In this survey study, we evaluated Polish medical students’ perception of online learning during the COVID–19 pandemic.
Ease of access to educational materials and the ability to choose the time and place to study were shown as the strongest advantages of online learning among respondents in our survey. Remote access is of particular importance during the COVID–19 pandemic, but it can also reduce the cost of accommodation and transportation in other settings[13,14]. E-learning enables learning materials to be quickly delivered to students, standardized, and if needed, updated[15]. Content can be delivered to students using two different approaches: self-directed and instructor-led learning. Self-directed e-learning allows the learner to manage his activity independently. Recent findings by Peine et al. showed that self-directed e-learning can outperform traditional face-to-face learning[16].
E-learning is not without its disadvantages. The main problem for respondents in our survey, especially those in their 4th to 6th year of study, was lack of interaction with patients. Learning from real patients in a clinical setting is crucial for medical education and it cannot be fully replaced with distance learning[17]. To some extent, a solution to this issue could be the use of virtual patients (VPs). VPs are designed to simulate real-life clinical scenarios and they enable the learner to prepare him/herself before a real patient encounter[18].
Surprisingly, over 60% of the respondents in our survey had never experienced any form of e-learning before the COVID–19 pandemic, which might be the reason why technical issues were the second major disadvantage of e-learning in this study. E-learning requires a reliable internet connection and the necessary hardware and software[19,20]. Both students and teachers must be familiar with the equipment and they should receive technical support and guidance from the IT department before and during an online course. Self-learning requires the student to maintain self-discipline, which can be difficult without direct supervision from the teacher. Poor interaction between learners and facilitators, and a lack of clarity of the purpose and goals of the learning can impede the learning process[21,22]. Stacey and Gerbic advocated that students’ maturity might increase their degree of self-discipline[23], which is consistent with findings in our study.
Our study group assessed that e-learning enabled them to increase their knowledge to the same extent as traditional learning. However, in their opinion, e-learning is definitely less effective in terms of increasing their clinical and social skills. E-learning to teach clinical skills is most effective when combined with traditional classes. Instead of using text-based materials, video instruction seems to be superior in teaching practical skills[24] and it fits with Peyton’s four-step skill acquisition approach[25]. In this model, the teacher conducts a silent demonstration, then he repeats the procedure, this time describing all necessary sub-steps (deconstruction). Following this, the student has to explain each sub-step while the teacher follows the student’s instructions (comprehension). The last step is performance, where the student performs the complete skill while he or she describes it.
An interesting solution for improving social skills is the use of remote standardized patients (RSPs), who communicate with students via the internet. RSPs can not only portray a specific clinical situation, but they also assess the learner and provide real-time feedback. Langenau et al. studied the use of RSPs and Skype and their effects on residents’ social skills. In their study, 90% of participants agreed that this format was effective in teaching communication skills[26].
We found it interesting that respondents assessed that they were less active during e-learning than during traditional classes. One of the reasons could be the lack of an interactive approach when developing e-learning courses. Only 4% of the respondents chose class interactivity as an advantage of e-learning during the COVID–19 pandemic. E-learning methods that are less interactive are viewed less favorably[27]. There are different ways to boost the interactivity of online learning. One new and promising method is gamification, in which “game design elements are used in non-game contexts”[28]. In a systematic review conducted by Hamari et al., gamification has been proven to be effective in many fields, especially in education[29]. A different approach could be social and collaborative learning. This technique allows students to socially interact with each other as well as instructors. They can work together to share ideas and expand their knowledge in an open forum. In a study by Bergl et al., the majority of residents assessed that Twitter enhanced their education [30]. Another technique worth mentioning is branching scenarios, in which students get the opportunity to test their skills in a practical setting. This form of learning requires the learner to make a decision and then present the consequences. Each decision produces new challenges and more choices. This technique is associated with higher learning outcomes, mostly regarding increasing knowledge and clinical reasoning [31].