Impact of COVID-19 on Medical Education: A Narrative Review of Reports from Selected Countries

The COVID-19 pandemic presented unprecedented challenges for individuals around the globe, including those training to fight it. Approximately 3 years after discovering the novel coronavirus, the COVID-19 pandemic continues to unfold. The disruption of the medical education system is just one example of the pandemic's influence on medical education, learning, and the transfer of a crucial knowledge base for future physicians. In medical schools, students were challenged to engage and succeed in a rigorous curriculum amidst the pandemic. At the same time, administration and faculty were tasked with producing a class of educated professionals while following and staying updated on constantly changing protocols. Factors from safety concerns for medical students exposed to COVID positive patients to technological challenges for those delivering a virtual curriculum called all normal procedures into question. Traditional face-to-face lecture-based delivery was no longer possible, and a lack of resources presented additional challenges for many. Before the COVID-19 pandemic, colleges had experience using flexible learning models, such as online learning, in medical school. Online learning platforms such as massive open online courses (MOOCs) on health and medicine topics have been incorporated into medical curricula for many years and have grown significantly in the last 10 years. Institutions that had experience applying different learning modalities using information technology before the pandemic had a smoother, more rapid, and more effective transition to distance learning. Conversely, institutions that did not have adequate technology or infrastructure before the pandemic encountered multiple challenges. At the pandemic's start, approximately 2600 medical schools worldwide had to reorganize to sustain, remodel, and effectively deliver medical training throughout the crisis. The COVID-19 pandemic uniquely impacted colleges worldwide, with each school in its country of origin employing its own strategies for combating the disease and adapting medical education. This narrative review provides a unique analysis of the challenges and strategic changes that 10 medical schools around the world employed for pre-clerkship and clerkship medical education during the COVID-19 pandemic. We also highlight the effectiveness of strategies and differences in how students perceived them.

Prior to COVID-19, medical education had increasingly integrated flexible and online learning modalities, including MOOCs and blended learning, which supported rapid adaptations when in-person instruction ceased. The review synthesizes reports from diverse geographic regions on how curricula changed during the pandemic, including virtual platforms for lectures, problem-based learning, simulations, and telehealth involvement. It also examines student and faculty perceptions from earlier literature indicating online learning could add value through supplemental videos, case-based learning, question banks, and flipped classrooms, setting the context for assessing pandemic-era implementations.

Narrative literature review. Databases searched: PubMed, ScienceDirect, JSTOR, and Google Scholar. Objective: identify reports on change management in medical education during COVID-19 and adaptations in pre-clerkship and clerkship curricula. Exclusion: non–peer-reviewed journal articles. Timeframe: 2020–2022; no language restrictions. Keywords used alone or combined with Boolean operators AND/OR included: Medical education in COVID-19; Global medical education; E-learning during COVID-19; Online learning; Medical education in COVID-19 pandemic; Clerkship curriculum in COVID-19; Pre-clerkship curriculum in COVID-19. All manuscripts meeting parameters were those archived on PubMed. After deduplication, 109 manuscripts were analyzed. From these, 12 core articles representing experiences in 10 countries were identified to address the central questions: “How has COVID-19 impacted medical education in different geographic areas?” and “How did the students perceive changes in the learning process that accompanied curriculum adjustments?”

- From 109 analyzed manuscripts, 12 core articles represented strategies from 10 countries across pre-clerkship and clerkship levels. - Online learning became the predominant solution globally; success correlated strongly with access to technology, internet connectivity, and institutional infrastructure. - Flexibility was the most commonly cited advantage of online learning by students. - United Kingdom: In a cross-sectional survey across 39 medical schools, 19.5% of students cited flexibility as a benefit; 19.8% noted time saved from travel. However, 76% reported online education did not replace clinical teaching via direct patient contact; ~82% felt practical clinical skills could not be learned online. Common barriers: family distractions (~27%) and poor internet (~22%). - Japan (Chiba University): A virtual clerkship using simulated EHR (sEHR), electronic PBL (e-PBL), and online virtual medical interviews (online-VMI) delivered via an online simulated clinical practice system was rated “acceptable” overall. e-PBL and online-VMI scored higher than traditional clerkship in learning organization, efficiency, and writing medical summaries; all students reported improved clinical performance in medical interviews and counseling compared to baseline, though traditional clerkships remained superior for some clinical performance domains. - Republic of Korea: 70% of students and 35% of faculty cited flexibility to learn anytime/anywhere as the greatest advantage; strengths included ability to rewatch content and control playback. Students generally maintained concentration and motivation for self-directed learning. - India (All India Institute of Medical Sciences, Jodhpur): Rapid adoption of G-Suite for Education for lectures, demonstrations, and case discussions. About 92% of students reported real-time Q&A was supported and shared materials were useful; ~56% rated virtual classes as “as good as” or “better than” physical classes, though 51% still preferred physical classes. - United States (Perelman School of Medicine): An interactive virtual otolaryngology rotation used live-streamed surgeries via head-mounted cameras, telehealth, and small-group didactics; students had more one-on-one attending time, but technical skill acquisition remained limited compared to in-person. - United States (UCSF): A virtual rounds (VR) curriculum for internal medicine clerkship improved prerounding skills (86% of 29 respondents), presentation skills (93%), and clinical reasoning (62%); all found small-group discussions helpful. - Uganda (Makerere University): Return to in-person clerkships amid rising cases led 81.7% of students to feel at risk; >66% reported difficulty following hospital COVID-19 protocols; ~12% were discouraged from internal medicine careers. - Jordan and Pakistan: Major obstacles included insufficient infrastructure, technology, and internet quality; limited prior distance-learning experience hindered adoption. Recommendations included telecom partnerships for high-quality internet, faculty development in educational technology, and platform unification. Pre-clerkship was more adaptable than clerkship. - Libya: Amid civil war and financial crisis, many schools halted education; e-learning resumed in some settings. Students reported anxiety (31%) and depression (10%); 78% had financial challenges participating in e-learning; 66% cited political conflict as a barrier; ~65% disagreed that e-learning could be easily implemented. - Ireland (University College Dublin): 54.5% reported moderate or higher stress; 66.7% reported moderate-or-more stress due to the transition to online learning. Higher stress associated with lower confidence in institutional/governmental responses. - Overall indicators of success: robust technology/infrastructure, equitable access, and careful consideration of mental health impacts. Clerkship skills, especially hands-on procedural competencies, were least amenable to full online substitution.

The review demonstrates that while many institutions rapidly transitioned to online and hybrid models to maintain educational continuity, the effectiveness of these adaptations varied widely by national context, institutional resources, and student circumstances. The findings address the research questions by mapping how different regions implemented virtual platforms, simulations, telehealth, and alternative clerkship experiences, and by capturing student perceptions of flexibility, engagement, clinical exposure, and stress. Countries with established technological infrastructure (e.g., US, UK, Japan, India) generally reported smoother transitions and positive outcomes in knowledge acquisition and some clinical reasoning skills, though hands-on clinical skill development remained constrained. In resource-limited or unstable settings (e.g., Jordan, Pakistan, Libya), inadequate internet, devices, and training impeded online education and exacerbated psychosocial burdens. Safety considerations and local infection rates critically influenced decisions about hospital re-entry, affecting student anxiety and clinical readiness (e.g., Uganda). The discussion highlights the need to tailor strategies to local realities—technology access, infrastructure, political climate, infection levels, and student demographics—and to provide mental health support. It also suggests leveraging emerging technologies, including AI, to augment learning and clinical decision-making while recognizing new challenges they introduce. Virtual rounds, telehealth participation, and streamed procedures can partially preserve clinical exposure, particularly if infrastructure is in place, but do not fully replace in-person skill acquisition.

The COVID-19 pandemic disrupted medical education and exposed gaps in curricula and delivery methods, necessitating rapid adaptations across pre-clerkship and clerkship training. Compiled international experiences can guide institutions in future disruptions, but solutions are not one-size-fits-all. Key take-home points include: it is crucial to consider the complexities of syndemic conditions when adjusting curricula; prioritize disciplines addressing health equity and crisis management; leverage information technology to enhance inclusivity; online learning provides flexibility and learner-centered benefits; and ensure equitable access to technology and robust internet. Virtual strategies such as simulations, telehealth involvement, and virtual rounds can supplement clinical exposure, but sustained investment in infrastructure and attention to student mental health are essential. These approaches offer enduring value beyond pandemic contexts and can inform resilient, adaptable medical education models.

The review synthesizes reports predominantly from individual institutions and may not represent entire countries or account for systemic national issues. Included studies varied in design, with many relying on electronic surveys and non-standardized or non-validated tools to assess clinical learning during COVID-19, limiting comparability and generalizability. Selection of 12 core articles to represent 10 countries may omit other relevant experiences. Potential publication bias and rapidly evolving pandemic conditions further constrain interpretation.