Discussion
LEVEL 2 - LEARNING
Similar to level 1 ( reaction ), there was conflicting evidence in the literature as to whether virtual medical education supported the acquisition of relevant knowledge , skills , and attitudes . Some studies found that virtual education improved student learning . To demonstrate this , Geha et al . organized a 14-day pilot virtual clerkship curriculum for medical students , resulting in advancements in internal medicine knowledge and clinical reasoning skills through social learning and cognitive apprenticeship . The authors also indicated an increase in student engagement due to engagement with peers , patients , and teachers ( Geha & Dhaliwal , 2020 ; Mian & Khan , 2020 ). They found that providing a database of cases and recordings of patient interviews increased students ' clinical reasoning skills . Soled et al . reported that the virtual medical student response teams developed and implemented by the Harvard Medical School indirectly raised student understanding and familiarity with COVID-19 ( Soled et al ., 2020 )
Other investigators reported negative effects of virtual education on learning . There was an observed decline in clinical and surgical skills that could be due to the online teaching of medical students . Investigators also reported a decrease in student engagement because of virtual teaching . Longhurst et al . stated that the lack of a mandatory attendance requirement might be the cause of the decline in student participation ( Longhurst et al ., 2020 ). Kaup et al . attributed the lower student engagement to technical difficulties and other environmental factors related to the students themselves ( Kaup et al ., 2020 ). Sahi et al . suggested that the loss of bedside teaching and direct contact with patients and clinicians could result in a loss of feedback from clinical faculty . This in turn would lead to a slower progression of the competencies of medical students ( Sahi et al ., 2020 ).
LEVEL 3 - BEHAVIOUR
Kazerooni et al . conducted a study creating a social media platform with near peer mentoring . Ten senior medical students under supervision provided advice and support to 371 junior medical students during the pandemic . 71 % of junior medical students believed the platform had a significant impact on their ability to adjust to these emergency pandemic conditions more quickly ( Rastegar Kazerooni et al ., 2020 ). Other literature has reported increased student attendance at webinars with positive feedback to web-based extracurricular lectures ( Marques da Silva , 2020 ).
Objective Structured Clinical Examination ( OSCE ) is routinely used in medical education to assess students ' clinical skills . Some researchers believed that students will be negatively affected by the lack of face-to-face instruction for history taking and physical examination techniques during clinical rotations ( Hilburg et al ., 2020 ; Servin-Rojas et al ., 2022 ). Lara et al . used a novel teleconference objective structured clinical examination ( teleOSCE ) to assess clinical skills . The authors observed that both in-person OSCE and teleOSCE are equally effective in assessing students as there was no difference in the students ' failing rate or average score ( Lara et al ., 2020 ).
LEVEL 4 AND 5 - RESULTS , ROI AND SOCIETAL IMPACT
There is no available data yet to show the impact of virtual medical education on institutional metrics related to output , quality , time , productivity , educational climate , and ROI . Furthermore , there is no data of virtual education on society as a whole .
Discussion
The global impact of COVID-19 is widespread and has required all aspects of life to adapt in the face of the challenges it caused . The world of medical education is no exception ; the COVID-19 pandemic has provided medical educators with a unique opportunity to reimagine medical education and take innovative steps to revolutionize curricula . Although virtual teaching is not new , indeed medical educators have been using e-learning or “ blended learning ” methods for at least two decades ( Graham , 2012 ; Mourad et al ., 2016 ), yet the unexpected and immediate shift to virtual education challenged both the readiness of both medical educators and students to move everything to a virtual platform .