Building a Sustainable e-Learning Medical Education Ecosystem for the Post-COVID-19 World

Vol 8 #3

Hategan A1,, Levinson AJ2, Payne SC3, Chisholm T4

Author information

1   Department of Psychiatry and Behavioural Neurosciences, Division of Geriatric Psychiatry, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. ✉ [email protected]

2   Department of Psychiatry and Behavioural Neurosciences, Division of e-Learning Innovation, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

3   Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

4   Department of Psychiatry, Division of Geriatric Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada


Clinician educators are considering how they can stay connected with and be a support to medical residents during the COVID-19 crisis. There is now a sense of urgency in the time of pandemic for medical educators. As such, they have been tasked to create online curricula and other pragmatic virtual educational activities to meet current learning objectives and post COVID-19 global demands. To this end, the authors propose the implementation of new medical curriculum models with a focus on building a sustainable e-learning ecosystem.

What problem was addressed?

In recent years, medical educators have been increasingly shifting toward online teaching, even pre-dating the COVID-19 pandemic [1, 2]. In an era of limited faculty and financial resources, especially in small-sized subspecialty residency training programs, one must anticipate adaptation of the more traditional curriculum models of medical schools. This is especially true in the time of the COVID-19 pandemic that requires limiting physical contact in order to mitigate virus spread. In order to build a more sustainable curricular ecosystem, training programs do not need to reinvent the wheel, but can share it instead [3].

What was tried?

In early 2020, Canadian geriatric psychiatry subspecialty teams at McMaster University and Dalhousie University partnered in response to a call to action to implement a new shared e-curriculum model. While both training programs had been working separately, the combined effort led to a pilot project with a common digital curricular component ecosystem shared between the two programs. As shown by others [4, 5], formulating a clear set of goals is an essential preparatory stage. This project has been developed around consensus-built foundational learning objectives aligned with core competencies. Previous literature suggested that the desired e-learning outcomes should direct both the overall design and the content used in the lessons [4].  de Leeuw et al. [5] believed that e-learning should go beyond delivery of facts in order to address skills/behaviors and to allow for the application of knowledge and skills. Furthermore, a user-friendly experience has been found to be central in increasing learner uptake [6].

For this project, an e-learning specialist was consulted in order to discuss what software platform would allow for a user-friendly experience and an evaluation specialist helped to support the development of modules. Additionally, advice on the structure of the e-learning modules, length of modules, and how to best incorporate test-enhanced learning was sought out. On review of the planned syllabus for the academic year, a few key topics that were felt to be adaptable to the e-learning platform were identified. The participating medical educators and resident/fellow authors then created several e-learning modules based upon core geriatric psychiatry topics, with an emphasis on instructional design and imbued with engaging case-based activities, and content-specific clinical guidance to help trainees study strategically. Case studies, engaging visuals and media have been employed with the goal of stimulating learning, which is in keeping with Mayer’s cognitive theory of multimedia learning [5]. The modules expound upon the benefits of test-enhanced learning in promoting enhanced retention of learning material.

The e-learning sessions were subsequently plotted into the remaining current and next, 2020-2021 academic syllabuses in a manner that is consistent with the national competency based medical education stages of training. Both of the participating geriatric psychiatry training programs provide weekly 90-minute protected time slots for subspecialty residents/fellows to access the e-learning modules. We elected to first pilot the e-learning platform in order to then solicit feedback from faculty members and learners on their e-learning experience. Moreover, we anticipate that these e-learning modules will also be shared with geriatric psychiatry residents/fellows throughout Canada who no longer have access to traditional learning in the time of COVID-19.

What lessons were learned?

Our global future must develop through communication, collaboration, and innovation. The benefits of such collaboration in the creation of a shared, content-specific, curricular product are manifold:

  • The development of a digital curriculum meets the existing requirement for physical distancing during the COVID-19 pandemic – the “new school normal” – because it allows for education to continue virtually.
  • Such collaboration can allow best knowledge-based principles and practices to be disseminated widely.
  • A core e-curriculum ecosystem shared amongst medical training programs can free-up faculty time to develop high-value teaching activities at their respective training programs. This may also facilitate a blended model or “flipped classroom,” where self-directed learning of asynchronous e-learning modules is complemented by other pedagogical models such as virtual coaching or instructor-led training.
  • Trainees benefit from a consistent, accessible educational experience that aligns with national licensure exams. Theoretically, there is the benefit of consistent application of high-quality instructional design with respect to the development of a shared e-learning curriculum; however, there is also the risk of poor instructional design, which may hamper learning or diminish the value proposition.
  • A shared, core e-curriculum can increase medical education value by lowering the cost of implementation without compromising quality. It is also feasible to scale up and spread this format of curriculum within Canadian institutions, and beyond; it could also potentially scale internationally to help address the increasing global shortage of medical educators.
  • Implementing a shared, core e-curriculum has the potential to reduce human capital resources and administrative burden.

While the benefits and effectiveness of e-learning have been known for some time [7, 8], less is known about the most important aspects with regard to implementation. In this respect, a recent systematic review of enablers and barriers affecting e-learning in health sciences is of interest [9]. The pandemic has become another key driver in the delivery of curricula that was not anticipated by the authors [9], and undergraduate medical education has had no choice but to respond rapidly to the impact of the COVID-19 pandemic [10]. Regmi and Jones [9] identified four key themes with respect to enablers, and our shared curriculum development initiative echoes these themes, including how the e-curriculum can:

  • facilitate learning;
  • enhance learning in practice (e.g., through interactive virtual cases);
  • use a systematic approach to learning (e.g., through best practices in instructional design/application of adult learning theory); and
  • emphasize the importance of integration of e-learning into curricula.

It is equally important for us as educators to be mindful about some of the barriers and challenges to e-learning implementation [9]. Not all learners may be motivated or engaged by e-learning, particularly if it is inadequately designed. High quality, multimedia rich e-learning can be quite resource-intensive to develop, including the time commitment of the subject matter experts and instructional designers. Asynchronous e-learning may not be suitable for all disciplines or types of content, and not all programs or learners have the necessary information technology infrastructure for successful e-learning.

Two other historical barriers to shared e-curriculum development have been economic and cultural. From an economic standpoint, the benefits of investing in this type of shared e-curriculum development have to outweigh the costs, including the costs associated with longer term maintenance, hosting, service/support, and updates. Culturally, many medical educators have often “talked a good game” with respect to the sharing of resources or co-development, but become disinclined to share materials in the end. There can also be challenges with respect to particular formats of e-learning, and implementation strategies, as copyright of material and licensing restrictions may complicate delivery of shared curricula through a single institution’s learning management system. However, if adequately prepared for and addressed, these factors need not deter from the successful implementation of a valuable and sustainable e-learning ecosystem.

Academic institutions must strive to maximize resources and increase efficiencies by promoting collaborative teaching and curricular development efforts among institutions. This is particularly true of smaller, more specialized programs, and necessarily true during a time of pandemic, when medical educators may be overwhelmed with other clinical responsibilities, or even physically unwell. How faculty members optimize the new concept of shared curricula, including delivery through digital platforms while maximizing trainee outcomes, requires ongoing evaluation.

Practice Points 

  • Creating online curricula and other pragmatic virtual educational activities can meet learning goals and objectives, while allowing for education to continue virtually during the COVID-19 pandemic, and beyond.
  • In order to build a more sustainable curricular ecosystem, training programs must strive to maximize resources and increase efficiencies by promoting collaborative teaching and curricular development efforts across institutions.


Conflict of Interest:

The authors report no conflicts of interest concerning the subject matter of this article.



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