This survey of medical students who took an online course in gynecology and obstetrics that replaced a face-to-face practical course revealed great acceptance of digital learning in general; most participants indicated that they desired more online teaching in the future. In addition, all three digital teaching formats used in the course (online lectures, video tutorials featuring real patient scenarios, and online education in practical skills) received good ratings.
As modern technology and web-based systems are now integral parts of everyday life, medical students’ demand for and use of digital learning options (e.g., self-directed programs from local universities and other institutions) has increased [8]. These students’ use of social media platforms has also increased and provides the opportunity to interact, discuss cases, and study in session for examinations [9]. Some authors believe that the availability of 5G and artificial intelligence technologies represent a breakthrough enabling the optimization of educational programs [10]. The COVID-19 pandemic obligated students to engage in digital learning and revitalized digital learning options [11]. For example, during the period of campus closure, universities in China implemented 24,000 online courses (401 including virtual experimental simulation and 22 providing learning platforms), coordinated by the Chinese Ministry of Education, which monitored online education progress and quality [10]. A survey of 39,854 students at the Southeast University in China emphasized the importance of this tremendous undertaking; 50 % of respondents believed that the planned teaching objectives were attained fully [10]. The survey also revealed that students prefer a mixture of different learning formats, such as the use of recorded videos in combination with live courses; this mixed teaching style appeared to increase students’ participation and mitigate the impact of unstable networks [10]. The researchers concluded that in the absence of face-to-face communication, teachers need to put greater effort into preparing for online courses, innovating and designing lessons [10]. The good ratings that students gave to the different teaching formats in this study are in line with these findings, but our students also indicated that teaching and learning with real patients were elementary for future curricula.
Data from the University of Washington document a tenfold increase in digital education in pathological anatomy for distant students during the COVID-19 pandemic. One such course examined was similar to ours; it was a comprehensive two-week remote-learning program for third- and fourth-year students that included lectures, slide presentations, virtual discussion groups, and case-based activities [12]. A survey on course effectiveness yielded positive student feedback; in contrast to our findings, the students found the educational quality to be equivalent to that of an in-person course [12]. This difference might be explained by the difference in course objectives, which included practical skill development in our course and were more theoretical in Parker et al.’s course, although those authors did not report results by teaching format. We obtained high ratings for online lectures that imparted theoretical knowledge, but our students preferred to learn practical skills with real patients.
Schulz-Quach et al examined 670 medical students’ acceptance of a digital course in palliative care that included online lectures, YouTube videos, self-reflection exercises, and interactive case management, and culminated in a multiple-choice examination. In line with our results, responses to a standardized university questionnaire on students’ palliative care competence revealed broad acceptance of digital learning in e-learning and non–e-learning subgroups [13]. The authors also observed a positive, but not significant, trend toward higher examination grades among students who took the digital course, but no difference in self-estimated palliative care competence between groups, argued to be attributable to the lack of experience-based learning with real patients. Like our findings, this result emphasizes the need for patient contact in the teaching of skills to medical students.
In a study conducted with 205 medical students, Brockfeld et al. found that video lectures were as effective as live lectures for preparation for a medical examination consisting of 301 multiple-choice questions; 48 % of students preferred live lectures, 27 % preferred video lectures, and 25 % had a neutral opinion. The authors concluded that video lectures could serve a complementary role in medical education [14]. These results are in line with our findings of good lecture ratings and some students’ preference of online over traditional lectures. The affinity toward digital learning is known to vary among students; based on a two-semester-long prospective study, Backhaus et al. identified two types of medical student: digital natives and traditional learners. Digital learners had greater difficulty with traditional lectures than with e-learning, whereas traditional learners showed no difference in knowledge gain between formats. The author emphasized that medical educators should be aware of changes in learning habits, and our results may provide hints of such changes [3].
A broad array of options is available for the remote teaching of theoretical content; for education in the history of medicine and medical ethics, these include podcasts, chatrooms, and a vocabulary trainer [15]. The use of digital teaching for gross anatomy and pathological anatomy is also common [6, 12]. Our results suggest that the acceptance of digital teaching of theoretical background content is also increasing in clinical medicine.
In a randomized study, Gonzalves et al. investigated the use of video tutorials and slide shows to teach maneuvers for shoulder dystocia to medical and midwifery students. At the end of the course students were evaluated by graders. Scores in practice and theory were significantly higher among students in the video tutorial group, leading the authors to conclude that video tutorials improved learning relative to standard lectures alone [16]. Our survey also showed broad acceptance of video tutorials among medical students. Such tutorials are also used to teach skills to radiology residents; a course composed of ten minute video tutorials improved these residents’ ultrasound knowledge and hands-on skills, as measured by pretest and posttest questionnaires [17].
Schlupeck et al. reported medical students’ acceptance of an online course on wound care; 69.4 % of students found the online course to be superior to a conventional lecture, and students’ perceived competence increased significantly. In line with these results, our students rated the online course highly [18]. Despite the good performance of the digital teaching formats and the broad acceptance of digital learning, our results reflect an important limitation of digital education, namely that it does not allow for learning with real patients. Our students indicated that the online course could not replace a practical course with patient contact and indicated that they missed patient-centered learning, an elementary educational component that enhances students’ understanding and awareness of the complexity of patient care [19, 20]. In addition to bedside teaching, practical units on diverse topics (e.g., intrauterine devices, conization, laparoscopy, and obstetric ultrasound) with patient contact or realistic scenarios improve medical students’ knowledge and understanding [21–29].
Arús et al. showed that conventional learning was superior to digital learning for skill development for magnetic resonance imaging of the temporomandibular joint among dental students, despite improvements in both groups [30]. A review of e-based learning programs for nursing students yielded similar results, showing that e-learning is a flexible teaching method but is not superior to face-to-face patient simulation. The authors concluded that combined traditional and e-based learning could achieve the best results [31].
The limitations of this study include those inherent to survey-based research. In addition, we evaluated only students’ opinions, and not the effectiveness of online teaching, as reflected for example in examination scores. Thus, although the students showed broad acceptance of online teaching, we cannot comment on the effectiveness of this educational approach in terms of knowledge and medical skill acquisition. As the degree of knowledge transfer is a key indicator in the evaluation of teaching methods, additional studies of the relative effectiveness of online and conventional teaching formats are needed.