Utilizing Advanced Technologies for eLearning in Clerkship

Medical education in the U.S. can be divided into two distinct phases: pre-clerkship and clerkship education. Pre-clerkship involves conventional classroom learning, where students interact with instructors, engage with content, and undergo assessments. Clerkship education, however, entails hands-on clinical training, wherein students are placed in hospital settings to engage with real cases and patients under the guidance of physician mentors. Clerkship students reach a critical juncture in their medical journey, shifting from theoretical classrooms to practical clinical environments [1]. Teaching hands-on skills is challenging in fields like medicine and engineering. As students seek more diverse learning options, faculty need to offer additional online alternatives. However, the challenge lies in the fact that many faculty members are not aware of the available technologies or how to use them effectively. Therefore, we turned our attention to medical clerkships to explore what insights we could gain.

To address these obstacles, the integration of eLearning in clerkship education emerges as a potent solution. eLearning offers simulated scenarios and virtual patient cases to refine students' skills [2]. Moreover, eLearning acts as a conduit, granting clerkship students remote access to learning materials and online mentorship, effectively bridging knowledge gaps and honing proficiencies [3]. By embracing eLearning within clerkship education, medical educators can equip students for imminent clinical practice, ultimately enhancing patient care quality.

EdTech in Clerkship Education

Amidst the COVID-19 pandemic, the adoption of eLearning by clerkship instructors has surged through the incorporation of various educational technologies (EdTech) such as virtual patients, simulators, video-conferencing tools, and mobile apps [4]. These technological interventions hold immense potential, enriching clerkship learning through versatile avenues, remote access to vital resources, and personalized guidance. Robust eLearning experiences are created by integration of appropriate EdTech. But what EdTech are clerkship educators using? An inventory of the technology tools used in clerkship education today can guide other clinical educators who want to expand their use of EdTech or start using EdTech in their teaching practice. 

To gain insight into the current state of EdTech adoption within clerkship education, we conducted a comprehensive review of empirical studies with a specific focus on EdTech published from 2020 to 2023. Our search was carried out in January 2023, encompassing the Medline, Embase, and Web of Science databases, with a focus on English-language, peer-reviewed empirical studies. We employed a range of keywords including “educational technology,” “computing methodologies,” “simulation training,” and “education, distance” to identify relevant research. Our inclusion criteria were limited to studies conducted in clerkship settings involving medical students, while studies related to dental, nursing, post-graduate education (e.g., residency and fellowship), and those primarily centered on curriculum redesign were deliberately excluded. Additionally, our review specifically targeted studies that emphasized individual EdTech tools and solutions. 

EdTech Tools in Use

A broad spectrum of EdTech tools was used by clerkship educators (see Table 1). Cutting-edge virtual reality technologies like Oculus Rift [5]and Revinax Video ​​[6], virtual patients [7], and the Holoeyes XR/VR headset [8] were used to create immersive learning experiences and surgical simulators. Learning platforms such as Psy-Q [9] and Virtual Resus Room [10], and video-conferencing tools like Google Meet [11] and Zoom [12], boosted educational access. Mobile technology included hardware tools such as iPads [13] and eClinic Cards [14]. Gamification was utilized as an active learning strategy through EdTech, such as virtual escape boxes and serious games. GoPro cameras were utilized for live streaming [15]. The integration of technology-enhanced accessibility, interactive learning, precise assessment, and administrative efficiency.

Table 1. EdTech in Use

Advantages of EdTech in Clerkship Education

The incorporation of EdTech into clerkship education offers diverse advantages. One significant benefit is the heightened realism and authenticity achievable through advanced technologies like virtual reality (VR) [16]. Medical students can engage in immersive illness scenarios, gaining a first-person perspective that enhances their visualization and understanding of clinical situations. Real-time feedback mechanisms in VR training further refine clinical skills, bridging the gap between theory and practice. EdTech also facilitates remote learning and accessibility, overcoming geographical constraints and fostering self-paced education. Remote video conferencing enables active participation and expert guidance, transcending physical boundaries [17]. Moreover, integrating technology drives cost-effectiveness and efficiency, streamlining training sessions and reducing the time required for instruction [18]. Simulator-based training minimizes harm to real patients while fostering an error-forgiving environment for skill development [19]. These multifaceted advantages position EdTech as a pivotal tool in reshaping medical education and cultivating competent healthcare professionals. Please refer to Table 2 for details. 

Table 2. Advantages of EdTech

Challenges with EdTech in Clerkship Education

Challenges in EdTech adoption encompass unequal technology availability, limited interaction fidelity, and clear guideline establishment. For example, the cost of VR technology is a barrier to large-scale adoption [20]. Furthermore, VR technologies are not sufficiently developed yet to provide complete interaction fidelity. Feedback quality and assessment logistics also suffer since guidelines and best practices have yet to be developed [6]. Tactile learning, cognitive load, and diverse learning styles raise concerns [21]. In synthesizing, technical issues and real-world application hurdles emerge. Please see Table 3 for details.

Table 3. Challenges of EdTech

Benefits of Incorporating EdTech in Clerkship Education

In the analysis of 35 reviewed studies, it becomes evident that the incorporation of EdTech into clerkship education yields impressive results, particularly exemplified through the implementation of remote VR training. This approach surpasses conventional methods, demonstrating heightened engagement, perceived knowledge acquisition, and learner contentment. Moreover, it substantially improves self-assessment of clinical performance and equips students for real-world clinical environments. The influence of EdTech is discernible in usage trends, with students displaying a preference for virtual platforms and mobile learning applications. Active engagement with VR corresponds positively to enhanced examination performance, improved understanding of medical concepts, and more effective interpretation of medical imagery. This technology also bolsters clinical proficiency and fosters confidence, especially in intricate procedures like microsurgery, accompanied by the transferability of virtual consultation skills. The seamless integration of EdTech augments user-friendliness and engagement, mirroring the efficacy of traditional bedside teaching. Furthermore, the acceptance of mobile technology for workplace-based assessments underscores the adaptability and versatility of EdTech. Overall, EdTech is profoundly reshaping medical education, delivering dynamic and effective learning experiences. For a comprehensive overview of the outcomes of incorporating EdTech into clerkship education, refer to Table 4.

Table 4. Outcomes

Conclusion

In the recent past, there has been a notable surge in the adoption of EdTech in medical education, a trend that has been further accelerated by the onset of the COVID-19 pandemic. The integration of EdTech has resulted in favorable educational outcomes, as evidenced by learners expressing contentment, active participation, and generally favorable experiences. These improved learning results can be attributed to several factors, including interactive elements, heightened engagement, the availability of remote learning opportunities, and personalized instructional approaches. While it remains crucial to address obstacles and apprehensions linked to the use of EdTech, it is clear that most clinical educators acknowledge the positive influence of incorporating technological tools into students' learning journey.

References

Further Reading

About the Authors

Eulho Jung, Ph.D., serves as an assistant professor of medicine at the Uniformed Services University of the Health Sciences, a federal military medical school located in Bethesda, MD. His research primarily focuses on instructional design, technology, and their applications in the field of medical education. Additionally, he explores the realms of e-learning and emerging technologies across various disciplines, with a particular emphasis on developing personalized learning systems. Dr. Jung obtained his doctoral degree from Indiana University Bloomington, where he conducted extensive research for his dissertation on expertise development. His study delved into the utilization of theories from human cognition and learning science to advance the understanding of this subject.

Anita Samuel, Ph.D., is the Editor-in Chief of elearn Magazine. She is Assistant Dean for Graduate Education and Associate Professor at the School of Medicine and Associate Director of Distance Learning at the Center for Health Professions Education, Uniformed Services University of Health Sciences, Maryland. Her areas of expertise are online learning, educational technology, and adult education. Dr. Samuel’s research focuses on continuing professional development and workplace training for healthcare professionals. She publishes articles at the intersection of medical education, adult education, and online learning. She explores online learning spaces as effective training environments for professionals. She has won the 2022 USU School of Medicine Impact Award for her work in facilitating distance education and the 2019 USU Education Day award for using videos in online courses to create presence for learners.