*Article* **Facilitating Interprofessional Education in an Online Environment during the COVID-19 Pandemic: A Mixed Method Study**

**Jitendra Singh \* and Barbara Matthees**

School of Nursing & Healthcare Leadership, College of Science, Health, & the Environment, Minnesota State University Moorhead, Moorhead, MN 56563, USA; matthees@mnstate.edu

**\*** Correspondence: jitendra.singh@mnstate.edu

**Abstract:** With the COVID-19 crisis and rapid increase in cases, the need for interprofessional education (IPE) and collaborative practice is more important than ever. Instructors and health professionals are exploring innovative methods to deliver IPE programs in online education This paper presents a mixed methods study where an interprofessional education program was delivered/taught using online instruction. Using a survey/questionnaire adapted from the Readiness for Interprofessional Learning Scale (RIPLS) and qualitative discussions, students' readiness towards online IPE program and the importance of such preparation was examined. Out of two hundred fifteen students who completed the IPE program, one hundred eighty five students from clinical and non-clinical health disciplines responded to the questionnaire (86.04% response rate). Additional qualitative content analysis was conducted on a total of seven hundred and thirty six online discussions. Data analysis across all the four subscales of RIPLS suggests that students felt positively about teamwork and collaboration, and valued opportunities for shared learning with other healthcare students. Qualitative data analysis demonstrated that IPE increases awareness of team members' roles, enhances communication and collaboration and can lead to better care for COVID-19 patients.

**Keywords:** interprofessional education (IPE); COVID-19; pandemic; nursing; healthcare; health care; online education; communication; collaboration; mixed methods study

#### **1. Introduction**

Interprofessional Education (IPE) is defined as "occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care" [1]. Errors in processes, failure to work as part of a team and lack of a coordinated effort result in medical complications or even patient deaths in healthcare settings. These events not only lead to patient safety issues, but also result in increased costs to the healthcare system [2]. Understanding team members' roles in patient care processes and a team-based approach that involves collaboration among the different units and departments of an organization can be used to make the system safer for consumers of healthcare services [3]. Interprofessional education and the ability to work in collaboration with other health professionals can lead to reductions in difficulties faced by health organizations in different countries [4]. Teamwork, collaboration, and involvement of employees from different disciplines (who may have been operating in silos) promotes interaction among colleagues, which, in turn, could lead to a fresh look at existing issues/problems and identification of potential solutions to those problems [3,5].

With the global health crisis and rapid increase in COVID cases, there is an increased need for interprofessional education and collaborative programs. As interprofessional practice continues to evolve, instructors and health professionals are exploring innovative methods to deliver IPE programs in online medium of practice. While using online platform/medium for interprofessional learning is a laudable goal for academic institutions [6], there is extremely limited evidence on online IPE programs where clinical and

**Citation:** Singh, J.; Matthees, B. Facilitating Interprofessional Education in an Online Environment during the COVID-19 Pandemic: A Mixed Method Study. *Healthcare* **2021**, *9*, 567. https://doi.org/10.3390/ healthcare9050567

Academic Editors: Luís Proença, José João Mendes, João Botelho and Vanessa Machado

Received: 23 April 2021 Accepted: 8 May 2021 Published: 11 May 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

non-clinical health students learn together in a team-based setting. This preparation will help students in undergraduate programs who wish to serve in clinical and/or non-clinical environments in healthcare settings. While clinical disciplines include nursing, athletic training, and other field of study, non-clinical disciplines include (but are not limited to) programs such as health administration, gerontology, social work, and public health. Inclusion of IPE programs during the first year of education will allow students to learn from each other and appreciate what team members can accomplish as a team in a complex healthcare environment.

#### *Background*

As problems posed by the COVID-19 pandemic continue to grow, it is imperative that clinical providers work in close coordination with professionals from different disciplines, departments and sectors of healthcare. Evidence suggests that patients and families experience fragmented care, especially when health professionals are unable to work as one team within healthcare settings. The consequences of failing to work effectively in a teambased setting results in increased costs, inefficiency, lower quality of care and decreased patient satisfaction. Further, failure to work as part of a team and lack of a coordinated effort may result in medical complications or even patient deaths in healthcare settings [7]. Wakely et al. (2013) conducted a study where students from several health disciplines participated in a program that incorporated interprofessional learning modules [8]. It was found that learning about various health disciplines led to improvement in student attitudes (indicated by scores on readiness for interprofessional learning scale). Sani et al. (2011) assessed changes in students' attitudes after they completed interprofessional learning module. This study reported noteworthy improvements in scores on collaboration and team work [9].

A case study conducted by Evans et al. (2012) examined the effect of inclusion of interprofessional learning modules on students who were studying dentistry and dental technology at the Griffith University. Closer analysis of results suggested that inclusion of interprofessional practices led to positive professional identity and better communication between students [10]. In a quantitative study (Evans et al., 2013), perceptions regarding roles, responsibilities, communication, and team work were compared across two student groups enrolled in dental technology programs. While one group was exposed to a program with content in interprofessional education, other group was a part of traditional program. Results indicated that exposure to interprofessional learning led to changes in attitudes and resulted in improved collaboration among students [11]. Research suggests that interprofessional education and knowledge-sharing among the different disciplines can lead to highly-coordinated, effective patient care in health care settings [12]. This, in turn, can lead to better patient outcomes, increased satisfaction for the provider, and better usage of existing resources. While there are several studies that show importance of interprofessional education programs, it is important to note that health care disciplines still operate in silos and there is a very little opportunity for students in different disciplines to learn together [13].

Research on IPE has focused on clinical programs and traditional on-campus/university based programs. Given that the COVID-19 crisis will continue, academic institutions need to explore new methods to offer IPE and prepare a next generation of leaders who are not afraid to utilize methods that could transform healthcare delivery. There is a scarcity of literature that examines how interprofessional education can be delivered using online medium of instruction [6]. With growth in online education, especially in the field of healthcare, it is important to explore opportunities where professionals from different disciplines can learn together. Using a mixed methods approach, this study aimed to examine students' readiness and attitudes towards online interprofessional education and importance of such preparation during COVID-19, a public health crisis that has resulted in more than 70 million cases and approximately 1.6 million deaths worldwide.

#### **2. Materials and Methods**

#### *2.1. Participants and Study Design*

A total of 215 students, enrolled in an undergraduate healthcare program focused on interprofessional education and learning, were invited to participate in the study. It is important to focus on undergraduate healthcare students because education/training of the majority of these students takes place in silos with a very little chance to collaborate with professionals from different disciplines. An email describing the purpose of the study was sent to all the students. In order to assess impact of IPE training, a pre and post-test methodology was used. All the students were required to complete a survey/questionnaire adapted from Readiness for Interprofessional Learning Scale (RIPLS) prior to beginning of the IPE curriculum and once they finished the IPE curriculum. Qualitative content analysis was completed to analyze students' responses recorded during IPE program. This provided direct insights into students' thoughts about collaboration and team-work as they worked in interprofessional teams. The study commenced once approval to conduct the study was obtained from the Institutional Review Board at the university.

#### *2.2. Description of IPE Program*

The entire IPE educational program was divided into five online modules. These modules were based on the core competencies outlined by Interprofessional Collaborative Practice [14]. The first module focused on introduction of participants and discussion of key concepts in the field of IPE. Student introductions were recorded and used later to form interprofessional teams needed to work on case studies.

In the second module, quality and safety concepts were discussed such as problems related to COVID-19 pandemic, medical complications, and shortage of medical staff. Instructor engaged students in conversations/topics focused on the importance of IPE and need for interprofessional team work required to treat serious COVID patients who suffer from complex medical conditions or conditions that require health care professionals from different disciples to work together.

The third module focused on roles and responsibilities of team members in clinical and administrative processes in healthcare settings. More specifically, content included readings and videos on trainings of providers, importance of engaging family and care givers in the plan of care, and scope of knowledge and abilities of team members as they work on providing safe, high quality and efficient care to patients.

The fourth module focused on the importance of communication between providers during the patient care processes especially in COVID-19 cases. The learning material allowed students to think critically about problems due to faulty communication, fragmented systems of care and adverse events that may lead to patient/resident deaths in facilities. Further, content on utilization of standardized format for communication, importance of respectful communication to patient, providers and families and several communication strategies were included.

The readings and material in the fifth module focused on the importance of team work between providers as they provide care to critical patients in healthcare facilities. Content related to the process of team development, ethical guidelines, shared decision making, problem solving and leadership practices was covered.

#### *2.3. Interprofessional Case Studies and Assignments*

The entire program included four quizzes, three discussion questions, and two case studies. While quizzes focused on basic understanding of the content, discussion questions and case studies required students to demonstrate in-depth understanding of the material. Case study and discussions focused on scenarios where providers from different disciplines worked as a team when severe cases of COVID-19 were admitted to healthcare facility, roles of providers, team-work, and collaboration. Students completed these cases and discussions via zoom meetings. Students also submitted written response to discussion question via online learning management system. Practitioners from different health

disciplines, both clinical and non-clinical, were invited, electronically, to meet with students and present their point of view while dealing with COVID-19 cases.

#### *2.4. Quantitative Study Instrument*

The Readiness for Interprofessional Learning Scale (RIPLS) was used to collect data for this study. The RIPLS has gained wide acceptance amongst researchers who focus on interprofessional education and learning in healthcare. This scale consists of 19 items, divided into four different subscales. These subscales are as follows: (a) *team work and collaboration* (items 1–9), (b) *negative professional identity* (10–12), (c) *positive professional identity* (13–16), and (d) *roles and responsibilities* [15–17]. Researchers have demonstrated statistical validity of the research instrument [18]. Demographic items were added to the scale to collect information about the students.

#### *2.5. Quantitative Data Analysis*

The data analysis program, IBM SPSS 23.0 was utilized for storing data and analysis. Descriptive statistics were used to examine demographic information. For all the RIPLS subscale, items were summed and scores were calculated. T-tests (independent) were conducted to compare pre-test and post test scores.

#### **3. Results**

#### *3.1. Results of Survey*

A total of 185 students responded to the RIPLS (86.04% response rate). Approximately 73% of the participants were females. The median age of the participants was 21 years (IQR = 15) and ranged from 23 to 67 years. The median amount of time spent in their academic program was 10 months and ranged between 1 and 28 months. The participants were mainly white and non-Hispanic or Latino. The majority of the participants worked in healthcare organizations and were from health administration and nursing program (see Table 1).

#### **Table 1.** Characteristic of Sample (*N* = 185).


#### *3.2. Comparison of RIPLS Scores*

Results of the RIPLS scores demonstrated that there was no significant difference between disciplines/fields of study. More specifically, scores on pre-test (Mean = 69.25 ± 10.06) were not very different from scores on post-test (Mean = 72.12 ± 9.01) across different disciplines'. The RIPLS pre-test score ranged between 67.42 ± 9.32 and 71.54 ± 7.28 with psychology scoring the lowest among the disciplines and athletic training scoring the highest. RIPLS pre-test score for Health Administration was lower than athletic training and health and medical science students. The pre-test score of social work students was lower than health administration students.

The RIPLS post test scores ranged between 68.42 ± 9.34 and 71.94 ± 8.62. There were improvements in groups of students who were from health administration, psychology, and nursing programs. Further, students in gerontology, health and medical sciences and social work demonstrated increase in their post-test scores (see Table 2).


**Table 2.** Comparison of Scores.

#### *3.3. Online Discussions and Qualitative Data Analysis*

Online open-ended discussion questions were included as one of the data sources for the study. These open-ended questions allowed students to express their own thoughts. Response time and the amount of text was not restricted and these questions enabled students to explain themselves freely [19] and describe how they felt about teamwork, communication, and shared learning especially during the public health crisis. This can be extremely hard to achieve when questionnaires or surveys are used. Researchers made every effort to reduce bias and did not influence participants' responses. The students were asked to describe (1) how interprofessional education and team work can be used to enhance patient safety and care for patients suffering with COVID-19, (2) their perceptions regarding how members of interprofessional teams strive to work on clinically complex cases and (3) the importance of awareness of team members' roles and communication between members while caring for COVID-19 cases.

An inductive approach using content analysis was utilized to conduct the analysis of participants' discussion posts. A total of seven hundred and thirty six posts were analyzed. Content analysis allows researchers to examine participants' responses by carefully coding and finding themes in the collected data. It is noteworthy that content analysis has been widely utilized on written texts irrespective of the data collection approach. The principal investigator of the study hired two research assistants to perform data analysis of the study. Both the assistants were trained in research methods and had prior experience in working on qualitative research projects. Upon completion of open coding, researchers independently created codes, subcategories, generic categories, and main categories. Once individual data analysis was completed, the team met to discuss data analysis and reach to final consensus on categories and results [19,20]. The summary of findings are reported here.

#### *3.4. Result of Qualitative Content Analysis*

The final analysis resulted in generation of 38 codes, 15 sub categories, six generic categories and three main categories. The main categories were (1) IPE increases awareness of team members' roles and enhances collaboration (2) Increased communication and cohesion among members of teams is critical during the pandemic (3) IPE can lead to better care for COVID-19 patients (See Table 3)

**Table 3.** Categories.


#### 3.4.1. IPE Increases Awareness of Team Members' Roles and Enhances Collaboration

Interprofessional education and experience as part of a diverse healthcare team allows team members to learn about roles and responsibilities of different practitioners. This allows team members to break past professional barriers and build more collaborative infrastructure.

One of the students noted:

*"Increased communication and training on how to collaborate with other departments/specialties, outside facilities, and better communication between provider and patients would be the most significant methods and approaches to increased patient safety and satisfaction."*

Using complex COVID cases as example, another student noted, "IPE leads to better communication between different departments in a facility, its affiliated clinics, and between providers and patients. It also makes it easier to forward information to outside facilities or other hospital companies (with appropriate patient authorization). This allows for more of a "whole person" treatment plan vs. segmented treatment plans from each department. Everyone can see what has been done, is currently being done, and what hasn't been tried yet."

Furthermore, another participant indicated:

*"One unique feature of the interprofessional education is that the professionals working together are expected to not only be an expert in their own field, but to understand the basics of the disciplines they work with. By understanding the basics of disciplines beyond their own, they can better understand a patient's condition, and this contributes information to paint a better picture of how to help a patient, leading to better results and better quality."*

Participants indicated that knowing both one's role and place amidst the team is an important attribute, as well. By understanding their responsibilities to the team, a professional can fulfill their role effectively and take responsibility for their actions. The shared identity of a team is another key component for success. Being able to trust and work with one another is essential for providing patient care in an efficient manner.

Another student clearly stated "the balance between the two is perhaps the most important; knowing when one's role overlaps another, and what matters they should or should not get involved with. Further, making sure the information they are relaying to the team is relevant and will assist other professionals in their jobs."

Adding to this claim, a student who works as nurse mentioned "in midst of pandemic, I have seen that team members are so rushed and may not demonstrate knowledge of how team works as a cohesive unit. Although each discipline is knowledgeable about their individual role, they are not knowledgeable of other roles and there is a lack of coordination and collaboration. This gap could lead to a delay in the length of stay, errors in communication, and even in safety for the patient."

As students completed the IPE program, they clearly indicated that when there is an interprofessional team approach, each discipline works in parallel to the other and crosses over with collaboration and coordination to meet the needs of the patient. This might look like bedside huddles, situational awareness of the whole person and environment, and a well-coordinated series of tasks that feel very safe and flowing to the patient. The patient and caregivers will feel confident in the care of the team and this will increase satisfaction. 3.4.2. Increased Communication and Cohesion among Members of Teams Is Critical during the Pandemic

Students described that IPE leads to an increase in communication and cohesion among team members. This results in improved care for patients and families dealing with COVID-19 crisis.

For example, a student who worked as a nursing home administrator indicated that "communication between healthcare teams is super important when it comes to safety and collaboration. In health care the goal is to care for patients which includes keeping them safe. With interprofessional education/practice we can increase the safety of the patients by all of the nurses, doctors, surgeons, etc. involved with them updating each other on the patient. Some patients have a long journey of medical problems when they are admitted to the facility and having all the care providers working together will ensure them that they know what they are doing."

Another student reemphasized how a patient suffering with a COVID -19 problem will need to interact with doctors, nurses, long term care workers, pharmacists, physical therapists, and a whole host of other team members throughout the process. The student further added "*if this team of care providers have effective communication and collaboration between them the patient will receive better, more effective quality care. Training health care professionals with different backgrounds and areas of focus to work together and collaborate is where interprofessional learning and education can play a major role. Interprofessional education is when students from different care professions learn from and with each other to improve patient care.*"

Students used various examples to explain their points. One example that is worth noting is the infection control nurse's role which includes the responsibility for policies/procedures that keep staff, visitors, and patients safe. This student added "*one staff member cannot do it all. These committees arise to complete a task or tasks that one individual could not do on their own. An example of working together is implementation of a policy for patient safety during the current pandemic. Upon arrival to the clinic, masks are passed out to patients who are symptomatic, and they are brought back to be treated quickly to help stop the spread of the virus. Team members have to develop a process through collaboration. They then have to implement it to other staff members through education. Not one person alone can develop a policy that doesn't affect others around them; interprofessional communication/teamwork is necessary in any healthcare setting*."

#### 3.4.3. IPE Can Lead to Better Care for COVID-19 Patients

Students recognized the effect of the COVID-19 crisis on healthcare system including personal lives of patients, care providers, and professionals who work in public health and data collection. Students called for collaboration and better training to improve the response to emergency situations such as the current pandemic. To avoid adverse events which could lead to deaths, students felt the need for IPE programs where professionals from multiple disciplines can collaborate and work as a part of team.

For instance, a public health nurse indicated:

*"Interprofessional education can help in dealing with challenges related to the pandemic especially when researchers and data analysts work with providers of clinical services. This would allow us to better plan, prioritize who needs urgent care, coordinate care, identify and deal with gaps and avoid duplication of services. We can use data to identify population with chronic diseases and others who are more vulnerable to the problem"*

Students mentioned how IPE can help in building trust and establishing clear lines of communication between members of the patient care team and families. Supporting this claim, a student in Social Work mentioned "*IPE can help in providing foundation for our response. Important relationships between acute care providers, public health professionals, data collection people, and skilled nursing facilities needs to be built. We should make efforts to understand the needs of the community and then focus our attention on the section of community that needs urgent attention*."

Students expressed themselves freely and used personal examples to demonstrate that they have seen applications of IPE when their relatives were admitted to the hospital. For example, one of the students indicated that "*interprofessional team not only provided assistance to the patient but they worked collaboratively together to come up with a care plan which best fit our needs. They would meet regularly to compare notes and come up with a schedule of care that would benefit the patient. They were so clear about what they were doing and acted quickly when our patient was admitted.*"

Corroborating previous statements and participants response, another student who works in a frontline position at an acute care hospital mentioned that "*you'd much rather have a team of professionals working together than to just have one doctor try to do all the work and fail. A patient is more likely to feel assured when they see a group of health care professionals collaborating to find a solution. That patient will be satisfied and content with the care they are receiving due to the collaboration."*

#### **4. Discussion**

Interprofessional collaboration and communication in healthcare has been shown to improve patient outcomes [21]. It is expected that including experience and practice in interprofessional practice during the professionals' education leads to more successful interprofessional collaboration in practice. This interprofessional education lays the groundwork for effective practice.

Research has shown that the setting for learning is critical [21]. Ideally, these educational experiences happen in a face to face, live simulation experience with a mixture of professional practice students, guided by expert educators/practitioners. Research has shown that students' learning improves as carefully developed interdisciplinary simulations mimic reality closely [22]. However, in the current state of COVID-19 restrictions, live experiences in simulation or a clinical setting may not be easy to perform. At the same time, interprofessional collaboration has never been more important. An alternative educational format becomes necessary to accomplish the outcome of practice professionals entering the clinical arena with interprofessional communication and collaboration skills.

Online education provides access to programs for many working professionals, especially those distant from the educational setting or unable to attend 'class' due to work schedules or other constraints. Indeed, much of higher and professional education has moved to online settings, even prior to the advent of COVID. With the arrival of the pandemic, a great majority of coursework and clinical experiences pivoted rapidly into an online delivery methodology. Usage of e-learning tools has not been consistent across different health profession programs and countries [23]. Recent studies suggested that inclusion of mobile applications and virtual hospitals were well received by students [23–25]. It has also been suggested that if used correctly, e-learning can enhance teaching and learning methods in clinical programs [23]. The questions then become whether IPE can be done in an online setting, and whether it is effective in practitioner development.

This study provides important insight into the opportunities that online asynchronous education offers for healthcare students' understanding of their interprofessional roles. Both quantitative and qualitative methodologies were utilized. Use of a mixed-methods approach may address the 'what' and 'how' of an IPE intervention and its outcomes [21].

This online IPE program focused on four areas: key concepts in the field of IPE, quality and safety, roles and responsibilities of the various providers, and the importance of communication and teamwork. Several different health-related majors were represented by the enrolled students, which is consistent with professional practice. A variety of educational tools including quizzes, discussion questions, and case studies, are reflected in this mixed methods study.

The quantitative Readiness for Interprofessional Learning Scale (RIPLS) found that students clearly reflected the positive outcomes of IPE, even in the online setting. Qualitatively, students responded to discussion questions and described that:

(1) IPE increases awareness of team members' roles and enhances collaboration


These RIPLS quantitative results and qualitative student perspectives provide optimism that IPE can be learned effectively in an online environment, which will be critical moving forward as healthcare aims to improve care through interprofessional collaboration, even in an online, asynchronous environment. This study is unique in that the students were entirely online during a pandemic and represented a variety of healthcare roles. More work needs to be done to expand the understanding of the most effective online teaching/learning tools. Follow up with program graduates will be significant as they move into their professional positions.

#### **5. Limitations**

Because many students were working in healthcare and other institutions, they did not check their university email regularly. As a result, faculty members struggled to reach out to students and communicate in a timely fashion. This program was offered at a single academic institution located in the Midwest US. While findings and methodology can be utilized at other institutions, these findings may not be generalizable across the US or the globe. COVID-19 pandemic academic management posed additional problems for the implementation of the program. It was hard to invite healthcare practitioners to the class as they were extremely busy in dealing with COVID cases in their roles. As online education in healthcare disciplines continue to grow, more research is needed that can explore students attitudes towards online IPE program across several university campuses.

#### **6. Conclusions**

The aim of this mixed method study was to examine attitudes and readiness towards interprofessional education and significance of this preparation during the pandemic. Findings suggest that students from both clinical and non-clinical programs valued opportunities for learning together and felt that IPE enhances awareness of team members' roles and responsibilities and improves collaboration. Participants further suggested that IPE increases communication and cohesion, and results in better care of patients' which is extremely important while working with COVID patients. Further studies across medical centers and academic settings are needed to explore attitudes of students towards IPE programs. Inclusion of different education settings and additional clinical and non-clinical programs not currently represented in the study sample will allow better understanding of IPE especially while working with patients during public health crisis.

**Author Contributions:** Conceptualization, J.S.; methodology, J.S.; software, J.S.; validation, J.S.; B.M.; formal analysis, J.S.; investigation, J.S.; resources, J.S.; data curation, J.S.; visualization, J.S.; supervision, J.S.; project administration, J.S. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Minnesota State University Moorhead.

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** Data available on request due to restrictions.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


### *Article* **Experiences of Pathology Course among Hospital Management Graduates**

**Jung Hee Park <sup>1</sup> , Woo Sok Han <sup>2</sup> , Jinkyung Kim <sup>2</sup> and Hyunjung Lee 3,\***


**Abstract:** The purpose of this study was to explore hospital management graduates' experience in pathology courses. Data were gathered through four focus group interviews by 16 hospital management graduates who attended pathology courses. Data were collected from June to August, 2020. Conventional content analysis was used for data analysis. Six categories were extracted that described hospital management graduates' experience in pathology courses, as follows: "Suggestions for the curriculum," "Students' preference for pathology professor," "Demands for various teaching methods," "Broad and difficult class content," "Recognition of pathology courses during college years," and "The importance of studying the pathology course realized after graduation." The findings suggest that it is important to identify hospital management graduates' perspectives to improve pathology curriculum in the educational process. Additionally, it is necessary to continuously connect educational and practical environments for the effective management of pathology courses.

**Keywords:** hospital management; pathology; qualitative study

#### **1. Introduction**

The department of hospital management encourages and trains professionals in the field of health administration by teaching theories and practices that are essential for the effective management of different health care organizations, with an emphasis on basic medical education [1]. Students majoring in hospital management build their careers in the health and medical industry, and most of the graduates are employed in medical institutions. Different departments associated with health administration, such as the department of public health, department of health care management, department of health administration, department of health policy, and department of hospital management, follow a similar curriculum. In South Korea, since the 1980s, health administration departments have distributed their curriculum over four-year bachelor courses at colleges, demonstrating how four-year-course college departments are gradually subdividing and specializing in accordance with the current trends and the social demand [2].

Currently, with the advancement of information technology, life science, and genetics, the medical industry is rapidly changing [3]. Thus, practitioners in the field of health administration are expected to show multiple competencies such as basic medical knowledge, knowledge about the systems used in the medical field, operation, and management skills [1]. The primary duties assigned to health administration majors in medical institutions include medical records and insurance reviews alongside computerized data management, hospital administration, planning and public relations, human resources, supplies, and the general administration of the hospital. As such, it is necessary to cultivate professionalism that can be used in overall work related to hospital management. Previous study findings revealed that the level of satisfaction among college students majoring in health administration had a positive correlation with career preparation and

**Citation:** Park, J.H.; Han, W.S.; Kim, J.; Lee, H. Experiences of Pathology Course among Hospital Management Graduates. *Healthcare* **2021**, *9*, 347. https://doi.org/10.3390/ healthcare9030347

Academic Editors: Luís Proença, José João Mendes, João Botelho and Vanessa Machado

Received: 10 February 2021 Accepted: 15 March 2021 Published: 18 March 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

decisions [2,4,5], and the level of satisfaction with the curriculum of their major had a significant effect on becoming qualified and employed in the respective fields [6]. Therefore, colleges with four-year-courses offering majors in hospital management include classes on basic medical fields such as anatomy, pathology, and physiology in their curriculum; this aids in strengthening the competencies of students majoring in hospital management [7,8]. Additionally, the department of health administration belongs to the colleges of health or medical science, with the department of hospital management. Furthermore, it was found that basic medical education, including pathology, was chiefly taught by professors majoring in basic medicine or nursing [1,4]. Previous studies on basic medicine have largely focused on students majoring in nursing or medical engineering [9]; however, there have been very few studies on the effectiveness of basic medicine as a subject for departments related to health administration. This gap may have occurred due to the lack of importance given to basic medicine compared to other subjects. However, this subject is central because students from the department of hospital management are often employed in fields relevant to medicine; therefore, they need to have knowledge about diseases to enable seamless communication with other medical workers and to understand patients. In addition, hospital management graduates can be put into overall hospital management-related tasks. Since medical knowledge is required to support the work of healthcare workers, the awareness of the importance of pathology is increasing in clinical practice [1,3]. However, the hospital management department belongs to the college of health sciences or medical sciences, which focus on hospital management, health insurance claims, administration, and statistics rather than professional knowledge in medicine. To that end, both professors and students have difficulties in teaching and studying pre-clinical medical classes such as pathology and anatomy [6]. The results of overall course evaluations, which are customarily done at the university level, have only shown a formal quantitative score and have limitations in understanding students' needs. Thus, more in-depth exploration was required. Moreover, it is important to understand the students' educational needs and implement effective instructional strategies to promote competencies among learners [6,9]. Therefore, with the rapid development in the multidisciplinary field of medicine, it is essential to examine the pathology course curriculum from the perspective of students majoring in hospital management.

The ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model, which structures the teaching–learning planning in different stages (analysis, design, development, implementation, and evaluation) [10], enables educators to create programs using a systematic approach designed to meet learner's needs. Thus, this study aimed to thoroughly understand the experience of students attending pathology courses who are majoring in hospital management; this study conducted focus group interviews and analyzed the results to serve as basic data for the effective management of pathology courses by reflecting on the perspectives of the graduates.

#### **2. Materials and Methods**

#### *2.1. Study Design*

This phenomenological qualitative study aimed to obtain insights into the essence of hospital management graduates' experiences by vividly describing the experiences of a pathology course in at Konyang University.

#### *2.2. Participants*

Participants were recruited in this study by posting a recruitment notice on an online portal with an active audience of hospital administration graduates. Graduates who agreed to participate in the research further introduced the researchers to their colleagues. The inclusion criteria for the participants of this study were: (1) those who had majored in hospital administration, (2) those who had attended pathology courses when enrolled in hospital administration, (3) those who had graduated in the last five years, and (4) those who were employed in fields relevant to their major. A total of 16 individuals met

all the inclusion criteria and provided informed consent to participate in the study. It is recommended to conduct three or more focus groups with four to six participants in each to extract and obtain reliable data [11,12]. Therefore, participants were divided into four groups as per their workplace (medical records office group, hospital administration group, hospital office group of the same university hospital, and insurance company group) to ensure the homogeneity of participants and free flowing discussions in each group (Table 1).


**Table 1.** General characteristics of study participants (N = 16).

L: medical records office team; P: Insurance company team; K: hospital administration team; H: hospital office team.

#### *2.3. Interviews*

The questions were formed in accordance with the format recommendations of Krueger and Casey; our interview questionnaire comprised an opening question, introductory questions, transitional questions, main questions, and a closing question in an open-ended question format [11,12]. The questions were reviewed by a qualitative research expert before the final completion to ensure that their content did not deviate from the research investigation. The overall purpose of the interview was to obtain an answer to "How was your experience of taking pathology courses while in school?" Other questions are shown in Table 2.

#### *2.4. Data Collection*

Qualitative research uses the principle of "appropriacy" for sampling; therefore, it is important to select participants who can provide the most relevant information about the research topic and objective [13]. Focus group interviews, in particular, enable a broader understanding of the research topic since intensive conversations among participants with common characteristics generate detailed research material [11,12]. Thus, four interviewees were assigned to each group to facilitate effective conversation management and enable participants to freely express their feelings.


**Table 2.** Questions for this study.

Focus groups were led by skilled moderators experienced in qualitative research and familiar with the scope of this research. The first author attended most of the focus groups. If this was not possible for logistic reasons, another co-author familiar with the interview protocol took over. The data collection period was from 25 July to 15 August 2020, and the interviews were conducted in a quiet and comfortable location as per the participants' convenience and availability. There were two times of interview at each group, approximately 1 h and 1 h and 20 min long for each session, and participants were notified of the topic and questions of the study prior to the interview. Data collection was finished after second interview when no new information was generated from the interviews; therefore, data from 4 previously selected groups with 16 participants were finally included.

#### *2.5. Data Analysis*

The data transcribed by two assistant researchers were analyzed based on the consensual qualitative research (CQR) developed by Hill et al. [14]. The analysis followed an in-depth process. First, the researchers repeatedly listened to the recorded interviews, accurately transcribed the interviews, and then reviewed the participant protocols several times to identify and understand the underlying emotions throughout the interviews. Second, the researchers recorded the initial feelings experienced by the participants, the first thoughts that occurred to them, and the initial analysis of the data, and then they generated codes for their statements. Third, the researchers conducted a detailed discussion to record sub-themes for core factors of the responses; additionally, the extracted sub-themes were combined to form clusters of themes with similar contents, and these theme clusters were grouped into domains. Throughout the entire data analysis process, the researchers met several times and continuously contacted each other to compare, discuss, and agree on the data analyzed by each of them. In addition, to evaluate the appropriateness of the extracted codes, sub-themes, and theme clusters, the process was repeated to reconfirm and revise the original statements. Researchers proceeded with the analysis immediately after the data were collected, and repeatedly interviewed the participants until there was no new content in the following interviews. Once the statements, concepts, and themes started to appear repeatedly in the data analysis, the process was deemed to have reached theoretical saturation. The first and co-authors separately coded and analyzed the data, and the corresponding author supervised this process.

Data were sent to the participants via e-mail after analysis and reporting to identify their accuracy with the participants' experiences and to improve the credibility of the study; furthermore, participant feedback was obtained for this purpose. In order to maintain neutrality, the researchers conducted an extensive literature review on the research subject, and all judgments were reserved throughout the process to avoid researchers' prejudice or bias as much as possible.

#### *2.6. Pre-Understanding*

The researchers of this study were professors who have experience in teaching pathology courses, in addition to clinical and hospital administration experience at university hospitals. They have continuously participated in seminars to conduct qualitative studies, explored and discussed qualitative research methods, and developed their capabilities for qualitative research. Moreover, a mentor professor provided general guidance on qualitative research performance over the course of this study. In addition, the corresponding author of this study studied qualitative research in graduate school, conducted qualitative research for the last five years, and published it in academic journals.

#### *2.7. Ethical Considerations*

This study was approved by the Institutional Review Board of Konyang University, which the authors were affiliated prior to data collection (IRB No 2020-096-01). Participants were informed about withdrawing their participation at any time during the study with no disadvantages, and their consent was obtained to record the interview. The audio files and transcripts of the recordings were coded to prevent the identification of the participants' identities, and separate unique numbers were assigned. Documents were stored in a document storage box with a lock, and they were discarded using a shredder after the completion of the study.

#### **3. Results**

A total of 232 meaningful statements were extracted from the original data provided by the 16 participants. We extracted two broad content areas: (1) regarding course management and (2) regarding the learners. These areas were further classified into six theme clusters and 12 themes (Table 3).

**Table 3.** Area, theme clusters, and themes of hospital management graduates' pathology course experiences.


#### *3.1. Area: Course Management*

The course management area included four theme clusters: "Suggestions for the curriculum," "Students' preference for pathology professor," "Demands for various teaching methods," and "Broad and difficult content." Participants provided their opinions based on their personal experience of the pathology course.

#### 3.1.1. Theme Cluster: Suggestions for the Curriculum

This theme cluster was composed of three themes: "the need to assign relevant courses," "the necessity to understand the educational level and needs of students," and "the desire to learn before or after the hospital placement." The participants shared their subjective experiences and existing difficulties with the curriculum.

#### Theme: The Need to Assign Relevant Courses

Participants frequently experienced the need to study the relevant material prior to attending these classes due to the use of technical terminology and unfamiliar diseases in the pathology course. It was also considered necessary to learn by sequentially assigning the pathology course and subjects relevant to pathology courses to help with education in pathology, which was considered difficult to learn.

*"I think it would be better to study (pathology) together with a field or part such as pharmacology or anatomical physiology, and* . . . *such subjects will be more beneficial, so I think it will be more beneficial if pathology was studied together during the semester that pharmacology or anatomical physiology is studied."* (H3)

Theme: The Necessity to Understand the Educational Level and Needs of Students

Pathology is an unfamiliar area of study for these students and provides basic medical knowledge. Therefore, participants hoped to learn smoothly without difficulties by being taught at an eye-level; they wanted the professors to consider the students' educational level while teaching. In addition, participants suggested that understanding the educational needs of the students will help in establishing an in-depth course for students who wish to learn in-depth contents in accordance with the diverse interests and concerns of the pathology course.

*"Because the professor teaches from a completely different background of knowledge from us, when we are trying to accept the content, um* . . . *I thought it would have been good if the professor could explain it more easily and extensively."* (P4)

*"For students who want to learn pathology even during their undergraduate years because they find it fun, this would be an opportunity for them to choose... so, if there is an opportunity to receive the education then I think the students who want to study further could do so and use it in their future somehow."* (L1)

#### Theme: Desire to Learn before or after the Clinical Practice

The participants' opinions about the study period of the pathology course varied. Several participants had hoped to learn pathology during the second or third year in order to ensure practical application during their clinical practice in hospitals. Participants generally agreed that pathology courses had a positive influence on clinical practice at hospitals.

*"I think the semester students can usually focus is around the second year. I don't think there will be a lot to do for employment or to attain other qualifications, so I think it would be good to learn intensively before the clinical practice."* (H3)

*"Now that I have completed the clinical practice, I think learning in the first semester of the third year and then immediately following it with clinical practice would be a good idea."* (P1)

#### 3.1.2. Theme Cluster: The Pathology Professor the Students Want

This theme cluster consisted of two themes: "the professor with extensive hospital clinical experience" and "the professor who interacts with students and teaches in a way that students can easily learn." Participants presented their opinions about the characteristics they desired in their professors based on their experiences and impressions formed during classes.

Theme: Professor with Extensive Hospital Clinical Experience

In accordance with the unfamiliarity and difficulty of the pathology course, students desired a professor who could help them easily understand the topic. Professors, who taught using their real-life clinical experiences and case studies, engaged the students' interest in a fun and memorable way during the pathology course.

*"The vivid experiences of the clinical field encountered through the professors enriched the pathology course memories."* (K4)

*"We are now graduating and moving forward because the professor gave lectures to us while working in the hospital field and* . . . *professors are normally employed in hospitals or insurance companies, which enables us to hear a lot about the direct experiences that they had while working, so* . . . *that helped a lot."* (P4)

Theme: Professor Who Interacts with Students and Teaches in a Way That Students Can Easily Learn

Since pathology was a difficult subject, learners reflected their positive experience with professors based on the highest learning effect. Participants positively evaluated those professors who usually attempted to interact with students, and their efforts subsequently led to high learning outcomes.

*"The professor asked the students if anyone had ever suffered a disease, and how and where they were sick. The professor asked a lot of questions like this, so I think that helped a lot learn intensively before the pathology was conducted pleasant classes, which* . . . *was a good method."* (H1)

3.1.3. Theme Cluster: Demands for Various Teaching Methods

This theme cluster consisted of two themes: "memorable case-based role-play classes" and "boring lecture-style classes." The participants desired learner-centered teaching methods based on their previous learning experience.

Theme: Memorable Case-Based Role-Play Classes

In terms of learning methods, participants wanted learner-centered class plans conducted through various mediums that were easy to approach and participate in.

*"It is good when they give case scenarios and give some time to think about the examinations or diagnosis* . . . *"*. (L2)

*"It wasn't just lectures, but we were grouped together we were given a disease each and did something like a role play. So, I think it was good that I was able to learn and understand more specifically about the disease while directly participating in the role play, in addition to the theoretical part of the disease* . . . *"*. (P1)

*"We did something like a role-play in the last class of pathology. Each group was assigned the name of a disease and played the roles of a doctor, a patient, and a nurse for such situation. It was followed by an evaluation, and I wondered why we were doing such a thing back then. Looking back now, I think that was what helped me."* (L4)

Theme: Boring Lecture-Style Classes

In general, there were many negative evaluations for lecture-style classes (professor-centered).

*"When I listened to the lecture, had to wrote it down without thinking, so I became much less attentive and* . . . *just listening to lectures was not suitable for me"*. (L2)

*"I wasn't able to concentrate due to um* . . . *incomprehensive terminology and boring lecture* . . . *"*. (K2)

#### 3.1.4. Theme Cluster: Broad and Difficult Class Content

This theme cluster consisted of two themes: "excessive amount of learning content" and "difficulties in concentrating on basic medical content." The participants had various content requirements based on their current employment, and they wanted practical contents that could be applied to their job duties.

#### Theme: Excessive amount of Learning Content

Participants' primary memory of the pathology classes was the difficulty faced due to the unfamiliarity and large proportion of the curriculum. The excessiveness of the content was especially higher for liberal arts students who were completely unaware of basic medicine.

*"There were too many disease to learn and memorize."* (H1)

*"It was difficult because the amount of study was too much compared to other subjects."* (K4)

#### Theme: Difficulties in Concentrating on Basic Medical Content

Participants complained about difficulties in concentrating during the classes due to the use of unfamiliar and technical pathological terminology of pathology, which is starkly different from those used in other hospital administration courses, and the rapid progression into specialized medical content.

*"Due to the nature of the pathology, there is a lot of medical knowledge and a lot of information to be delivered* . . . *Personally, it was difficult to understand because there was a lot of information being given at once."* (P4)

*"Incomprehensible terminology gave me hard time* . . . *"*. (P1)

#### *3.2. Area: The Learners*

This area consisted of two theme clusters: "recognition of pathology courses during college years" and "the importance of pathology courses participants learned after graduation." Study participants suggested ideas to help the future students gain a positive experience, based on their personal experiences. This was classified as the learners' area.

#### 3.2.1. Theme Cluster: Recognition of Pathology Courses during College Years

This theme cluster consisted of two themes: "lack of motivation to learn" and "subjects requiring memorization that participants wanted to give up." Participants emphasized the necessity and importance of learning pathology and the role of learners who are the focal point of education in accordance with their real-life experiences.

Theme: Lack of Motivation to Learn

The participants believed that there was a lack of awareness about the effect of pathology courses on their future practice.

*"Since we do not do practical work but rather do administrative work, I think I attended the pathology classes with an underlying opinion that pathology is not important."* (K4)

Theme: The Memorization Subjects That Participants Wanted to Give Up

Participants revealed that a lack of motivation for learning pathology, the excessive amount of studying, and the realization that pathology requires memorization negatively affected the learning outcomes.

*"Students give up because there is so much to learn* . . . *hard to understand and probably because they do not want to memorize."* (L3)

*"All I can recall is the memorization techniques."* (P2)

3.2.2. Theme Cluster: The Importance of Studying the Pathology Course Realized after Graduation

This theme cluster consisted of two themes: "coming to know that pathology is an important course that is helpful in clinical practice" and "helpful in obtaining a majorrelated qualification."

Theme: Coming to Know That Pathology Is an Important Course That Is Helpful in Clinical Practice

The participants emphasized the importance and usefulness of the pathology course based on their positive experiences during their employment practice; although they did not recognize this importance while attending the classes.

*"It helped me greatly to understand which areas are diseases with high severity and to understand whether patients have high severity when reading the list."* (H3)

*"I think once you go to work after understanding the subject called pathology, you can communicate more comfortably with people in the medical department, nurses, or even with the patients you directly encounter."* (K4)

*"It is content you need to know after you get a job and results will change according to how you study so I hope students study hard and learn a lot."* (L2)

#### Theme: Helpful in Obtaining a Major-Related Qualification

The participants in this study vividly remembered their experiences while preparing for employment after graduation. Participants conveyed the pre-requisite role of the pathology course in obtaining further certification related to their major, such as that of a health information manager. Additionally, they acknowledged that studying the course provided practical guidance for obtaining the certification.

*"There are a lot of places that require a certificate than you would expect...They prefer people with a certificate...and it's a very good certificate to have...I think studying pathology will be absolutely indispensable to get a certificate such as health information manager certificate in the future."* (K1)

*"I think it was helpful when I was taking the medical recorder's license exam. It really helped my studies when I looked through the materials I had studied before."* (L3)

#### **4. Discussion**

This paper presents a qualitative study that aimed to understand the underlying experience of studying in a pathology course among hospital management graduates, and six theme clusters were subsequently extracted. An unexpected question from the participants during the interview was when they asked for an explanation of what a pathology course entails. This was surprising because all the participants had opted into this course and had only graduated within the last five years. Therefore, this indicates the relatively low importance attached to basic courses in hospital management majors, as administration and management courses are considered more essential. However, a general understanding of disease is becoming necessary with the increased engagement in medicine-related duties. Fortunately, the participants began to comprehensively reminisce about the overall experience of the course management and learning throughout the rest of the interview.

Pathology involves the in-depth study of disease mechanisms; H3 of the hospital office team expressed the desire to sequentially study relevant courses such as medical terminology, anatomy, physiology, and clinical practice. H3 also suggested the need for conducted pathology courses, before or after hospital placements, at the medical institutions in consideration with the educational level and needs of the students. Previous studies with students of health and medical department-related subjects have revealed that satisfaction with the major subject was high if high satisfaction was experienced with the curriculum and field placement [4–6,15]. This demonstrates that a systematically

designed curriculum has a significant influence on overall course satisfaction. Similarly, other participants of the current study also wanted the pathology course to be taught before or after hospital placements. Therefore, it is necessary to conduct detailed discussions about the completion period of the course while designing the curriculum in order to increase student satisfaction with basic courses among hospital management graduates. These changes in curriculum design will aid the clinical placement of students, which can be an important turning point for those studying subjects relevant to health and medical departments; moreover, it will help in satisfying their intellectual curiosity related to their major and in fostering their potential [15]. Furthermore, due to the adaptive and dynamic nature of the curriculum, the pathology content may be added or reduced according to the educational needs of learners [4–6,15]; therefore, it is necessary to assess student satisfaction with the pathology course for those who are currently enrolled.

The second theme cluster in course management was concerned with student preferences for the professor of the course. Students preferred pathology professors who had clinical experience in hospitals and taught students in an interactive way that facilitated easy learning. Since professors enjoy a high degree of autonomy in class planning and evaluation, their competency acts as a crucial factor in determining the quality of their classes [16]. Students preferred professors with practical clinical experience who facilitate easy learning for students using real-life clinical cases during the pathology lectures. The results of a previous study reported that highly prioritized competencies in college professors are "systematic compositions" and "the explanation capacity" [17]. The current study findings were consistent with the results of this previous study. Thus, professors must seek techniques to systematically organize the contents of the pathology curriculum to easily explain the contents for students studying hospital administration while emphasizing important core contents.

Participants also expressed difficulty to motivate themselves to learn pathology during their college years, as the subject dealt with the mechanism of diseases. Therefore, professors with specialized knowledge and experience should use clinical case studies to make pathology classes less technical and more practical.

These requests were categorized into the third theme cluster of course management concerning the demands for various teaching methods, which included classes using audio–visual materials and case-based, role-playing techniques as the preferred lesson methods in order to tackle the difficulties expressed by the participants to engage in learning with lecture-based lessons due to boredom. The characteristics of excellent instructors are well-organized class content, clear delivery, and harmonious interactions with students [18]. Rote learning with professor-centered education to deliver extensive amounts of knowledge was the method preferred in the past when knowledge itself was the resource. However, modern day students require learner-centered classes (e.g., problem-based and team-based learning) to acquire and apply knowledge by participating in various learning activities based on student–professor interactions [9]. Due to the gap in previous research on the management of basic courses such as pathology for hospital management students, this study reviewed the available literature on the educational needs of nursing students, which is another health-related department. The reviewed literature revealed that nursing students also preferred performance-oriented education that enabled learning through direct participation and experiential learning, which was similar to those studying hospital administration [19]. Role-playing education, which participants positively recalled, involves the process of autonomously constructing specific scenarios, planning roles, and promoting the understanding of diseases; it can be an effective learning method that improves problem-solving and self-directed learning skills A previous study identified "media and technology utilization " as a component of an appealing class [20]; therefore, professors must seek methods to appropriately use relevant audio–visual materials to promote the interests and understanding in learners regarding unfamiliar disease mechanisms and terminology.

In the fourth theme cluster about the broad and difficult class content, the participants' complaints regarding the excessive amount of learning material and the basic medical contents that were difficult to concentrate on were recorded. Participants expressed the following concerns: (1) difficulty due to technical terminologies, (2) unfamiliarity with the content, (3) limitations due to the excessive amount of study material, (4) treating the course as a memorization subject, and (5) giving up learning altogether.

This is connected with the recognition of pathology courses during college years, which was the first theme cluster in the learner's area. Participants suggested that they were indifferent to the pathology course during their school years due to a lack of motivation to learn and because it was a subject that they wanted to give up studying due to the extensive amount of memorization involved. However, participants independently confirmed the importance of basic knowledge about diseases during their employment after graduation; they eventually realized the importance of the pathology course. Such factors are important for motivating students studying hospital management to learn pathology. As the learning and academic achievement increases, the purpose of taking a class becomes clearer for a learner [21]. These experiences of graduates can have a positive effect on inducing learning motivation for students who are currently enrolled.

A lack of effort or awareness in a learner who is the focus of education can prevent correct learning and lead to the abandonment of an course altogether [21]. In other words, a learner's proactive learning attitude is a determining factor in achieving learning outcomes.

Participants suggested that their experience of taking a pathology course as a student was crucial for reviewing and determining medical records at work in the medical institutions and insurance companies where they currently work. However, they expressed regret over not recognizing this importance during college. These findings demonstrate highly meaningful statements for professors teaching pathology in the field of education. Since the career paths of students studying hospital management are associated with medical institutions, it is imperative to improve their ability to seamlessly communicate with other health care workers and to understand their patients. Therefore, specific goals need to be determined for students studying hospital management to achieve the learning outcomes of the pathology course. Furthermore, there is also an urgency to seek solutions that consider the educational needs and the academic achievement of students while planning pathology classes to implement education at the eye-level for students who are studying hospital management.

#### **5. Conclusions**

This study divided the experience of the pathology course among graduates of hospital management into the areas of: (1) course management and (2) learners. The graduates commonly and consensually expressed a lack of motivation to study pathology and difficulties in concentrating on the course content due to the excessive amount of study material. However, graduates appeared to have recognized the importance of the pathology course after graduation during their employment in fields relevant to their major.

There are limitations in generalizing these results because this study conducted focus group interviews with the graduates of hospital management from the same local university. However, this study is significant because it has provided a deeper understanding of the experience of studying the pathology course in hospital management students amidst an insufficiency of relevant literature.

Based on the results of this study, the following recommendations are proposed: (1) the current management of basic courses, including pathology, in the department of hospital management must be evaluated and recognized; (2) pathology course curriculum should facilitate practical learning for effective the study management of pathological courses, which could be facilitated through collaborations with the employment centers where students can work after their graduation; and (3) learning contents should be constructed based on major diseases to enhance learning motivation. The findings of this study will be helpful for developing pathology course for hospital management students.

**Author Contributions:** Conceptualization, H.L.; methodology, J.H.P., and H.L.; software, J.H.P. and J.K.; validation, J.H.P., W.S.H., J.K., and J.H.P.; formal analysis, J.H.P., W.S.H., J.H.P., and H.L.; investigation, W.S.H., J.K., and H.L.; resources, W.S.H., J.K.; data curation, J.H.P., and H.L.; writing—original draft preparation, J.H.P.; writing—review and editing, J.H.P., W.S.H., J.K., and H.L.; supervision, H.L.; project administration, J.H.P. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by Konyang University Research Fund in 2020.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Konyang University (IRB No 2020-096-01).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** The data presented in this study are available on request from the corresponding author. The data are not publicly available due to data restriction policies.

**Acknowledgments:** The authors deeply thank the graduates who participated in this research.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

