Yale Research Compares Virtual and In-Person Learning Among Medical Students

Since the COVID-19 pandemic, when much of medical education shifted from in-person to virtual settings, Yale School of Medicine (YSM) researchers have sought to understand how virtual learning environments impact medical student learning.

In a quantitative study led by Alex Choi, MD, assistant professor of medicine (general medicine), and Jaideep Talwalkar, MD, associate professor of medicine (general medicine) and of pediatrics, researchers used objective assessment scores and survey results from medical students to investigate differences between in-person and virtual learning environments for an advanced communication skills Objective Structured Clinical Examination (OSCE).

The OSCE is a station-based assessment method in health care education that uses standardized patients and structured checklists to evaluate clinical, communication, and decision-making skills in a simulated environment. At YSM, senior medical students are required to attend an advanced communication skills OSCE, which emulates clinical scenarios involving intense emotions they will encounter during residency.

The team found that although the modified Master Interview Rating Scale (mMIRS) scores from virtual workshops were unchanged from in-person workshops, Communication Behavior Checklist (CBC) scores were lower. While preserved mMIRS scores suggest that students were able to carry out medical interviews effectively—for example, avoid jargon and demonstrate empathy—decreased CBC scores suggest that the content of the virtual interviews lacked depth compared with those that took place in-person.

To better understand the qualitative differences between these learning environments, the team performed a subsequent study comparing virtual and in-person OSCEs on advanced communication skills. Based on qualitative analysis of transcripts from debriefing sessions with Yale medical students, the research team determined that some medical students may struggle with experiential learning in the virtual format and have difficulty accessing or practicing reflective observation skills.

“Subtle yet significant qualitative differences exist between these two learning environments,” says Choi. “For example, in the virtual format, medical student debriefs focused on more matter-of-fact or fact-checking content, whereas in the in-person debriefs, students discussed challenges and reflections from the cases.”

Overall, the research team’s findings show that virtual learning environments can be sufficient alternatives to in-person, though perhaps with specific alterations.

Down the road, the team plans to investigate how to alter virtual learning environments to accommodate the loss of in-person experience. Additionally, they hope to explore which types of skills are adequately taught through virtual versus in-person learning environments.

The challenge is using technology to improve how we teach, Talwalker said. “Virtual platforms can offer distinct advantages in preparing students for patient care,” he says. “In addition, medical students need to learn to communicate virtually since telehealth is here to stay.”

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