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The adoption of the flipped classroom in undergraduate medical education calls on students to learn from various self-paced tools—including online lectures—before attending in-class sessions. Hence, the design of online lectures merits special attention, given that applying multimedia design principles has been shown to enhance learning outcomes.
The aim of this study was to understand how online lectures have been integrated into medical school curricula, and whether published literature employs well-accepted principles of multimedia design.
This scoping review followed the methodology outlined by Arksey and O'Malley (2005). Databases, including MEDLINE, PsycINFO, Education Source, FRANCIS, ERIC, and ProQuest, were searched to find articles from 2006 to 2016 related to online lecture use in undergraduate medical education.
In total, 45 articles met our inclusion criteria. Online lectures were used in preclinical and clinical years, covering basic sciences, clinical medicine, and clinical skills. The use of multimedia design principles was seldom reported. Almost all studies described high student satisfaction and improvement on knowledge tests following online lecture use.
Integration of online lectures into undergraduate medical education is well-received by students and appears to improve learning outcomes. Future studies should apply established multimedia design principles to the development of online lectures to maximize their educational potential.
The modern classroom has changed significantly since the days of paper and pencil learning. Increasing numbers of elementary and secondary school students are using online textbooks, writing their tests online, and watching videos created by their teachers [
Coherence: exclude extraneous words, pictures, and sounds
Pretraining: ensure students possess prior knowledge about names and characteristics of the main concepts
Spatial contiguity: present corresponding words and pictures in close proximity to one another
Temporal contiguity: present corresponding words and pictures simultaneously rather than successively
Signaling: highlight important words
Redundancy: pair animation and narration together without on-screen text
Voice: use non-accented human spoken voice for narration over a machine simulated or foreign-accented human voice
Personalization: employ conversational style, instead of formal, to present words
Segmenting: offer narrated animation in learner-paced segments rather than a continuous unit
Modality: pair animation and narration together instead of pairing animation and on-screen text
For the purposes of this review, online lectures were defined as primarily didactic lectures accessed through digital platforms that do not require active interaction with the video playback interface. Examples of interactivity which would merit exclusion as an online lecture included instructional media in which students “click through” or complete “drag and drop” activities.
In 2007, the Association of American Medical Colleges Institute for Improving Medical Education (AAMC-IIME) published the landmark report
Despite the purported benefit of careful multimedia design, it is unclear whether best practice has become routine practice in medical education. The AAMC-IIME note that a cultural lag often occurs between the development of novel educational technologies and their effective implementation [
We searched OVID Medline (1946 to present, In Process & Other Non-Indexed Citations), OVID PsycINFO (1806 to present), OVID Social Work Abstracts (1968 to present), EBSCO Education Source, PROQUEST Abstracts in New Technology & Engineering, ASSIA, Canadian Research Index, CBCA Education, Computer & Information Systems Abstracts, ERIC, Computer Science Collection, Engineering Journals and PSYCTESTS, and FRANCIS, to identify articles addressing the subjects of online learning and medical education. Search strategies were developed by an academic health science librarian (APA) with input from the project leads and content experts (ML, BT). The search strategies were translated using each database platform’s command language, controlled vocabulary, and appropriate search fields. Medical Subject Headings terms, American Psychological Association thesaurus terms, and text words were used for the search concepts of “e-learning”, “video lectures”, “medical education”, and “medical students”. Searches were completed on July 1, 2016 and limited to articles published between July 1, 2006 and July 1, 2016, given that we were predominantly interested in examining literature published since the release of the AAMC-IIME report in March 2007. English-language limits were applied to all databases.
All articles were independently screened (by 2 of BT, AC, AQ, or HB) through a 2-step process of abstract and full-text review to determine eligibility for inclusion. Only articles that were not excluded through abstract review underwent full-text review. Articles that ultimately met inclusion criteria were then analyzed and charted according to the following iteratively developed categories: (1) lecture topic; (2) participants and setting; (3) lecture design components; (4) process of lecture design; (5) method of assessment; and (6) results.
Primary research articles written in English were included if they (1) discussed online, didactic lectures whose primary purpose was to teach or review curricular content; (2) did not require active interaction with the video playback interface; (3) were created by or for a medical school; (4) involved undergraduate medical students; (5) were watched independently by students; and (6) included either video, a slide deck, or an informal talking head. Articles were excluded if they discussed teaching modalities that required active participation (eg, problem-based learning), were not online, involved nonmedical doctor health care students, involved advanced trainees (eg, medical residents), were not designed by or for the medical school (eg, external YouTube channel), were watched by students in a group setting, or involved a lecture that was not a core educational component (eg, used for an extracurricular activity).
Assessment methods were then categorized according to the Kirkpatrick 4-level model of evaluation, interpreted in the context of online lecture evaluation [
Lastly, the rigor of studies included in the final analysis was assessed using the Newcastle-Ottawa Scale (NOS) [
Our search revealed 16,159 potentially relevant studies, of which 45 articles ultimately met inclusion criteria (
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for the article search.
Online lectures were employed in preclinical and clinical years, covering diverse topics such as basic sciences (12/45, 27%), clinical medicine (16/45, 36%), and clinical skills (17/45, 38%). Please refer to
The most common elements of online lectures included slide decks (25/45, 56%), narration (23/45, 51%), and video (18/45, 40%), with slide decks and narration typically occurring in conjunction. Several studies used the terminology online “lecture” or “module”, but did not clarify the specific design of these interventions (5/45, 11%). A summary of design features can be found in
Of the studies, 56% (25/45) commented on the development of online lectures in terms of process, content, or design (
All studies assessed learning outcomes (
Summary of online lecture design components (N=45).
Design componenta | n (%) |
Slide deck (eg, Microsoft PowerPoint) | 25 (56) |
Audio or narration | 23 (51) |
Video (eg, procedural demonstration; does not include video recordings of slide decks) | 18 (40) |
Unspecified design (eg, only described as online “lecture” or “module”) | 5 (11) |
Animation (eg, dynamic 2D or 3D images) | 4 (9) |
Visible lecturer (eg, talking head) | 1 (2) |
aArticles often utilized more than one design component.
Summary of online lecture development (N=45).
Development processa | n (%) | ||
No comment on development process | 20 (44) | ||
Developed from live lectures or recordings of live lectures | 10 (22) | ||
Medical student consultation | 6 (13) | ||
Consideration of multimedia design principles (eg, slide topography) | 3 (7) | ||
Literature-driven development of content (eg, 6-step approach to curriculum development from |
7 (16) | ||
Faculty or expert selection of content | 6 (13) |
aArticles often utilized more than one development process.
Summary of assessment methods for online lectures (N=45). OSCE: objective structured clinical examination; USMLE:
Assessment methoda | Kirkpatrick Level | n (%) |
Any method | 1 to 3 | 45 (100) |
Self-assessment of satisfaction, attitudes, knowledge, or confidence (eg, survey, questionnaire, or focus group) | 1 | 39 (87) |
Knowledge assessment (eg, multiple choice, true/false, matching, key feature, or free-response questions; content-specific knowledge test such as electrocardiogram interpretation) | 2 | 30 (66) |
Correlation to other performance measures (eg, final course grades, or USMLE) | 3 | 11 (24) |
Practical assessment (eg, OSCE, practical examination, or direct observation) | 3 | 8 (18) |
Written assignment or project | 2 | 4 (9) |
aArticles often utilized more than one assessment method.
In some cases, a practical examination was defined as Kirkpatrick Level 2, when the examination tested direct transfer of knowledge from the lecture (eg, lecture on differential diagnosis generation and an oral examination on the same topic).
Regardless of the method of assessment, almost all studies reported high satisfaction and increased knowledge following the intervention. Student self-assessment typically revealed positive attitudes toward online lectures as a teaching modality [
The quality and rigor of studies included in the final analysis (N=45) were evaluated based on the criteria set out by the NOS [
This review demonstrated that online lectures have been integrated into several aspects of undergraduate medical education curricula, tailored toward diverse subject matter and learners at all levels. This suggests that the flipped-classroom model—and associated online lectures—have become widely embraced by medical educators. Although preclinical students appear to prefer live lectures when given the option, online lectures are perceived to allow for increased rate and quantity of knowledge acquisition [
Results from this review demonstrated that 10 years after the publication of
The most common method of assessment involved student self-assessment (Kirkpatrick Level 1), consistent with other reports of assessment in medical education [
Essentially all studies reported high student satisfaction with online lectures and improved knowledge following such an intervention. However, each study assessed the use of online lectures within a particular context of students, educational topics, and assessment methods, making it difficult to directly compare relative effectiveness. Nonetheless, the broader body of literature suggested that online lectures, as a whole, were widely applicable and effective. Although positive outcomes were almost uniformly described, multimedia design principles were employed in only 3 studies, suggesting that these interventions could further optimize student learning by applying these well-established concepts [
Multiple studies reported equivalent or superior learning outcomes in medical students learning from online lectures compared to traditional didactic teaching. These findings are consistent with a large meta-analysis conducted by the United States Department of Education, which found that kindergarten to grade 12 (K-12) students in online learning conditions had better learning outcomes than those receiving in-person instruction [
Online teaching modalities included didactic online lectures (the definition employed in this review), interactive online modules, online courses, and many other interventions. However, the term “online lecture” was used to refer to a diverse range of online teaching modalities in published studies, and sometimes without an accompanying description of the lecture. Applying common terminology when describing online teaching modalities would help medical educators communicate more clearly about the nature of interventions, as well as delineate between different intervention designs to facilitate the study of their relative effectiveness.
In line with this goal, we propose standardized definitions to describe different online teaching modalities (
Further research would be helpful to identify the specific design features of online lectures that best facilitate medical student learning, given the widespread but variable application of this teaching modality. For example, future research could investigate which multimedia design principles correlate best with improved learning outcomes. Moreover, an understanding of the effectiveness of online lectures (didactic) compared to online modules (interactive), and the settings in which each modality is best applied, would allow for more purposeful application of online teaching interventions. Finally, to bridge the gap between effective use and common practice, findings from this review suggest that enhanced faculty development, updated guidelines incorporating the latest evidence on multimedia design, and fostering a culture of conscientious development of online lectures are all necessary for the continued expansion and application of online education.
Traditional lecture
Description: delivered live, in-person, and with no or minimal online component; typically limited student-lecturer interaction, unless a flipped classroom format is applied
Design components: video, slide decks, and drawing on projector screen or blackboard
Interactivity: minimal (students ask questions, but do not influence lecture output or pace)
Online lecture
Description: intended for students to independently watch online, at their own pace; defined by low student interaction with the teaching modality (in some ways akin to a traditional lecture except viewed online)
Design components: audio, slide decks, drawings on blackboard (similar to Khan Academy or other educational channels), talking head
Interactivity: low to minimal (students can control speed of lecture, rewind, and fast-forward)
Online module
Description: intended for students to independently complete online, at their own pace; involves interactivity, in which students “click through” the module or complete “drag and drop” or other activities
Design components: “click-through” modules, embedded exercises (eg, matching, multiple choice questions); may also include components of online lectures
Interactivity: moderate to high (students actively engage with the online interface)
The definition of online lecture utilized in this scoping review excluded interactive teaching tools such as self-paced online modules, meaning that it did not comprehensively capture all literature involving the use of online learning modalities in medical education. This was a purposeful decision given our understanding that Richard Mayer’s principles of multimedia design were initially developed through experimentation on traditional slide deck lectures. A final limitation is that although the majority of studies did not describe the use of multimedia design principles, it is possible that these concepts were employed without being explicitly mentioned.
The integration of online lectures into undergraduate medical education is well-received by students and appears to improve knowledge, clinical skills, and other learning outcomes. Moreover, it appears that the use of multimedia design principles is not yet standard practice in the development of online lectures for medical students. As the adoption of flipped classroom learning and online lectures continues to expand, employing multimedia design principles could further optimize the potential for student learning. Further research on the design of online lectures and other online teaching modalities, enhanced faculty development, incorporation of best practice, and recognition of the importance of conscientious design are critical as online lectures become a mainstay of undergraduate medical education.
Summary of included studies.
Association of American Medical Colleges Institute for Improving Medical Education
Newcastle-Ottawa Scale
objective structured clinical examination
United States Medical Licensing Examination
We greatly appreciate the assistance of Farah Friesen and Drew Countryman for their assistance with the article screening process.
None declared.