Teaching and Learning in Medicine

An International Journal

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/htlm20

Changing Medical Education, Overnight: The

Curricular Response to COVID-19 of Nine Medical
Schools

Andrew P. Binks, Renée J. LeClair, Joanne M. Willey, Judith M. Brenner, James

D. Pickering, Jesse S. Moore, Kathryn N. Huggett, Kathleen M. Everling, John
A. Arnott, Colleen M. Croniger, Christa H. Zehle, N. Kevin Kranea & Richard
M. Schwartzstein

To cite this article: Andrew P. Binks, Renée J. LeClair, Joanne M. Willey, Judith M. Brenner,
James D. Pickering, Jesse S. Moore, Kathryn N. Huggett, Kathleen M. Everling, John A. Arnott,
Colleen M. Croniger, Christa H. Zehle, N. Kevin Kranea & Richard M. Schwartzstein (2021):
Changing Medical Education, Overnight: The Curricular Response to COVID-19 of Nine Medical
Schools, Teaching and Learning in Medicine, DOI: 10.1080/10401334.2021.1891543

To link to this article: https://doi.org/10.1080/10401334.2021.1891543

© 2021 The Author(s). Published with Published online: 11 Mar 2021.

license by Taylor & Francis Group, LLC.

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Teaching and Learning in Medicine
https://doi.org/10.1080/10401334.2021.1891543

OBSERVATIONS

Changing Medical Education, Overnight: The Curricular Response

to COVID-19 of Nine Medical Schools
Andrew P. Binksa , Renée J. LeClaira, Joanne M. Willeyb, Judith M. Brennerb , James D.
Pickeringc , Jesse S. Moored, Kathryn N. Huggette, Kathleen M. Everlingf, John A. Arnottg,
Colleen M. Cronigerh, Christa H. Zehle, N. Kevin Kranea and Richard M. Schwartzstein
a
Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virgina, USA; bDepartment of Science
Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; cDivision of Anatomical
Education, School of Medicine, University of Leeds, Leeds, UK; dDepartment of Surgery, Larner College of Medicine, University
of Vermont, Burlington, Vermont, USA; eDepartment of Medicine, Larner College of Medicine, University of Vermont, Burlington,
Vermont, USA; fOffice of Educational Development, School of Medicine at University of Texas Medical Branch, Galveston, Texas, USA;
g
Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA; hDepartment of
Nutrition, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; iDepartment of Pediatrics, Larner College
of Medicine, University, of Vermont, Burlington, Vermont, USA; jDepartment of Medicine, Tulane University School of Medicine,
New Orleans, Louisiana, USA; kDepartment of Medicine, Harvard Medical School, Boston, Massachusetts, USA

ABSTRACT KEYWORDS
Issue: Calls to change medical education have been frequent, persistent, and generally limited Online education; undergraduate
to alterations in content or structural re-organization. Self-imposed barriers have prevented medical education; COVID-19
adoption of more radical pedagogical approaches, so recent predictions of the ‘inevitability’
of medical education transitioning to online delivery seemed unlikely. Then in March 2020
the COVID-19 pandemic forced medical schools to overcome established barriers overnight
and make the most rapid curricular shift in medical education’s history. We share the collated
reports of nine medical schools and postulate how recent responses may influence future
medical education. Evidence: While extraneous pandemic-related factors make it impossible
to scientifically distinguish the impact of the curricular changes, some themes emerged. The
rapid transition to online delivery was made possible by all schools having learning management
systems and key electronic resources already blended into their curricula; we were closer to
online delivery than anticipated. Student engagement with online delivery varied with different
pedagogies used and the importance of social learning and interaction along with autonomy
in learning were apparent. These are factors known to enhance online learning, and the
student-centered modalities (e.g. problem-based learning) that included them appeared to be
more engaging. Assumptions that the new online environment would be easily adopted and
embraced by ‘technophilic’ students did not always hold true. Achieving true distance medical
education will take longer than this ‘overnight’ response, but adhering to best practices for
online education may open a new realm of possibilities. Implications: While this experience
did not confirm that online medical education is really ‘inevitable,’ it revealed that it is possible.
Thoughtfully blending more online components into a medical curriculum will allow us to
take advantage of this environment’s strengths such as efficiency and the ability to support
asynchronous and autonomous learning that engage and foster intrinsic learning in our
students. While maintaining aspects of social interaction, online learning could enhance
pre-clinical medical education by allowing integration and collaboration among classes of
medical students, other health professionals, and even between medical schools. What remains
to be seen is whether COVID-19 provided the experience, vision and courage for medical
education to change, or whether the old barriers will rise again when the pandemic is over.

Introduction medical education continue to be numerous, per-

In 1988, Bloom noted that despite all the changes in sistent,2–5 and mostly unanswered as barriers to change
medical practice over the previous half-century, med- limit progress.2,6 But a sudden, radical shift in medical
ical education had changed little, referring to “a his- education occurred in March 2020 when COVID-19
tory of reform without change.” 1 Calls for change in caused dramatic increases in hospitalizations and

CONTACT Andrew P. Binks [email protected] Department of Basic Science Education, Virginia Tech Carilion School of Medicine, 1 Riverside Circle,
Roanoke, VA 24016, USA.
© 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ((http://creativecommons.org/
licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not
altered, transformed, or built upon in any way.
2 A. P. BINKS ET AL.

deaths across the globe. As a result of the pandemic, authors for collective editing and approval at the
every educational institution began to consider how beginning of June. The findings are therefore limited
best to ensure the safety of their community and 90% to academic year, 2019-2020.
of US medical schools abruptly halted on-campus
teaching and removed medical students from clinical
care. 7 Medical education, however, could not be Themes in curricular responses
paused as the students left campus, even though the
We have focused our discussion on the pre-clinical
pandemic affected every aspect of medical education
components of medical education for two reasons.
from Medical College Admission Test administration
Firstly, the prospect of significant changes in basic
to graduation requirements and residency programs.8–13
science teaching in medical education is a current
Medical educators across the country were challenged
and controversial topic of conversation;15 the pan-
with common goals: keep the curriculum going, keep
demic response could offer insight into the impacts
the students on track, and keep them safe.14 Responses
of such changes. Secondly, post-COVID clinical cur-
to the disruption brought about by COVID-19 gave
ricula seem unlikely to shift away from the clerkship
rise to innovation in many aspects of medical
model as 1) all schools had difficulty replacing
education.
in-person clinical rotations; and 2) the AAMC reversed
In April 2020, a group of nine schools from the
its initial recommendation to withdraw medical stu-
U.S. and U.K. shared reports on their curricular
dents from the clinical environment16 because of their
responses to the cessation of on-campus classes, deter-
importance to the future of the profession.
mined common themes, highlighted differences and
assessed potential consequences, some anticipated and
some unexpected. The reports showed how each The shift to remote delivery: Not easy, but quick
school made monumental shifts in curricular delivery
at a pace never previously seen in medical education. Unsurprisingly, the need to immediately avoid
We report these findings here and speculate on the in-person contact resulted in all schools transitioning
ramifications for post-COVID-19 medical education. to remote delivery of their curricula. What was sur-
Although numerous COVID-related educational arti- prising was the speed with which this was achieved.
cles have been published since the outbreak, we Urgency and necessity overwhelmed barriers to med-
believe this is the first collective report to discuss ical curricular change that had held since P.C.
how the pandemic revealed some of the educational Anderson described them fifty years ago17 (i.e., exces-
priorities of today’s medical students and envision sive traditionalism, faculty resistance and division,
how these revelations might springboard medical edu- lack of leadership). More specifically, obstacles that
cation into real change. had supposedly prevented medical education from
moving online, such as time constraints, poor tech-
nical skills, lack of institutional support, and negative
attitudes 18 were overcome in a matter of days.
The schools
Just prior to the pandemic, Ezekiel Emanual fore-
The nine schools, with particular attention to their casted that pre-clinical education was ‘inevitably’ going
class size and curricular structure, are described in to transition online by 2025.15 His prediction had a
Table 1. All schools had a significant active-learning mixed reception, but the incredibly quick conversion
component to their pre-clerkship curriculum. The to a new form of delivery was made possible by an
main distinguishing feature between the schools was already established reliance on online learning man-
class size, ranging from 42 to 280 per class. The agement systems and the movement to flipped class-
schools were invited to participate at the end of room instruction, which resulted in the creation of
March, 2020 as a sample of convenience through pro- on-line study/preparatory material;19 these key online
fessional connections and with the help of the then elements were already blended into their curricula.
president of the International Association of Medical Even though several commercial vendors offered free
Science Educators (IAMSE; see acknowledgements). access to their medical education resources, all nine
Representatives from each school (the authors) schools already had their own content and resources
reported details of their immediate curricular response and used them instead. This material included record-
to campus closures in a standard format. The initial ings of previous lectures, voice-over-PowerPoints or
reports were collated and a thematic analysis was videos formerly used as preparatory or supplementary
performed. A summary report was distributed to all material, or new material that was rapidly generated
 Teaching and Learning in Medicine 3

Table 1. Nine schools shared reports of their curricular responses to the COVID-19 pandemic and consequent
cessation of on-campus activities.
School Location Class Size Sector Primary Teaching Modality
Virginia Tech Carilion School of Medicine VA, USA 42 Public PBL
Zucker School of Medicine at Hofstra/Northwell NY, USA 100 Private PBL
Geisinger Commonwealth School of Medicine PA, USA 107 Private CBL & LIC
Larner College of Medicine, University of Vermont VT, USA 124 Public PBL, TBL, CBL
Harvard Medical School MA, USA 165 Private CBCL
Case Western Reserve University School of Medicine OH, USA 184 Private PBL
Tulane University School of Medicine LA, USA 190 Private Active Lecture
University of Texas Medical Branch School of Medicine TX, USA 230 Public PBL
School of Medicine, University of Leeds United Kingdom 240-280 Public Active Lecture
Relevant details of each school are shown. PBL, Problem Based Learning; CBL, Case Based Learning; Longitudinal Integrated
Curriculum; TBL, Team Based learning; CBCL, Case Based Collaborative Learning.

for the move to virtual delivery. Re-purposing these connection to other learners and educators. Improving
resources allowed most basic science curricula to stay a sense of connection might not have a significant
on schedule, either by replacing planned class time impact on performance of highly motivated learners,
with these resources, or by maintaining the resources but it may positively impact their satisfaction.
as preparatory materials for online facilitated learning
sessions. All schools transitioned active small-group
teaching to video-conferencing forums and collabo- Interaction and autonomy
rative virtual workspaces in which students interacted Factors that promote engagement, social presence, and
with each other and faculty.20 autonomy in an online environment have been well
described for online learning27 but are only recently
coming into the consciousness of medical educators
Delivery modalities and student engagement
due to this shift to remote learning.28 Research has
Engagement in the new virtual learning process was demonstrated that online education is most successful
mixed, with some schools finding students appearing and engaging when learners have 1) some autonomy;
less engaged online than with the pre-COVID 2) there is a specified purpose to an activity; and 3)
on-campus format. With reflection, some online deliv- there is interaction with peers or educators.27 Therefore,
ery methods and elements appeared to promote stu- it should come as no surprise that curricular elements
dent engagement better than others. such as Problem-Based Learning (PBL) and other
forms of active small-group learning that retained these
characteristics were more successful when moved online.
‘Live’ not ‘previously recorded’
To stimulate interaction, the optimal “classroom”
The remote delivery of either ‘live’ or ‘previously size for e-learning is about 16 students, 29 which is
recorded’ classes varied across the nine schools. The much closer to the small group sizes used by our
two forms of delivery are equally effective learning schools (4-17 students). When University of Texas
paradigms21–23 but students at two schools (Virginia Medical Branch and Case Western Reserve gave
Tech Carilion and Case Western Reserve) requested more autonomy to students for managing and run-
‘live’ online lectures within a few days of receiving ning online PBL sessions, the engagement was
‘previously recorded’ online classes. Given the trend reportedly higher than in previous on-campus ses-
of poor class attendance in pre-COVID on-campus sions. Second, the impact of social presence was
classes24 this request was surprising but nonetheless illustrated by the higher level of engagement in
granted. Should we have been surprised? Although small-group online sessions where student-student
reportedly effective, a recorded online delivery is less and student-educator interaction was intrinsic to the
engaging than an on-campus class,22 and it may be educational format. The form of interaction and
that the lack of an ‘in-person’ component and social duration of sessions also affected engagement; Larner
connection also reduces online engagement; one of the College of Medicine (University of Vermont) stu-
major factors for medical students to attend on-campus dents were more engaged when their cameras were
classes is for social learning and interaction with expected to be on and sessions were limited to less
peers.25 Level of engagement and personal connection than 1.5 hours. Longer sessions or having to attend
can be improved by implementing facets of online multiple sessions of video-conferences per day is
social presence26 that influence a learner’s sense of more tiring than the same schedule experienced in
4 A. P. BINKS ET AL.

person.30,31 The similarities and differences in what of Medicine, and Leeds University School of Medicine
was achieved in the pandemic-instigated rush to are consequently now considering financial and tech-
online learning and what is practiced in established nical support to ensure all students can use quality
e-learning are worth considering and using as the internet access. While some students relied on campus
foundation for future planning. access for internet, others needed to be on campus to
have a quiet space for learning that was not available
in their home environment. Another possible stressor
Similarities and differences to online was the ‘intrusion’ of classmates and faculty ‘virtually’
education walking into the student’s private physical space during
Having been recently and appropriately described video-conferencing and gaining insights into their per-
as being performed under the “tyranny of the sonal lives and socioeconomic situation.37,38
urgent,” 32 the COVID-19 transition online is
unlikely to be representative of a permanent,
Delivery
planned, and purposefully designed online
pre-clinical curriculum. Optimal online learning One of the cardinal rules of distance education is,
design is not achievable in only a few days and is ‘Do not take what you do in the classroom and
dependent on faculty development, appropriate expect the same outcomes.’27 Despite this warning,
resources, and delivery methods that are explicitly that is largely what many programs did. All of our
focused on online learning and purposefully orga- schools already had produced much of the content
nized and accessible. 33 Therefore, the decision to that could be remotely distributed, but neglected the
integrate online learning into medical education need to adapt how content was made available and
should involve a well-devised plan that considers used to enhance learning.39 Established use of learn-
curricular structure and required resources as well ing management systems (LMS) made content dis-
as content development, management, and tribution easier; however, most programs do not use
standardization. 34 the LMS to its fullest extent and likely relied upon
it primarily as a filing system vs. a delivery platform.
Programs continued to focus on delivering the same
Faculty development content, instead of focusing on achieving the same
outcome, potentially increasing the extraneous cog-
At the onset of campus closures, faculty development
nitive learning load.40 Better use of new internally
was rapidly implemented and occurred despite fac-
developed resources or commercial material pur-
ulty having numerous additional responsibilities nec-
posefully designed for online delivery may have been
essary to establishing an online curriculum. Faculty
warranted.
development initially involved ensuring competency
with the associated technology, which is normally
secondary to establishing understanding of issues of Students’ adaptation
quality and student learning online.35 The nuanced
differences between planning online and face-to-face While the material, educational goals, and delivery
sessions are numerous, and lack of appreciation of were often the same, the environment was unfamiliar.
these issues can negatively impact the learning envi- One of the key elements to student success and sat-
ronment. Since the onset of the pandemic, faculty isfaction in online education is student preparedness
development has been ongoing and establishing skills and awareness of expectations.27 Students generally
to teach online may positively affect educators’ lacked preparation for this transition and without
face-to-face teaching and be a catalyst for change in preparing and coaching the students about the new
the classroom.36 environment, we may also have increased their anx-
iety regarding expectations. Coupled with this chal-
lenge, our expectation was that the ‘technophilic’
generation of students would have the necessary
Resources
technical savvy to be as engaged online as during
The transition to the online environment also illus- on-campus sessions. These assumptions may have
trated a disparity in access to high-speed internet at been misplaced as the online transition and intro-
home. Special arrangements had to be made for some duction of unfamiliar software caused challenges for
students, and Harvard Medical School, Larner College some students.41
 Teaching and Learning in Medicine 5

Issues and responses specific to the COVID- Modifications had to be made to assessment
19 pandemic structures that confound the interpretation of the
impact of curricular changes on student perfor-
While the pandemic presented the stimulus to tran-
mance. The eight U.S. schools had little choice other
sition online, it also presented many confounding
than to maintain their assessment schedule in order
factors to assess the transition’s impact. Extraneous
for students to progress. This resulted in significant
pandemic-related factors not only affected students
changes in the form, sources, and delivery of exam
and faculty, but also the content delivered and how
questions. To avoid students traveling, exams were
it was assessed. These extraneous factors thereby made
mostly delivered remotely and sometimes unproc-
comparative data scarce and a more scientifically rig-
tored. The form of assessment in some cases had
orous interpretation impossible at this time.
to be modified for remote delivery. At some schools,
Students’ performance, engagement, and motivation
exams and assessment were a focus of student anx-
were all likely to be affected by their environment.
iety so some assessment was converted to formative
Some students were alone for weeks as their educa-
or students were allowed to take exams multiple
tional environment changed rapidly and radically from
times. Conversely, remote delivery of exams at
the familiar, while outside a global pandemic grew
Larner College of Medicine was well received by
larger and closer. Beyond the threat of infection, the
students as it decreased stress and improved auton-
uncertainty of when rotations would be completed,
omy by allowing them to identify a comfortable
whether board exams would be rescheduled or can-
location to take the exam. Unrestricted by USMLE
celed, and changes in graduation requirements and
timelines, the University of Leeds School of Medicine
ceremonies only heightened emotions. Confinement
in the U.K. was able to delay first-year assessments
to the home and social isolation blurred the life/work
until the second-year. These changes make it impos-
divide, and morale of some students started to decline.
sible to interpret the impact of online education on
Students’ use of supportive services at Virginia Tech
student performance, however they do afford us a
Carilion was estimated to have risen by 30% during
glimpse of what opportunities that could lie ahead.
the first online course. The pandemic reinforced the
educational maxim that basic human needs should be
addressed before academic needs (aka “Maslow before
Bloom”42) Effective education also included concerns The opportunities
for the emotional needs of students and the impact The transition online has been implemented at all
of the pandemic on learning. While communication levels of education and has been heralded as an
was increased with town hall meetings, briefings from opportunity to make permanent changes to K-12 and
frontline physicians (Zucker School of Medicine), and undergraduate education.44,45 Likewise, it has pre-
online social events (Geisinger Commonwealth School sented medical education with many insights and
of Medicine and Harvard Medical School), small-group possibilities. The blending of more online learning
learning sessions offered an opportunity for students into medical curriculum should not be seen as the
to talk to faculty informally and for faculty to gauge phasing out of our roles as educators, but rather a
the wellbeing of individual students. change in our role. Nor should online learning be
Some students reported their inability to join the considered a lowering of educational standards or an
workforce as qualified physicians and fight COVID-19 inevitable slide toward a homogenous, standard med-
as a point of frustration. Instead, students became ical education. Instead, increasing online learning in
trained COVID-19 contact tracers, secured personal medical education could be viewed as playing to the
protective equipment, and engaged in the surrounding strengths of the modern medical student and be an
community. This effort was formalized and expanded opportunity to increase inclusion and open new doors
in Zucker School of Medicine’s innovative service of innovation.
learning curriculum focused on practical action to
address the pandemic surrounding the school. Harvard
Medical School students designed a COVID-19 cur-
Changing role of medical educators
riculum that has been used in countries around the
world. Students at Larner College of Medicine created When the pandemic is over, what will be the moti-
The Medical Student COVID-19 Action Network web- vation for faculty to maintain or develop the new
site43 to collect and share volunteer opportunities for paradigm we find ourselves in today and not go
medical students across the U.S. ‘back-to-normal’? Before the pandemic, our
6 A. P. BINKS ET AL.

traditional roles as transmitters of information46 was only model.27 Other approaches with high levels of
effectively being transferred to extra-curricular innovation, variation, and product (post-Fordist
resources and our classrooms were emptying. 24 The approaches) can be adopted that are decentralized.
pandemic has allowed us to experience new roles Post-Fordism would maintain the role of the faculty
as educator coaches, facilitators, and role models. 46 member as a skilled curriculum developer (along with
This transition of roles was not considered by the other roles described above)46 while assuring the
Emanual’s forecast that we might be replaced by heterogeneity and branding of each medical school.
online resources.15 Instead, these new roles will be There may also be concerns that incorporation of
a major component of the predicted shift in medical more online learning is juxta-posed to the transition
education away from information transmission and from teacher- to student-centered medical education.
toward facilitated, active learning 19 with a new At its inception, online learning was video-based and
emphasis on educational research; a paradigm shift mimicked the lecture-based environment. This was
that has been completed in Vermont’s lecture-free also the case for many of the resources we used in
curriculum. the pandemic response, such as voice-over-Power-
Our recent experience has shown that adding true Points; students listened and took notes. The internet
online learning to curricula will require substantial and online resources negate this original TV-style
faculty development in instructional design, running approach and student-centered elements can and
online sessions, and generation of specific online should be incorporated53 (given more time for faculty
resources aligned and tailored to curricular compo- and resource development). Use of these elements
nents.47 Development of these resources is a critical and along with the capacity for asynchronous deliv-
component of a blended curriculum and can be a ery and student autonomy gives the online learning
substantial amount of work. However, development environment the potential to be the pinnacle of
of materials can be given tangible credit as publishing student-centered education.
these resources in peer-reviewed repositories (e.g.
MedEdPortal) can be considered scholarship and Meeting the modern medical student online
allow us to fulfill our faculty role as a scholar;46
submitting such publications have been incorporated Above, we described students’ responses to the
into the faculty development program at Virginia pandemic-related changes we made, including mixed
Tech Carilion. engagement and coping with technical hurdles and
Our role as ‘assessor’46 will also be challenged. Our insufficient resources. Inclusion of online learning
developed resources will have to help medical students should therefore ensure students have sufficient inter-
learn numerous highly complex concepts and our net connectivity, technical savvy, and understanding
assessment of their learning must be authentic, deter- of online learning. Nevertheless, we should also dove-
mining the depth and contextual transfer of knowl- tail this work with a growing understanding of how
edge, problem-solving abilities, and adaptive today’s medical student interacts with the content,
expertise.48–50 Developing this authenticity will go their peers, and the educator.
beyond simple text-based measures of ability51 and The efficiency of learning is important to medical
will challenge us to match innovations in our online students given the volume of material they must cover.
educating with creativity in our assessment. Facing Online learning provides that efficiency54 and is a fac-
this challenge scientifically will be another opportunity tor that draws students to external electronic resources
for scholarship. and interactions outside the lecture hall. Familiar mate-
rial within electronic resources can be skipped and
unfamiliar material can be repeated, whereas a
Educational heterogeneity and unique medical 50-minute lecture has to be experienced at a pedestrian
school experiences pace of 1x speed. External resources can be improved
upon by providing in-house resources that are
There may be concerns that increasing the online peer-reviewed, better aligned with learning objectives
components might result in an ‘industrial’ approach52 and assessment and still allow efficient use of time.
to medical education with a centralized, single mode Interactivity with peers and educators appeared to
of delivery. This Fordist approach to online learning be an important component to our students’ engage-
(akin to Ford’s production lines producing a single ment. The impact of peer-peer learning is well estab-
model of car via single method) is by no means the lished and it can be adapted to the online environment
 Teaching and Learning in Medicine 7

with development of interactive skills;55 likewise inter- online in the context of telemedicine. Asynchronous
action with educators remains an important contrib- clinical electives in pathology and radiology (neither
utor to learning online.56 The importance of interaction requiring patient contact) were generated and helped
and social learning are elements that were not con- students fulfill graduation requirements. While neces-
sidered in Emanual’s forecast but we suggest they are sity was the mother of these inventions, maintaining
essential to generate the experience that the modern this momentum and perpetuating this progress
medical student seeks. depends solely on us.
Student autonomy, perhaps the greatest asset of
online learning, is also a major element of
student-centered learning and it promotes intrinsic Summary
motivation. 57 We saw a glimpse of this when stu-
dents at two schools became more engaged when The changes that were implemented in March 2020
given more choice in how they ran their PBL provided glimpses into how medical curriculum and
groups. Moving away from the prescribed schedule the role of medical educators might evolve over the
and allowing some degree of choice would allow rest of the 21st century. While the pandemic-related
students to relate their learning to personal values data will be too noisy to make scientific, robust deci-
and goals and leverage their established skills. sions, the insights we have gained should give us
While medical students have a set educational des- confidence and motivation to try novel learning meth-
tination, they maybe more engaged and intrinsically ods and approach them scientifically.
motivated 58 if they can determine (to some extent) The importance of social interaction and social
how they reach it. A goal of blending more online learning in medical education makes Emanuel’s proph-
learning should therefore to be to introduce more ecy unlikely. Although online ‘lecture-style’ videos
autonomy, while ensuring students meet expected might students help pass board exams, it seems
outcomes and are not demotivated by too many unlikely to us that students will be satisfied, effectively
choices. 59 engaged and able to achieve deep learning with these
sources alone. Our brick-and-mortar lecture halls were
already empty. Integrating more active, online learning
New doors of innovation can help us harness its strengths of efficiency and
student autonomy to promote engagement and intrin-
As we consider introducing more online learning into sic motivation to learn in our students. If we blend
our curriculum it is worth considering the innovations more online learning into our curricula, we must
could be made when freed from the constraints of appreciate that our roles as educators are not dimin-
time and physical space. Online learning’s ability to ished, but they are different and faculty might embrace
allow asynchronous learning and assessment would these new roles to engage and inspire curiosity in our
let students leverage previously honed skills and spend students.
more time on unfamiliar material.
With constraints on room sizes and locations
removed, online learning can enhance collaborative
learning, allowing different classes to learn together Acknowledgements
in the same virtual space and engage in near-peer The authors wish to thank Jennifer Hallam of Leeds
learning/teaching; not only could content be vertically University School of Medicine for compiling the data
integrated, but the students could be as well. The and report from her institution. We would also like to
thank Richard Vari (President of IAMSE) and William
logistics of interprofessional education might also be
Jeffries (Geisinger Commonwealth School of Medicine)
simplified if students from different health professions for supporting this project and helping put this team
could meet online. It would also allow us to group together.
medical students together by their interests, not just
within their school, as collaborative or shared courses
could be established. ORCID
Our recent movement toward online education
also gave us opportunity to think about new content Andrew P. Binks http://orcid.org/0000-0002-6469-0798
Judith M. Brenner http://orcid.org/0000-0002-8697-5401
priorities. During the pandemic, apropos courses on James D. Pickering http://orcid.org/0000-0002-0494-6712
the history of pandemics and telemedicine were Richard M. Schwartzstein http://orcid.org/0000-0002-
developed and clinical interview skills were taught 8709-4884
8 A. P. BINKS ET AL.

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