e-Learning has been a key feature of learning technologies in medical education and is expected to maintain its position of prominence [1,2]. e-Learning encompasses many technologies and activities that constitute it, where the learning process is supported or mediated using technologies [3]. A meta-analysis of research in medical education indicates e-learning is associated with positive outcomes across a wide variety of learners, learning contexts, clinical topics, and learning outcomes [4].

Still, studies have shown several significant barriers hinder the adoption and implementation of e-learning by medical schools [5]. Universities and colleges in South Korea have actively adopted e-learning since the early 2000s in parallel with rapid, nationwide developments in information and communication technologies (ICT). This was due, in large part, to a government initiative to become a global leader in ICT and to provide lifelong education. In 2006, about half of all colleges in Korea were offering e-learning, but relatively few of the contents of these courses were developed in medical schools [6]. This tardy adoption of e-learning by Korean medical schools was largely due to lack of resources for it [6]. To resolve this issue, Korean medical schools established a national consortium with the aim of offering quality e-learning resources developed by medical faculty to medical students. Currently, 36 of 40 Korean medical schools are participating in this consortium, which has grown from 25 schools since its inception in 2007.

Despite the wide adoption of e-learning in Korean medial schools initiated by the consortium, little is known about the current status of e-learning in Korean medical education. This paper reports the use of e-learning based upon the data from e-MedEdu accumulated over a decade to investigate medical students’ online learning patterns and needs. We sought to answer the following questions: (1) How many users have registered and how many faculties have contributed contents to e-MedEdu? (2) What types of resources are available at e-MedEdu and in what subjects? (3) How often these resources are accessed and which ones are the most frequently visited?

Our study demonstrates e-learning is being increasingly used for medical education in South Korea. We have seen that e-learning has increasingly become mainstream in the teaching and learning in medical education over the past decade. Our experience shows e-learning in this context is feasible, given collaboration among medical schools to develop strategic plans for e-learning and implement them. We believe the Korean e-learning consortium has demonstrated a successful model for implementing e-learning in medical education at the national level.

One of reasons for the increasing use of e-learning found in the present study was the consistent efforts made by medical educators to develop learning resources that meet the curricular needs in basic medical education. Due to the broad range of subjects that must be covered in medical education, it is a considerable challenge to develop resources on all subjects. In terms of the on-going development of e-MedEdu, we have matched existing contents with learning outcomes for basic medical education. In doing so, we were able to recognize that there were some clinical presentation topics in which clinical cases were not available. As a result of this process, we have built up a repository of contents that covers most of the basic learning outcomes in terms of clinical presentations and clinical skills. Having over 30 faculty members from various disciplines in the executive committee of the consortium and a large volume of medical teachers who have contributed contents to e-MedEdu, we were able to draw on these members for support and identify experts in subject areas on a nationwide basis. Expanding collaboration with faculties with expertise in other diverse disciplines will further develop our ability to promote advances in e-learning.

This study also shows the popularity of learning resources offered by e-MedEdu differs substantially across resources types. Our study illustrates the current popularity of online videos as learning resources among medical students. This finding concurs with that of Khogali et al. [13] that students valued animation and video demonstrations highest among e-learning resources. It is likely that the prevalent use of online videos continues in the foreseeable future as they play an important role in clinical education. It is also likely that the creation and use of educational videos becomes more widespread in medical education with the increasing popularity of social media. This trend may emulate the learning styles of today’s medical students, who are millennial learners living and learning with technologies [14].

Moreover, the effectiveness of using technology to enhance the learning of clinical skills using video clips appears to have motivated students to engage in e-learning. Our previous study showed medical student perceptions of clinical videos available at e-MedEdu that those resources were helpful in supplementing conventional face-to-face instruction on clinical skills [15]. This finding is also consistent with those of previous studies that showed student satisfaction with clinical videos for the learning of clinical skills [16,17]. This rise in popularity of clinical videos is also in large part due to the implementation of clinical skills test in the Korean licensing exam since 2009, which illustrates the medical student needs for e-learning that meet their curricular needs.

Despite the importance of clinical cases in medical education, our findings show they are not being widely used at e-MedEdu. This finding indicates our clinical cases need to be better integrated with medical school curriculum, which warrants more active use of these resources as teaching materials on the part of the faculty. In the previous study, we found the low use of learning resources at e-MedEdu by faculty members for their teaching and the main reasons were lack of awareness of these resources and of pedagogical understanding of their utilities [15]. The consortium may need to enhance its efforts to identify best practices in the use of clinical cases by faculty members and to disseminate them so that they make active and effective use of learning resources in their teaching.

Furthermore, our finding of the low use of clinical cases by medical students may suggest they are not suited for the learning styles of today’s students as well as online videos are. This indicates we need to make clinical cases more interactive and engaging for the students. This warrants future research on the design of clinical cases. There are various formats for presenting clinical cases, from a simple text-based format to promoting interaction with the virtual patient in a computer-based simulation environment [18]. It is also plausible to present patient encounters using virtual and augmented reality, which are likely to become a prevalent technology in the near future [19] and are increasingly garnering the attention of medical educators [20]. Still, research is scant on such learning environments. Future research is warranted on more effective design of clinical cases to investigate whether they are used more widely by medical students and how to design them to better promote students’ clinical reasoning skills.

Our study also found differences in the popularity of learning resources across subjects. Among online videos, clips on procedural skills were more frequently viewed by users than those on patient encounters and video lectures. Moreover, there were also differences in the frequency of use of online videos on procedural skills across content domains. Such differences might reflect the learning needs for medical students to supplement conventional instructions on clinical skills particularly on those not readily available for direct observation or those that demonstrate somewhat complex procedural skills. There were also differences in the frequency of use in clinical cases, and there might be several reasons for that. Some cases likely fit more closely with the core curriculum and some might be beyond the scope of basic medical education.

Our study has implications for future directions of e-learning in Korean medical education. First, there is a need to build up more multimedia resources in response to the trend of incorporation of multimedia items for student assessment to enhance its authenticity [21,22]. Our efforts to build up resources have been active on clinical cases and online videos, yet it has been slow in other multimedia resources such as images and sound clips. Second, our findings show our resource development has focused on the core curriculum pertinent to learning outcomes for basic medical education. There is a growing emphasis on “student-selected components” (SSCs) in medical school curricular to promote student-centered learning by offering subjects of more choice and depth of study than the core curriculum [23]. Therefore, there is a need to expand our resources to support such curricular components. Furthermore, e-learning has the potential to offer an effective learning environment for SSCs by offering diverse learning resources and the flexibility for the learning of such components. The inter-institutional collaboration model of the e-learning consortium offers valuable experience in such collaborative efforts to provide learning resources that cover a broad range of subjects for SSCs.

This study has some limitations. First, this study was limited to the format of e-leaning which offer online learning resources through an e-learning portal. As there are various formats of e-learning, such as online courses, and various forms of learning resources are available in medical education, cautions need to be taken in generalizing our findings to other e-learning contexts. Second, although this study found the use of learning resources differed across resource types and subjects, it does not offer direct evidence as to what caused such differences. This study calls for future research to explore what causes such differences to better understand medical students’ use of learning resources in their learning. Such a study will help us advance of our knowledge of more effective use of e-learning that meets the learning needs of today’s students and help improve medical education by supplementing face-to-face instructions. Third, our data was not sufficient to explore students’ activities at our website associated with their academic performance. Future study of learner analytics regarding differences in the use of resources at e-MedEdu between high-achieving and low-achieving students is recommended to advance our understanding of effective use of e-learning.