ONLINE LEARNING DEVELOPMENTS IN UNDERGRADUATE MEDICAL EDUCATION IN RESPONSE TO THE COVID-19 PANDEMIC: A BEME SYSTEMATIC REVIEW: BEME GUIDE NO. 69

• Jennifer N. Stojan
• Mary Haas
• Satid Thammasitboon
• Lina Lander
• Sean Evans
• Teresa Pawlikowska
• Cameron Pawlik
• Madelyn Lew
• Deena Khamees
• William Peterson
• Ahmad Hider
• Ciaran Grafton-Clarke
• Hussein Uraiby
• Morris Gordon
• Michelle Daniel

Abstract

Background. The COVID-19 pandemic spurred an abrupt transition away from in-person educational activities. This systematic review investigated the pivot to online learning for nonclinical undergraduate medical education (UGME) activities and explored descriptions of educational offerings deployed, their impact, and lessons learned.

Methods. The authors systematically searched four online databases and conducted a manual electronic search of MededPublish up to December 21, 2020.

Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias. A third author resolved discrepancies. Findings were reported in accordance with the STORIES (Structured approach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance.

Results. 56 articles were included. The majority (41) described the rapid transition of existing offerings to online formats, whereas fewer (15) described novel activities. The majority (27) included a combination of synchronous and asynchronous components. Didactics (40) and small groups (26) were the most common instructional methods. Teachers largely integrated technology to replace and amplify rather than transform learning, though learner engagement was often interactive. Thematic analysis revealed unique challenges of online learning, as well as exemplary practices. The quality of study designs and reporting was modest, with underpinning theory at highest risk of bias. Virtually all studies (54) assessed reaction/satisfaction, fewer than half (23) assessed changes in attitudes, knowledge or skills, and none assessed behavioral, organizational or patient outcomes.

Conclusions. UGME educators successfully transitioned face-to-face instructional methods online and implemented novel solutions during the COVID-19 pandemic. Although technology's potential to transform teaching is not yet fully realized, the use of synchronous and asynchronous formats encouraged virtual engagement, while offering flexible, self-directed learning. As we transition from emergency remote learning to a post-pandemic world, educators must underpin new developments with theory, report additional outcomes and provide details that support replication.

Keywords:best evidence medical education, remote learning, online learning, undergraduate medical education, COVID-19

Литература/References

· Alkhowailed M.S., Rasheed Z., Shariq A., Elzainy A., El Sadik A., Alkhamiss A., et al. Digitalization plan in medical education during COVID-19 lockdown. Inform Med Unlocked. 2020; 20: 100432.

· Allen W.C. Overview and evolution of the ADDIE training system. Adv Dev Hum Resour. 2006; 8 (4): 430–41.

· Bramer W.M., Giustini D., de Jonge G.B., Holland L., Bekhuis T. Deduplication of database search results for systematic reviews in EndNote. J Med Libr Assoc. 2016; 104 (3): 240–3.

· Branch R.M., Dousay T.A. Survey of instructional design models. Bloomington, IN: Association for Educational Communications and Technology (AECT), 2015.

· Burns R., Wenger J. A remotely conducted paediatric bootcamp for fourth-year medical students. Med Educ. 2020; 54 (7): 668–9.

· Chandrasinghe P.C., Siriwardana R.C., Kumarage S.K., Munasinghe B.N.L., Weerasuriya A., Tillakaratne S., et al. A novel structure for online surgical undergraduate teaching during the COVID-19 pandemic. BMC Med Educ. 2020; 20 (1): 324.

· Chen B.Y., Kern D.E., Kearns R.M., Thomas P.A., Hughes M.T., Tackett S. From modules to MOOCs: application of the six-step approach to online curriculum development for medical education. Acad Med. 2019; 94 (5): 678–85.

· Chen C.H., Mullen A.J. COVID-19 can catalyze the modernization of medical education. JMIR Med Educ. 2020; 6 (1): e19725.

· Clark J.M., Sanders S., Carter M., Honeyman D., Cleo G., Auld Y., et al. Improving the translation of search strategies using the Polyglot Search Translator: a randomized controlled trial. J Med Libr Assoc. 2020; 108 (2): 195–207.

· Clarke V., Braun V. Teaching thematic analysis: overcoming challenges and developing strategies for effective learning. Psychologist. 2013; 26 (2): 120–3. URL: http://eprints.uwe.ac.uk/21155

· Cleland J., Durning S.J. Researching medical education. West Sussex, UK: John Wiley and Sons, 2015.

· Clemmons K., Boehme K., Cannon M., Graham J., Lipschitz R. Building up while shutting down: an academic health system educational response to the COVID-19 pandemic. MedEdPublish. 2020; 9 (1): 165.

· Co M, Chu K.M. Distant surgical teaching during COVID-19 – a pilot study on final year medical students. Surg Pract. 2020; 24 (3): 105–9.

· Coiado O.C., Yodh J., Galvez R., Ahmad K. How COVID-19 transformed problem-based learning at Carle Illinois College of Medicine. Med Sci Educ. 2020; Aug 24: 1–2.

· Cook D.A., Beckman T.J., Bordage G. A systematic review of titles and abstracts of experimental studies in medical education: many informative elements missing. Med Educ. 2007a; 41 (11): 1074–81.

· Cook D.A., Beckman T.J., Bordage G. Quality of reporting of experimental studies in medical education: a systematic review. Med Educ. 2007b; 41 (8): 737–45.

· Cook D.A., Bordage G., Schmidt H.G. Description, justification and clarification: a framework for classifying the purposes of research in medical education. Med Educ. 2008; 42 (2): 128–33.

· Cook D.A., Levinson A.J., Garside S. Method and reporting quality in health professions education research: a systematic review. Med Educ. 2011; 45 (3): 227–38.

· Cook D.A., Reed D.A. Appraising the quality of medical education research methods: the medical education research study quality instrument and the Newcastle-Ottawa Scale-Education. Acad Med. 2015; 90 (8): 1067–76.

· Cuschieri S., Calleja Agius J. Spotlight on the shift to remote anatomical teaching during Covid-19 pandemic: perspectives and experiences from the University of Malta. Anat Sci Educ. 2020; 13 (6): 671–9.

· Daniel M., Gordon M., Patricio M., Hider A., Pawlik C., Bhagdev R., et al. An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME guide no. 64. Med Teach. 2021; 43 (3): 253–71.

· Emanuel E.J. The inevitable reimagining of medical education. JAMA. 2020; 323 (12): 1127.

· Fatani T.H. Student satisfaction with videoconferencing teaching quality during the COVID-19 pandemic. BMC Med Educ. 2020; 20 (1): 396.

· Gaber D.A., Shehata M.H., Amin H.A.A. Online team-based learning sessions as interactive methodologies during the pandemic. Med Educ. 2020; 54 (7): 666–7.

· Garg M., Eniasivam A., Satterfield J., Norton B., Austin E., Dohan D. Rapid transition of a preclinical health systems science and social justice course to remote learning in the time of coronavirus. Med Educ Online. 2020; 25 (1): 1812225.

· Gaur U., Majumder M.A.A., Sa B., Sarkar S., Williams A., Singh K. 2020. Challenges and opportunities of preclinical medical education: COVID-19 crisis and beyond. SN Compr Clin Med. 2020; Sep 22: 1–6.

· Geha R., Dhaliwal G. Pilot virtual clerkship curriculum during the COVID-19 pandemic: podcasts, peers and problem-solving. Med Educ. 2020; 54 (9): 855–6.

· Gill D., Whitehead C., Wondimagegn D. Challenges to medical education at a time of physical distancing. Lancet. 2020; 396 (10 244): 77–9.

· Gordon M., Hill E., Stojan J., Daniel M. Educational interventions to improve handover in health care: an updated systematic review. Acad Med. 2018; 93 (8): 1234–44.

· Gordon M., Daniel M., Patricio M. What do we mean by «systematic» in health education systematic reviews and why it matters! Med Teach. 2019; 41 (8): 956–7.

· Gordon M., Farnan J., Grafton-Clarke C., Ahmed R., Gurbutt D., McLachlan J., et al. Non-technical skills assessments in undergraduate medical education: a focused BEME systematic review: BEME Guide No. 54. Med Teach. 2019; 41 (7): 732–45.

· Gordon M., Gibbs T. STORIES statement: publication standards for healthcare education evidence synthesis. BMC Med. 2014; 12 (1): 143.

· Gordon M., Patricio M., Horne L., Muston A., Alston S., Pammi M., et al. Developments in medical education in response to the COVID-19 pandemic: a rapid BEME systematic review: BEME Guide No. 63. Med Teach. 2020; 42 (11): 1202–15.

· Hammick M., Dornan T., Steinert Y. Conducting a best evidence systematic review. Part 1: from idea to data coding. BEME Guide No. 13. Med Teach. 2010; 32 (1): 3–15.

· Hodges C., Moore S., Lockee B., Trust T., Bond A. The difference between emergency remote teaching and online learning. Educause Reviews. 2020. URL: https://er.educause.edu/articles/2020/3/the-difference-between-emergency-remote-teaching-and-online-learning

· Howley L., Szauter K., Perkowski L., Clifton M., McNaughton N. Quality of standardised patient research reports in the medical education literature: review and recommendations. Med Educ. 2008; 42 (4): 350–8.

· Hrastinski S. Asynchronous & synchronous E-learning. Educause Reviews. 2008; 31 (4): 5. URL: http://www.educause.eduleducause+ouarteriyieducauseouarteriymagazinevolumlasynchronousandsynchronouseleal163445/

· Iqbal M.Z., Alradhi H.I., Alhumaidi A.A., Alshaikh K.H., Al Obaid A.M., Alhashim M.T., et al. Telegram as a tool to supplement online medical education during COVID-19 crisis. Acta Inform Med. 2020; 28 (2): 94–7.

· Jeong L., Smith Z., Longino A., Merel S.E., McDonough K. Virtual peer teaching during the COVID-19 pandemic. Med Sci Educ. 2020; 30 (4): 1–2. DOI: https://doi.org/10.1007/s40670-020-01065-1

· Jones T.A., Vidal G., Taylor C. Interprofessional education during the COVID-19 pandemic: finding the good in a bad situation. J Interprof Care. 2020; 34 (5): 633–46.

· Joseph J.P., Joseph A.O., Conn G., Ahsan E., Jackson R., Kinnear J. COVID-19 pandemic medical education adaptations: the power of students, staff and technology. Med Sci Educ. 2020; 30 (4): 1–2.

· Jumat M.R., Wong P., Foo K.X., Lee I.C.J., Goh S.P.L., Ganapathy S., et al. From trial to implementation, bringing team-based learning online-Duke NUS medical school’s response to the COVID-19 pandemic. Med Sci Educ. 2020; 30 (4): 1–6.

· Khalil R., Mansour A.E., Fadda W.A., Almisnid K., Aldamegh M., Al-Nafeesah A., et al. The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students’ perspectives. BMC Med Educ. 2020; 20 (1): 285.

· Kim J.W., Myung S.J., Yoon H.B., Moon S.H., Ryu H., Yim J.J. How medical education survives and evolves during COVID-19: our experience and future direction. PLoS One. 2020; 15 (12): e0243958.

· Kimmons R., Graham C.R., West R.E. The PICRAT model for technology integration in teacher preparation. Contemp Iss Technol Teach Educ. 2020; 20 (1): 176–98. URL: https://citejournal.org/volume-20/issue-1-20/general/the-picrat-model-for-technology-integration-in-teacherpreparation

· Kirkpatrick J.D., Kirkpatrick W.L. Four levels of training evaluation. East Peoria, IL. Versa Press, 2016.

· Laksov K.B., Dornan T., Teunissen P.W. Making theory explicit – an analysis of how medical education research(ers) describe how they connect to theory. BMC Med Educ. 2017; 17 (1): 18–9.

· Lapane K.L., Dube C.E. Rigor and reproducibility training for first year medical students in research pathways. Clin Transl Sci. 2021; 14 (3): 1026–36.

· Liang S., Taylor L.N., Hasan R. Student-led adaptation of improvement science learning during the COVID-19 pandemic. PRiMER. 2020; 4: 20.

· Mahima S.M., Sasirekha M., Leonoline E.J., Vaijayanthimala P. Perception of undergraduate medical and dental students towards learning anatomy in google classroom. Indian J Public Health Res Dev. 2020; 11 (10): 18–25.

· Mann K., Dornan T., Teunissen P.W. Perspectives on learning. In: T. Dornan, K. Mann, A. Scherpbier, J. Spencer (eds). Medical Education: Theory and Practice. New York, NY: Elsevier, 2011: 17–38.

· Martinez L., Holley A., Brown S., Abid A. Addressing the rapidly increasing need for telemedicine education for future physicians. PRiMER. 2020; 4: 16.

· Masters K. They shoot horses, don’t they? A warning to medical schools about medical teacher burnout during COVID-19. MedEdPublish. 2021; 10 (1): 47.

· Mayer R.E. Introduction to multimedia learning & cognitive theory of multimedia learning. In: The Cambridge Handbook of Multimedia Learning. Cambridge, MA: Cambridge University Press, 2005: 1–48.

· McHugh M.L. Interrater reliability: the kappa statistic. Biochem Med. 2012; 22 (3): 276–82.

· Means B., Toyama Y., Murphy R., Bakia M., Jones K. Evaluation of evidence-based practices in online-learning: a meta-analysis and review of online learning studies. Washington, DC: US Department of Education, Office of Planning, Evaluation, and Policy Development, 2009.

· Mendez-Reguera A., Lopez Cabrera M.V. Engaging my Gen Z class: teaching with memes. Med Sci Educ. 2020; 30 (4): 1–2.

· Millwood R. Learning theories map. Holistic Approach to Technology Enhanced Learning (HoTEL). 2013. URL: http://hotel-project.eu/content/learning-theories-map-richardmillwood (date of access February 25, 2021)

· Mohos A., Mester L., Barabas K., Nagyvari P., Kelemen O. Orvos-beteg kommunikacios gyakorlat szimulalt pacienssel a koronavırusj arvany idejen. (A COVID-19-pandemia orvosszakmai kerdesei) [Doctor-patient communication training with simulated patient during the coronavirus pandemic]. Orv Hetil. 2020; 161 (33): 1355–62.

· Moro C., Stromberga Z. Enhancing variety through gamified, interactive learning experiences. Med Educ. 2020; 54 (12): 1180–1.

· Morris Z.S., Wooding S., Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011; 104 (12): 510–20.

· Naidoo N., Akhras A., Banerjee Y. Confronting the challenges of anatomy education in a competency-based medical curriculum during normal and unprecedented times (COVID-19 Pandemic): pedagogical framework development and implementation. JMIR Med Educ. 2020; 6 (2): e21701.

· Newcomb A.B., Duval M., Bachman S.L., Mohess D., Dort J., Kapadia M.R. Building rapport and earning the surgical patient’s trust in the era of social distancing: teaching patient-centered communication during video conference encounters to medical students. J Surg Educ. 2021; 7204 (20): 30 211–7.

· Parker E.U., Chang O., Koch L. Remote anatomic pathology medical student education in Washington State. Am J Clin Pathol. 2020; 154 (5): 585–91.

· Prasad N., Fernando S., Willey S., Davey K., Kent F., Malhotra A., et al. Online interprofessional simulation for undergraduate health professional students during the COVID-19 pandemic. J Interprof Care. 2020; 34 (5): 706–10.

· Price E.G., Beach M.C., Gary T.L., Robinson K.A., Gozu A., Palacio A., et al. A systematic review of the methodological rigor of studies evaluating cultural competence training of health professionals. Acad Med. 2005; 80 (6): 578–86.

· Rapanta C., Botturi L., Goodyear P., Guardia L., Koole M. Online University teaching during and after the Covid-19 crisis: refocusing teacher presence and learning activity. Postdigit Sci Educ. 2020; 2 (3): 923–45.

· Ratanawongsa N., Thomas P.A., Marinopoulos S.S., Dorman T., Wilson L.M., Ashar B.H., et al. The reported validity and reliability of methods for evaluating continuing medical education: a systematic review. Acad Med. 2008; 83 (3): 274–83.

· Reed D., Price E., Windish D., Wright S., Gozu A., Hsu E., et al. Challenges in systematic reviews of educational intervention studies. Ann Intern Med. 2005; 142 (12 Pt 2): 1080–99.

· Reed D.A., Cook D.A., Beckman T.J., Levine R.B., Kern D.E., Wright S.M. Association between funding and quality of published medical education research. JAMA. 2007; 298 (9): 1002–9.

· Rehman R., Fatima S.S. An innovation in Flipped Class Room: a teaching model to facilitate synchronous and asynchronous learning during a pandemic. Pak J Med Sci. 2020; 37 (1): 131–6.

· Robertson B., McDermott C., Star J., Lewin L.O., Spell N. Synchronous virtual interprofessional education focused on discharge planning. J Interprof Educ Pract. 2021; 22: 100388.

· Rosasco J., Hanson Z., Kramer J., Steele L., Beachy B., Gothard M.D., et al. A randomized study using telepresence robots for behavioral health in interprofessional practice and education. Telemed J E Health. 2020; 27 (7): 755–62.

· Rosenberg M. E-Learning: strategies for delivering knowledge in the digital age. New York: McGraw-Hill, 2001.

· Roy H., Ray K., Saha S., Ghosal A.K. A study on students’ perceptions for online zoom-app based flipped class sessions on anatomy organised during the lockdown period of COVID-19. J Clin Diagn Res. 2020; 14 (6): AC01–04.

· Rucker J., Steele S., Zumwalt J., Bray N. Utilizing zoom breakout rooms to expose preclerkship medical students to TeleMedicine encounters. Med Sci Educ. 2020; 30 (4): 1–2.

· Ruiz J.G., Mintzer M.J., Leipzig R.M. The impact of E-learning in medical education. Acad Med. 2006; 81 (3): 207–12.

· Rutledge C., Hawkins E.J., Bordelon M., Gustin T.S. Telehealth Education: an Interprofessional online immersion experience in response to COVID-19. J Nurs Educ. 2020; 59 (10): 570–6.

· Sa-Couto C., Nicolau A. How to use telesimulation to reduce COVID-19 training challenges: a recipe with free online tools and a bit of imagination. MedEdPublish. 2020; 9 (1): 129.

· Sandars J., Patel R.S., Goh P.S., Kokatailo P.K., Lafferty N. The importance of educational theories for facilitating learning when using technology in medical education. Med Teach. 2015; 37 (11): 1039–42.

· Schlegl A.T., Pinter Z., Kovacs A., Kopjar E., Varga P., Kardos D., et al. Teaching basic surgical skills using homemade tools in response to COVID-19. Acad Med. 2020; 95 (11): e7.

· Selwyn N. Looking beyond learning: notes towards the critical study of educational technology. J Comput Assist Learn. 2010; 26 (1): 65–73.

· Shahrvini B., Baxter S.L., Coffey C.S., MacDonald B.V., Lander L. Preclinical remote undergraduate medical education during the COVID-19 pandemic: a survey study. Res Sq. 2020; Jun 10: 1–39.

· Sharma S., Ray A., Sadasivam B. Adaptations in teaching modalities for medical undergraduates in response to coronavirus disease 2019 at a single teaching institute in India. Korean J Med Educ. 2020; 32 (4): 291–5.

· Singal A., Bansal A., Chaudhary P., Singh H., Patra A. Anatomy education of medical and dental students during COVID-19 pandemic: a reality check. Surg Radiol Anat. 2021; 43 (4): 515–21.

· Singh K., Srivastav S., Bhardwaj A., Dixit A., Misra S. Medical education during the COVID-19 pandemic: a single institution experience. Indian Pediatr. 2020; 57 (7): 678–9.

· Spaletra P., Sigal A.R., Gelpi R.J., Alves de Lima A. Implementation of a virtual rotation in Cardiology in times of COVID-19. Medicina. 2020; 80 (5): 587–8.

· Srinivasan D.K. Medical students’ perceptions and an anatomy teacher’s personal experience using an e-Learning platform for tutorials during the Covid-19 crisis. Anat Sci Educ. 2020; 13 (3): 318–9.

· Steehler A.J., Pettitt-Schieber B., Studer M.B., Mahendran G., Pettitt B.J., Henriquez O.A. Implementation and evaluation of a virtual elective in otolaryngology in the time of COVID-19. Otolaryngol Head Neck Surg. 2021; 164 (3): 556–61.

· Sterne J.A., Hernan M.A., Reeves B.C., Savovic J., Berkman N.D., Viswanathan M., et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355: i4919.

· Sud R., Sharma P., Budhwar V., Khanduja S. Undergraduate ophthalmology teaching in COVID-19 times: students’ perspective and feedback. Indian J Ophthalmol. 2020; 68 (7): 1490–1.

· Sudhir M., Mascarenhas S., Isaac J., Alfroukh J., Abdul Rahuman S. Adapting to the need of the hour: communication skills simulation session using an online platform during COVID-19. MedEdPublish. 2020; 9 (1): 3048.

· Sweller J., Ayres P., Kalyuga P. Cognitive load theory. New York, NY: Springer-Verlag, 2011.

· Tan J., Lee Y., Tan L., Cheong Y., Nyo Y. The conduct of paediatric surgery collaborative learning cases via an online platform during the COVID-19 outbreak: challenges and lessons learnt. MedEdPublish. 2020; 9 (1): 261.

· Tang B., Coret A., Qureshi A., Barron H., Ayala A.P., Law M. Online lectures in undergraduate medical education: scoping review. JMIR Med Educ. 2018; 4 (1): e11.

· Taylor D.C., Hamdy H. Adult learning theories: implications for learning and teaching in medical education: AMEE Guide No. 83. Med Teach. 2013; 35 (11): e1561–72.

· Thum DiCesare J.A., Segar D.J., Donoho D., Radwanski R., Zada G., Yang I. Democratizing access to neurosurgical medical education: National efforts in a medical student training camp during coronavirus disease 2019. World Neurosurg. 2020; 144: e237–43.

· Torre D.M., Daley B.J., Sebastian J.L., Elnicki D.M. Overview of current learning theories for medical educators. Am J Med. 2006; 119 (10): 903–7.

· Vala N.H., Vachhani M.V., Sorani A.M. Study of evaluation of E-learning classes among medical students during COVID-19 pandemic phase in Jamnagar city. Natl J Physiol Pharm Pharmacol. 2020; 10 (12): 1042–2.

· Verma A., Verma S., Garg P., Godara R. Online teaching during COVID-19: perception of medical undergraduate students. Indian J Surg. 2020; 82 (3): 299–300.

· Vollbrecht P.J., Porter-Stransky K.A., Lackey-Cornelison W.L. Lessons learned while creating an effective emergency remote learning environment for students during the COVID-19 pandemic. Adv Physiol Educ. 2020; 44 (4): 722–5.

· Walton R., Greenberg A., Ehlke D., Sola O. Development of a health policy elective for medical students during the COVID-19 pandemic: a pilot study. PRiMER. 2020; 4: 29.

· Wentling T., Waight C., Gallaher J., La Fleur J., Wang C., Kanfer A. E-Learning: a review of literature. Urbana-Champaign, IL: University of Illinois National Center for Supercomputer Applications (NCSA), 2000.

· Wilcha R.J. Effectiveness of virtual medical teaching during the COVID-19 crisis: systematic review. JMIR Med Educ. 2020; 6 (2): e20963.

· Wintraub L., Xie M., Issa M., Jeyakumar Y., Nelms M., Sharma D., et al. Wearable technology and live video conferencing: the development of an affordable virtual teaching platform to enhance clinical skills education during the COVID-19 pandemic. Can Med Educ J. 2020; 11 (5): e121–5.

· Wish-Baratz S., Crofton A.R., Gutierrez J., Henninger E., Griswold M.A. Assessment of mixed-reality technology use in remote online anatomy education. JAMA Netw Open. 2020; 3 (9): e2016271.

· Wolf F.M. Methodological quality, evidence, and research in medical education (RIME). Acad Med. 2004; 79 (Suppl 10): 68–9.

· Worthington T. Synchronizing asynchronous learning. Collections: Australian National University Digital. 2013. DOI: http://dx.doi.org/10.1109/ICCSE.2013.6553983

· Yardley S., Dornan T. Kirkpatrick’s levels and education «evidence». Med Educ. 2012; 46 (1): 97–106. PMID: 22150201.

· Zhang Q., He Y.J., Zhu Y.H., Dai M.C., Pan M.M., Wu J.Q., et al. The evaluation of online course of Traditional Chinese Medicine for MBBS international students during the COVID-19 epidemic period. Integr Med Res. 2020; 9 (3): 100449.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)