support future projects. Our work fits into an increasing body of evidence showing the effectiveness of online distance learning (Chirikov et al. 2020); the relevance of which is even more apparent due to the constraints on teaching experienced in the COVID-19 pandemic. A meta-analysis of over one-thousand research articles on the topic by the U.S. Department of Education confirmed the efficacy of distance-learning(Means et al. 2009). A number of organisations (including OxPal (Penfold & Ali 2014), MedicineAfrica (Bowen et al. 2012) and Queen Mary University of London(Theodorakopoulou et al. 2019)) have previously demonstrated this to be true in a medical education context in LMICs. An online health research course was shown to equally enhance health research capacity when compared to in-person instruction in a small RCT of Indian research scientists by Aggarwal et al (Aggarwal et al. 2011). OxPal’s objectives are not to replace local engagement, but to aim to support and supplement local capacity to build medical students’ confidence through shared knowledge and resources. The optimal use of online distance learning for this purpose requires careful study of the local context and close collaboration with students. OxPal is among many successful medical educational partnerships which work to sustainably increase local medical knowledge and best practice. For example, for the oPt there are at least two groups of UK doctors that travel once a year to provide teaching in neurology (Nashef & Prevett 2011) and surgery (Holmes 2011). These short visits provide intense periods of transfer of skills and knowledge but require a greater amount of tutor time and funding and cannot be easily scaled up; due to the associated tutor, financial and logistical resource cost of each marginal student addition. Online teaching surmounts these ease-of-deployment, financial and scalability challenges. Further it overcomes geographic and geopolitical barrier based challenges, for example by providing a recording of lectures on YouTube 85% of students were able to continue engaging with the course despite extensive power and internet cuts in the region, and variable timetables between the medical schools. Increasing local understanding of quality health care research could produce long term benefits to the region. A stronger healthcare research system is crucial in assessing the strengths and limitations of the local healthcare system and addressing public health challenges the region faces (AlKhaldi et al. 2018) (Nuyens & McKee 2005). A review of all MEDLINE and Scopus indexed medical research published between 2000 and 2015 by Palestinian institutions suggests that international collaboration is associated with significantly improved research quality (Albarqouni et al. 2018). One underlying cause of this is a lack of local instruction, international teaching can help bolster subsequent local instruction availability via capacity building whilst also increasing research interest and quality. This will be a topic for further research and efforts - a small group of attendees of this course (n=7), were invited to take part in a pilot mentorship programme to help them translate their learning into practical usage and interim qualitative analysis has been positive. Research on local health research capacity strengthening is limited but the effects of fostering a research culture to allow a sustainable, self-assessing, self-correcting and responsive healthcare system are clear(Penfold & Ali 2014; Bowsher et al. 2019). Greater efforts in the oPt are needed to tackle this issue. Students reported that the teaching had improved their ability to critically appraise research and to understand how it is conducted. The focus group discussions with students revealed a sizeable proportion of increased interest in medical research can be attributed to Dr Khamis Elessi. Dr Elessi works locally with clinicians to promote evidence-based medicine (EBM) (Elessi et al. 2017) (Albarqouni & Elessi 2017) and has also extended to conducting lectures to medical students on the topic. Dr. Elessi has frequently worked in collaboration with the Oxford Centre for Evidence Based Medicine on his research promotion (Elessi, Albarqouni, et al. 2019) reinforcing the role of international support for locally oriented initiatives. Evaluation of the course is limited by its use of self-reported outcome measures, without objective measures of improvement or knowledge. There were a significant proportion of students who watched the lectures and did not fill in a feedback survey nor take part in the focus groups. However, the continued attendance of students across the course is an objective measure of their engagement. After an initial expected fall in attendance, as students determined the fit between this educational opportunity with their educational needs and interests, attendance remained steady. Further work will seek to use objective means of assessing students’ knowledge gain from lectures, such as pre- and post-course quizzes. This aligns with students’ feedback asking for quizzes and coursework as a means to consolidate learning. In the longer term, students will be followed up to further understand the impact of the course. Further, our pilot mentoring programme is ongoing and will help a small number of attendees translate their learning into meaningful research output under the stewardship of international mentors. Medical research should be included as an important topic in replicas of this partnership, as research capacity is a key pillar in sustainable healthcare system improvement. In Palestine, the dearth of research skills amongst clinicians has been demonstrated as primarily being due to lack of prerequisite knowledge/instruction; though negative attitudes among senior colleagues towards the influence of research on practice, lack of relevant resources, work overload and lack of institutional support also contribute(Albarqouni & Elessi 2017). An understanding of health research is essential for local buy-in and application of evidence-based medicine (EBM) as well as for conducting effective research in the oPt healthcare system. There are open-access online courses dedicated to teaching clinical research (https://www.coursera.org/courses?query=clinical%20research). However, most courses are neither locally tailored, nor interactive in real-time. This limits their ability to provide relevant perspectives on how to engage in research within the local healthcare research ecosystem. Further it reduces the chances of reaching a concentrated engagement in a single locality, sufficient to affect bottom-up systemic change. Conclusions The evaluation of the OxPal course shows the effectiveness of a collaborative distance-learning partnership for delivering medical research education. Clinicians and students reported feeling more confident in critical appraisal and taking part in medical research in the future. Redirecting tutor time at resource-rich institutions to medical students in challenging environments through low cost, locally tailored interactive real-time online courses can be easily used to widely distribute medical teaching. This is one example of this overall strategy, which can be used in a wide variety of creative means to foster a boom global medical education. At OxPal we have since expanded into research mentorship programmes, medical simulation provision, further lecture courses and journal clubs which have all been running for more than a year since this study was conducted. OxPal will continue evaluating its work to ensure that these partnerships provide a sustainable, self-reinforcing and empowering method of improving health care in complex environments. List of abbreviation oPt: occupied Palestinian territory; COVID-19: Coronavirus Disease 2019; IUG: Islamic University of Gaza; LMICs: low-to-middle-income countries. Declarations Acknowledgement We would like to thank all participants who took part in this study. Ethical approval and consent to participate The Ethics Committee of the local Ministry of Health, oPt ruled that no formal ethics approval was required. Participants consented to share their responses for research purposes by indicating so when submitting the online survey. Data were kept de-identified to protect participants’ confidentiality. Consent for publication Not applicable. Availability of data and materials The dataset used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests We declare no competing interests. Funding No funding was received for this study. Authors' contributions KS contributed to the design of the study, data collection, data analysis, data interpretation and drafting of the manuscript. RJ, RCJ, RP, OA contributed to data analysis, interpretation and drafting the manuscript. OA supervised the research project. All authors have read and approved the final manuscript. Acknowledgement We would like to thank all participants who took part in this study. References Aggarwal R, Gupte N, Kass N, Taylor H, Ali J, Bhan A, Aggarwal A, Sisson SD, Kanchanaraksa S, McKenzie-White J, et al. 2011. 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Attitudes of Palestinian medical students on the geopolitical barriers to accessing hospitals for clinical training: a qualitative study. Confl Health [Internet]. 10(1):5. https://doi.org/10.1186/s13031-016-0067-8 Theodorakopoulou E, Goutos I, Mason K, Ghanem AM, Myers S. 2019. London calling Gaza: The role of international collaborations in the globalisation of postgraduate burn care education. Scars, Burn Heal [Internet]. [accessed 2021 Mar 6] 5:205951311983051. http://journals.sagepub.com/doi/10.1177/2059513119830519 Thomas PA, Kern DE, Hughes MT, Chen BY. 2016. Curriculum development for medical education : a six-step approach. Third edition. Baltimore. World Health Assembly 72. Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan: report by the Director-General [Internet]. https://apps.who.int/iris/handle/10665/328758 Additional Declarations No competing interests reported. Supplementary Files OxPalSupplementarymaterial.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4228949","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":289073101,"identity":"e75d48e5-b82a-40c0-9412-5a996c961ac1","order_by":0,"name":"Kirandeep Saini","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Kirandeep","middleName":"","lastName":"Saini","suffix":""},{"id":289073104,"identity":"9ee3f6bb-4dff-48ab-9e1f-d1afe71ca2f6","order_by":1,"name":"Rebecca Jurdon","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Jurdon","suffix":""},{"id":289073106,"identity":"7f76b072-6b62-4d13-b348-11589533c452","order_by":2,"name":"Rebecca Conway-Jones","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Conway-Jones","suffix":""},{"id":289073107,"identity":"b876d498-b5ff-4cea-ae1e-f0084e2cca00","order_by":3,"name":"Rose Penfold","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Rose","middleName":"","lastName":"Penfold","suffix":""},{"id":289073108,"identity":"52e366d1-8b43-4b74-a939-0a94c8b6f6df","order_by":4,"name":"Osaid Alser","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYJCCAzwMFiCa8TGYy8zcQIwWCbBaYwYGAyDFSFgLA1QLmzRYCwMBLfz8hx8eeFMjYc8vffZZdUHFn2j+dqCWHxXbcGqRnJFmcHDOMYnEmX3pZrdnnDHInXGYsYGx58xtnFoMbjAYHOZhk0gwOMPGdpu3zSC3AaiFmbENj5bzxz8c5vknYW8P1FIM0jKfoJYDOQaHedskGDfwsLExg7RsIKRFckZOwcG5fRKJM86wMUvznDHO3QjUchCfX/j5j2/+8OabjT1/DxvjZ54Kudx55w8ffPCjArcW7OAAiepHwSgYBaNgFKABAHJxVAdMX/Z+AAAAAElFTkSuQmCC","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":true,"prefix":"","firstName":"Osaid","middleName":"","lastName":"Alser","suffix":""}],"badges":[],"createdAt":"2024-04-07 00:14:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4228949/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4228949/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54566102,"identity":"a62779a3-7052-41cd-a817-d126b278a0cc","added_by":"auto","created_at":"2024-04-12 11:22:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":221662,"visible":true,"origin":"","legend":"\u003cp\u003ePerceived insufficiency of teaching by topic. Free text responses by oPt students to question ‘Which subjects do you think are not covered sufficiently in your medical school?’. Other responses included psychiatry, anatomy, forensic medicine, and clinical genetics.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4228949/v1/7c38a62de45c056d235bb490.jpg"},{"id":54566104,"identity":"91081245-dbb2-4357-a3b5-a37484265845","added_by":"auto","created_at":"2024-04-12 11:22:58","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":187326,"visible":true,"origin":"","legend":"\u003cp\u003eResponse to: ‘How would you rate the tutorial quality?’ for each lecture session. Average feedback response rate was 73% of live attendees, per lecture.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4228949/v1/221c4a950f6c51370f501e3b.jpg"},{"id":54566525,"identity":"264f6ee6-33b8-4dc6-b677-0957857ca849","added_by":"auto","created_at":"2024-04-12 11:30:58","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":101407,"visible":true,"origin":"","legend":"\u003cp\u003eHow would you rate the method of teaching delivery (online distance learning)? (n=93)\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4228949/v1/59e4e3beb82b1d0a411ff130.jpg"},{"id":54566100,"identity":"93272733-1b88-4790-b1fa-4d4ceed4018c","added_by":"auto","created_at":"2024-04-12 11:22:58","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":111968,"visible":true,"origin":"","legend":"\u003cp\u003eHow would you rate the course quality? n=93\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4228949/v1/16c4964f887dd116f82c81d8.jpg"},{"id":54566527,"identity":"7d73aee6-1680-406a-9c88-d1603e69e2e7","added_by":"auto","created_at":"2024-04-12 11:30:59","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":115228,"visible":true,"origin":"","legend":"\u003cp\u003eHow challenging was the course? n=93\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4228949/v1/ebb6c2e585c583c05911e320.jpg"},{"id":54566526,"identity":"a73a0205-a5c7-4f5a-9d4a-b0dc03dff413","added_by":"auto","created_at":"2024-04-12 11:30:58","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":107776,"visible":true,"origin":"","legend":"\u003cp\u003eHow relevant has the course been to teaching/ training in Palestine? (Likert scale: 1 = not at all relevant, 3 = somewhat relevant, 5= very relevant) n=93\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4228949/v1/2279af20a3beaea4d0856042.jpg"},{"id":54566992,"identity":"14576328-6a35-40e3-b5d7-086f3115f413","added_by":"auto","created_at":"2024-04-12 11:38:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":593785,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4228949/v1/8b076ec1-4c7f-44fe-b095-015e0df0f5da.pdf"},{"id":54566524,"identity":"8da6959c-126a-4906-8c6b-bc2d20e6c8dc","added_by":"auto","created_at":"2024-04-12 11:30:58","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20829,"visible":true,"origin":"","legend":"","description":"","filename":"OxPalSupplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-4228949/v1/db613b0d044b2525791e98d3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eOxford-Palestine (OxPal) partnership: evaluation of an online medical research fellowship aiming to build local research capacity\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eHigh-quality medical education is a vital component of effective and sustainable healthcare infrastructure. Globally, there is a misalignment of healthcare resource generation; whereby, regions with the greatest need to rapidly grow and upskill their healthcare workforce are those facing the most significant barriers to medical education. The role that partnerships between education-resource rich institutions and those in resource-constrained regions can play in increasing healthcare and health workforce capacity has previously been investigated and serious calls have been made for further published research on the topic(Guilfoyle et al. 2021). Studies are needed on the optimal methods of teaching delivery and nature of these educational partnerships. Further, with rapidly changing technology infrastructure worldwide, these methods need constant re-examination. The increasing availability of the Internet and improvements in reliability and bandwidth capacity worldwide have allowed partnerships to develop that rely on teaching via online distance-learning modalities. Successful partnerships have utilised these platforms to work with local students to produce interactive, location-specific courses (Bowen et al. 2012)(Frehywot et al. 2013) (Mars 2012). Their effectiveness in providing long-term benefit to local students and improvement to health care remains unclear.\u003c/p\u003e\n\u003cp\u003eThe current geopolitical context of the occupied Palestinian territories (oPt) results in unique challenges to healthcare and medical education (World Health Assembly) (Giacaman et al. 2009) (Horton 2009). Medical students in the oPt face a number of barriers to local medical education including but not limited to: difficulties accessing facilities for teaching both at home and abroad due to check points and denied permit applications, lack of research facilities, a shortage of clinicians with time to provide teaching, brain drain and the psychological impacts of living in occupied territory (Elessi, Aljamal, et al. 2019) (Shahawy \u0026amp; Diamond 2016) (Kerr Winter et al. 2015).\u003c/p\u003e\n\u003cp\u003eOxPal is an educational partnership between University of Oxford clinicians, alumni and medical students and their counterparts in the oPt, founded in 2011 to respond to these barriers. This partnership aims to address the educational needs of Palestinian medical students with high-quality online courses which are free, interactive and led by the needs of local students. Tutors, in relative surplus at the University of Oxford, Harvard University and the University of London, offer their time to supplement the education of students. Evaluating whether the OxPal partnership achieves its objectives and understanding its limitations is essential for the development of distance-learning as a means of international collaboration. OxPal is part of the wave of educational initiatives and individuals championing free and open access medical education for all. Further, the COVID-19 pandemic has intensified the need for supplemental medical education but, thankfully, spurred innovation in the remote and virtual education ecosystem.\u003c/p\u003e\n\u003cp\u003eThe World Health Organisation has highlighted the importance of research for the achievement of universal healthcare coverage, allowing locally driven improvements in quality and accessibility whilst reducing cost (Cuervo 2013) (Dye et al. 2013) . Production of reliable evidence that can lead to locally practical clinical application requires appropriately designed investigations by local clinicians versed in both medical research methods and the local context.\u003c/p\u003e\n\u003cp\u003eHere, we present an investigation of the ability of a cross-border educational partnership to uncover, design and implement means to meet the educational needs of Palestinian medical students and doctors. We evaluate the viability and effectiveness of a cross-border implemented, interactive, online medical research training course in the oPt, designed to meet expressed needs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe Kern\u0026rsquo;s six step model for curriculum development (Thomas et al. 2016) was used to design the course: 1) problem identification and general needs assessment, 2) targeted needs assessment, 3) outline of goals and objectives, 4) decision on educational strategies, 5) implementation and 6) evaluation and feedback of the course.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNeeds Assessment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe created a needs assessment questionnaire for medical students and doctors in the oPt comprising of 9 questions on demographic information and expressed, perceived educational needs(Ratnapalan \u0026amp; Hilliard 2002) and consent for the use of anonymised responses for research purposes. Facebook, Twitter, Linkedin and the OxPal email list were used to disseminate the questionnaire in October 2018. High-frequency answers were identified, and a course designed based on the responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProgramme design\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interactive-lecture course ran from 03/01/20 \u0026ndash; 01/05/20 (Supplementary material table 1), and was conducted on Zoom, a commercial platform. A licence for Zoom costing \u0026pound;120 p.a. and a \u0026lsquo;large room\u0026rsquo; expansion costing \u0026pound;40/month for 3 months was used (Total cost - \u0026pound;240). The course was left open to all, including non-Palestinians. The first 8 lectures were given in Arabic and the 3 subsequent lectures were given in English. The interactive lectures lasted approximately 1 hour followed by a 15-30-minute discussion. The lectures on data analysis were taught using SPSS (IBM Corp., Armonk, N.Y., USA) with students following along on their own computers. Lectures were recorded and uploaded to YouTube (https://www.youtube.com/channel/UClmkl_oB5igJjU2-zpjjCjg) and posted on our website (https://www.oxpal.org/upcoming-programmes/) to provide an ongoing resource and to increase the number of students able to access the teaching. We analysed the feedback collected after each lecture to inform the next lecture in the series.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData collection and analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter each lecture students were emailed a survey (via Google Forms) to collect quantitative and qualitative feedback. The post-lecture survey consisted of 12 questions (Supplementary material table 2), using binary, Likert scale and qualitative questions. We obtained post-course overall feedback comprising 28 questions collecting both quantitative and qualitative feedback (Supplementary material table 3), Students were asked to assess the course quality, its impact on their training, any technological issues they faced, and their main learning outcomes. We analysed responses for the overall course feedback and each individual lecture using descriptive statistics; data analysis was performed in Microsoft Excel.\u003c/p\u003e\n\u003cp\u003eWe conducted four voluntary focus groups via Zoom at the end of the lecture series (May 2020). We asked standardised open questions to help understand the impact of the program on the students, the format of any medical research teaching provided to them at their medical school and suggestions for future improvements. An OxPal member conducted the interviews, transcribed the recordings and analysed students\u0026rsquo; responses to identify emerging themes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNeeds assessment findings\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic and experience of online teaching\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn November 2018, 121 students completed the Needs Assessment. The stages of training of respondents were 61 (50%) 4\u003csup\u003eth\u003c/sup\u003e year students, 26 (21%) 6\u003csup\u003eth\u003c/sup\u003e year students, 24 (20%) 5\u003csup\u003eth\u003c/sup\u003e year students, 7 (6%) intern doctors and 3 (2%) other levels of training. 87.6% (n=106) of respondents had not received online distance-learning tutorials before. Only 1 student said they would not be able to access an online platform for weekly or fortnightly tutorials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubject, mode of delivery and objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost respondents (n = 77, 62.6%) said that Medical Research/Audits skill teaching were not covered sufficiently at their medical school (Figure 1). In a single answer question 78 (63.6%) of respondents said what they most wanted from an online collaboration was to be better prepared for future clinical practice. Only 5 (4.1%) said they wanted to prepare for finals examinations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFindings from individual lecture feedback\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter the first lecture, 184 feedback forms were completed, this decreased over the first 5 lectures until remaining stable at a mean of 77.8 surveys filled in for lecture 6 to 11 (Figure 2). Most respondents reported that the lectures filled a gap in their medical education, ranging from 92.4% to 98.8% of respondents saying yes, per lecture. Figure 2 shows the variation in quality ratings of lectures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOverall course feedback\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall course feedback survey was completed by 93 students. Students from LMICs in the surrounding region accessed the course (Supplementary material table 4). The stages of training of those who completed the course and provided feedback were 17 (18.3%) 5\u003csup\u003eth\u003c/sup\u003e year students, 15 (16.1%) 6\u003csup\u003eth\u003c/sup\u003e year students, 14 (15.1%) intern doctors, 12 (12.9%) 4\u003csup\u003eth\u003c/sup\u003e year students, 11 (11.8%) 3\u003csup\u003erd\u003c/sup\u003e year students, 9 (9.7%) 2\u003csup\u003end\u003c/sup\u003e year students, 7 (7.5%) resident doctors, 6 (6.5%) specialist or consultant doctor, and 2 (2.2%) 1\u003csup\u003est\u003c/sup\u003e year students.\u003c/p\u003e\n\u003cp\u003eAll students reported that the course covered a gap in their medical training thus far. 71 (76%) respondents rated the method of teaching delivery as better than \u0026lsquo;in person teaching\u0026rsquo; they had received (Figure 3). All respondents rated the course quality as satisfactory to excellent (Figure 4) and 67 (72%) rated the difficulty of the course as \u0026lsquo;About right\u0026rsquo; (Figure 5). The reported relevance of the course to teaching in the oPt is shown in Figure 6. When asked how they had accessed the course only 15% of students reported not watching any of the lectures on YouTube.\u003c/p\u003e\n\u003cp\u003eQualitative feedback included reporting of technical issues faced by students, the most common theme was that students in Gaza had internet and electrical issues preventing them from finishing the whole lecture. When students were asked how the course could be improved the most common answers were requests for quizzes and coursework to practice what they had learnt. Students also requested mentorship on how to get involved in a research project or carrying out research themselves.\u003c/p\u003e\n\u003cp\u003eWhen asked what the impact of the course had been on their studies 47 students reported it had had a good impact, or improved their studies or had been helpful. 22 reported it had improved their medical research skills, 5 reported improved critical thinking skills and 12 students reported feeling encouraged to become involved in research. Only 4 students said it had no effect and 0 students reported a negative effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFocus group findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTen medical students and four doctors volunteered to participate in a focus-group discussion, after the course. Students reported that when technical issues or timetable clashes occurred, they were able to access the rest of the lecture on YouTube, and this secondary upload process greatly enhanced course accessibility. This is in keeping with the end of course feedback showing 22% (n=20) reported internet of electricity issues affected their ability to watch at least 1 session, with most reporting YouTube viewing overcame these issues. They also provided an overview of the current teaching on medical research provided at their universities with some (Al Quds, Al Azhar) providing teaching only in the pre-clinical years, or in the first clinical year (IUG) meaning the course was helpful revision for clinical students. Some universities (Al Quds, IUG) require a graduate research project, so many students were watching to prepare for this. All students reported that the course covered topics their university teaching had not covered and were very enthusiastic to have further teaching provided on the topic of medical research.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis work uncovered a strong desire for medical research teaching among medical students and doctors in the oPt, and demonstrated a successful method of meeting this need through a partnership with research-rich institutions in the form of an online lecture course. It establishes that most students rate the quality of this online distance-learning research course as comparable to or better than in-person teaching they have received. There is huge potential for educational resource-rich institutions to deliver online interactive teaching in partnership with medical students in resource constrained regions. This course had high uptake, lasting engagement and students reported that the teaching filled a gap in their medical training. This was achieved by ensuring course design was led by local students, both by conducting a needs assessment and reflecting on extensive feedback and course execution was via carefully selected tutors.\u003c/p\u003e\n\u003cp\u003ePreviously, there have been no studies in the literature elucidating medical research as the student-reported area of most need in the oPt. Further, we interpret the finding that 11.8% of course attendees, who filled out feedback, were from other LMICs (Egypt, Sudan, Syria, Libya) as evidence that there is a wider desire for such teaching. Further, our needs assessment demonstrated the ubiquity of reliable internet access amongst medical students even in Gaza; marking a key infrastructure development that can support future projects.\u003c/p\u003e\n\u003cp\u003eOur work fits into an increasing body of evidence showing the effectiveness of online distance learning (Chirikov et al. 2020); the relevance of which is even more apparent due to the constraints on teaching experienced in the COVID-19 pandemic. A meta-analysis of over one-thousand research articles on the topic by the U.S. Department of Education confirmed the efficacy of distance-learning(Means et al. 2009). A number of organisations (including OxPal (Penfold \u0026amp; Ali 2014), MedicineAfrica (Bowen et al. 2012) and Queen Mary University of London(Theodorakopoulou et al. 2019)) have previously demonstrated this to be true in a medical education context in LMICs. An online health research course was shown to equally enhance health research capacity when compared to in-person instruction in a small RCT of Indian research scientists by Aggarwal et al (Aggarwal et al. 2011). OxPal\u0026rsquo;s objectives are not to replace local engagement, but to aim to support and supplement local capacity to build medical students\u0026rsquo; confidence through shared knowledge and resources. The optimal use of online distance learning for this purpose requires careful study of the local context and close collaboration with students.\u003c/p\u003e\n\u003cp\u003eOxPal is among many successful medical educational partnerships which work to sustainably increase local medical knowledge and best practice. For example, for the oPt there are at least two groups of UK doctors that travel once a year to provide teaching in neurology (Nashef \u0026amp; Prevett 2011) and surgery (Holmes 2011). These short visits provide intense periods of transfer of skills and knowledge but require a greater amount of tutor time and funding and cannot be easily scaled up; due to the associated tutor, financial and logistical resource cost of each marginal student addition. Online teaching surmounts these ease-of-deployment, financial and scalability challenges. Further it overcomes geographic and geopolitical barrier based challenges, for example by providing a recording of lectures on YouTube 85% of students were able to continue engaging with the course despite extensive power and internet cuts in the region, and variable timetables between the medical schools.\u003c/p\u003e\n\u003cp\u003eIncreasing local understanding of quality health care research could produce long term benefits to the region. A stronger healthcare research system is crucial in assessing the strengths and limitations of the local healthcare system and addressing public health challenges the region faces (AlKhaldi et al. 2018) (Nuyens \u0026amp; McKee 2005). A review of all MEDLINE and Scopus indexed medical research published between 2000 and 2015 by Palestinian institutions suggests that international collaboration is associated with significantly improved research quality (Albarqouni et al. 2018). One underlying cause of this is a lack of local instruction, international teaching can help bolster subsequent local instruction availability via capacity building whilst also increasing research interest and quality. This will be a topic for further research and efforts - a small group of attendees of this course (n=7), were invited to take part in a pilot mentorship programme to help them translate their learning into practical usage and interim qualitative analysis has been positive. Research on local health research capacity strengthening is limited but the effects of fostering a research culture to allow a sustainable, self-assessing, self-correcting and responsive healthcare system are clear(Penfold \u0026amp; Ali 2014; Bowsher et al. 2019). Greater efforts in the oPt are needed to tackle this issue.\u003c/p\u003e\n\u003cp\u003eStudents reported that the teaching had improved their ability to critically appraise research and to understand how it is conducted. The focus group discussions with students revealed a sizeable proportion of increased interest in medical research can be attributed to Dr Khamis Elessi. Dr Elessi works locally with clinicians to promote evidence-based medicine (EBM) (Elessi et al. 2017) (Albarqouni \u0026amp; Elessi 2017) and has also extended to conducting lectures to medical students on the topic. Dr. Elessi has frequently worked in collaboration with the Oxford Centre for Evidence Based Medicine on his research promotion (Elessi, Albarqouni, et al. 2019) reinforcing the role of international support for locally oriented initiatives.\u003c/p\u003e\n\u003cp\u003eEvaluation of the course is limited by its use of self-reported outcome measures, without objective measures of improvement or knowledge. There were a significant proportion of students who watched the lectures and did not fill in a feedback survey nor take part in the focus groups. However, the continued attendance of students across the course is an objective measure of their engagement. After an initial expected fall in attendance, as students determined the fit between this educational opportunity with their educational needs and interests, attendance remained steady. Further work will seek to use objective means of assessing students\u0026rsquo; knowledge gain from lectures, such as pre- and post-course quizzes. This aligns with students\u0026rsquo; feedback asking for quizzes and coursework as a means to consolidate learning. In the longer term, students will be followed up to further understand the impact of the course. Further, our pilot mentoring programme is ongoing and will help a small number of attendees translate their learning into meaningful research output under the stewardship of international mentors.\u003c/p\u003e\n\u003cp\u003eMedical research should be included as an important topic in replicas of this partnership, as research capacity is a key pillar in sustainable healthcare system improvement. In Palestine, the dearth of research skills amongst clinicians has been demonstrated as primarily being due to lack of prerequisite knowledge/instruction; though negative attitudes among senior colleagues towards the influence of research on practice, lack of relevant resources, work overload and lack of institutional support also contribute(Albarqouni \u0026amp; Elessi 2017). An understanding of health research is essential for local buy-in and application of evidence-based medicine (EBM) as well as for conducting effective research in the oPt healthcare system. There are open-access online courses dedicated to teaching clinical research (https://www.coursera.org/courses?query=clinical%20research). However, most courses are neither locally tailored, nor interactive in real-time. This limits their ability to provide relevant perspectives on how to engage in research within the local healthcare research ecosystem. Further it reduces the chances of reaching a concentrated engagement in a single locality, sufficient to affect bottom-up systemic change.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe evaluation of the OxPal course shows the effectiveness of a collaborative distance-learning partnership for delivering medical research education. Clinicians and students reported feeling more confident in critical appraisal and taking part in medical research in the future. Redirecting tutor time at resource-rich institutions to medical students in challenging environments through low cost, locally tailored interactive real-time online courses can be easily used to widely distribute medical teaching. This is one example of this overall strategy, which can be used in a wide variety of creative means to foster a boom global medical education. At OxPal we have since expanded into research mentorship programmes, medical simulation provision, further lecture courses and journal clubs which have all been running for more than a year since this study was conducted. OxPal will continue evaluating its work to ensure that these partnerships provide a sustainable, self-reinforcing and empowering method of improving health care in complex environments.\u003c/p\u003e"},{"header":"List of abbreviation","content":"\u003cp\u003eoPt: occupied Palestinian territory; COVID-19: Coronavirus Disease 2019; IUG: Islamic University of Gaza; LMICs: low-to-middle-income countries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e We would like to thank all participants who took part in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u0026nbsp;\u003c/strong\u003eThe Ethics\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eCommittee of the local Ministry of Health, oPt ruled that no formal ethics approval was required. Participants consented to share their responses for research purposes by indicating so when submitting the online survey. Data were kept de-identified to protect participants\u0026rsquo; confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e The dataset used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e We declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e No funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003eKS contributed to the design of the study, data collection, data analysis, data interpretation and drafting of the manuscript. RJ, RCJ, RP, OA contributed to data analysis, interpretation and drafting the manuscript. OA supervised the research project. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e We would like to thank all participants who took part in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAggarwal R, Gupte N, Kass N, Taylor H, Ali J, Bhan A, Aggarwal A, Sisson SD, Kanchanaraksa S, McKenzie-White J, et al. 2011. A Comparison of Online versus On-site Training in Health Research Methodology: A Randomized Study. BMC Med Educ [Internet]. 11(1):37. https://doi.org/10.1186/1472-6920-11-37\u003c/li\u003e\n\u003cli\u003eAlbarqouni L, Abu-Rmeileh N, Elessi K, Obeidallah M, Bjertness E, Chalmers I. 2018. The quality of medical and public health research from Palestinian institutions: a survey-based study. Lancet [Internet]. 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Curriculum development for medical education : a six-step approach. Third edition. Baltimore.\u003c/li\u003e\n\u003cli\u003eWorld Health Assembly 72. Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan: report by the Director-General [Internet]. https://apps.who.int/iris/handle/10665/328758\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gaza, Palestine, Remote teaching, medical education, OxPal","lastPublishedDoi":"10.21203/rs.3.rs-4228949/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4228949/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInnovative methods of delivering medical education across borders have the potential to further the development of healthcare capacity in austere environments. Medical students and doctors in the occupied Palestinian territory (oPt) face barriers to their education; whilst geographical, technological, and financial obstacles have limited the ability of institutions in high-income countries to share effective educational resources. We aimed to investigate the effectiveness of an international partnership in meeting the expressed educational needs of Palestinian medical students and doctors, through a locally tailored research training online course.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA needs assessment was used to guide the design, format, topic and content of an interactive lecture course. It was delivered to medical students in the oPt by clinicians \u0026amp; scientists from the U.K. and U.S.A. through an online lecture platform. The programme was evaluated through questionnaires and focus groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe found students’ greatest expressed need was for supplementary teaching on medical research. Students perceived interactive online distance-teaching, delivered by utilising excess tutor capacity at educational-resource rich institutions, as equal (22%, n = 20) or superior (76%, n=71) to local in-person alternatives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe demonstrate a low-cost, replicable method of supplementing medical education, generating engagement and building healthcare research capacity in an austere environment. Other institutions can rapidly deploy this model to upscale outreach efforts and improve global medical education.\u003c/p\u003e","manuscriptTitle":"Oxford-Palestine (OxPal) partnership: evaluation of an online medical research fellowship aiming to build local research capacity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-12 11:22:53","doi":"10.21203/rs.3.rs-4228949/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b11380a3-c874-4781-b27b-55f059d19b04","owner":[],"postedDate":"April 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-12T11:30:56+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-12 11:22:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4228949","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4228949","identity":"rs-4228949","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}