The results illustrated that the information technology for medical teaching had not been widely used before the outbreak of the COVID-19 epidemic, the teachers' ICT competency was generally insufficient, and the web-based teaching mode was imperfect in medical education. To adapt to the effect of the COVID-19 pandemic, educators had tried their best to redesign the curriculum and have adopted information technology in teaching. However, in doing this, medical educators have been faced with many challenges. Some medical educators recognized that the online teaching method was just a short-term teaching approach under the temporary pandemic situation. It may be the fundamental reason that led to the satisfaction of the online teaching method's contribution presented slightly better than the medium level. Nevertheless, they still believed that it would be a definitive trend of integrating information technology with medical education in the future and holding a positive attitude towards it. Although the current circumstance of the integration is still in the early stage, the COVID-19 pandemic has accelerated the evolutionary scheme of medical education informatization to a reasonable extent.
The 26 participants of the study with varied demographic backgrounds have covered different age groups, length of teaching, and university affiliation types. It can enhance the study's reliability, creating a benefit for carrying an evaluation of the difficulties linked to ICT competency between different ages and different gender. However, the result demonstrated no significant relationship between the technical challenges and the diversity of age or gender. In other words, the main challenges medical educators met when they conduct the ERT during the COVID-19 epidemic would not be distinguished by the difference in age or gender. This result was slightly out of expectation because it was generally believed that the older people are, the more difficulties they may encounter in using information technology. The difficulties and challenges faced by medical educators in the use of emergency distance learning are universal. The biggest challenge for medical educators in ETR was web-based instructional design, which revealed that redesign the offline course would need medical educators' much effort and time, particularly for the clinical course, which is hard to be replaced by the online teaching model entirely. Therefore, in the future, the reformation of clinical courses would likely combine an online and offline teaching method. For instance, the offline teaching method will be conducted for medical students' practical demands, while the online teaching method will be conducted for the theoretical learning demand. The second biggest challenge was unfamiliar with the online teaching tools, which was reasonable under the unpredicted pandemic situation. The effect of COVID-19 led to the large-scale closure of medical colleges and emerged a sudden shift to online teaching, which limited the time for medical educators to get familiar with these new pedagogical online techniques. Fortunately, this difficulty can be solved by further training or within a long-term regular online teaching pattern. The next three difficulties were the challenging online teaching environment, the insufficient online teaching resources, and the limited ICT competency, respectively. Three of them shared a similar percentage, which indicated that all of them were the secondary challenges in the ETR, and they can be overcome through further training for educators and improvement in the online teaching circumstances. The least challenging one was the higher authorities or leaders giving no adequate attention to the ERT or supporting it, which intimated that the school supported medical educators to tide over the difficulties faced on online teaching.
Although many difficulties are encountered in ERT, they also co-exist with opportunities. When medical educators try to solve these difficulties, they promote the improvement and reformation of medical education. Comparing with medical educators' experience towards online medical teaching before the COVID-19, around half of them conducted online teaching for the first time, which enhanced the covered level of medical education informatization and identified more issues in online medical teaching. The time spent on online teaching dramatically raised though it was an external environment forced to conduct online teaching. The more they used the online teaching method, the more familiar with it. Most medical teachers utilize online multimedia platforms to ensure the interaction with students. As for their perceptions, a majority of them believed that the online teaching method was beneficial for work-life balance and enhanced flexibility of the courses, study methods, and the interactive communicating way. Although the online teaching was new to most medical teachers, they regarded the contemporary information technology in online teaching as current accessible, reliable, and worthy. However, because the ERT shorten the preparation process of online teaching, in medical educators' opinions, the contribution level of online teaching method in medical education was average posited at the level of a little higher than the medium level. It has been undeniable that the ERT helped develop a new teaching method, and the online teaching method did contribute to medical education to adapt to the effect of the pandemic situation.
Based on the challenges and opportunities that have been discussed above, some suggestions are proposed for future medical education reformation. Firstly, emphasizing knowledge and experience, the clinical clerkship course is an essential part of medical education. Unlike the traditional clerkship that happened in a physical place or hospital, the current online teaching was not advanced enough to provide the same clerkship experience on an online platform, which waves the demand for an advanced and standardized online medical teaching system in China. It would be helpful if China can refer to some other advanced countries' practices or suggestions in online medical education . For example, in the UK, they have proposals for a "networked" medical school based on district general hospitals and the corresponding community . Although facing many challenges in online teaching, medical educators still hold a strongly positive attitude towards the medical education informatization in the future and believed that the broad application of modern technology in medical education needs the cooperation and joint efforts of various stakeholders to promote the application of digital technology in medical education reformation. Concrete leadership and practical policy are essential for the implementation of modernizing medical education. We believe that catastrophes like the COVID-19 pandemic may repeatedly come and pass in the future, just like all human history records. What can we do to reduce the damage to the medical education system? We believe that developing an advanced and better online teaching system is one of the answers.
All in all, students and teachers generally accept the online teaching of medical courses during the pandemic period because of its advantages of flexibility, information accessibility, global reach, and efficiency. However, online education also has shortcomings, including the lack of teacher-student interaction, the presence of distractions, and the decrease of students' self-discipline. Especially for online medical education, there is still a problem of technological constraints. Students cannot participate in the laboratory and clinical practice. As to teachers, a big challenge for them is that they are not adapted to change of teaching methods well and dissatisfied with the construction of some online course platforms, which is the main reason that affects the teaching quality. The paper focuses on the current situation and future trend of online education in medical courses, consistent with earlier findings showing that online courses will play an essential role in many schools' long-term survival. However, our analysis neglects several potential conditions. An important direction for further work might be to study how to realize remote clinical practice teaching better. Online education will continue to play an important role, an emerging trend, and become the next normal in the post-COVID-19 pandemic. The results of this research may help educators to progress current education form. By incorporating artificial intelligence and mobile education, online education will co-exist with traditional education to provide more education options, promote education equity, and enhance education innovation.