To the Editor:
The rapid shift to online learning imposed by the COVID-19 pandemic created uncharted territory for medical educators. 1 Little evidence exists to guide remote learning in medical education. To inform best teaching practices at Harvard Medical School, we conducted an anonymous survey of our medical students, who transitioned to remote learning in March 2020, to assess their needs and preferences for online learning. The survey request was emailed 4 weeks after the transition to all current students. The response rate was 39% (255/654).
Responding students highly valued small-group learning (82% rated breakout groups “effective or very effective”) but preferred reducing required synchronous online instruction (86% of students preferred less than 4 hours per day, with 3–4 hours optimal). We were concerned to learn that many students were regularly struggling with basic remote learning necessities, including an adequate Internet connection (20% “often/always,” 40% “sometimes”) and a quiet space to attend class and study (18% “often/always,” 35% “sometimes”). Only 39% reported “rarely/never” having either of these issues.
Before our analysis of our data, many faculty expected all students to attend synchronous sessions and participate in discussions with their microphones and video cameras turned on. Informal discussions with faculty indicated that lack of such participation was perceived negatively, without the understanding that a significant number of students were unable to participate effectively.
Following our needs assessment, programs were launched to assist students in meeting basic requirements to assure their full participation in remote learning. For example, the medical school raised a student emergency fund to provide funds to students with financial need to help with expenses related to broadband Internet access. Our future analysis of our survey data will further explore the relationship between lack of an accessible and predictable learning environment and attitudes toward remote learning by including qualitative analysis of students’ open-ended comments.
Medical schools must seek to uncover disparities in student access to remote learning and pursue ways to close the gap to enable all students to reach their potential during this time of distance learning. Students with difficulty accessing the Internet or a quiet learning environment may also be vulnerable to other stressors. Faculty must be mindful that individual learning environments may vary greatly and strive to support every student as challenges arise. It is important that faculty approach students with a mindset that assumes students are doing the best they can with the resources they have. From a programmatic point of view, it is critical that our decisions are not only based on preferences and consensus but also on a careful assessment of the needs of the most vulnerable students.
The survey was developed in collaboration with the following Harvard Medical School students: J. Zhou, B. Nelsen, S. Onorato, S. Ashrafzadeh, J. Yoon, I. Alty, and A. Joshi. S. Pelletier contributed to the analysis.
1. Rose S. Medical student education in the time of COVID-19. JAMA. 2020;323:2131–2132.