Online learning developments in undergraduate medical education in response to the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 69

Abstract

Background

The COVID-19 pandemic spurred an abrupt transition away from in-person educational activities. This systematic review investigated the pivot to online learning for nonclinical undergraduate medical education (UGME) activities and explored descriptions of educational offerings deployed, their impact, and lessons learned.

Methods

The authors systematically searched four online databases and conducted a manual electronic search of MedEdPublish up to December 21, 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias. A third author resolved discrepancies. Findings were reported in accordance with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance.

Results

Fifty-six articles were included. The majority (n = 41) described the rapid transition of existing offerings to online formats, whereas fewer (n = 15) described novel activities. The majority (n = 27) included a combination of synchronous and asynchronous components. Didactics (n = 40) and small groups (n = 26) were the most common instructional methods. Teachers largely integrated technology to replace and amplify rather than transform learning, though learner engagement was often interactive. Thematic analysis revealed unique challenges of online learning, as well as exemplary practices. The quality of study designs and reporting was modest, with underpinning theory at highest risk of bias. Virtually all studies (n = 54) assessed reaction/satisfaction, fewer than half (n = 23) assessed changes in attitudes, knowledge or skills, and none assessed behavioral, organizational or patient outcomes.

Conclusions

UGME educators successfully transitioned face-to-face instructional methods online and implemented novel solutions during the COVID-19 pandemic. Although technology’s potential to transform teaching is not yet fully realized, the use of synchronous and asynchronous formats encouraged virtual engagement, while offering flexible, self-directed learning. As we transition from emergency remote learning to a post-pandemic world, educators must underpin new developments with theory, report additional outcomes and provide details that support replication.

Keywords:

• Best evidence medical education
• remote learning
• online learning
• undergraduate medical education
• COVID-19

Acknowledgments

The authors would like to express their appreciation to Whitney Townsend for her expertise developing the search strategy and assistance running the database search. The authors would also like to express appreciation to Laura Stojan for her computer expertise.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Jennifer Stojan

Jennifer N. Stojan, MD, MHPE, is an Associate Professor of Internal Medicine and Pediatrics at the University of Michigan Medical School in Ann Arbor, Michigan, USA.

Mary Haas

Mary Haas, MD, MHPE, is Assistant Residency Program Director and Clinical Instructor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.

Satid Thammasitboon

Satid Thammasitboon, MD, MHPE, is a Director of the Center for Research, Innovation and Scholarship in Medical Education (CRIS), Co-Director of a BEME International Collaborating Centre, and Associate Professor of Pediatric Critical Care Medicine at Texas Children's Hospital, Houston, Texas, USA.

Lina Lander

Lina Lander, ScD is an Associate Professor, Family Medicine and Public Health and Associate Dean, Education Technology, Innovation and Assessment at the University of California, San Diego, School of Medicine, La Jolla, California, USA.

Sean Evans

Sean J. Evans, MD is a Clinical Professor of Neurosciences and Associate Dean for Undergraduate Medical Education at the University of California, San Diego, School of Medicine, La Jolla, California, USA.

Cameron Pawlik

Cameron Pawlik, BS, is a first-year medical student at the University of Michigan Medical School, Ann Arbor, Michigan, USA.

Teresa Pawilkowska

Teresa Pawlikowska, MB BS, PhD FRCPI, is Foundation Director of The Health Professions Education Centre (HPEC) which is also a BEME International Collaborating Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.

Madelyn Lew

Madelyn Lew, MD, is an Associate Professor of Pathology and Director of Medical School Pathology Education Curriculum at the University of Michigan Medical School in Ann Arbor, Michigan, USA.

Deena Khamees

Deena Khamees, MD, is an Assistant Professor of Emergency Medicine, McGovern Medical School, university of Texas Health Science Center, Houston, TX, USA.

William Peterson

William Peterson, MD, is a Director of Emergency Medicine Residency Preparatory Course, Assistant Clerkship Director, and an Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.

Ahmad Hider

Ahmad Hider, MPhil, is a second-year medical student at the University of Michigan Medical School, Ann Arbor, Michigan, USA.

Ciaran Grafton-Clarke

Ciaran Grafton-Clarke, MBChB, is a Clinical Education Fellow at University Hospitals of Leicester, UK, and Honorary Fellow at the University of Leicester, UK.

Hussein Uraiby

Hussein Uraiby, MBChB, PGCert, FHEA is a Specialty Trainee in Histopathology and a Clinical Education Fellow at the University Hospitals of Leicester NHS Trust.

Morris Gordon

Morris Gordon, MBChB, PHD, MMed, is Cochrane Coordinating Editor, Chair of the BEME Executive Committee, and a Professor of Evidence Synthesis and Systematic Review, University of Central Lancashire, Preston, UK.

Michelle Daniel

Michelle Daniel, MD, MHPE, is Chair of the BEME Review Committee, Associate Editor for Medical Teacher, and Vice Dean for Medical Education and Clinical Professor of Emergency Medicine at the University of California, San Diego School of Medicine, La Jolla, California, USA.