Virtual Learning and Medical Student Clerkships

Katelynn Baska, OMS-III, Philadelphia College of Osteopathic Medicine
EMRA MSC North East Coordinator

The COVID-19 pandemic has hit the United States hard, with a total of 690,714 confirmed cases as of April 19, 2020.¹ In response to this ongoing health crisis, most, if not all, medical schools have cancelled in-person lectures, and suspended clinical clerkships in compliance with the global recommendation of “social-distancing.” For first and second-year students, the transition from face-to-face lectures to online learning may not seem like an extreme change, however, third and fourth-year students have had to adapt to a drastic alteration in the educational environment and experience.

The third year of medical school marks the point in a student’s medical career where classroom knowledge is actively applied in a clinical environment. Clerkships allow students to interact with various members of a healthcare team, learn the ins-and-outs of working in a hospital, clinic, or office setting, and practice skills such as history-taking, physical exams, and formulation of assessment and treatment plans. Moreover, clinical rotations offer students exposure to different specialties and personalities. Students cultivate their bedside manner, communication skills, and clinical gestalt. The complete immersion of a student within the real-life complexities of modern medicine adds immeasurable value to clinical rotations. This begs the question, how does virtual learning compare to the traditional in-person rotation experience?

In the age of the internet and constantly evolving technological advancements, the use of e-learning platforms has been adopted by many medical schools to complement conventional, non-digital techniques in a blended learning approach. E-learning incorporates adaptive tutorials, visual models, audiovisual clips, games, simulations, and virtual patients.2 Simulations and virtual patients in particular allow for exposure to a variety of clinical presentations, with the ability to control and adapt the scenario. This ability to standardize clinical exposure and experience digitally is notable in comparison to traditional rotations where student experiences vary widely based on institution, location, time of the year, and faculty assignment. In addition, a systematic review and meta-analysis conducted in 2019 found that the use of virtual patients more effectively improved clinical reasoning, procedural skills, and team skills with global applicability when compared with traditional education.² Though it’s important to note that this study does not suggest replacement of real patient contact, rather the integration of virtual patients as a supplement.

Furthermore, some virtual tools offer experiences impossible to attain in a real-world scenario. For example, the University of Florida College of Medicine offers a Virtual Dementia Tour for their students during geriatric rotations. This program, created by the non-profit Second Wind Dreams, is a simulation experience that utilizes dark goggles, gloves, shoe inserts and a headset blasting various noises to give students an idea of what living with dementia entails, broadening understanding and empathy for these patients.³

Although in-person clinical experience is the gold standard for preparing us as future physicians, advancements and availability of virtual learning tools offer an alternatively valuable educational model to those of us tethered to our homes. While remaining at home during this outbreak leaves many of us feeling helpless and anxious, good health practices support this strategy for reducing further spread of the novel coronavirus. The use of these e-learning tools may provide us with a valuable bridge while we continue learning from home.

The following is a list of helpful virtual learning applications designed to enhance the medical student curriculum:

• Simulab
  • Procedure Simulation
  • Ultrasound Guided Central Venous Catheterization Curriculum is currently free for EMRA members-- follow the link above!
• EM:RAP
  • EM Podcast
  • Free for EMRA members!
• Visual Dx
  • Diagnosis App with thousands of photos
  • $20/year for EMRA members
• InSimu
  • Virtual patient simulation app
  • Currently offering free premium access to medical students via medical school request
• Medscape Patient Simulations
  • Online patient simulations
  • Free
• Airway Ex
  • Endoscopic simulation app
  • Free
  • See also Cardio Ex, Pulm Ex, Gastro Ex
• Touch Surgery
  • Surgery simulation app
  • Free
• Full Code
  • EM simulation app
  • Mostly free (access available to many free cases, can’t upgrade to pro at this time)
• SonoSupport
  • Ultrasound simulation app
  • $10
• Isabel
  • Diagnosis app
  • Try for free for 30 days
• AAMC MedEd Portal of Virtual Learning Resources during COVID-19, Applicable for M1-M4’s
• Free Access Clinical Skills Training Modules and Videos compiled by EMRA Medical Student Council member, Matt Christensen. Applicable for M1-M4’s

1) Cases in U.S. (2020, April 19). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

2) Kononowicz, A. A., Woodham, L. A., Edelbring, S., Stathakarou, N., Davies, D., Saxena, N., … Zary, N. (2019, July 2). Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6632099/

3) Francischine, T., Francischine, T., Francischine, T., Francischine, T., UF Health, UF Health, & UF Health. (n.d.). Innovation Corner: A glimpse at dementia. Retrieved from https://floridaphysician.med.ufl.edu/2019/01/09/innovation-corner-a-glimpse-at-dementia/