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Utilizing Advanced Technologies for eLearning in Clerkship

By Eulho Jung, Anita Samuel / March 2024

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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

Type of technology

Name of technology


Virtual Reality (VR)

Oculus Rift

Young et al. (2021)

Revinax video

Ros et al. (2020)

Virtual Patient

De Ponti et al. (2020)

Holoeyes XR + VR headset

Imai et al. (2022)

Body Interact™

De Ponti et al. (2020)

Curated presentation of operative footage

Stairs et al. (2021)

Interactive 360-degree VR walkthrough

Tsang et al. (2022)


Google Meet

Okada et al. (2022)

MS Teams

Booth et al. (2022)


Manriquez et al. (2022)

Live Streaming

GoPro camera

Koh et al. (2020)

C-MAC video laryngoscope

Koh et al. (2020)

Xperteye smart glasses

Feeley et al. (2022)


A virtual escape box

Cantwell et al. (2022)

Physician avatars in simulations

Torda (2020)

Learning Platform


Torous et al. (2020)

Learning Moment (LM)

Chu et al. (2020)

Virtual Resus Room

Foohey (2022)

Mobile Technology


Folger et al. (2021)

eClinic Card

Duggan et al. (2021)

A mobile app that substitutes for checkerboards

Guadalajara (2021)



Coffey et al. (2020)

Other Technologies

Simulated electronic health records, virtual medical interviews, surgical simulator

Oliven (2021)

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


Illustrative Data and Reference

Realism and Authenticity

· Greater opportunity for realism in illness scenarios (Zackoff et al., 2020)

· Real-time feedback in virtual reality training (Young et al., 2021)

· Overcoming decreased exposure to operating environment (Stairs et al., 2021)

· Providing an experience close to reality (Ros et al., 2020)

· First-person view for superior visualization (Feeley et al., 2022)

Remote Learning and Accessibility

· Remote clerkships and learning platforms (Tsang et al., 2022)

· Self-paced learning and accessibility (Kasai et al., 2021)

· Access to remote platforms for exploration and individual learning styles (Coffey et al., 2020)

· Remote videoconferencing for active learning (Coffey et al., 2020)

Cost and Efficiency

· Cost-effectiveness of incorporating virtual reality into lectures (Mason et al., 2022)

· Efficiency and time-saving in training sessions (Foohey et al., 2022)

· Lower staff time and inhibition threshold compared to small-group teaching (Hadvani et al., 2021)

· Prevention of harm and discomfort to patients through simulator-based training (Koh et al., 2020)

Feedback and Assessment

· Objective assessment in virtual reality training (Zackoff et al., 2020)

· Better feedback and assessment through technology (Seagrave et al., 2022)

· Improved identification of small details (Koh et al., 2020)

· Immediate and objective feedback in simulator-based training (Duggan et al., 2021)

Collaboration and Sharing

· Co-creation of learning platforms by educators and learners (Torous et al., 2020)

· Sharing best teaching materials and resources (Torda et al., 2020)

· Introducing programs to prospective applicants (Mason et al., 2022)

Gamification and Engagement

· Gamification in medical education for teaching concrete topics and abstract skills (Cantwell et al., 2022)

· Engaging learners through interactive and immersive experiences Ros et al., 2020)

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


Illustrative Data and Reference


· VR availability at different institutions (Zackoff et al., 2020)

· Limitations and challenges in establishing clear guidelines for VR use (Ros et al., 2020)

Feedback and Evaluation

· Challenges in collaborative question writing and educator feedback (Torous, 2020)

· Lack of feedback and transparency in virtual training (Guadalajara et al., 2021)

· Limitations of assessment tools and validation (Krawiec et al., 2020)

Hands-On Experience and Clinical Practice

· Lack of hands-on experience and clinical practice in virtual clerkships (Mason et al., 2022)

· Limitations in teaching physical examination and interpersonal communication skills (Chao et al., 2023)

· Mismatch in users' ability to apply devices and hesitancy to use devices in front of patients/teachers (Folger et al., 2021)

Cognitive Load and Learning Preferences

· Differences in cognitive load between different VR formats (Chao et al., 2023)

· Learning preferences and accommodation of specific learning styles (Coffey et al., 2020)

Cost and Time

· Costs, skills needed to use software, and time required for setup (Feeley et al., 2022)

· Short training intervals and high attrition rates (Deuchler et al., 2022)

· Technical issues with online user interface (DePonti et al., 2020)

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


Illustrative Data and Reference

Effectiveness and Satisfaction

· Effectiveness of remote VR training compared to other teaching methods (Young et al., 2021)

· High engagement, self-perceived knowledge gains, and satisfaction with VR modules (Seagrave et al., 2022)

· Improvement in self-evaluation of clinical performance and preparation for clinical settings (Kasai et al., 2021)

Utilization and Usage Patterns

· Usage patterns of devices and locations to access virtual platforms (Duggan et al., 2021)

· Utilization and quality assessment of virtual platforms and questions (Torous et al., 2020)

· Acceptance and feasibility of mobile learning applications (Folger et al., 2021)

Learning Outcomes and Performance

· Improvement in performance on final exams and assessment scores through engagement with VR (Krawiec et al., 2020)

· Improved understanding of medical concepts, interpretation of images, and interest in specific areas (Imai et al., 2022)

· Improvement in clinical skills, suturing skills, and consultation skills (Feeley et al., 2022)

Confidence and Preparedness

· Increased confidence in microsurgical skills and preparation for surgical fields (Deuchler et al., 2022)

· Improvement in confidence and transferability of virtual consultation skills (Booth et al., 2022)

Usability and Engagement

· Perceived usability and engagement with virtual platforms (Chu et al., 2020)

· Engagement, involvement, and learning in bedside teaching compared to virtual teaching (Feeley et al., 2022)

· Usability and acceptance of mobile technology for workplace-based assessments (Duggan et al., 2021)


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.


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Further Reading

Booth, E., McFetridge, K., Ferguson, E., and Paton, C. Teaching undergraduate medical students virtual consultation skills: a mixed-methods interventional before-and-after study. BMJ Open 12, 6 (2022), e055235

Cantwell, C., Saadat, S., Sakaria, S., Wiechmann, W., and Sudario, G. Escape box and puzzle design as educational methods for engagement and satisfaction of medical student learners in emergency medicine: survey study. BMC Medical Education 22, 1 (2022), 518 

Chu, A., Biancarelli, D., Drainoni, M. L., Liu, J. H., Schneider, J. I., Sullivan, R., and Sheng, A. Y. Usability of learning moment: Features of an e-learning tool that maximize adoption by students. Western Journal of Emergency Medicine 21, 1 (2020), 78

Coffey, C. S., MacDonald, B. V., Shahrvini, B., Baxter, S. L., and Lander, L. Student perspectives on remote medical education in clinical core clerkships during the COVID-19 pandemic. Medical Science Educator 30 (2020), 1577–1584.

De Ponti, R., Marazzato, J., Maresca, A. M., Rovera, F., Carcano, G., and Ferrario, M. M. Pre-graduation medical training including virtual reality during COVID-19 pandemic: A report on students’ perception. BMC Medical Education 20 (2020), 1–7.

Deuchler, S., Scholtz, J., Ackermann, H., Seitz, B., and Koch, F. Implementation of microsurgery simulation in an ophthalmology clerkship in Germany: a prospective, exploratory study. BMC Medical Education 22, 1 (2022), 1–8.

Feeley, A., Feeley, I., Healy, E., Sheehan, E., and Hehir, D. J. Acquisition of surgical skills in medical students via telementoring: A randomized controlled trial. Journal of Surgical Research 270 (2022), 471–476.

Guadalajara, H., et al. Towards an open medical school without checkerboards during the COVID-19 pandemic: How to flexibly self-manage general surgery practices in hospitals? Healthcare 9, 6 (2021).

Hadvani, T. et al. (2021). Effectiveness of modalities to teach evidence based medicine to pediatric clerkship students: a randomized controlled trial. Academic Pediatrics, 21(2), 375–383.

Kasai, H., et al. Alternative approaches for clinical clerkship during the COVID-19 pandemic: online simulated clinical practice for inpatients and outpatients—A mixed method. BMC Medical Education 21 (2021), 1–13.

Mason, M. W. and Aruma, J. F. C. An orthopaedic virtual clinical clerkship for visiting medical students: early successes and future implications. Journal of Surgical Education 79, 2 (2022), 535–542.

Ogur, B., Hirsh, D., Krupat, E., and Bor, D. The Harvard Medical School-Cambridge integrated clerkship: An innovative model of clinical education. Academic Medicine 82, 4 (2007), 397–404.

Oliven, A., Nave, R., and Baruch, A. Long experience with a web-based, interactive, conversational virtual patient case simulation for medical students’ evaluation: comparison with oral examination. Medical Education Online 26, 1 (2021), 1946896.

Seagrave, M. P., Foster-Johnson, L., Waits, J. B., Margo, K., and Leong, S. L. Enhancing examination success: The cumulative benefits of self-assessment questions and virtual patient cases. Medical Science Educator 32, 5 (2022), 985–993.

Stairs, J., Amir, B., and Vair, B. The “virtual OR:” Creation of a surgical video-based gynaecologic surgery teaching session to improve medical student orientation and supplement surgical learning during COVID-19. Canadian Medical Education Journal 12, 4 (2021), 149–151.

Torda, A. CLASSIE teaching–using virtual reality to incorporate medical ethics into clinical decision making. BMC Medical Education 20 (2020), 1–8.

Tsang, H. C., Truong, J., Morse, R. J., Hasan, R. A., and Lieberman, J. A. The transfusion service laboratory in virtual reality. Transfusion 62, 3 (2022), 713–715.

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.

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