Medical Student Learning Research Articles

Global trends and future directions in online learning for medical students during and after the COVID-19 pandemic: A bibliometric and visualization analysis.

This study explores the evolution of online learning research in the context of medical education during and following the COVID-19 pandemic. It aims to understand the principal focus areas, and trends that have emerged in this rapidly evolving landscape. A total of 2751 publications related to online learning were retrieved from the Web of Science Core Collection (WoSCC) from 2020 to 2022. Bibliometric analysis and visualization techniques were employed to comprehensively examine the landscape of online learning research. Publications, co-cited references, and keyword co-occurrence were analyzed to identify patterns and trends in research focus and collaboration networks. The significant surge in research output reveals the academic community's response to the pandemic. Various themes have emerged in online learning research, encompassing online teaching, flipped classrooms, mental health, and blended learning. The evolution trajectory of research has traversed 3 stages, reflecting a shift in research focus from immediate pandemic responses to more refined strategies and interdisciplinary perspectives. Keyword co-occurrence analysis was also conducted to show the effects of the COVID-19 pandemic on the research. The study underscores the global scholarly engagement, collaborative networks, and principal themes that have shaped the field. As medical education adapts to the shifting landscape, the trajectory of online learning research points toward increased learner autonomy, integration of advanced technologies, and interdisciplinary collaboration. This transformative shift promises to reshape medical education, equipping learners and educators with the tools needed to navigate the dynamic realm of modern healthcare education.

Flipped Classroom for Undergraduate Medical Students in India: Are we ready for it?

The teaching-learning environment has undergone a paradigm shift with the recent implementation of a Competency-Based Medical Curriculum in India. Despite this, the concept of flipped classrooms for medical students is still in its infancy in our country. We conducted an experimental randomized crossover study to find if a flipped teaching model improves learning for first-year medical undergraduate students. Students' perceptions of this novel method were also obtained and analyzed. In the first period (first part of the study), one group of students underwent the Flipped Model Teaching (Flipped Teaching Group), and the second group (Traditional Teaching Group) was taught by the conventional method. A crossover was done with a second topic in the second period. A written test was conducted at the end of each period. Student feedback was also obtained. There was no statistically significant difference in students' performance on comparing traditional and flipped teaching methods. Reasons for this could be the level of the learner, prior exposure to active learning strategies, learner readiness/motivation for active learning, and timing of the study. Out of the participants 80% of students preferred the flipped model classroom teaching, especially the interactive discussion, and expressed their desire for more frequent similar learning activities. We conclude that there was no difference in marks obtained by students in the two groups, yet they preferred the flipped classroom method, which indicates that it is feasible to adopt this method in the Indian medical undergraduate classroom.

The Impact of the COVID-19 Pandemic on Medical Education: a Systematic Review of Distance Learning, Student’s Perceptions, and Mental Health

Introduction: the COVID-19 pandemic has impacted on mortality and several adverse health outcomes. It has also affected education as schools and universities had to adapt to remote learning due to social isolation strategies. Objective: to analyze the pandemic’s impact on medical education including undergraduate and graduate students and lecturers, as follow: i) teaching methods adopted by education institutes during shutdown, ii) students and lecturers’ perceptions and iii) impacts on students’ mental health. Methods: this systematic review includes the following study designs: cross-sectional, surveys, case-control, cohort, and clinical trials. The literature search was performed in four databases: PubMed, Scopus, Embase, and SciELO . The risk of bias and the quality of the evidence were evaluated. Results: a total of 1,576 articles were identified through searching databases, and 40 articles were included. We found the use of several teaching methods such as virtual platforms and social media, pre-recorded videos, discussion forums and others. Student’s challenges related to interference during online study such as family distractions, lack of a study room, challenges with internet connectivity, difficulties in communication between students and lecturers, gaps encountered during clinical skills learning. Lecturers’ challenges were difficulty in grasping students’ progress and learning outcomes and the lack of experience in online teaching. Only five studies explored mental health issues of medical students and found the occurrence of depression, anxiety, and stress. However, their prevalence was not comparable due to the use of different diagnostic instruments. Conclusion: there has been a wide range of teaching methods implemented for distance learning of medical students globally. The perceptions of medical students about these methods and their impact were also varied. Infrastructure, family, and curriculum problems represented the greatest difficulties in adherence and satisfaction with distance learning. However, the flexibility of digital learning was one of the factors that helped reduce these problems. Regarding mental health, the occurrence of anxiety, depression, and stress was reported.

Education Research: Evaluating Medical Student Learning Preference and Its Relationship to Clerkship Satisfaction.

The Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges' commitment to competency-based medical education (CBME) has shifted the medical education landscape. Education methods conducive to CBME are learner-centered and give educators the opportunity to develop a more personalized approach to curricular development and delivery. By understanding learning preferences, educators are better positioned to respond to the changing needs of students. The Learning Preference Inventory (LPI) is a validated tool that assesses preferences across 3 domains: (1) content delivery (concrete vs abstract), (2) instruction (teacher-centered vs student-centered), and (3) learning structure (individual vs interpersonal). Using the LPI, our objective was to describe the learning preferences of medical students in the Neurology clerkship and to evaluate how preferences correlate with satisfaction with curricular elements. A cohort of second-year through fourth-year medical students rotating through the required Neurology clerkship at a single institution was identified. All students completed the LPI and a survey to assess satisfaction with curricular elements, including an in-person localization session, virtual simulation, and a summative case study. Five hundred thirty medical students were included. Preference for concrete content delivery was much more common than abstract (83% vs 17%); otherwise students were evenly divided in their preferences for teacher-centered vs learner-centered instruction and interpersonal vs individual learning structure. There was a significant difference in LPI responses across medical school years: More third-year and fourth-year students preferred individual learning structure compared with second-year students (p = 0.040). Learning preferences also correlated with course satisfaction survey responses. Student satisfaction with the course activities was overall positive, with 69% of students agreeing that the course enhanced their learning. Abstract learners were significantly more likely to report that the virtual simulation enhanced their learning than concrete learners (p = 0.018). Neurology clerkship students demonstrated clear learning preferences that were associated with satisfaction with specific curricular content. There were significant differences in learning preferences across medical school years, suggesting that learning preferences may shift throughout training and may be influenced by clinical exposure. In an educational environment that cultivates the success of all learners, the LPI provides important data to inform curricular development and achieve personalized medical education.

Communities of practice: A theoretical framework for undergraduate longitudinal placements.

There has been a global shift towards longitudinal placements in undergraduate medicine, which are believed to play an important role in supporting medical student learning and professional identity formation. A better understanding of how learning occurs on such placements is needed, and community of practice (CoP), a social learning theory, has been proposed to form their pedagogical foundations. However, empirical research exploring learning through CoPs on longitudinal placements is limited. Case study methodology triangulating data from interviews, written reflections and routine evaluations was undertaken to explore how second-year students on an undergraduate longitudinal General Practice placement participated within CoPs and the factors enabling this participation. Routine evaluation data were available for 57% (n239) of students and in-depth interviews were carried out with five students and three tutors across eight placements. Themes identified through inductive thematic analysis were (i) participation within CoPs, (ii) enablers of legitimate peripheral participation and (iii) socialising agents. Student legitimate peripheral participation was greatly facilitated by making contributions to patient care, a welcoming clinical environment, access to the informal spaces and repertoires of the practice and effective brokerage of educational activities by tutors. CoP is a theory that allows us to make tangible the somewhat abstract when deepening our understanding of how students learn on longitudinal placements. The extent to which students become legitimate peripheral participants varies, and this theoretical framework allows us to consider the factors that can enable such participation, with implications for how educators design curricula and placement infrastructure.

What Do Medical Students Learn about Community Care from Discussions with General Physicians? A Thematic Analysis.

Background and Objectives: Sustainable healthcare is fundamentally rooted in community medicine education. The COVID-19 pandemic disrupted global advancement in integrating traditional teaching and experiential learning. Additionally, an alarming decline in interest in community care has been observed among senior medical students. Here, we examined the perspectives on community care obtained from conversations with general physicians in rural medical universities. Materials and Methods: Using a constructivist lens, a qualitative methodology was employed to examine the perceptions of second-year medical students from Shimane University Medical School regarding community care, informed by dialogues with general physicians. We conducted a thematic analysis at Shimane University, Japan, an area known for its aging population. In 2023, 116 second-year students participated, none of whom had prior formal training in community care. The study was structured into three phases: (1) Pre-education: Students wrote essays about their initial understanding of community care, its advantages, disadvantages, and potential improvements; (2) Dialogue: Grouped by topic, students engaged in discussions that culminated in a comprehensive session with general physicians; and (3) Reflection: After discussions, students wrote essays reflecting any shift in their views on community care. A thematic analysis of essays from the pre-education and reflection phases provided a comparative perspective on the students' understanding. Results: Five dominant themes emerged from the thematic analysis: (1) Re-evaluating community care: Recognizing diversity and addressing societal challenges; (2) Interdisciplinary collaboration: Promoting shared roles and teamwork; (3) Learning and practice: Emphasizing hands-on experience and self-reflection; (4) Technological influence: The mutual relationship between community care and technological advancements; and (5) Challenges and resolutions: Identifying problems and crafting solutions. Conclusions: This study sheds light on the evolution of medical students' views on community care and underscores the importance of continuous adaptation in medical education programs.

Practical tips for teaching the undifferentiated medical student in the emergency department.

Emergency medicine clerkships have become more prevalent in the third year of medical school, a time when students are immersed in the core clinical training of their undergraduate medical education. There is little guidance for clinician educators, however, on how to effectively scaffold learning for third-year medical students when rotating in the emergency department (ED) during core clerkships. The authors sought to provide best practices in teaching to leverage the rich learning environment of the ED - regardless of their specialty selections. Based on an extensive review of the literature spanning on-shift teaching, feedback, clinical medicine, and bedside teaching, the following twelve tips are offered to guide the instruction of the undifferentiated third-year medical student in the ED.

Online case-based learning for medical students as a teaching method for biochemistry at King Abdulaziz University amid COVID-19 pandemic (a study conducted in 2021).

Online case-based learning (CBL) is a method used by King Abdulaziz University to teach medical students in their preclinical years. The use of CBL in basic sciences is important for enabling medical students to correlate basic sciences with future clinical practice. This study implemented online CBL for biochemistry teaching as part of the medical genetic module for 3rd-year preclinical students. Teaching during the study was completely online because of restricted precautions caused by the COVID-19 pandemic, except for practical sessions that were held on campus. The case was presented to the students involved in prenatal screening and diagnosis. Students were guided to learn and discuss the biochemical tests used for prenatal screening and diagnosis and their clinical importance. They were divided into two groups: the control group was given an online lecture and the intervention group was given an online CBL session before the lecture. The online lecture was given to both groups simultaneously by the same instructor, and then 10 MCQs tests were distributed to both groups after the lecture, and their test scores were compared. A 10-question survey was administered to the intervention group to assess their perception of the online CBL session after the test. A significant difference was found between the intervention and control groups regarding test scores (p < 0.001), and most students found the online CBL session enjoyable and motivating.

The influence of a digital clinical reasoning test on medical student learning behavior during clinical clerkships

Recently, a new digital clinical reasoning test (DCRT) was developed to evaluate students’ clinical-reasoning skills. Although an assessment tool may be soundly constructed, it may still prove inadequate in practice by failing to function as intended. Therefore, more insight is needed into the effects of the DCRT in practice. Individual semi-structured interviews and template analysis were used to collect and process qualitative data. The template, based on the interview guide, contained six themes: (1) DCRT itself, (2) test debriefing, (3) reflection, (4) practice/workplace, (5) DCRT versus practice and (6) ‘other’. Thirteen students were interviewed. The DCRT encourages students to engage more in formal education, self-study and workplace learning during their clerkships, particularly for those who received insufficient results. Although the faculty emphasizes the different purposes of the DCRT (assessment of/as/for learning), most students perceive the DCRT as an assessment of learning. This affects their motivation and the role they assign to it in their learning process. Although students appreciate the debriefing and reflection report for improvement, they struggle to fill the identified knowledge gaps due to the timing of receiving their results. Some students are supported by the DCRT in exhibiting lifelong learning behavior. This study has identified several ways in which the DCRT influences students’ learning practices in a way that can benefit their clinical-reasoning skills. Additionally, it stresses the importance of ensuring the alignment of theoretical principles with real-world practice, both in the development and utilization of assessment tools and their content. Further research is needed to investigate the long-term impact of the DCRT on young physicians’ working practice.

Medical Student Learning Experience With Attending or Resident Preceptors in the Emergency Department.

Objectives The emergency department (ED) provides a unique learning environment for medical students. However, environment, patient, and preceptor factors limit standardized teaching. We explored the most effective educational interactions for fourth-year medical students during an emergency medicine (EM) clerkship designed to allow clinical interaction with both residents and faculty. Methods This is an exploratory, prospective, needs assessment study of objective cards and surveys submitted by medical students as part of their month-long fourth-year clinical rotation at a tertiary care academic ED. Students marked which topics or procedures they had reviewed, and who had precepted them. In an exit survey, students were asked to rate how often they received individualized teaching and whether their educational goals were met when working with residents and attendings. Qualitative and quantitative data were collected anonymously with institutional review board (IRB) exemption. Results Shift card data was collected from 69 of the rotating students. Attendings tended to precept visual diagnostics while residents tended to teach technical procedures. Forty-four students completed the exit survey. Results showed that students felt they received individualized teaching from both attendings and residents (7.9 and 8.0 respectively, p = 0.059). Students felt their goals were met more when reporting to the residents than the attendings but not significantly so (8.6 and 8.0, respectively, p = 0.088). Additional themes were that students wanted more individualized experiences with the attendings and requested more dedicated teaching shifts. Conclusions Fourth-year medical students in the ED felt they received individualized teaching on most shifts. They reported their education goals were met as often when working with residents as with attendings; however, interactions feature different educational content. Clerkship curricula design would benefit from resident and attending-directed teaching experiences to optimize the educational experience in the ED.

The Implementation of Simulation-Based Learning for Training Undergraduate Medical Students in Essential Surgical Care Across Sub-Saharan Africa: a Scoping Review.

Much surgery in sub-Saharan Africa is provided by non-specialists who lack postgraduate surgical training. These can benefit from simulation-based learning (SBL) for essential surgery. Whilst SBL in high-income contexts, and for training surgical specialists, has been explored, SBL for surgical training during undergraduate medical education needs to be better defined. From 26 studies, we identify gaps in application of simulation to African undergraduate surgical education, including lack of published SBL for most (65%) World Bank-defined essential operations. Most SBL is recent (2017-2021), unsustained, occurs in Eastern Africa (78%), and can be enriched by improving content, participant spread, and collaborations.

How self-regulated learning influences undergraduate medical students to conduct student-centred learning: a scoping review protocol

IntroductionSelf-regulated learning is one of the influencing factors in successful learning. There is a need to understand the factors influencing self-regulated learning in undergraduate medical students in implementing a student-centred...

Motivation as an integral factor in English language learning for medical students

Motivation as an integral factor in English language learning for medical students

Learning and clinical reasoning experience of second-year medical pharmacology students and teachers with virtual patients developed using OpenLabyrinth

&lt;b&gt;Objective: &lt;/b&gt;To determine the perceived usefulness of a virtual case scenario developed and delivered through the OpenLabyrinth platform among medical students and teachers.&lt;br /&gt; &lt;b&gt;Methods: &lt;/b&gt;20 second-year medical students and 12 teachers of pharmacology were invited to complete a virtual case scenario exercise. The participants accessed the case scenario using their laptops or mobile devices. Participants’ feedback was obtained using the electronic virtual patient consortium-developed questionnaire.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;19 students and 12 teachers provided feedback. All the faculty members and 95% of students felt that they had to make the same decisions a doctor would have to make in real life; ‘authenticity of patient encounter’ received the highest percentage of positive responses and ‘the learning effect’ the least.&lt;br /&gt; &lt;b&gt;Conclusions: &lt;/b&gt;The feedback obtained suggests that virtual case scenarios are likely to be well received by students and teachers. The availability of open-source software enables the use of this technology in resource-limited settings.

Bridging Anatomy, Histology, and Pathology: A Novel Curriculum Component Incorporating Self-directed Learning for First-Year Medical Students.

During cadaveric dissection or prosection, medical students frequently encounter pathology that can be a springboard to further learning. We designed a novel educational activity linking anatomy, histology, and pathology that incorporated self-directed learning and teamwork, followed by feedback and instruction from pathologists. Post-activity, more than 97% of students rated the activity as useful (Likert scale of 1 to 5), indicating this activity should be continued in the future. Strengths included self-directed learning, content and design, and teamwork, peer, and faculty interactions. Clarity of assignment expectations, range of pathologies, and virtual presentation format remained areas for improvement.

The Impact of Online vs Blended Clinical Skill Laboratory Learning on Student Academic Performance: A Case Study in Indonesia

ObjectiveOnline and blended learning methods have experienced rapid growth in higher education due to the COVID-19 pandemic. Our study aimed to compare students’ academic performance between online and blended Clinical Skill Laboratories (CSL) learning in undergraduate medical students. MethodsA total of 101 undergraduate medical students at Maulana Malik Ibrahim State Islamic University, Malang, Indonesia, were enrolled (50 students from the academic year 2020 [group 1: online CSL]; 51 students from the academic year 2020 [group 2: blended CSL]). The main outcome was students’ academic performance collected from the Objective Structured Clinical Examination (OSCE) score. Additionally, students also completed an evaluation questionnaire to assess the quality of the learning scheme. ResultsBoth groups agreed that CSL is an important subject and clinical video demonstration is useful for their OSCE preparation. However, students who received online learning felt that online CSL was ineffective and scored lower in the OSCE compared to the blended CSL. Qualitative data also supported these findings. ConclusionBlended learning provides more value than online learning in terms of teaching clinical skills for undergraduate medical students. Additionally, online CSL may not be sufficient for medical students to attain critical skills.

2 Medical student learning in the operating room: Through the lens of the surgical teacher

Abstract Aims and Objectives The aims were to deduce surgeons' experiences and challenges of teaching medical students in the operating room and solutions to overcome them. The objectives to achieve this was using pre-existing published and grey literature relating to surgeons' experiences teaching medical students in the operating room. Methods A systematised literature review based on a comprehensive search strategy, including quality assessment, was conducted. Two databases, MEDLINE and EMBASE, were searched since inception until March 2022. Grey literature was searched for in The Royal College of Surgeons in Ireland (RCSI) bulletin, as they publish relevant manuscripts related to surgical education. Title and abstract review was performed by two reviewers on 220 papers. The identified studies were then assessed against the eligibility criteria. Results A total of 8 papers were included in this review. Following the analysis of the literature, the commonalities captured were categorised into themes for thematic analysis. Themes included student preparation and organisational aspects, attitudes towards active participation of learner, student learning priorities, undergraduate curricula awareness and learning objectives, educational environment of the operating room and teaching techniques and engagement in the operating room. Conclusion Numerous commonalities were captured in the literature, replicable in multiple countries, highlighting the need for a standardised undergraduate surgical curriculum. Many of the challenges of teaching identified by surgeons are modifiable, therefore more initiatives need to be in place to extract the educational potential in the operating room.

FTP4.5 ANKI digital flashcards: an effective tool for undergraduate musculoskeletal revision

Abstract Introduction ANKI is a programme that allows users to produce digital flashcards consisting of text, pictures and/or videos. It is based on the principle of active recall and spaced repetition creating an effective revision tool. This study investigated the benefits of ANKI digital flashcards used by 2nd year medical students when revising their musculoskeletal (MSK) module. Method A prospective study of 121 2nd year medical students at the Anglia Ruskin University. Learning objectives were stated at the start of each MSK lecture. Each student created ANKI flashcards for the learning objective assigned to them. These flashcards were combined to create a crowdsourced complete MSK deck available to the entire cohort. Anonymised student feedback was obtained at the beginning and end of the module. Results The mean value of a Likert scoring system (1least – 5most) from both surveys was used. Pre-assignment questions assessing students’ familiarity and aspiration towards ANKI: Use cards as part of revision =3.24; Comfort with IT systems=3.82; Familiar with ANKI system=4.04, Interest in using ANKI =3.88. Post assignment questions to assess the outcome success: Would you use ANKI for revision =4.55, Use ANKI in other modules =3.95. Free text responses included praise towards communal effort, manageable workload and creation of a revision resource. Conclusion ANKI provided an additional useful digital resource learning and revision for medical students. The cards created by students, for students, provided autonomy. However, this effected the quality of some slides. Overall, the feedback was positive with this assignment expanded to other modules.

Workshop for Basic Gynaecological Examinations: Improving Medical Student Learning through Clinical Simulation.

This study was designed to evaluate whether the Workshop on Basic Principles for Clinical Gynaecological Exploration, offered to medical students, improves theoretical-practical knowledge, safety, confidence, global satisfaction and the achievement of the proposed objectives in the area of gynaecological clinical examinations. This was a quasi-experimental pre-post-learning study carried out at the Gynaecology and Obstetrics department of Gregorio Marañón Hospital in Madrid (Spain). The volunteer participants were 4th-year students earning a degree in Medicine during the 2020-2021 and 2021-2022 academic years. The study period was divided into the following stages: pre-workshop, intra-workshop and 2 weeks post-workshop. In the pre-workshop stage, students completed a brief online course to prepare for the workshop. The effectiveness of the workshop was evaluated through multiple-choice tests and self-administered questionnaires to assess self-assurance, self-confidence, self-satisfaction and the achievement of the objectives. Of the 277 students invited in both academic years, 256 attended the workshop (92.4%), with a total participation in the different stages of the study greater than 70%. A total of 82.5% of the students in the 2020-2021 academic year and 80.6% of students in the 2021-2022 academic year did not have any type of experience performing gynaecological clinical examinations. Between the pre-workshop and 2 weeks post-workshop stages, there was significant improvement in theoretical-practical knowledge (improvement mean = 1.38 and 1.21 in 2020-2021 and 2021-2022 academic years, respectively). The security and confidence of the students prior to the workshop were low (average scores less than 5 points) in both academic years. However, post-workshop scores for satisfaction and the achievement of objectives were high in the two academic years; all the values approached or exceeded 8 points. Our students, after outstanding participation, evaluated the BPCGE, and improved their theoretical and practical knowledge, as well as their skills in a gynaecological clinical examination. Moreover, in their view, after the workshop, they felt very satisfied, far outreaching the proposed aims. In addition, excellent results were maintained over time, year after year.

Social learning and integration factors that affect first-year medical students transitioning directly from high school

Medical student's transition from high school to a new educational environment poses academic and personal challenges that could lead to withdrawal, dismissal or failure. Students who do not feel connected to the social and academic life of the educational environment are at risk of drop-out. Hence, most medical education institutions use remediation programmes to address learning gaps and increase the chances of student success. This study aimed to identify factors that affected the social learning and integration of undergraduate medical students who had failed the first year of study. The nominal group technique (NGT) was used involving 15 participants who had completed a six-month remediation programme. Results revealed the top five ranked and themed social learning and integration factors were underpreparedness, self-management, alienation, confidence and academic advice. Self-awareness and self-management were identified as complementary skills to address these factors. The study found that students could make valuable contributions to address challenges in the educational environment and enhance successful transition. In addition to other studies recommending a focus on academic integration, these results also pointed to the importance of social integration of first-year students as they transition from high school to a new educational environment at university.