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20th October 2022

The impact of e-learning on undergraduate clinical medicine

Institutions and instructors are looking at widespread integration of e-learning to improve the quality of education for undergraduate medical students. Furthermore, this motion stands a chance at adapting education to changing realities.

Impact of e-learning methods on medical education

Today’s medical students are familiar with computer-generated 3D anatomical models, virtual classes and rotations, and virtual microscopy as part of the learning process.

According to Zehry et al., e-learning is the “use of information technology or the internet for learning activities.” Also referred to as web-based, online, or distributed learning; e-learning has been touted to present new opportunities for students and instructors to transform the classroom experience. In fact, E-learning is not a new trend in medicine. It has been in use for a while already. However, the 2019 pandemic led to a wider adoption of e-learning even in the developing countries. Besides, the familiarity of today’s medical students with technology makes e-learning inevitable for the evolution of medical education.

How much of an impact does e-learning have on the quality and effectiveness of medical education? Studies have indicated favorable opinions from medical students. An important benefit of using e-learning models is the increase in student satisfaction—multiple studies in medical and nursing education record greater learner satisfaction with e-learning. Besides improving learner outcomes in satisfaction, online platforms have been associated with achieving higher exam scores, the ability to self-monitor knowledge gaps, and improved knowledge retention from repeat exposure. Improved learner satisfaction indicates greater effectiveness of e-learning interventions.

Some studies have also shown increased knowledge and skills acquisition with e-learning methods. A study by Kourdioukova and other researchers on ‘The Quality And Impact Of Computer Supported Collaborative Learning (CSCL) In Radiology Case-Based Learning’ reported improved knowledge and skills with computer-based collaborative learning. Likewise, a 2010 randomized control trial showed a statistically significant improvement in knowledge acquisition after participating in an online module, as judged by performance in end-of-year assessments.

On the flip side, randomized control trials (RCTs) that compared pre- and post-intervention test scores or followed participants for longer periods do not record significant differences in knowledge mastery when comparing the control and intervention groups. Hence, one may argue that earlier indicators of improved knowledge gain with e-learning interventions may have needed more thorough investigation.

For example, in a 2006 study by Wahlgren evaluating an interactive case simulation system in dermatology and venereology, students reported a better understanding of disease diagnosis and management. However, a formal assessment did not show a statistically significant difference between the intervention and the control groups. Given that clinical training does require a good amount of in-person education and human-human interaction, further investigation is needed to determine the exact cases where e-learning may be preferential.

Virtual Interventions: The integration of e-learning into Medical Education

E-learning and clinical training come in various forms, and the adoption of e-learning into medical education has been similarly varied. Before the pandemic, medical students used internet-based tools for accessing information provided by the university, networking with colleagues, and communicating. Free Open Access Meducation, or the FOAM movement, was well-documented as a supplementary solution to college-provided resources.

According to a 2019 study involving 1500 students in 41 medical schools in the UK, medical students dedicated nearly half of their independent study time to non-college-provided information. Such resources included free or paid websites, question banks, YouTube, and podcasts. In addition, students explored other novel educational modalities, such as apps and social media.

Importantly, however, classroom teaching was mostly traditional, requiring the physical presence of students. The COVID pandemic necessitated a shift in methods of instruction. Due to the immediate need for physical distancing measures, teaching had to switch to online media, with most institutions acquiring infrastructure to meet the cross-cutting need.

Institutions have mostly played a host role, providing infrastructure or policies to facilitate online learning. Certain institutions provide e-learning platforms as a revision aid to facilitate the discussion and sharing of knowledge or to enable in-time learning.

Winning characteristics: Optimizing the e-learning ecosystem for better outcomes

The e-learning ecosystem is not perfect in and of itself. Learning has important differences from entertainment, which is what most students are familiar with on online platforms. To ensure a result-oriented approach to online learning, students and instructors have roles to play to ensure maximal gain from e-learning interventions.

According to multiple studies, learner characteristics that are critical for successful e-learning include good digital skills, willingness to collaborate with peers, and willingness to embrace change. The role of instructors is also evolving as the media of instructions change. However, key goals include providing clear instructions to learners, selecting topics of broad interest to students, and guiding students through the learning process. Also, critical appraisal is essential in every phase of the e-learning intervention process to ensure that learning goals are met.

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