Letter to the Editor     September 2021  

Student-Centred or Teacher-Centred: Promises and Pitfalls of Online Medical Education

By Fahad Azam1, Abida Shaheen1, Riffat Shafi2, Mohammed Amir3


  1. Department of Pharmacology & Therapeutics, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  2. Department of Physiology, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  3. Department of Surgery, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan


E-learning in medical education witnessed a surge during the COVID-19 pandemic as most institutions worldwide were forced to switch to online education. This trend seems to be continuing into the foreseeable future.

A common observation during this period was the popularity of web-conferencing tools to deliver online lectures. Before the COVID-19 pandemic, a gradual consensus was building up regarding the benefits of problem-based and case-based small group learning.1 Given the current situation, it has become a difficult task for the medical educationists to plan strategies for limiting the number of online lectures; and to plan effective online small group discussions. Student-engagement during synchronous online discussions is another unique challenge. It requires training of Faculty to equip them with the intricacies of online tools to maximise the real-time interaction with students. Furthermore, medical educationists now have an opportunity to incorporate asynchronous tools in the delivery of the medical curriculum as the main pedagogical potential of online teaching is to enhance student learning.

E-learning can shift the focus of curriculum planning towards technology and fancy interfaces at the cost of instructional designs. Faculty must bear in mind that even the best animation and sophisticated learning management systems are counterproductive, if the design and construction of curriculum delivery strategies are flawed.2 The lack of interaction amongst Faculty members, and logistical issues might compromise vertical and horizontal integration, which requires a conscious effort to preserve integration while planning a competency-based online curriculum.

Another trend is to burden medical students with redundant online assignments and presentations. This over-reliance should be discouraged, and ample time should be given for the submission of assignments.3 A crucial component of curriculum delivery is alignment between objectives, contents and assessments; thus the Faculty should be mindful of not compromising on these fundamentals, while juggling with idiosyncrasies of virtual environment coupled with logistical difficulties.4                                      

Online assessments require e-proctoring to maintain the fairness of assessments; and in our opinion, this may shift the utilisation of resources towards acquiring sophisticated proctoring systems. In this scenario, we believe that online formative assessments, together with exploration and validation of new assessment methods, could save precious resources. We recommend that the Faculty should be trained for a different set of communication skills such as asynchronous communication, netiquettes, and time management skills to compensate for the lack of in-person communication. Student-centeredness of curriculum delivery should be preserved; and the capacity building of faculty should be accelerated for effective online pedagogical and social skills. Last but not least, it is imperative to incorporate students’ perspectives before implementing any changes in the methods of curriculum delivery.5

The authors declared no conflict of interest.

FA, AS: Conceptualised the idea, reviewed literature, and drafted write-up.
RS, MA:  Conceptualised the idea, critical revision, and final approval. 


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  2. Lewis KO, Demiroz E, Chen H, Albold C, Mahan JD. A four-pronged approach for evaluating e-learning modules with a newly developed instructional design scale. J Contemporary Med Edu 2020; 10(2):31-54. doi: 10.5455/jcme.2019 0307082154.
  3. Iqbal T. Medical students’ e-learning during Covid-19 lockdown. Pak J Physiol 2020; 16(1):1-2.
  4. Fitz Patrick B, Hawboldt J, Doyle D, Genge T. Alignment of learning objectives and assessments in therapeutics courses to foster higher-order thinking. Am J Pharm Educ 2015; 79(1):10. doi: 10.5688/ajpe79110.
  5. Al-Balas M, Al-Balas HI, Jaber HM, Obeidat K, Al-Balas H, Aborajooh EA, et al. Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: Current situation, challenges, and perspectives. BMC Med Educ 2020; 20(1):341. doi.org/10.1186/s12909-020- 02257-4.