The COVID-19 pandemic has provided medical education institutions with a unique opportunity to adapt and advance their medical teaching methods. Previously, medical institutions relied upon classroom teaching, such as lectures, for preclinical year medical students, followed by various specialty medical attachments, completed in hospitals, for clinical year medical students [35]. As a result of the COVID-19 pandemic, university studies were suspended, and a rapid transition to virtual learning occurred [35].

The analysis of the available literature reveals several advantages of virtual teaching for medical students. First, the development of interactive virtual clinical teaching has been shown to be one of the most effective forms of virtual teaching, ranked by advancement of knowledge, student engagement, and student feedback. Hofmann et al [6] explored the use of virtual ward rounds to allow medical students to observe and interact with patients with COVID-19 while eliminating the risk of infection. Although their sample size of 14 students was limited, Hofmann et al demonstrated that students were enthusiastic to learn about a novel disease that is directly relevant to the world. Through student feedback, it was found that 92.9% of students recommended this form of teaching and agreed that it stimulated learning [6]. Similarly, a study by Murdock et al [19] evaluated the use of virtual morning reports to deliver effective and engaging teaching to medical students from multiple institutions worldwide. The strengths of this mode of teaching included the active development of student clinical reasoning skills as well as the ability to gain feedback from tutors and peers alike. Some institutions developed virtual clerkships, via the use of Zoom, to further increase medical students’ clinical exposure. Chandra et al [17] reported on the use of virtual callbacks conducted by medical students for patients who had recently evaluated in the emergency department. This program was found to help all parties; student feedback was overwhelmingly positive as a result of the direct patient interaction, and the students further stated that they felt that this mode of teaching increased their clinical reasoning and communication skills. Moreover, there was a reduced clinical load for the medical team, and the patients found it comforting to receive a follow-up appointment upon discharge. Likewise, a pilot study from Geha et al [23] reported on the use of 14-day virtual clerkships for medical students. The results of this paper indicated an advancement in medical knowledge and clinical reasoning skills through social learning and cognitive apprenticeship, increased student engagement due to interactivity, and the ability to learn from real-life patients. Although the study was limited due to a sample size of 6 students, the study showed that 5 of the 6 students felt positive about the placement and wanted to continue with this form of teaching above others [23]. Furthermore, Imperial College London hosted virtual patient interviews for medical students; the study reported excellent student attendance and interaction, with benefits of increasing student clinical reasoning skills and diagnostic thought processes as well as reducing the burden on the health care system by providing an efficient triage system [35]. Finally, Harvard Medical School developed the use of virtual medical student response teams that consisted of 500 students arranged into 4 virtual teams with the aim to either educate or help the community or health care teams [9]. Due to the active role of helping during a worldwide pandemic, students reported feeling empowered and enthusiastic, and they felt a sense of purpose during uncertain times. Moreover, the project facilitated team working skills and indirectly increased student knowledge and awareness of COVID-19 [9]. Despite the highlighted successes of these highly interactive forms of virtual teaching, limited literature is available on these programs, suggesting that they are underdeveloped and not in use by most medical education facilities. Potential factors that may contribute to the underdevelopment of these specific programs are the scalability of the programs as well as the time commitments needed from clinicians when work demand is already at a critical stage [23].

The main format of virtual teaching for medical students is through virtual web-based platforms. Virtual web-based platforms consist of webinars, case discussions, reading assignments, and prerecorded virtual scenarios [28]. An advantage, noted through multiple publications available on this theme, was the ease of accessibility and unlimited flexibility of medical resources [8,11,12,19,22,24,25]. In a time of great uncertainty and doubt, providing students with increased flexibility and access to teaching materials may further encourage self-directed learning and motivation. Furthermore, open access teaching from world-renowned medical specialists, irrespective of location and cost, has now become available during the COVID-19 crisis [8]. Teaching provided by experts and promoted through social media platforms such as Twitter and Instagram Live can act as valuable adjuncts to virtual teaching. This teaching can also accelerate student knowledge and interest in specialties a student has not yet experienced and can enable students to observe the latest medical advancements [8,12,28,34]. Networking between students and physicians, which many students thought would be lost due to the suspension of attachments, has been revived through the use of virtual conferences and social media [8,12].

Peer mentoring during the COVID-19 crisis has proved to be a valuable form of teaching. Peer mentoring involves student-to-student teaching; it helps develop active discussion, exchange of ideas, critical thinking, and collaboration between colleagues [26]. In uncertain times such as the COVID-19 pandemic, peer mentoring can help drive student motivation and task management, increasing the effectiveness of self-directed study [26]. Personal development may also be improved by peer mentoring; qualities such as resilience, conflict resolution, and leadership may all be developed through this mode of teaching [26]. A study by Mohammed Sami Hamad et al [26] demonstrated that peer learning may also lead to increased examination performance due to improvements in problem-solving skills. Peer mentoring can also be used to provide psychological support to colleagues. A study by Rastegar Kazerooni et al [45] discussed the use of a WhatsApp group consisting of 371 medical students to provide advice and reassurance during the pandemic. Using student feedback from the study, it was found that 71% of junior medical students reported a smoother transition with quicker adjustment to the COVID-19 crisis, and senior students benefited from significant professional growth [45].

Student perception of virtual teaching is imperative to understand to deliver effective teaching throughout the pandemic. A study conducted by Sud et al [38] reported that 97.2% of students felt that web-based classes were a good alternative to classroom teaching during the pandemic. This was further reiterated by a study by Kaur et al [39] that surveyed 983 medical students on their satisfaction with virtual teaching during the COVID-19 crisis. The outcomes of the study showed that students felt that virtual teaching was as effective as classroom teaching for improving communication, increasing knowledge and skills, professional growth, and submission of assignments. Moreover, students were happy with the availability of electronic resources offered by virtual learning platforms [39]. Upon review of the current literature, it is evident that medical students have a strong passion and determination to learn during the pandemic. Articles written by Sandhu et al [21] and Marques du Silva [31] demonstrated increased class attendance at webinars and positive student feedback of web-based extracurricular lectures. Guadix et al [10] conducted a survey to understand what medical students with an interest in neurosurgery desired from virtual teaching. Of the 127 students who responded, 67% wanted virtual mentorship programs and virtual surgical skills workshops in addition to their medical school studies [10].

A significant number of published studies indicated that a major disadvantage of virtual teaching is technical difficulties [11,15,18,21,22,25,27,29,30,37,38,42,44]. On further analysis of the technical difficulties experienced by students, several different challenges to virtual teaching arose. The largest problem presented by virtual teaching was that some students had no access to digital technology; thus, virtual learning was an ineffective or impossible form of teaching for those students [22,29,30,38,42,44]. Other technical challenges included difficulties establishing a reliable internet connection [11,18,27,30,38,42], problems with hardware and software for virtual learning platforms [21,42], problems relating to internet speed and quality [22,37], and problems with audio and video playback [25]. Moreover, a study by Machado et al [15] reported that virtual learning platforms may become overloaded due to the sheer number of students accessing the materials; overload of a platform stops the platform from working and hinders student learning [15].

Papers by Murdock et al [19] and Sleiwah et al [25] raised concerns with respect to confidentiality and security issues [19,25]. “Zoom-bombing” is a practice in which hackers invade Zoom sessions; therefore, virtual sessions that document real patient information may be at risk of security breaches [19].

The loss of face-to-face teaching was another significant weakness of virtual teaching. The loss of clinical attachments was referenced by numerous publications [10,12,22,34]. Dedeilia et al [12] suggested that the loss of clinical attachments, subsequently causing a loss of bedside teaching, a lack of direct patient care, and a loss of feedback from clinicians, halted the progression of the competencies of a medical student. This was further reiterated by Kaup et al [22], who reported a decline in the clinical and surgical competencies of medical students during the pandemic [22]. Interestingly, Sahi et al reported a possible cessation of professional growth of medical students due to a lack of influential clinical role models during this time [11]. Furthermore, Hilburg et al [34] described a life-changing effect in which the loss of clinical attachments during medical school may impact the specialty the student chooses to pursue in later life [34].

The transition to virtual teaching via the use of web-based medical education platforms presents its own individual disadvantages. Studies by Machado et al [15] and Atreya et al [18] reported the hardships of maintaining focus and concentration whilst sitting in front of a screen. Similarly, Lee et al [13] found that without academic input, students were more likely to have ineffective learning strategies, poor motivation, and reduced communication. Physical discomfort, such as exhaustion, visual problems, and muscle and joint pain, was also reported with long periods of virtual teaching [30]. Unsurprisingly, papers by Longhurst et al [16] and Kaup et al [22] found reduced student engagement levels associated with virtual teaching. Longhurst et al [16] suggested that student engagement decreased as a result of reduced monitoring of students, whereas Kaup et al [22] argued that reduced student engagement was due to a lack of student focus, interest in other environmental activities around students, and technical difficulties [22]. Surkhali et al [30] highlighted that a further disadvantage of virtual teaching is that tutors have difficulties assessing student disengagement, frustration, and disinterest; this may reduce the quality and effectiveness of virtual teaching. Loss of student-tutor interactivity was another potential causative factor for reduced student engagement, as evidenced by Michael et al [27] and Sud et al [38].

Concerns regarding preclinical year medical student education were also identified in this review. Studies by Hilburg et al [34] and Mian et al [35] highlighted that this student cohort would have significantly weak clinical foundations, which provide the building blocks for students’ clinical years and subsequent life as physicians. Hilburg et al [34] argued that the lack of face-to-face teaching for skills, such as history taking and physical examinations, would negatively impact students’ transition to their clinical years. Furthermore, suspension of studies has drastically disrupted the teaching of anatomy. A paper by Singal et al [14] documented the difficulties faced by students in understanding anatomy without the tools of dissection, practical teaching, specimens, or slides. A future concern of anatomists and medical education facilities alike is a lack of cadavers following the COVID-19 pandemic due to the potential risk of infection of the deceased [14].

The loss of formal assessments is an additional weakness of virtual teaching. A study by Longhurst et al [16] reported that 50% of medical student examinations had been cancelled, and even more had been adjusted to unfamiliar formats. Kaup et al [22] argued that this was due to a lack of security and validity of conducting virtual examinations. Interestingly, a study published by Lara et al [40] documented the novel use of a teleconference objective structured clinical examination (teleOSCE) during the COVID-19 pandemic. The results of this study indicated that for the 49 medical students who participated, there was no difference in mean score or failure rate between face-to-face and virtual OSCEs, suggesting that this form of assessment was an effective and reliable method of testing and could be explored in the future [40].

Weaknesses of virtual teaching identified by medical students included reduced interaction between peers and tutors, reduced understanding of individualized learning needs by tutors, and the difficulties of balancing practical and theoretical skills [39]. Virtual teaching platforms from the perspective of medical education faculties were found to be costly and time-consuming [11,15,16,21].

The literature included in this review includes papers written worldwide. Upon analysis, it is evident that virtual teaching for medical students differs by country and that students may have exceedingly different learning experiences [9,18,24,29,30,35,37]. These different learning experiences delivered by virtual teaching may create inequalities of knowledge, confidence, and skills of medical students on a global basis [15].

In developed countries, such as the United Kingdom, Italy, the United States, and Australia, virtual teaching for medical students is a praised method of teaching [9,35-37]. Studies by Soled et al [9] from the United States and Roskvist et al [37] from Australia highlight the advancement of virtual medical teaching formats away from the standard virtual web-based platforms. Soled et al discussed the use of interactive virtual medical committees consisting of 500 medical students with the aim to educate or partake in community activism to help with and understand the global pandemic, whereas Roskvist et al documented the replacement of normal clinical attachments with interactive e-learning placements in Australia. The results of the study by Roskvist et al [37] showed web-based learning to be as effective as traditional teaching. Virtual teaching within the United Kingdom mirrored virtual learning in Australia and America; more interactive and advanced technological forms of virtual learning were found to increase student engagement and focus [35]. Italy reported that virtual learning is an effective way to teach medical students during a time of crisis [36].

In stark contrast, developing countries such as Nepal, Iran, and Brazil negatively reported on the effectiveness of virtual teaching due to poorly funded and inadequate infrastructures for virtual learning [18,24,29,30]. Studies conducted in Nepal demonstrated apparent barriers to virtual teaching, including lack of knowledge on how to operate virtual platforms by staff and students alike, difficulties finding a quiet environment to study, technical challenges, reduced student engagement due to the use of self-directed learning with limited interactivity, and mental distress from social isolation [18,30]. In Iran, due to a lack of preparation of virtual learning resources, not all age groups within the medical curriculum had access to virtual teaching materials; also, medical education facilities experienced difficulties virtualizing different aspects of the medical course [28]. Finally, Carvalho et al [29] published a letter from Brazil documenting the challenges faced by the medical education system in Brazil. Similarly, the reported challenges to virtual teaching primarily arose due to a lack of investment. Moreover, Carvalho et al [29] documented the important points that not all students within Brazil have access to digital technology and some may be socially vulnerable, which further inhibits learning away from the university.