gms | German Medical Science

GMS Journal for Medical Education

Gesellschaft für Medizinische Ausbildung (GMA)

ISSN 2366-5017

Asynchronous, digital teaching in times of COVID-19: a teaching example from general practice

short report Asynchronous Digital Teaching

  • author Piet van der Keylen - Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
  • author Nikoletta Lippert - Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
  • author Raphael Kunisch - Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
  • author Thomas Kühlein - Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
  • corresponding author Marco Roos - Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany

GMS J Med Educ 2020;37(7):Doc98

doi: 10.3205/zma001391, urn:nbn:de:0183-zma0013913

This is the English version of the article.
The German version can be found at:

Received: July 27, 2020
Revised: October 22, 2020
Accepted: October 23, 2020
Published: December 3, 2020

© 2020 van der Keylen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at


Background: The SARS-CoV-2 pandemic had a strong impact on academic teaching and could change it sustainably. Ad hoc digitization of teaching had to be carried out.

General practice teaching situation: Education in general practice at the Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) offers, in addition to the main lecture, various elective courses, clinical traineeships, internship as well as the elective part in the final practical year. The main lecture and one clinical elective course were offered digitally in the summer term 2020.

Digital methods: In the main lecture, an adapted inverted-classroom concept was used. Podcasts and audio annotated videos were provided. Teaching materials were reflected via a weekly, 1hr video consultation and in a forum. An asynchronous learning module was developed for the elective course “Smart Decision-making in Clinical Practice”. Each module consisted of course preparation, podcasts and follow-ups as well as a supervised forum.

Results: The main lecture (response rate n=115/170; 67.6%) was rated “very good” on average. The same applies to the commented videos. The forum, reflective video consultation and teaching materials were rated “good” on average. The predominantly desired forms of presence were “Focus on virtual with in-depth presence phases” (n=54) and “Focus on presence phases, virtual support only” (n=37).

Discussion and implications: The digital restructuring enables students to work on the course contents independently. This requires self-regulation strategies, which in future shall be taught through portfolio work. The teaching focus shifts from a passive teaching format to an interactive one. First evaluation results showed a very good acceptance by the students.

Keywords: digital teaching, COVID-19, general practice, inverted-classroom, blended-learning

1. Background

In the wake of the SARS-CoV-2 pandemic, measures were initiated in Bavaria which could change academic teaching sustainably [1]. The challenge lay in the short-term transformation of established courses into a digital format. Although the Master Plan 2020, irrespective of the current situation [2], points to the urgency of digitizing medical teaching, it was the SARS-CoV-2 pandemic that created the necessary pressure to digitize teaching and implement knowledge transfer in a creative and proactive way for participants. The following report is intended to show how general practice teaching can work digitally and asynchronously in the clinical section of the study program, thus going didactically beyond the conventional frontal classroom teaching. Interactive learning activities according to the “ICAP Framework” can be supported by the “Reflective Video Consultation” and an “Online Forum” [3]. These enable the experience of autonomy and competence as well as relatedness, which according to self-determination theory have a positive influence on learning motivation and performance [4].

2. General practice teaching situation

At the Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), general practice is anchored in the 1st clinical semester as a lecture with two semester hours per week (SWS). The internship is to be completed from the 5th to the 10th semester. (Pre-)clinical elective courses are offered. The practical elective part can be completed in the final practical year (see figure 1 [Fig. 1]). In the summer term 2020, the “Lecture General Practice” and the clinical elective course “Smart Decision-making in Clinical Practice” were offered digitally. Other elective courses could not be offered digitally due to the highly practice-oriented interactive setting (e.g., small groups, role-play), or – after suspension – were offered again in analogue form (clinical traineeship, internship, elective part).

3. Digital methods

3.1. Lecture General Practice

The lecture was transformed into a solely digital teaching format. The 90-minute lectures were offered as video podcasts. Each lecture was divided into smaller thematic sections (“Segmenting Principle”) [5] and made available as audio annotated videos via ILIAS, a learning platform []. In-depth assignments for self-study and further materials were offered to counteract the possible passivity by reduced interaction. The contents were made available one week before the actual “presence date”. At this meeting, a reflective video consultation with practical examples took place on WebEx (Cisco Systems, []). A forum on the learning platform, supervised by the lecturers, encouraged additional interaction. This resulted in a variant of an inverted-classroom concept with the possibility of reflexive learning in an asynchronous environment and at an individual pace [6]. To promote digital learning, the formats were held in common language, and the video lesson was conducted by two lecturers in dialogue with each other and with the students, in accordance with Mayer's “Personalization Principle” [7]. At the end of the lecture, students evaluated their learning experience. This included self-developed items for the evaluation of didactic methods, satisfaction and the desired form of presence. Items were answered, following the school grading principle (1 “very good” through 6 “deficient”). A free text answer (open wishes/criticism) was also possible.

3.2. Elective "Wise Decision-Making in Clinical Practice”

The clinical elective course was initially established as a hybrid event (presence-digital, 2 SWS). In the summer term 2020 it was further developed as an online learning module (ILIAS, []) and interlocked with the lecture thematically and didactically. For each thematic section, there was an activating preparation, supplemented by podcast contributions of the lecturers. A course follow-up intensified the content in self-study by means of exercises or control questions and thus informed students about the learning progress. A forum supervised by lecturers and student tutors enabled asynchronous interaction.

4. Results

Evaluation results – assessment according to German school grades – of the lecture (response rate n=115/170; 67.6%, see figure 2 [Fig. 2]) showed a high level of acceptance with an average grade of “very good”. The same applies to the commented videos. Forum, reflective video consultation and teaching materials received an average grade of “good”. The most desired teaching formats were “Focus on virtual with in-depth presence phases” (n=54) and “Focus on presence phases, virtual support only” (n=37). In the free-text responses, the “very good organization” and “didactic method” were highlighted in comparison to other clinical subjects. The evaluation of the elective course has not yet been completed and will be published elsewhere.

5. Discussion and implications

Asynchronous teaching enables students to work independently at their individual learning pace, regardless of time and place. Nevertheless, personal contact must be possible at all times. In addition to content and method, students appreciate reliable structure, organization and support in a virtual environment.
Students need self-regulation strategies to ensure that online courses do not become more boring and less enjoyable than in class [8]. Self-regulation can be encouraged, for example, through portfolio work [9].
Asynchronous, digital blended-learning/inverted-classroom concepts can strengthen clinical teaching (e.g. general practice) [10], [11]. The focus is shifting from passive teaching of content to interactive content handling.
Evaluation differences between videos and the forum may result from a different level of activity (passive vs. interactive) [3].
A further development of the evaluation is planned.


The described elective is a course for the introduction to evidence-based medicine. It is recognized as a continuing education course (DNEbM e.V.) and is funded by the German Federal Ministry of Education and Research (“QuiS II No. 01PL17017”).


PK and NL share first authorship and were responsible for manuscript preparation, data collection and analysis as well as the development of the evaluation. RK and TK revised the manuscript. MR developed the evaluation and, together with PK, was responsible for the development of the teaching idea. MR revised the manuscript, data collection and data presentation.

The present work was performed in (partial) fulfillment of the requirements for obtaining the degree “Dr. rer. biol. hum.” for NL.


The authors thank the student tutors for their support. The authors would like to thank the Medical Faculty of the FAU Erlangen-Nuremberg and the Institute for Learning Innovation of the FAU Erlangen-Nuremberg for their constructive support.

Competing interests

The authors declare that they have no competing interests.


Bayerisches Staatsministerium für Gesundheit und Pflege. Coronavirus - Maßnahmen 2020. München: Bayerisches Staatsministerium für Gesundheit und Pflege; 2020. Zugänglich unter/available from: External link
Bundesministerium für Bildung und Forschung. Masterplan Medizinstudium 2020. Berlin: Bundesministerium für Bildung und Forschung; 2017. Zugänglich unter/available from: External link
Chi MT, Wylie R. The ICAP framework: Linking cognitive engagement to active learning outcomes. Educ Psychol. 2014;49(4):219-243. DOI: 10.1080/00461520.2014.965823 External link
Deci EL, Ryan RM. The "What" and "Why" of Goal Pursuits: Human Needs and the Self-Determination of Behavior. Psychol Inq. 200011(4):227-268. DOI: 10.1207/S15327965PLI1104_01 External link
Clark R, Mayer R. Applying the segmenting and pretraining principles: managing complexity by breaking a lesson into parts. E-Learning and the Science of Instruction: Proven Guidelines for Consumers and Designers of Multimedia. Hoboken, NJ: Wiley Online Library; 2010. p.207-218.
Tolks D, Schäfer C, Raupach T, Kruse L, Sarikas A, Gerhardt-Szép S, Klauer G, Lemos M, Fischer MR, Eichner B, Sostmann K, Hege I. An introduction to the inverted/flipped classroom model in education and advanced training in medicine and in the healthcare professions. GMS J Med Educ. 2016;33(3):Doc46. DOI: 10.3205/zma001045 External link
Mayer RE. Principles of multimedia learning based on social cues: Personalization, voice, and image principles. In: Mayer RE, editor. The Cambridge handbook of multimedia learning. Cambridge: Cambridge University Press: 2005. p.201-212. DOI: 10.1017/CBO9780511816819.014 External link
Stephan M, Markus S, Gläser-Zikuda M. Students' Achievement Emotions and Online Learning in Teacher Education. Front Educ. 2019;4:109. DOI: 10.3389/feduc.2019.00109 External link
Gläser-Zikuda M, Fendler J, Noack J, Ziegelbauer S. Fostering self-regulated learning with portfolios in schools and higher education. Orbis scholae. 2011;5(2):67-78. DOI: 10.14712/23363177.2018.101 External link
Engel B, Esser M, Bleckwenn M. Piloting a blended-learning concept for integrating evidence-based medicine into the general practice clerkship. GMS J Med Educ. 2019;36(6):Doc71. DOI: 10.3205/zma001279 External link
Northey G, Bucic T, Chylinski M, Govind R. Increasing student engagement using asynchronous learning. J Market Educ. 2015;37(3):171-180