An examination of the online resources implemented both before and after the COVID-19 pandemic reveals which are the most beneficial for medical student education and what areas exist for further research.
Online teaching resources are needed in the continued education of medical students(6). Enhanced clinical experience using instructional videos was studied in 2011 when medical students were asked to watch the short videos before interacting with a patient and presenting the case(7). A survey showed that the students’ perceived confidence and effectiveness of the case presentation were improved after viewing the video. Although this does not empirically prove the benefits of instructional videos, it implies that there is a place for hand-held mobile learning technology in a clinical setting. Further analysis carried out in a systematic review of 20 papers concluded that online instructional videos benefitted postgraduate medical students in learning and retaining clinical skills(17). This study suggests that further research could identify what makes instructional videos effective.
Online resources could completely replace in-person patient interactions. Final year students in Rutgers New Jersey Medical School participated in patient consultations via the virtual platforms collectively known as telehealth(12). In particular, students valued the sense of purpose or usefulness that the platform provided. Not only did they appreciate the opportunity to practice the essential skill of history taking but they felt encouraged by the chance to aid front line workers with “decision making, patient and family counselling, and the planning of implementations”. Virtual patient simulations (VPS) are another way to gain clinical experience in a rural setting. A study in 2016 introduced interactive digital patient cases to first-year medical students(18). VPS was found to be an effective classroom technique that increased engagement among the students.
Resources like telehealth and VPS offer hope to students in continuing their clinical education during the ‘educational crisis’(5) caused by the COVID-19 pandemic. However, written exams will also be a concern to students, with remote teaching and learning posing new challenges to students’ exam performance. In a study by Bientzle et al., online learning techniques were assessed in the context of exam performance(3). Medical students that used online learning cards, MCQs and took individual notes were analysed. The higher the number of learning cards, test questions or MCQs used, the higher the percentage of questions answered correctly by the student in the exam. Those taking individual notes from online also answered a higher percentage of questions correctly than those who didn’t take any notes. The conclusion to this study found that online learning resources can be very helpful to medical students that engage in the learning material online.
Student engagement with online learning resources was also studied in the context of online mentorship. A RTC was carried out that compared mentored and unmentored doctors that had to do their continued medical education (CME) in a remote or distant setting. An odds ratio implied that doctors that were mentored were three times more likely to complete the CME modules compared to those that weren’t mentored. Mentored doctors also seemed to engage in the reflection at a higher level. Mentors felt that their contribution had little impact and both mentors and mentees found it difficult to make contact. Perhaps a larger scale study with more support and structure for communication would produce more statistically significant results(15).
The question remains: are there aspects of medical education that simply cannot be performed digitally? There is little evidence that interactions via telehealth(12) thoroughly prepare student doctors for the hospital environment. Inadequate infrastructure and technical difficulties appear to be unnecessary barriers in the online setting that distract from learning(10). Students taking part in virtual patient simulations report difficulties with navigating technology, overwhelming text and limited tutor guidance(12). There is low-quality evidence supporting students’ ability to develop a rapport or connection with patients through the confines of a computer screen(11) and it is unclear how this may stunt a student’s communication skills. It appears that whilst virtual patient interactions can be a useful adjunct to clinical experience, it is most beneficial as part of a blended learning approach(11).
Students rated their own preparedness as relatively unchanged by the shift to online teaching due to the adoption of virtual assessment tools(15). However, this solution has a number of limitations. For one, the delivery of these assessments and the validity of their results relies greatly on the infrastructure provided by the school. Many universities have far to go in improving their LMS(8), especially for the purposes of more high stakes examinations. Secondly, online methods of assessment create potential inequality between students. Stable internet connection, quiet home environment and access to a personal computer are essential for proper completion of an online exam, possibly creating an unfair advantage for more privileged students(19). Medical schools must address these issues before online assessments can be used beyond a supplementary tool.
‘Clinical thinking’ and problem-solving are important skills for student doctors and one way medical schools can encourage this kind of critical thinking is through PBL sessions. Students asked to interpret a virtual patient preferred a written account of the problem to a video version(13). The video was thought to slow down the pace of the session and inhibited students from being able to critically review the information given(13). This shows the cost of technical difficulties and poor infrastructure to student development(14) and demonstrates the advantage of traditional methods in situations where technology creates unnecessary barriers to student engagement.