The main finding of present study is accepting the null hypothesis that there is no difference between academic achievements of internal interns with actual and virtual education models. In the present study we assess the learning outcomes in the 9 areas. Surprisingly we found that different educational models had no effect on student learning. However results of two-way ANOVA showed that actual education for women and virtual education for men have resulted in higher difference scores in pre-test and post-test.
Following the Corona pandemic, the need for changes in traditional teaching methods became inevitable. Virtual learning, which is mainly web-based, also brings challenges. To what extent learners can keep up with this style of teaching requires precise evaluation and comparison of this new method of teaching with actual training.
Just as actual training has its advantages, such as face-to-face communication, so does virtual training. Among the advantages of virtual learning can be mentioned the following. First, this method of education allows medical students to observe and interact with patients with COVID-19 while eliminating the risk of infection. In the Hofmann et al study, 92.9% of medical students were agreed with the virtual methods of teaching (9). Second, virtual education provides the opportunity for other students from different parts of the world to participate and exchange information between them. One of the strength of this mode of training is active participation of all students in clinical reasoning skills and gets a guide from tutors and peers alike. Murdock et al. (10) used the virtual method for holding morning report. Participants stated that this method is an effective and suitable method for using different physician in different physical places and reduced clinical load for the medical team.
In a study conducted by the Imperial College London, interns visited patients virtually. The results of this study show that the interns eagerly attended these visits and the patients' visits were well done without the physical presence of the patient and the doctor (11).
Like actual training, students' learning in e-learning is related to the mastery of the teacher and the correct transmission of concepts. Results of one study showed that 97.2% of students were satisfied from virtual teaching and this method was known as the efficiency of the actual method (12). Consistent with present study, Kaur et al study also confirmed satisfaction of 983 medical students with virtual teaching during the COVID-19 crisis (13).
In addition to the advantages mentioned for virtual education, this educational method also has disadvantages. One of the most important weaknesses of virtual training is no access to digital technology for some students. Availability of trustworthy internet connection (14, 15), hardware and software problems for virtual learning platforms (16, 17), problems relating to internet speed and quality (18, 19), and problems with audio and video playback (20) are the other disadvantages of this mode of teaching. Besides, in some cases, the educational website may become inaccessible due to overloaded, which can make learning difficult for learners (21).
Elimination of face-to-face training and clinical examination by medical students are other weaknesses of e-learning (22, 23). Results of recently published systematic review declare that progression of the competencies of a medical student were highly impacted by loss of clinical examinations, loss of bedside training and reduced direct patient care (22). Moreover other studies have confirmed these findings (14, 18, 24).
The move to virtual education by means of web-based medical teaching has problems in its nature. Some of these problems can be referred to lose focus and concentration whilst sitting in front of a screen (15). Besides, reduced motivation, poor communication, physical discomfort for instance exhaustion, visual issues, and muscle and joint pain, were related to virtual education especially in long period (25).
Another disadvantage of the virtual learning method is the lack of validity of evaluations and tests. Results of several studies showed that due to the lack of supervision during the exam, many of the scores obtained were significantly higher than the students' academic level based on their academic records (18, 21, 24, 25). Surprisingly, Lara et al (26) published a study whose results show that the scores obtained by 49 medical students in the objective structured clinical examination (OSCE) who participated in the teleconference were not significantly different from the scores of the same test in the form of face to face.