Table 1 Characteristics and outcomes of included studies
Study (Year) | Country | Study type | Participants (Sample size; sex) | Mean age in years ± SD | Type of intervention | Type of clinical skills assessed | Summary of findings |
|---|---|---|---|---|---|---|---|
Durán-Guerrero (2019) [16] | Colombia | Quasi-experimental and retrospective study | Medical students (294; NS) | NS | Five online radiology education modules | Diagnostic imaging knowledge | The online modules improved the median final exam score compared to the traditional lecture learning method only. There was a significant association between gained knowledge and the number of visits to online modules. |
Nathan (2022) [17] | UK | Randomised controlled trial | Medical students from all year groups (72; 65% female) | 21.3 ± 2.1 | Virtual classroom basic surgical skills training | Proficiency in placing three interrupted sutures with hand-tied knots | Suturing and knot-tying proficiency did not differ between virtual classroom training and face-to-face training. Virtual classroom training and face-to-face training produced superior results compared to computer-based learning. The costs per attendee associated with virtual classroom training, face-to-face training and computer-based learning were £22.15, £39.69 and £16.33, respectively. |
Cho (2022) [18] | South Korea | Randomised controlled trial | Third-year medical students (68; 38.2% female, 61.8% male) | 24 (range; 23–25) | Computer-based learning using non-interactive instructional video | Cardiopulmonary resuscitation | Although all students in both groups passed the post-training assessment, the computer-based learning group demonstrated less superior understanding during CPR, including fewer calling for assistance and using of defibrillator compared to the face-to- face group. |
Azman (2021) [19] | Malaysia | Prospective interventional study | Final year medical undergraduates (45; (58% female, 42% male) | 24 (n = 31) 25 (n = 13) 26 (n = 1) | Virtual classroom otoscopy training | Level of confidence and diagnostic ability in common ear pathologies | Level of confidence and diagnostic ability scores were significantly higher after the intervention and four months following the intervention. Both level of confidence and diagnostic ability scores showed sustained improvements at four months post intervention across. |
Grosser (2019) [20] | Germany | Randomised controlled trial | Medical student users from the TSC-database (114; 51% female) | 24.3 ± 7.38 | Videos about Anterior Cruciate Ligament reconstruction | Knowledge | Participants in the video-based format acquired more clinical knowledge than in the lecture condition but there was no difference in acquisition of anatomical knowledge. Participants perceived the video-based format to be superior in comprehensibility of the presentation, conceivability of the surgical procedure and to be more entertaining. |
Lehmann (2019) [21] | Germany | Randomised controlled trial | 5th-year medical students (103; 40% female, 60% male) | 25.1 ± 2.62 | Interactivity and animations in virtual patients | Paediatric basic life support skill | The intervention did lead to a difference in the adherence to the correct algorithm. Self-instruction with animated media – through videos or animation-enriched virtual patients – resulted in a better adherence to temporal demands compared to training with static virtual patients. The static virtual patients group performed considerably compared to the animated media and animation-enriched virtual patients. |
Herrmann-Werner (2019) [22] | Germany | Randomised controlled trial | Medical students (46; 74% female) | 25.4 ± 2.3 | Videos on patient communication | Empathy and competency | The videos significantly improved the students’ competency in dealing with e-patients as judged by expert video raters. Students’ rating showed a similar non-significant trend. |
Berland (2019) [23] | United States | Prospective study | First-year matriculating students in year one, year two and year three in a medical school (234; NS) | NS | Online-training modules on opioid overdose prevention | Knowledge, attitudes and preparedness | There were statistical differences that the authors deemed as not meaningful in knowledge, attitudes and preparedness. |
Hansen (2020) [24] | Denmark | Prospective case comparison study | Clerkship students (128; 70% female) | 26.3 | Videos on Mental Status Examination (MSE) | Mental Status Examination | The students with video access scored higher compared to students without access. |
Nazari (2020) [25] | Netherlands | Randomised controlled trial | Medical students (43; 51% female, 49% male) | 20 [19-21] (median [IQR]) | Step-by-step or continuous video-demonstration | Open inguinal hernia repair | The surgical performance was not significantly different between both groups. The step-by-step group perceived a lower extraneous cognitive load compared to the continuous group. |
Power (2020) [26] | United States | Pretest-post-test study | Second-year medical students (147; NS) | NS | Online clinical vignette, photo, and auditory clips | Cardiac auscultation skills | The cardiac auscultation skills score was higher post-intervention compared to the preintervention score. |
Plackett (2020) [27] | UK | Randomised controlled trial | Final year undergraduate medical students (264; 46% female, 54% male) | 20–22 (n = 5) 23–24 (n = 152) 25–26 (n = 68) 27–28 (n = 21) > 29 (n = 18) | eCREST — the electronic Clinical Reasoning Educational Simulation Tool. | Clinical reasoning, knowledge and diagnostic choice | eCREST improved students’ ability to gather essential information from patients compared to the control group. Most students in the intervention group agreed that eCREST helped them to learn clinical reasoning skills. |
Viljoen (2020) [28] | South Africa | Prospective study | Fourth-year medical students (153; NS) | NS | Web application | Electrocardiogram competence | Blended learning with the web application was associated with significantly better scores compared to conventional teaching in immediate and delayed post-intervention tests. The blended learning was associated with better confidence in electrocardiogram analysis and interpretation. |
Kasai (2021) [29] | Japan | Mixed methods | Fifth-year medical students (43; NS) | NS | Simulated electronic health records, electronic problem-based learning and online virtual medical interviews | Multiple clinical skills: Medical interviewing, physical examination, professionalism, clinical judgement, counselling, organisation/efficiency and documentation | Using simulated electronic health records resulted in significant improvement in writing daily medical records and medical summaries. Students using electronic problem-based learning and online- virtual medical interviews reported significant improvement in medical interviews and counselling. Students indicated that clinical clerkships were more useful for learning medical interviews, physical examinations, and humanistic qualities than the online education for clinical practice. |
Brewer (2021) [30] | UK | Randomised controlled trial | Pre-clinical medical students (67; 55% female, 45% male) | 21 ± 2.03 | Online video | Examination of the shoulder joint | Mean post-intervention scores were highest in face-to-face group followed by video and textbook groups, respectively. There was no score change from day 5 to day 19 post-intervention. |
Vincent (2022) [31] | Switzerland | Randomised controlled trial | Fourth-year medical students (160; 88 (55.0%) female) | 22.8 ± 4.2 | Videos | Breaking bad news skills | The number of correctly identified breaking bad news elements did not differ between control and intervention group, but the mean number of inappropriate breaking bad news elements was significantly lower in the intervention than in the control group. |
Zaghal (2022) [32] | Lebanon | Randomised controlled trial | Pre-medical, first, and second-year medical students (118; 51% female, 49% male) | 21.4 (range; 18–27) | Interactive tele-simulation sessions utilizing web-based video-conferencing technology and demonstration videos | Suturing | All participants were successful in placing three interrupted sutures, with no significant difference in the performance between the face-to-face and intervention groups. 25 (44.6%) of the respondents in the intervention group provided negative comments related to the difficulties of remotely learning visuospatial concepts. |
Enoch (2022) [33] | South Africa | Non-random cross-sectional quasi-experimental study | Third-year medical students (488; 52% female, 48% male) | 18–25 (n = 457) > 25 (n = 31) | Virtual simulation-based training using Zoom as the online platform | Affective, cognitive and psychomotor skills | The blended group had the highest scored followed by the e-learning group. The face-to-face group had the lowest score. |
Huang (2022) [34] | China | Prospective and comparative stud | Fourth- and fifth-year medical students (76; 59.2% female, 40.8% male) | 20.95 ± 0.67 | Online course | Competency in the basic ocular examination | Students in the intervention group obtained overall higher scores in the slit lamp practical skills. The online course was deemed to increase learning interests and motivation but was preferred as an additional tool to traditional teaching methods rather than a replacement. |
Flatt (2023) [35] | UK | Randomised controlled trial | Medical students (42; 54.8% female, 45.2% male) | 20.5 | Videos | Clinical examination of the shoulder joint | The intervention led to a significantly higher improvement in score. |
Lang (2023) [36] | Germany | Randomised controlled trial | Medical students (55; 53% female, 47% male) | 24.1 ± 3.5 | Videos | Laparoscopic knot tying | The number of knot tying attempts until proficiency was reached did not differ between the intervention and control groups. However, there was a higher fraction of knots achieving technical proficiency in the intervention group after the first use of the coping model. The proportion of blinded attempts that met the criteria for technical proficiency was significantly higher for the intervention group. |
Rajendran (2021) [37] | UK | Pretest-posttest design | Medical students (117; NS) | NS | Radiographs on an online user interface | Interpretation of chest radiographs | The high drop-out rate during the study that made the quantitative measurement of effectiveness difficult. |
Gong (2021) [38] | China | Quasi-experimental study | Clinical medical undergraduates (200; 49.5% female, 50.5% male) | 22 ± 0.37 | Website with micro-lectures, demonstration videos, online exercises, screen-based simulation of clinical skills and a student-teacher communication platform | Cardiopulmonary resuscitation, pelvic examination, physical examination of children, urethral catheterisation and lumbar puncture | The results of the theoretical and practical assessments were higher in the intervention than in the control group. Blended learning was more effective for acquiring relevant knowledge, enhancing student-centered learning and improving clinical practice. |
Saeed (2023) [39] | Pakistan | Mixed methods | First and second-year medical students (200; 53% male) | NS | Virtual platform (Microsoft Teams) | History taking, examination, basic life support skills | The OSCE scores showed significant improvement in two out of four repeated stations (abdominal and precordial examination). The questionnaires showed a significant improvement in seven of the nine skills taught. Session evaluations showed that most students were satisfied with the learning experience. |
Heriwardito (2023) [40] | Indonesia | Randomised controlled trial | Second-year medical students (229; 59% female, 41% male) | NS | Videos | Endotracheal intubation and mask ventilation procedural skills | The rubric scores, global rating scores and the pass rate did not differ between the intervention and control groups. |
Somera (2021) [41] | Brazil | Mixed methods | First-year medical students (189; 41.8% female, 58.2% male) | 20.1 ± 2.6 | Virtual microscopy | Pelvis histology knowledge | Virtual microscopy led to higher scores in subjective impressions such as handling, suitability, learning effectiveness and pleasure using the tools compared to optical microscopy. No statistically significant differences in academic performance were found between groups. |
Saeed (2023) [42] | Pakistan | Mixed methods | Fourth-year medical students (200; 56% male) | NS | Hybridized video-based learning with simulation | Examination skills | Hybridization of video-based learning with simulation significantly improved self-efficacy scores for all examinations (cardiovascular, respiratory, neurological, and abdomen) and OSCE scores of the neurological and abdominal stations. The students stated that the intervention allowed reinforcement of basic concepts, retention, and further insight into clinical applications. |