An Evaluation of Virtual Learning During the COVID-19 Pandemic on Healthcare Education

Renee Mott, PharmD
PGY-1 Pharmacy Resident
Suburban Hospital – Johns Hopkins Medicine

During the COVID-19 pandemic, virtual learning quickly became the norm, however, virtual learning existed prior to March 2020. The earliest form of virtual learning was created in 1982 when a distance education program was created by The Western Behavioral Sciences Institute1. From here, availability of online courses quickly increased. In 1985, Nova Southeastern University in Florida became the first university in the United States to offer a fully online graduate program2. By 2015, the National Center for Education Statistics estimated approximately 43% of students were participating in online courses1. Technology has allowed for continued education throughout the past nearly 2 years of pandemic-life, but can virtual learning truly replace in-person learning in healthcare education?

Medical school in the United States consists of 4-years of intense training. The first two years, MS1 and MS2, are preclinical years where students attend lectures and learn the complex systems of the human body. While the COVID-19 pandemic quickly put a stop to in-person education, it is possible this was not a major disruption in learning for medical students in their preclinical years. A 2017 survey of MS2 students illustrated most students prefer to watch lectures on their own time rather than attending class at scheduled times3. While medical students in their preclinical years miss out on in-person opportunities like small group learning or labs, virtual learning is a reasonable option for these students. However, for MS3 and MS4 students in their clinical years, virtual learning significantly impacts their education. During these years’ medical students spend time in hospitals and clinics putting their knowledge and skills to use while gaining real world experience essential for learning to successfully care for patients. These experiences also help guide medical students in their decision of what specialty to pursue. It has been said “medicine is learned by the bedside and not in the classroom”4, but the COVID-19 pandemic has forced educators and medical students to quickly adapt to a virtual world.  

Analogous themes emerge when evaluating the impact of the COVID-19 pandemic on pharmacy education and nursing education. Both pharmacy and nursing students have clinical requirements as part of their programs, which require students meet a predetermined number of direct patient care hours prior to graduation. The question we must now ask is what can educators do from an instructional design perspective to enhance virtual learning during the COVID-19 pandemic?  

Many surveys and papers have emerged since the beginning of the COVID-19 pandemic which focus on the remote delivery of healthcare education3,5,6. One of the first things educators can do from an instructional design perspective when evaluating didactic education is create a virtual classroom similar to an in-person classroom3. Creating a private, quiet space to facilitate the virtual classroom is of utmost importance. Educators should lead by example, ensuring they have their camera on at an appropriate angle with an appropriate background. Encouraging or requiring students to use audio and video helps keep the class focused and engaged. 

Educators should also become comfortable with the technology available to them for use in their virtual classroom3. Platforms such as Zoom and Microsoft Teams include features like screensharing, polling, chat, and creating breakout rooms which can enhance virtual education3. Screensharing allows for students to view PowerPoint presentations in real-time similar to sitting in a large lecture hall, polling questions and chat features allow for active participation in class activities, and breakout rooms allow for small group discussion similar to “think-pair-share” exercises often utilized in healthcare education.  

Arguably the most crucial step educators can do when designing virtual learning experiences for students pursing a healthcare degree is listen to get to know their learners. A 2020 survey of pharmacy students revealed the many challenges student learners faced when suddenly shifting to a virtual learning format in Spring 20205. Students describe feeling that virtual learning was “detrimental to [their] education” for reasons including lack of quiet space to work at home, difficulties with technology including WiFi connection, and inability to work directly with other classmates to understand material5. It is also important to recognize the impact this rapid change has had on student’s mental health. If comfortable and appropriate, educators can have open discussions about this with their students. 

When designing virtual education for students pursing a degree in healthcare whom are in their clinical years of their programs, the challenges are greater. There is no way to truly replicate in-person clinical education in a virtual format, as certain aspects of patient care require physical contact. For example, a medical, pharmacy, or nursing student whom is learning to take blood pressure using a blood pressure cuff, stethoscope, and sphygmomanometer cannot possibly take the blood pressure of a patient through a computer screen. While not every aspect of clinical education is possible to achieve in a virtual format, participation in direct patient care activities has continued during the COVID-19 pandemic via methods such as telemedicine and virtual rounds3. Policies on use of these methods may differ by health system and should be addressed on a local level. 

Overall, the COVID-19 pandemic caused a rapid shift to a virtual world. Virtual learning is not ideal for students pursing a degree in healthcare nor can it fully replace in-person learning. However, there are ways to optimize virtual delivery of healthcare education and allow for students to continue progressing towards graduation. 

References: 

1. Thompson E. History of Online Education. [Internet]. 2021 May 27 [cited 29 September 2021]. Available from:  https://thebestschools.org/magazine/online-education-history/ 

2. eLearners.com. Nova Southeastern University ONline. [Internet]. [cited 29 September 2021]. Available from: https://www.elearners.com/colleges/nova-southeastern-university/ 

3. Hilburg R, Patel N, Ambruso S, Biewald MA, Farouk SS. Medical Education During the Coronavirus Disease-2019 Pandemic: Learning From a Distance. Adv Chronic Kidney Dis. 2020; 27(5): 412-417. doi: https://doi.org/10.1053/j.ackd.2020.05.017. 

4. Stanfordmedicine.edu. 10 Osler-isms to Remember in Your Daily Practice. [Internet]. 2014 November 25 [cited 29 September 2021]. Available from: https://stanfordmedicine25.stanford.edu/blog/archive/2014/10-Osler-isms-to-Remember-in-Your-Daily-Practice.html 

5. Nagy DK, Hall JJ, Charrois TL. The impact of the COVID-19 pandemic on pharmacy students' personal and professional learning. Curr Pharm Teach Learn. 2021 Oct;13(10):1312-1318. doi: 10.1016/j.cptl.2021.07.014. 

6. Jeon E, Peltonen LM, Block L, Ronquillo C, Tayaben JL, Nibber R, Pruinelli L, Perezmitre EL, Sommer J, Topaz M, Eler GJ, Shishido HY, Wardaningsih S, Sutantri S, Ali S, Alhuwail D, Abd-Alrazaq A, Akhu-Zaheya L, Lee YL, Shu SH, Lee J. Emergency Remote Learning in Nursing Education During the COVID-19 Pandemic. Stud Health Technol Inform. 2021 May 27;281:942-946. doi: 10.3233/SHTI210317.