Niina Nuottamo, BSc, ISMPP CMPP™, Eline Hanekamp, PhD, Tim Norris, PhD, Excerpta Medica, Amsterdam, The Netherlands

The COVID-19 pandemic radically changed the world of medical education as medical congresses were either canceled or switched to a virtual format. This change triggered the widespread adoption of virtually delivered medical education, such as e-learning modules, webinars, and virtual events, for the continued education of healthcare professionals (HCPs) worldwide.1 Virtual medical education offers multiple benefits, including on-demand access, customized content, and accessibility for audiences unable to travel.

In medical education, adult learning principles are applied to maximize information retention. These adult learning principles can also be utilized when developing medical communication deliverables, such as medical affairs slide decks, HCP training materials, and even publication-derived materials. Here, we provide a summary of some key adult learning principles (Figure 1) that medical communication professionals can take into consideration across all their deliverables in order to maximize HCP impact, recall, and, ultimately, patient outcomes.

Figure 1. Adult learning principles for virtual medical education.

Learner-Centric Design

To design impactful virtual medical education, it is imperative to understand learners and the everyday clinical challenges they face2 (Figure 2). Therefore, a thorough needs assessment and/or HCP interviews should be conducted to acquire valuable insights into current information needs, skill levels, and learner motivation. These insights should form the foundation of the design.

Every educational initiative should specify upfront how the topic will be relevant to HCPs’ daily practice, and, if feasible, offer options for learners to make choices and customize their own learning journey.2 For example, participants can be asked to complete an assignment within a given deadline, but allowed flexibility regarding how much time they choose to spend on the assignment, whether they want to work individually or collaboratively, and how they present the outcomes of their work.

Figure 2. Knowles’ 4 principles of andragogy (methods and principles used in adult education).2

Active Participation

According to established learning theory, a higher level of cognitive activity (and therefore learning) can be achieved with more active learner involvement during the learning process.3,4 Bloom’s3 or the SOLO (Structure of the Observed Learning Outcome)4 taxonomy can be used to define learning objectives and activities that align with the desired level of learning (Figure 3). For example, if learners are expected to remember information (the lowest tier of Bloom’s learning pyramid [Figure 3]), then the learning activity can be a presentation followed by multiple-choice questions to confirm they can appropriately and accurately recall the information. If you would like HCPs to evaluate whether current treatment guidelines or hospital protocols reflect the most recent data, the learning activity could involve a critique of recent publications and proposed updated recommendations.

Figure 3. Bloom’s taxonomy, showing learning levels (left), learning objectives (middle), and learning activities (right).3

Setting the Scene

Before inviting delegates to actively participate, make sure they feel it is “safe” to do so, for example by designing a relatively easy first assignment or activity. These can even be pre-meeting engagement activities – such as surveys, quizzes, or polls – before the main virtual educational activity. Pre-engagement activities serve several other important functions:

  • Building curiosity and anticipation
  • Priming learners to think about the topics and what they are going to learn
  • Creating a comfortable and inviting environment so that learners feel at ease and are confident to try, even though that might mean they have to learn from their mistakes
  • Providing information on learners’ current level of knowledge, skills, and baseline metrics against which to measure the impact of the educational program

Higher-Order Learning

A plenary presentation alone can only achieve lower-order learning (up to the “applying” level on Bloom’s learning pyramid [Figure 3]). To achieve higher-order learning, participants need to be engaged in problem- or project-based learning; this can involve having to research, consolidate, and report back on a specific topic, or being invited to participate in a “design sprint,” in which members of a multidisciplinary team brainstorm and co-create concrete solutions to problems that are common to all. Although such activities may be more challenging to execute virtually than during live meetings, their incorporation is feasible. Simply ensure the point of the exercise is clear at the outset, use a professional moderator to guide the learners, provide a structure (eg, a rubric) on expected deliverables, and specify the amount of time they should spend on each step.

System Requirements

Many technology platforms are available, each with their own interactivity options.5 The right platform should be utilized to achieve the objectives, learning activities, and desired level of engagement with the target audience. If developing an educational initiative (eg, a satellite symposium) during a medical conference, detailed technical specifications can be requested from the congress organizers. For virtual options not associated with conferences, knowledge of the many different platforms available will aid selection and help manage client, faculty, and learner expectations. In all cases, the selected platform should be readily accessible across all countries/institutions, the instructions should be clear, the login information easy to find, and the navigation process user friendly.


Studies have demonstrated that splitting content into smaller chapters or sections, known as microlearning or “chunking,” is a useful technique for boosting information retention.6 Each “chunk” should have its own goals and support to achieve the overall learning objective. For medical education events, it is not realistic to take an all-day face-to-face event program and deliver it virtually in the same format. It is essential to split events into shorter segments, each no longer than 1 hour, and incorporate regular “brain breaks” or energizers into the program to avoid screen fatigue and ensure that delegates stay focused and engaged throughout. Also consider providing a table of contents to help learners navigate to the section of most interest and visualize their progress.

To maximize value, repurpose single pieces of content into different formats. For example, a webcast could become a podcast, slide deck, and text transcript. This repurposing allows content to be offered to learners with different preferred learning styles (audio, visual, etc.), to reiterate some key takeaways across the different multimedia formats without seeming repetitive, and to amplify dissemination across various channels.


Networking has always been an important component of live congresses. During virtual medical education, it is also possible to encourage interactions and connections between participants, for example by:

  • Working in subgroups (or breakouts) of varying composition, so that participants have a chance to discuss, share, and listen to the various perspectives and experiences from different countries, regions, or specialties.
  • Asking participants to share their work/assignments with each other and to provide positive/constructive feedback on each other’s work. This encourages peer-to-peer learning and helps build a sense of learning community, which might be particularly relevant if there are multiple related events throughout the year.


The success of any virtual medical education initiative can be measured in different ways. For learning-specific metrics, constructive alignment should be applied so that the learning objectives, learning activities, and evaluation are all consistent with each other (Figure 4).7 For example, if the learning objective is that participants should be able to list three differential diagnostic features of a specific condition, then design a learning activity to highlight the various differential diagnostic features, and evaluate how many participants can recall three differential diagnostic features afterward. The success of online virtual medical education events or webinars can also be reported using other key performance indicators, such as number of attendees, number of views, or audience participation, depending on what is captured by the technology platform and/or learning management system.

Figure 4. Constructive alignment of learning objectives, learning activities, and assessment.7

End on a High

The last few moments of a virtual medical education initiative are important: according to the “peak-end rule,”8 participants are most likely to remember what happens at the end. Therefore, during the concluding remarks, reiterate the key points, include a call to action, or add a pleasant, unexpected surprise, eg, a video of patients who have recovered from their disease (if permitted by compliance, of course).


In the COVID-19 era, HCPs across all specialties continue to need content and education that will help them apply the most recently available data and knowledge to solve everyday clinical challenges and optimize patient care. Positive experiences and technical improvements in delivering virtual activities have reinforced the many benefits that virtual medical education can offer, especially against a background of restricted travel and limitations on group activities. While virtual initiatives will not necessarily replace all face-to-face educational activities, they will remain a significant part of our new normal. Medical communication professionals should gain knowledge of established adult education principles used by medical education professionals when designing virtual activities. When these principles are applied to medical communication and education projects, HCPs will maximize returns on their invested time and view virtual medical education as a valuable part of their professional growth.


1. Medical Science Liaison Society (MSLS). MSL activities during the COVID-19 pandemic. Available from: Accessed May 2020.

2. Knowles M. The adult learner: a neglected species. 3rd ed. Houston, TX: Gulf Publishing; 1984.

3. Bloom BS, et al. Taxonomy of educational objectives: the classification of educational goals. Handbook 1: cognitive domain. 1st ed. New York, NY: David McKay Company; 1956.

4. Biggs JB, Collis KF. Evaluating the quality of learning: the SOLO taxonomy (Structure of the Observed Learning Outcome). Educational Psychology Series. New York, NY: Academic Press; 1982.

5. Virtual meetings: virtually all you need to know! Available from: Accessed August 2020.

6. Gobet F, et al. Chunking mechanisms in human learning. Trends Cogn Sci. 2001;5:236-43.

7. Biggs J, Tang C. Teaching for quality learning at university: what the student does. 4th ed. London, UK: Society for Research into Higher Education & Open University Press; 2011.

8. Kahneman D, Fredrickson BL, Schreiber CA, Redelmeier DA. When more pain is preferred to less: adding a better end. Psychol Sci. 1993;4:401-5.

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