Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic – A BEME systematic review: BEME Guide No. 71

Abstract

Background

Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face ‘classroom’ activities for postgraduate learners.

Methods

Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned.

Results

Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher’s use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment.

Conclusions

This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.

Keywords:

• Best evidence medical education
• remote learning
• online learning
• postgraduate medical education
• COVID-19

Acknowledgments

The authors express their gratitude to librarian, Whitney Townsend, for her expertise developing the search strategy and assistance running the database search.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Deena Khamees

Deena Khamees, MD, is an Assistant Professor of Emergency Medicine, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA.

William Peterson

William Peterson, MD, is a Director of Emergency Medicine Residency Preparatory Course, Assistant Clerkship Director, and an Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.

Madalena Patricio

Madalena Patricio, PhD, is Past-President of the Association for Medical Education in Europe (AMEE), Chair of BEME, and Honorary Professor at the Department of Medical Education at the Faculty of Medicine, University of Lisbon, Portugal.

Teresa Pawlikowska

Teresa Pawlikowska, MB BS, PhD FRCPI, is Foundation Director of The Health Professions Education Centre (HPEC) which is also a BEME International Collaborating Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.

Carolyn Commissaris

Carolyn Commissaris, MD, is a Clinical Lecturer and Assistant Program Director of Emergency Medicine at the University of Michigan Medical School in Ann Arbor, Michigan, USA.

Andrea Austin

Andrea Austin, MD, is an Associate Physician Diplomate at the University of California, San Diego School of Medicine, La Jolla, California, USA.

Mallory Davis

Mallory Davis, MD is an Emergency Medicine resident at Michigan Medicine, Ann Arbor, Michigan, USA.

Maxwell Spadafore

Maxwell Spadafore, MD is an Emergency Medicine resident at Michigan Medicine, Ann Arbor, Michigan, USA.

Max Griffith

Max Griffith, MD, is an Emergency Medicine resident at Michigan Medicine, Ann Arbor, Michigan, USA.

Ahmad Hider

Ahmad Hider, MPhil, is a second-year medical student at the University of Michigan Medical School, Ann Arbor, Michigan, USA.

Cameron Pawlik

Cameron Pawlik, BS, is a first-year medical student at the University of Michigan Medical School, Ann Arbor, Michigan, USA.

Jennifer Stojan

Jennifer N. Stojan, MD, MHPE, is an Associate Professor of Internal Medicine and Pediatrics at the University of Michigan Medical School in Ann Arbor, Michigan, USA.

Ciaran Grafton-Clarke

Ciaran Grafton-Clarke, MBChB, is a Clinical Education Fellow at University Hospitals of Leicester, UK, and Honorary Fellow at the University of Leicester, UK.

Hussein Uraiby

Hussein Uraiby, MBChB, PGCert, FHEA, is a Specialty Trainee in Histopathology and a Clinical Education Fellow at the University Hospitals of Leicester NHS Trust, UK.

Satid Thammasitboon

Satid Thammasitboon, MD, MHPE, is a Director of the Center for Research, Innovation and Scholarship in Medical Education (CRIS), Co-Director of a BEME International Collaborating Centre, and Associate Professor of Pediatric Critical Care Medicine at Texas Children's Hospital, Houston, Texas, USA.

Morris Gordon

Morris Gordon, MBChB, PHD, MMed, is Cochrane Coordinating Editor, Chair of the BEME Executive Committee, and a Professor of Evidence Synthesis and Systematic Review, University of Central Lancashire, Preston, UK.

Michelle Daniel

Michelle Daniel, MD, MHPE, is Chair of the BEME Review Committee, Associate Editor for Medical Teacher, and Vice Dean for Medical Education and Clinical Professor of Emergency Medicine at the University of California, San Diego School of Medicine, La Jolla, California, USA.