Generation Z generally refers to the demographic cohort born between 1995 and 2012 [1], to which most of medical students today belong. Generation Z is the first to have access to the Internet and social networking using ubiquitous technologies [1,2], and they live and work differently than earlier generations. Knowing how this new generation of students engage in learning is critical to promote their learning. Therefore, medical faculty must know this new generation better to offer medical education suited to their learning needs [3].

The literature indicates some differences in how the generation Z perceive and engage in learning from their predecessors, in large part, due to the impact of technology on their living and learning. As digital natives, the generation Z prefer more personalized, flexible learning and learning environments that they can actively participate and learn independently [4]. The Generation Z tends to have shorter attention spans; thus, bite-sized, interactive, and visually engaging learning materials are more likely to capture their interest [5,6]. Today’s students have a broader concept of learning spaces and resources than previous generations [5]; thus, they have more choice of when and where to learn and what resources to use for learning. Generation Z’s proficiency in navigating the digital landscape goes beyond passive consumption of information, and they have high expectations regarding the immediate access to and delivery of information [7]. Still, they tend to lack information literacy in determining the credibility of their information sources [5].

There has been an increase in medical students’ engagement in e-learning since the coronavirus disease 2019 pandemic [8,9]. Several recent studies have examined medical students’ use of and preferences in e-learning. Lau and Bates [10] reviewed the literature on the current use of e-learning in basic medical education in the United States and Europe and found that about half of the studies explored e-learning for individualized learning and self-study purposes. Delungahawatta et al. [11] systematically reviewed studies on the scope and impact of e-learning on medical students. The authors found that multimedia, case-based learning, question banks, and quizzes were the most common e-learning resources in clinical medicine. In another study, medical students reported animated videos and simultaneous drawings as the most effective learning resources for retaining information [12]. Also, some studies found that question banks offered by off-the-shelf commercial learning platforms were popular with medical students and it was associated with their performance in licensing examinations [13,14].

Although there have been some studies on medical students’ use and preferences of e-learning, research is scant that offers insights for the design of e-learning environments suited for the needs of today’s students. This study investigated medical students’ perceptions and use of e-learning to identify their needs and provide suggestions for the design of e-learning from the perspectives of the generation Z.

This study used a mix of qualitative and quantitative research methods to triangulate data sources and to gain an in-depth understanding of medical students’ perceptions of and needs for e-learning. First, a focus group interview (FGI) was conducted with medical students. Second, the FGI participants were also surveyed on their perceptions of e-learning. Third, log data from the e-learning portal were analyzed to investigate medical students’ actual use of e-learning resources.

This study investigated generation Z medical students’ perceptions of e-learning to provide suggestions for its design tailored to their learning needs. The results showed that participants favored multimedia learning resources that were not readily available in traditional textbooks for studying subjects that could not be easily grasped by reading textbooks alone. In particular, participants preferred video resources, with the most frequent searches on physical examinations and clinical procedures. These findings are congruent with the characteristics of generation Z students, who are known to prefer seeking information through videos over reading long texts [5,6]. Moreover, previous studies have shown that videos are effective learning resources for medical students [17,18].

Moreover, this study found some differences in the popularity of use in video resources. Clinical videos which demonstrated physical examinations and clinical procedures were far more popular than other types of videos such as lecture videos and online modules. This finding seems to reflect medical students’ preference for short videos. Lecture videos tend to be longer than clinical videos, thus these findings are consistent with the learning styles of the generation Z who prefer shorts bite-sized information in learning materials [5,6].

This study showed medical students’ preference of learning resources recommended by their teachers. Although today’s students often use informal learning resources other than their course materials [19,20], this study shows they still prefer those created or recommended by instructors as credible sources of information. This finding is consistent with the assertion made by some researchers that generation Z students tend to lack information literacy in determining the credibility of their information sources [5]. This finding also highlights the importance of medical teachers’ role as resource developers in medical education [21].

Some participants were also motivated to use video resources as they were engaged in creating videos for extracurricular activities. Students’ creation of videos for learning is an example of student engagement in learning at the creative amplification level according to the Passive-Interactive-Creative-Replaces-Amplifies-Trans forms (PICRAT) model of technology integration [9,22]. Medical teachers need to pay attention to such teaching and learning activities to foster active engagement among generation Z students.

This study also revealed that students felt convenience in use was the most important factor in their use of e-learning, yet they were least satisfied with it. These findings are in line with the characteristics of generation Z who are accustomed to easy access to information in ubiquitous and mobile technology environments [5]. This study provides insights into the perspectives, styles, and preferences of e-learning of generation Z medical students. Today’s students have a much broader concept of learning spaces and resources than previous generations [5]. Still, Seemiller and Grace [6] contended that current campus environments do not fully meet the needs, interests, and learning preferences of generation Z students. Similarly, this study’s findings indicate that the current e-learning environment is not well suited to the needs of the new generation of medical students. To bridge this gap, the results highlight the need for improvement in the design and development of e-learning resources that are aligned with the practices and preferences of today’s medical students.

First, this study calls for better navigational design to provide more convenient access to the resources that closely match students’ specific learning needs. In doing so, it is suggested that a feature be added to the e-learning portal that recommends resources relevant to the student’s search terms, which is similar to the one in social media. Moreover, well-designed categorization of resources is fundamental to implementing such an e-learning system that automatically recommends relevant resources for the user. Besides, more segmentation of video resources into shorter pieces are recommended to allow students to easily skip or navigate to the specific points that want to tap into.

Second, this study reaffirms the importance of the role of medial teachers as resource developers. Although it is necessary to build up a comprehensive repository of resources that are credible and relevant to medical students’ learning needs, it consumes a great deal of faculty and institutional resources to develop learning resources for all subject areas needed for medical students. Thus, collaboration among medical schools is fundamental for building up such a comprehensive depository of resources.

Several limitations should be acknowledged when considering the results of this study, which also have implications for future studies. First, this study focused on the e-learning environment provided by Korean medical schools. Thus, the findings may not be generalizable to other types of e-learning that the e-learning portal under investigation is not currently offering. Future research is warranted to explore medical students’ needs for e-learning using emerging technologies, such as virtual patients, virtual or augmented reality, metaverse, and artificial intelligence. In particular, there might be some differences in medical student perceptions and use of e-learning across cultural or regional contexts. Thus, future study is recommended on medical student needs for e-learning across different contexts. Second, although the participants’ experiences in using the e-learning portal varied somewhat, they were likely highly motivated to use e-learning as to engage in creating learning resources by themselves. Thus, the findings may not be generalizable to those with little experience in e-learning. Also, the survey was conducted as a preliminary study with a small sample. Future studies with larger sample sizes are warranted to enhance the validity and reliability of the instrument.

In conclusion, this study highlights the needs for an e-learning environment closely aligned with the practices and preferences of today’s students. This study calls for better design and development of e-learning to offer more convenient browsing and searching of resources that are highly relevant to students’ specific learning needs. Also, strategic plannings are suggested to build up a comprehensive repository of resources that are credible and relevant to medical students’ learning needs.