Authors

1 Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Public Health, Centre for Global Health, Aarhus University, Aarhus, Denmark

3 Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

5 Department of Medical Education, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran

Abstract

The current outbreak of coronavirus disease 2019 (COVID‑19) across the world forced universities
to suspend learning to limit the spread of the virus. Many medical schools have shifted to online
education as an information delivery mechanism where the educator and learner are separated in
space and potentially also in time. This systematic review aims to explore and understand the variety
of distance learning strategies in medical students in the contexts of COVID‑19. A systematic review
was conducted in Web of Sciences, PubMed, Educational Resources and Information Center, and
Scopus from December 2019 to July 2020. Eight sets of terminology were used, combining “Distance
learning” AND “Medical education” AND “Pandemic.” Studies were reviewed independently by two
reviewers. Data were extracted and quality appraised using QualSyst tools, and synthesized by
performing thematic analysis. A total of 473 articles were identified after removing duplicates and
314 records were screened, of which 125 were included in this study. The primary articles were 52
primarily qualitative articles. Five learning strategies consisted of technology‑enhanced learning (TEL),
simulation‑based learning, technology‑based clinical education, mobile learning, and blended learning.
Tools, methods, and learning resources associated with these five learning strategies were extracted
from the articles. Our review highlights that TEL and simulation‑based learning were more commonly
used than others in distance learning in medical education during the COVID‑19 pandemic. These
strategies have the potential to improve learners’ level of knowledge and performance through
making online learning resources such as Massive Open Online Courses, virtual clinical cases, and
blended sources accessible.

Keywords

1. Hughes BA, Stallard J, West CC. The use of WhatsApp® as a
way to deliver Plastic Surgery Teaching during the COVID‑19
pandemic. J Plast Reconstr Aesthet Surg 2020;73: e1‑e2.
2. Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al‑Jabir A,
et al. World Health Organization declares global emergency:
A review of the 2019 novel coronavirus (COVID‑19). Int J Surg
2020;76:71‑6.
3. Spinelli A, Pellino G. COVID‑19 pandemic: Perspectives on an
unfolding crisis. Br J Surg 2020;107:785‑7.
4. Wang C, Cheng Z, Yue XG, McAleer M. Risk management
of COVID‑19 by universities in China. J Risk Financ Manag
2020;13:36.
5. Yusoff MS, Hadie SN, Mohamad I, Draman N, Muhd Al‑Aarifin I,
Wan Abdul Rahman WF, et al. Sustainable medical teaching and
learning during the COVID‑19 pandemic: Surviving the new
normal. Malays J Med Sci 2020;27:137‑42.
6. Zayabalaradjane Z. COVID‑19: Strategies for online engagement
of remote learners. Online Submission 2020;9:1‑1.
7. Siddiqui UD, Aslanian HR. The new virtual reality: Advanced
endoscopy education in the COVID‑19 Era. Dig Dis Sci
2020;65:1888‑91.
8. Longhurst GJ, Stone DM, Dulohery K, Scully D, Campbell T,
Smith CF. Strength, Weakness, Opportunity, Threat (SWOT)
analysis of the adaptations to anatomical education in the united
kingdom and republic of Ireland in response to the COVID-19
pandemic. Anat Sci Educ 2020;13:301‑11.
9. Billings DM. Distance education in nursing: 25 years and going
strong. Comput Inform Nurs 2007;25:121‑3.
10. Cook DA, Dupras DM. A practical guide to developing effective
web‑based learning. J Gen Intern Med 2004:19:698‑707.
11. Gewin V. Five tips for moving teaching online as COVID19 takes hold. Nature 2020;580:295‑6.
12. Schneider SL, Council ML. Distance learning in the era of
COVID‑19. Arch Dermatol Res 2020; 8:1–2.
13. Oliver R. Exploring strategies for online teaching and learning.
Distance Educ 1999;20:240‑54.
14. Sandhu P, de Wolf M. The impact of COVID‑19 on the
undergraduate medical curriculum. Med Educ Online
2020;25:1764740.
15. Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA
group. Preferred reporting items for systematic reviews
and meta‑analyses: The PRISMA statement. PLoS Med
2009;6:e1000097.
16. Clarke M. Overview of methods. In: Webb C, Roe B, editors.
Reviewing Research Evidence for Nursing Practice: Systematic
Reviews. Oxford: Blackwell Publishing Ltd; 2007. p. 1‑8.
17. Rodgers M, Sowden A, Petticrew M, Arai L, Roberts H, Britten N,
et al. Testing methodological guidance on the conduct of narrative
synthesis in systematic reviews. Eval 2009;15:47‑71.
18. Kmet LM, Lee RC, Cook LS. Standard Quality Assessment
Criteria for Evaluating Primary Research Papers from a Variety
of Fields. Canada; Alberta Heritage Foundation for Medical
Research (AHFMR); 2004. Available from: https://www.
biomedcentral.com/content/supplementary/1471‑2393‑14‑52
‑s2.pdf. [Last accessed on 2019 Oct 30].
19. Lee L, Packer TL, Tang SH, Girdler S. Self‑management education
programs for age‑related macular degeneration: A systematic
review. Australas J Ageing 2008;27:170‑6.
20. Maharaj S, Harding R. The needs, models of care, interventions
and outcomes of palliative care in the Caribbean: A systematic
review of the evidence. BMC Palliat Care 2016;15:9.
21. Kaup S, Jain R, Shivalli S, Pandey S, Kaup S. Sustaining academics
during COVID‑19 pandemic: The role of online teaching‑learning.
Indian J Ophthalmol 2020;68:1220‑1.
22. Mishra D, Nair AG, Gandhi RA, Gogate PJ, Mathur S,
Bhushan P, et al. The impact of COVID‑19 related lockdown
on ophthalmology training programs in India – Outcomes of a
survey. Indian J Ophthalmol 2020;68:999‑1004.
23. Kaveevivitchai C, Chuengkriankrai B, Luecha Y, Thanooruk R,
Panijpan B, Ruenwongsa P. Enhancing nursing students’ skills
in vital signs assessment by using multimedia computer‑assisted
learning with integrated content of anatomy and physiology.
Nurse Educ Today 2009;29:65‑72.
24. Zayapragassarazan Z. COVID‑19: Strategies for engaging remote
learners in medical education [version 1; not peer reviewed].
F1000Res 2020;9:273.
25. Anwar A, Seger C, Tollefson A, Diachun CA, Tanaka P, Umar S.
Medical education in the COVID‑19 era: Impact on anesthesiology
trainees. J Clin Anesth 2020;66:109949.
26. Bloom DA, Reid JR, Cassady CI. Education in the time of
COVID‑19. Pediatr Radiol 2020;50:1055‑8.
27. Chick RC, Clifton GT, Peace KM, Propper BW, Hale DF,
Alseidi AA, et al. Using technology to maintain the education
of residents during the COVID‑19 pandemic. J Surg Educ
2020;77:729‑32.
28. Agarwal S, Sabadia S, Abou‑Fayssal N, Kurzweil A, Balcer LJ,
Galetta SL. Training in neurology: Flexibility and adaptability
of a neurology training program at the epicenter of COVID‑19.
Neurology 2020;94:e2608‑14.
29. Roy SF, Cecchini MJ. Implementing a structured digital‑based
online pathology curriculum for trainees at the time of COVID‑19.
J Clin Pathol 2020;73:444.
30. Zuo L, Dillman D, Miller Juvé A. Learning at home during
COVID‑19: A multi‑institutional virtual learning collaboration.
Med Educ 2020;54:664‑5.
31. Gaba DM. The future vision of simulation in health care. Qual
Saf Health Care 2004;13 Suppl 1:i2‑10.
32. Mukhopadhyay S, Booth AL, Calkins SM, Doxtader EE, Fine SW,
Gardner JM, et al. Leveraging technology for remote learning in
the era of COVID‑19 and social distancing: Tips and resources
for pathology educators and trainees. Arch Pathol Lab Med
2020;144:1027‑36.
33. Lewis CT, Zeineddine HA, Esquenazi Y. Challenges of
neurosurgery education during the coronavirus disease
2019 (COVID‑19) pandemic: A U.S. perspective. World Neurosurg
2020;138:545‑7.
34. Chatziralli I, Ventura CV, Touhami S, Reynolds R, Nassisi M,
Weinberg T, et al. Transforming ophthalmic education into virtual
learning during COVID‑19 pandemic: A global perspective.
Eye (Lond) 2020;10:1‑8.
35. Barberio B, Massimi D, Dipace A, Zingone F, Farinati F,
Savarino EV. Medical and gastroenterological education
during the COVID‑19 outbreak. Nat Rev Gastroenterol Hepatol
2020;17:447‑9.
36. Regier DS, Smith WE, Byers HM. Medical genetics education in
the midst of the COVID-19 pandemic: Shared resources. Am J
Med Genet Part A 2020;182:1302‑8.
37. Roberts C. How medical education can help in a COVID-19 crisis.
Clin Teach 2020;17:241.
38. Roberts V, Malone K, Moore P, Russell‑Webster T, Caulfield R.
Peer teaching medical students during a pandemic. Med Educ
Online 2020;25:1772014.
39. Pather N, Blyth P, Chapman JA, Dayal MR, Flack NA, Fogg QA,
et al. Forced disruption of anatomy education in Australia and
New Zealand: An acute response to the COVID‑19 pandemic.
Anat Sci Educ 2020;13:284‑300.
40. Mousa AY, Broce M. The impact of COVID‑19 on vascular
training. J Vasc Surg 2020;72:380‑1.
41. Chong A, Kagetsu NJ, Yen A, Cooke EA. Radiology residency
preparedness and response to the COVID‑19 pandemic. Acad
Radiol 2020;27:856‑61.
42. García Vazquez A, Verde JM, Dal Mas F, Palermo M, Cobianchi L,
Marescaux J, et al. Image‑guided surgical e‑learning in the
post‑COVID‑19 pandemic Era: What is next? J Laparoendosc Adv
Surg Tech A 2020;30:993‑7.
43. Kesselman A, Lamparello NA, Malhotra A, Winokur RS, Pua BB.
Endovascular simulation as a supplemental training tool during
the COVID‑19 national emergency. Clin Imaging 2020;67:72‑3.
44. Ashokka B, Ong SY, Tay KH, Loh NH, Gee CF, Samarasekera DD.
Coordinated responses of academic medical centres to pandemics:
Sustaining medical education during COVID‑19. Med Teach
2020;42:762‑71.
45. Codispoti CD, Bandi S, Moy JN, Mahdavinia M. Running a virtual
allergy division and training program in the time of COVID‑19
pandemic. J Allergy Clin Immunol 2020;145:1357‑9.
46. Comer BT, Gupta N, Mowry SE, Malekzadeh S. Otolaryngology
education in the setting of COVID‑19: Current and future
implications. Otolaryngol Head Neck Surg 2020;163:70‑4.
47. Carvalho VO, Conceição LS, Gois MB Jr. COVID‑19 pandemic:
Beyond medical education in Brazil. J Card Surg 2020;35:1170‑1.
48. McCutcheon K, Lohan M, Traynor M, Martin D. A systematic
review evaluating the impact of online or blended learning vs.
face‑to‑face learning of clinical skills in undergraduate nurse
education. J Adv Nurs 2015;71:255‑70.
49. Almarzooq ZI, Lopes M, Kochar A. Virtual learning during
the COVID‑19 pandemic: A disruptive technology in graduate
medical education. J Am Coll Cardiol 2020;75:2635‑8.
50. Yuen JC, Gonzalez SR. Addressing the surgical training gaps
caused by the COVID‑19 pandemic: An opportunity for
implementing standards for remote surgical training. Plast
Reconstr Surg 2020;146:109e‑10.
51. Kim K, Bonk CJ, Oh E. The present and future state of blended
learning in workplace learning settings in the United States. Perf
Improv 2008;47:5‑16.
52. Kirkwood A, Price L. Technology‑enhanced learning and teaching in higher education: what is ‘enhanced’ and how do we know?
A critical literature review. Learn Media Technol 2014;39:6‑36.
53. Jha AK, Duncan BW, Bates DW. Simulator based training and
patient safety. In: Making Health Care Safer: A Critical Analysis
of Patient Safety Practices. United States; Agency for Health care,
Research and Quality. U.S. Dept of Health and Human Services.
2001: 511‑8.
54. Lateef F. Simulation‑based learning: Just like the real thing.
J Emerg Trauma Shock 2010;3:348‑52.
55. Henderson JV. Comprehensive, technology‑based clinical
education: The “virtual practicum”. Int J Psychiatry Med
1998;28:41‑79.
56. Guragai M. Nepalese medical students in the COVID‑19
pandemic: Ways forward. J Nepal Med Assoc 2020;58:352‑4.
57. El‑Hussein MO, Cronje JC. Defining mobile learning in the higher
education landscape. J Educ Technol Soc 2010;13:12‑21.
58. Plancher KD, Shanmugam JP, Petterson SC. The changing face
of orthopaedic education: Searching for the new reality after
COVID‑19. Arthrosc Sports Med Rehabil 2020;2:e295‑e298.
59. Moran J, Briscoe G, Peglow S. Current technology in advancing
medical education: Perspectives for learning and providing care.
Acad Psychiatry 2018;42:796‑9.
60. Wang FL, Fong J, Kwan R. Handbook of Research on
Hybrid Learning Models: Advanced Tools, Technologies, and
Applications. New York. Information Science Reference; 2010.
61. Kekkonen-Moneta S, Moneta GB. E‑Learning in Hong Kong:
Comparing learning outcomes in online multimedia and lecture
versions of an introductory computing course. Br J Educ Technol
2002;33:423‑33.
62. Chen CH, Mullen AJ. COVID‑19 can catalyze the modernization
of medical education. JMIR Med Educ 2020;6:e19725.
63. Wilder S. Impact of the problem‑based learning on high
school academic achievement: A systematic review. Educ Rev
2015;67:414‑35.
64. Gaba DM. The future vision of simulation in health care. Qual
Saf Health Care 2004;13 Suppl 1:i2‑10.
65. Zardosht R, Karimi Moonaghi H, Etezad Razavi M, Ahmady S.
Educational concern of surgical technology students in the
operating room: A grounded theory study. J Educ Health Promot
2020;9:58.
66. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al.
Health professionals for a new century: Transforming education
to strengthen health systems in an interdependent world. Lancet
2010;376:1923‑58.
67. Kononowicz AA, Woodham LA, Edelbring S, Stathakarou N,
Davies D, Saxena N, et al. Virtual patient simulations in health
professions education: Systematic review and meta‑analysis by
the digital health education collaboration. J Med Internet Res
2019;21:e14676.
68. Ellaway R, Masters K. AMEE Guide 32: E‑Learning in medical
education Part 1: Learning, teaching and assessment. Med Teach
2008;30:455‑73.
69. Leung GM, Johnston JM, Tin KY, Wong IO, Ho LM, Lam WW,
et al. Randomised controlled trial of clinical decision support
tools to improve learning of evidence based medicine in medical
students. BMJ 2003;327:1090.
70. Dolan B. Nine Medical Schools that Support Mobile Learning.
Mobihealthnews. Obtenido De; 2011. Available from:
http://mobihealthnews.com/12346/nine‑medical‑schoolsthat‑support‑mobile‑learning/(accessed 19 May 2015).
71. George P, Dumenco L, Doyle R, Dollase R. Incorporating
iPads into a preclinical curriculum: A pilot study. Med Teach
2013;35:226‑30.
72. Katibeh M, Sabbaghi H, Kalantarion M, Nikkhah H, Mousavi B,
Beiranvand R, et al. Eye care utilization in a community‑oriented
mobile screening programme for improving eye health in Iran:
A cluster randomized trial. Ophthalmic Epidemiol 2020;27:417‑28.
73. Mosa AS, Yoo I, Sheets L. A systematic review of healthcare
applications for smartphones. BMC Med Inform Decis Mak
2012;12:67.
74. Masters K, Ellaway RH, Topps D, Archibald D, Hogue RJ. Mobile
technologies in medical education: AMEE Guide No. 105. Med
Teach 2016;38:537‑49.
75. Mosalanejad L, Ahmady S. Implementation of blended learning
with native systems: A new model for the application of new
technology in Iranian medical education. J Educ Health Promot
2019;8:239.
76. Kaveevivitchai C, Chuengkriankrai B, Luecha Y, Thanooruk R,
Panijpan B, Ruenwongsa P. Enhancing nursing students’ skills
in vital signs assessment by using multimedia computer‑assisted
learning with integrated content of anatomy and physiology.
Nurse Educ Today 2009;29:65‑72.