A pneumonia epidemic, first reported in Wuhan, Hubei province in December 2019, has become a global issue because of its surprising infectivity through droplets, air, and physical contact (1). On 11 February 2019, the World Health Organization (WHO) officially named this disease as the coronavirus disease (COVID-19) (2) and the International Committee on Taxonomy of Viruses named the virus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (3). In this special epidemic period, traditional in class teaching no longer meets the needs for disease control and prevention due to the close social distance. To curb the further spread of virus and consolidate the obtained achievements in epidemic prevention, local governments decided to delay the reopening of schools at all levels. Educational authorities have proposed using online platforms and cloud classrooms for online teaching in the extended holiday to achieve “continuous teaching even when classes are suspended.” With richer teaching resources, more diversified course designs and free of time limits, online teaching has shown huge and magic power in this tough period. Despite all these advantages, there remain some hurdles and difficulties, such as the restrictions on course contents, the rigid demand for digital equipment, the requirement for students’ self-learning ability and most importantly, the loosened ties between students and teachers separated by the cold screen. All these problems will get tougher and trickier when it comes to clinical medical education, as it takes time to record the changes of the patient’s condition and put theory into practice. Therefore, it is of great importance to construct a novel teaching mode in the COVID-19 pandemic to improve the teaching quality for medical students.

Recently, medical education has generally adopted a teaching method of “mainly traditional teaching supplemented with online teaching,” which has gradually replaced traditional “spoon feeding” and has obtained positive feedback. After systematically reviewing the literature, we found that previous models and methods in neurology teaching have their limitations. Considering the dual needs of neurology teaching theory and practice, as well as the difficulties and challenges in comprehensive online teaching during the COVID-19 epidemic, we have constructed a diversified online teaching method for neurology education. We intend to combine online courses, massive open online courses (MOOC) and virtual reality simulation systems to improve the quality of online education. In this article, we took neurology education as an example to summarize the practical experience of online teaching and evaluate diverse online teaching methods during the COVID-19 pandemic. Besides, we combine multiple teaching modes to construct a new diversified online teaching mode to make up for the shortcomings of traditional online teaching. Though developed in response to challenges under COVID-19 pandemic, this teaching mode is also helpful in remote education and tans-national education, which can be further applied in the future.

As shown in Table 1 and Figure 3, the average test score of students who take online classes (84.27 ± 4.64) were significantly higher than those who take offline classes (82.08 ± 6.17) (P < 0.01).

One hundred and thirty copies of questionnaires were sent out and one hundred and thirty were received with a coverage rate of 100%. The questionnaire results were shown in Table 2 and Figure 4. There were 71.54% (93/130) students liked this online teaching mode and 63.85% (83/130) students believed that this teaching model was innovative. 60% (78/130) of the students thought the online teaching aroused their interest in the study of neurology. In all, 64.62% (84/130) students thought it a good way of teaching.

Online learning is a novel and rapidly growing field for undergraduates, graduate students and healthcare providers (13). In this article, we summarized online teaching methods for neurology and pointed out shortcomings in existing methods based on the teaching characteristics of neurology. We also pointed out and analyzed challenges in total online neurology teaching during the COVID-19 pandemic and constructed a student-centric, diversified and total online teaching method in neurology education to allow teachers to reform their current teaching practices while adhering to traditional teaching concepts.

We evaluated the effect of our mode through post-class tests and questionnaire survey. The results of tests indicated that the scores of students who take online classes were significantly higher than those who take offline classes (P < 0.01). Probably reason could be that online classes offer more opportunities for students to acquire and consolidate their lessons via reviewing and relearning. In addition, online teaching via pictures and videos could deepen students’ understanding of specialized diseases. This helps to cultivate their clinical abilities and advanced thoughts on solving complex diseases based on the learned theoretical knowledge and skills. Moreover, diversified teaching forms could promote students’ interest in neurology, their communicational skills and humanistic feelings at the same time. By learning neurology through this diversified online teaching mode, students deeply mastered the teaching content. According to the feedbacks from students, online classes were more attractive to students than the conventional one. It is worth noting that, online learning put forward higher requirements for the autonomous learning abilities of students.

As the population ages, the need for neurologists increases. However, the number of medical students going into neurology cannot meet this increasing need. This is somewhat associated with neurophobia (9), i.e., fear of neuroscience and clinical neurology, and the inability to apply basic neurological knowledge to clinical practice (14). Lin et al. recently published a paper in Neurology, which emphasized the challenges in clinician education and encouraged educators to teach “the art of neurology” (4). How to improve neurology education to make it a “golden lesson” with depth, difficulty and rigor? It is a question that requires serious consideration (15). Neurology has a higher demand for students in clinical thinking and practical skills, which are mainly presented in the following two aspects: (1) The highly required combination of clinical and basic sciences: The complicated neuroanatomical structures, diverse symptoms, obscure etiologies, and similar clinical manifestations in different diseases increases the difficulty in learning neurology. Comprehensive medical history collection and physical examination are powerful tools to determine the site (localization diagnosis) and nature (qualitative diagnosis) of the lesion for diagnosis and differential diagnosis, which requires a clear and logic clinical thinking (10). The neurology education puts forward a dual test in the master of both clinical and basic knowledge for students, and the models of both theoretical (including neuroanatomy, neurophysiology and neuroimmune) and clinical (including clinical manifestations, signs and diagnostic principles) teaching for teachers. (2) Cross-disciplinary training: With the rapid development of medical imaging, medical examinations, neuroimmunology, and neurogenetics, clinical neurology is dynamically growing. This requires educators to cultivate more talents in this field with logical clinical thinking and cross-disciplinary ability to innovate and develop this fast-changing field (16).

Educators and scientists around the world are constantly exploring a better online teaching mode for neurology education. Safdieh et al. (17) provided useful resources for medical students, including a streamlined list of symptom complexes, an abundant list of recommended clinical encounters combined with midrotation feedback. Chen and Evans (9) constructed a MOOC-based flipped classroom model for neurology, bearing “students as a learning entity” in mind. They employed images, flash animations, and videos in online classes and had face-to-face interactions between teachers and students in offline classes. The combination of online and offline education not only ignites the students’ interest in neurology but also promotes their self-learning ability and teamwork spirit, which compensates for shortcomings in the single problem-based learning (PBL) and case-based learning (CBL). Zhou et al. (18) incorporated online assignments, question and answer discussions, and knowledge summaries into offline courses to provide targeted teaching based on the individualized learning situation. Ding et al. (19) proposed the concept of micro-lectures to establish a teaching mode. In their project, traditional neurology teaching is combined with a micro-lecture so that students can get access to the knowledge unavailable in the traditional classroom through online courses. As a complement to traditional teaching, micro-lectures are widely used in basic medical education (20–22). However, its application in clinical education and practice looks dim nowadays as it fails to cultivate clinical thinking and skills in medical students.

With the advent of mobile internet, cloud computing, big data, and artificial intelligence, online teaching has become an important part of the modern education (23, 24). The fusion of information technology, such as MOOCs, flipped classrooms and high-quality network resources has gradually replaced traditional “spoon feeding” teaching mode and become today’s new trend (9). Compared with conventional classroom teaching, online teaching has the following characteristics: (1) Flexibility: online teaching is free of time and space limitations as both teachers and students can flexibly schedule their time to give or have a lecture (25); (2) Personalization: students can pause, advance, and replay the course video according to their own learning situation, which greatly elevates their study efficiency (26); (3) Abundant teaching resources: teaching images and video libraries are timely updated and available to all users (15); (4) Reduced costs: teachers can learn from each other to improve their teaching skills (27). Besides, online lessons could receive support from ads and charities, which reduces the teaching cost and ensures the teaching quality at the same time.

Conducting rational and effective online teaching remains a challenge. It is true that online teaching can be used for basic medical classes. Students who accomplish the tasks in different chapters will have a good grasp of theoretical knowledge. However, the clinical practice is of the same importance in their medical study, such as clinical operations, clinical thinking and physician-patient communication (28). Taking neurology study as an example, medical history collection and physical examination are indispensable for localization and qualitative diagnoses. Besides, lumbar puncture, the most common neurological procedure, requires enough practice to be acquired. In addition, online teaching requires more financial and technique support while many universities lack the required infrastructure. Further, online teaching has a higher requirement not only for the students’ self-discipline and self-learning ability, but also for teachers’ teaching method and quality.

This diversified online teaching mode makes up for the shortcomings of traditional online and offline teaching, explore the subjective initiative in students and fill their knowledge gaps. Besides, it increases students’ interest in learning, enables them to make personalized studying plans, provides them with abundant online exercises and attract them to choose online study. Diversified teaching and evaluation methods further deepen teachers’ understanding of students and contribute to the improvement in previous teaching methods. Therefore, we believe that neurology teaching under this diversified teaching forms can improve students’ autonomous learning and collaborative abilities, which helps them to truly internalize theoretical knowledge, to analyze and solve clinical cases better and to integrate into the clinical atmosphere. The diversified online teaching mode is also of reference and promoting value in ensuring students’ normal courses and continuing education in the face of sudden public health and safety emergencies.

In general, we constructed a diverse online neurology teaching method by combining advantages of modern information technology, scientific research, and online teaching. Our newly constructed teaching model is proven to be effective in neurology education under COVID-19 pandemic and has received recognition from students.

Moving forward from this pandemic, to maximize the benefits of offline and online teaching and to improve the efficiency of medical education in the future, we recommend that medical schools adopt a combination of both in calss and online teaching. Online teaching should be regarded as a supplement to, not a substitute for, traditional in class teaching. Further research is needed to explore the effectiveness of this novel and diversified teaching mode in remote education and tans-national education. We expect that this online teaching method can be further integrated into traditional medical education, not just in neurology, but also in other disciplines. This will combine the technological strengths with teaching strengths and achieve collaboration among networks, scientific research, and medical teaching to cultivate outstanding medical talents with outstanding clinical skills.

The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving human participants were reviewed and approved by the Ethics Committee of Xiangya Hospital, Central South University. The patients/participants provided their written informed consent to participate in this study.

MZ conceptualized the study, acquired the funding, and administered the project. HY and YF wrote the original draft. YF and ZC provided the resources. HW, XH, and TW worked on validation. All authors reviewed and edited the manuscript.