284 J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 Original Explaining the Conceptual Considerations of Virtual University in Medical Education: A Systematic Review Soleiman Ahmady1 , Amin Habibi1* , Zohreh Koshgoftar2 1Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran. *Correspondence to: Amin Habibi (Email: amin28@gmail.com) (Submitted: 23 July 2022 – Revised version received: 02 August 2022 – Accepted: 16 August 2022 – Published Online: 26 October 2022) Abstract Aim: Most of existing literature on the concept of virtual university of medical sciences have been collected in a non-systematic manner. This issue highlights the need to conduct research on virtual university-related topics through systematic research evidence and empirical evaluations. The aim of the present study is to investigate the real complexity and diversity of the concept of virtual university of medical sciences. Methods: This was a systematic review with the BeHEMoTH approach and aimed to identify, review, analyze and integrate models, theories and frameworks related to the concept of virtual university of medical sciences. Eligible articles were searched in PubMed, ERIC, IEEE, ISI, Scopus, Ecampus research unit from 2001 to 2022 using related keywords in three stages. Results: A total of 13 articles were finally identified according to inclusion and exclusion criteria. Pedagogical, technology, managerial, educational design, technology implementation, and educational-administrative management components were referred to in 5, 5, 4, 7, 6 and 4 articles, respectively. Thematic analysis of the models was carried out in two theoretical dimensions (pedagogical component, managerial component and technological component) and operational dimension (educational design, administrative-educational management and technology implementation). Conclusion: The results of the present study emphasize the need to pay attention to these six components in the establishment and development of virtual universities of medical sciences. In order to improve the education process in virtual universities, the process quality evaluation framework can be used. Keywords: Virtual university, medical education, systematic review, models ISSN 2413-0516 Introduction The use of online education as a means of delivering education has grown dramatically over the past decade. Online learning environments have become an important part of online training and evidence shows that this trend will continue with the technological advancement. Organizations and educa- tional institutions have welcomed this movement and are using the advantages of using computer and communication technology as a tool to transfer learning to learners.1,2 The virtual learning is a broad and multifaceted term that includes different methods of special presentation. Although virtual learning has different specific architectures, the phys- ical separation of the teacher and the learner is the basis of all types of this phenomenon. Besides, it is assumed in virtual learning that the educational materials are presented using technology to facilitate learning.3 The terms e-learning, distance education, virtual educa- tion, online education and other similar descriptions are syn- onymous and are all used interchangeably in the present research. Decades ago, virtual education could be thought of as a video recorded lecture by a teacher that was listened to by students using a videocassette player. Today, this term means using a computer and usually the Internet to provide this content.5 Modern virtual education uses methods such as e-mail, chat rooms, online forums and discussions with the guidance of instructors. It can be stated that the virtual uni- versity is a multimedia network learning environment that is different from traditional learning environments in terms of the possibility to personalize and customize the teaching environment.2 Harasim et al. state that the virtual university supports the design and delivery of courses and programs for any type of graduate education, which can include the provision of aca- demic degrees, staff training services, professional develop- ment and workplace training.6 Leidner & Jaronpa suggest a similar definition. They state that the mission and vision of any type of virtual learning environment (such as a virtual university) is to redefine the physical boundaries of the classroom; enable more team- work; transformation of learning into a continuous and time-independent process and the possibility of creating multi-level and multi-speed knowledge using information technology.7 A critical review of virtual university literature showed that there are many different terms related to virtual universities. Virtual universities are also known as virtual teaching/learning environments, online teaching/learning, web-based teaching/learning environments, virtual learning communities and flexible learning environments.8 Benatallah et al. explain that “the online or virtual uni- versity has emerged as a powerful vision for the future of higher education by using new information and communica- tion technologies to fundamentally restructure higher educa- tion and re-equip the university institution in the face of new environmental changes.”9 Such a scenario generally includes a university without walls, consisting of elements including learners and professors (students and employees), employers (job performance) and graduates, where the entire process of teaching and learning, research is implemented by informa- tion technology-based programs.10 Despite the validity of the previously mentioned defini- tions, virtual university is as much related to a method of dis- tance education as it is different from it. The main difference is related to the totality and individuality of its function. This means that the virtual university continues to work and exist https://orcid.org/0000-0003-0551-6068 https://orcid.org/0000-0002-0184-6716 https://orcid.org/0000-0002-8178-2619 mailto:amin28@gmail.com 285J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 S. Ahmady et al. Original Explaining the Conceptual Considerations of Virtual University in Medical Education without the need for a geographic environment to represent its existence (for example, traditional academic campuses). The existing literature on the virtual university has identi- fied some research issues associated with the transformation of a traditional classroom-based university into a virtual uni- versity. However, it is important to note that the current litera- ture does not provide a deep understanding of these issues, but tends to only acknowledge their existence.2 Dealing with the advantages and disadvantages of virtual universities, as well as providing guidelines for a shift towards virtual universities, should be one of the most basic priorities of any research in this field. This is important because univer- sities should be aware of the positive and negative aspects of virtual universities before converting from a traditional educa- tional environment to a virtual educational environment. It is also important for instructional designers to be aware of these issues. They need to follow such guidelines in order to reduce the potentially harmful effects and increase the advantages of virtual universities. Most of existing literature on the concept of virtual university of medical sciences have been collected in a non-systematic manner. This issue highlights the need to conduct research on virtual university-related topics through systematic research evidence and empirical evalu- ations.11 The aim of the present study is to investigate the real complexity and diversity of the concept of virtual university of medical sciences. Methods This was a systematic review with the BeHEMoTH approach and aimed to identify, review, analyze and integrate models, theories and frameworks related to the concept of virtual uni- versity of medical sciences. In recent years, the medical science research community has increasingly recognized the potential contribution for educational theories and models in system- atic reviews. However, the identification of educational theo- ries and models during a systematic review is generally opportunistic or even incidental in many cases. Therefore, there is a need for systematic, formal and predetermined methods in a systematic review to identify sources that iden- tify theories and models in the literature.12 Such findings have led to the development of the BeHEMoTH framework as a search method. This approach is a process to identify theories, models and frameworks for developing and testing complex interventions using systematic reviews. Considering that the goal of researchers is to combine frameworks; models and theories instead of examining interventions, therefore, with such a presumption in mind, the BeHEMoTh approach was used in the present study in order to search for theories, models and educational frame- works related to the concept of virtual university. In this approach, four main elements of Behavior of interest (Be), Health context (H), Exclusions (E) and Models or Theories (MoTh) are determined. Then various related theories are identified and the practical application of each theory is identified subsequently.13 To define and guide the final search strategy, the BeHE- MoTh model was used to systematically identify models, define Be, H, E, and MoTh (Table 1). Search strategy: In this systematic study, all published and peer-reviewed articles and related theses published Table 1. Definition of BeHEMoTh framework elements in the present study Be: Behavior of interest Virtual university, Open university, Cyber university H: Health context Healthcare, Medical education E: Exclusion No reference to the model, framework and theory No studies in the field of medical sciences Articles published before 2001 Non-English articles Articles published in newspapers, General journals, Reports and letters to the editor MoTh: Models or Theories: model* or theory* or concept* or framework* between 2001 and 2022 were searched in PubMed, ERIC, IEEE, ISI, Scopus, Ecampus research unit using keywords including (Virtual university) OR (Open university) OR (Cyber university)) AND ((health care) OR (medical educa- tion))) AND ((((theor*) OR (model*)) OR (concept*)) OR (framework*). The search process was guided in three different stages (Table 2). Inclusion and Exclusion Criteria The inclusion criteria included peer-reviewed English articles published from 2001 until now that were related to the concept of virtual university of medical sciences. In order to achieve the research objective, the following exclusion criteria were taken into account: no reference to the model, framework and theory no studies in the field of medical sciences, articles pub- lished before 2001, non-English articles. articles published in newspapers, general journals, reports and letters to the editor. Selection of Articles To avoid selection bias, the search was conducted by two researchers independently, and then similar and repeated searches were excluded from the study. At baseline, the titles of the articles that were searched by the research team using the above-mentioned keywords were equal to 64,571 titles. Finally, 66 articles were fully reviewed and 13 related articles were included in the final analysis phase after the searching process (Figure 1). A checklist was designed based on the study objectives and literature review, which investigates 6 pedagogical, tech- nological, managerial, educational design, technology implementation and educational-management components (Table 3). Quality Assessment To assess the quality of theoretical studies, there are no compa- rable tools like other types of studies such as the PRISMA checklist, PICO for clinical evidence, or CASP and SPIDER for qualitative studies.14 On the other hand, theoretical evidence cannot be evaluated using a variety of tools that have been developed for routine systematic reviews, most of which focus 286 J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 Explaining the Conceptual Considerations of Virtual University in Medical Education Original S. Ahmady et al. Table 2. Steps to conducting a systematic search based on the BeHEMoTh approach Steps Search strategy Database All articles found Number of articles after removing duplicates Step 1a Be AND H ((Virtual university) OR (Open university) OR (Cyber university)) AND ((health care) OR (medical education)) 1990- 23 Jul 2021 PubMed, ERIC, IEEE, ISI, Scopus, Ecampus research unit SID, Magiran 64571 138 Step 1b Be AND H AND Models, Theories, Concepts or Framework (((Virtual university) OR (Open university) OR (Cyber university)) AND ((health care) OR (medical education))) AND ((((theor*) OR (model*)) OR (concept*)) OR (framework*)) 20831 53 Step 1c Be OR H AND Models, Theories, Concepts or Framework (((Virtual university) OR (Open university) OR (Cyber university)) AND ((((theor*) OR (model*)) OR (concept*)) OR (framework*))) OR (((health care) OR (medical education)) AND ((((theor*) OR (model*)) OR (concept*)) OR (framework*))) 123477 168 Step 2 Step 1(a,b,c) with list of most common theories Step 1(a AND b AND c) with Number of lists of most common theories Step 1(a AND b AND c) :359 Step 1(a AND b AND c) :64 Number of lists of most common theories:4 Step3 Step 2 AND key Original model citation(s) Step 2 AND key original model citation(s) Step 2(68) AND key Original model Citation (5) 73 287J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 S. Ahmady et al. Original Explaining the Conceptual Considerations of Virtual University in Medical Education Ta bl e 3. C he ck lis t d es ig ne d ba se d on st ud y ob je ct iv es Th em es ex tr ac te d in th e fra m ew or k Bu ild in g A V irt ua l U ni ve rs ity fo r O rt ho pa ed ic s (4 6) A n Io M T ba se d cy be r tr ai ni ng fra m ew or k (4 5) Vi rt ua l u ni ve rs ity ed uc at io n in th e co nt ex t of th e he al th em er ge nc y du e to CO VI D -1 9 (4 4) To w ar ds G rid S er vi ce s fo r a V irt ua l Re se ar ch En vi ro nm en t (4 3) Th e ev ol ut io n of p ed ag og ic m od el s f or w or k- ba se d le ar ni ng w ith in a vi rt ua l un iv er sit y (4 2) M et ho do lo gy fo r D es ig n of V irt ua l Le ar ni ng En vi ro n- m en ts – Vi rt ua l U ni ve rs iti es (4 1) A D yn am ic M od el fo r a Cy be r- Ph ys ic al H ea lth ca re (4 0) A s tu dy o f pe da go gi - ca l a sp ec ts of a v irt ua l un iv er si ty (3 9) A Fr am ew or k Pr op os al fo r Bl oc kc ha in - Ba se d Sc ie nt ifi c Pu bl ish in g U sin g Sh ar ed G ov er na nc e (3 8) Th e Vi rt ua l H ea lth U ni ve rs ity (3 7) M od el lin g of W eb - Ba se d Vi rt ua l U ni ve rs ity Ad m in is - tr at io n fo r N ig er ia n U ni ve rs i- tie s (3 6) In no va tio n M od el in H um an Re so ur ce s Ca pa ci ty D ev el op m en t in S up po rt in g U ni ve rs ita s Te rb uk a as A C yb er U ni ve rs ity (3 5) A st ra te gi c m od el of v irt ua l un iv er si ty (3 4) Pe da go gi ca l co m po ne nt Te ch no lo gy co m po ne nt M an ag em en t co m po ne nt Ed uc at io na l de si gn Te ch no lo gy im pl em en ta tio n Ad m in is tr at iv e- ed uc at io na l m an ag em en t 288 J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 Explaining the Conceptual Considerations of Virtual University in Medical Education Original S. Ahmady et al. on internal validity and study design. In fact, study method- ology and theoretical development are different areas of research that require different skills.15 Therefore, the research team adopted a recommended inductive and subjective approach instead of using check- list-like tools. “Applied quality assessment prompts” were used as the most appropriate framework to ensure clarity of objectives, having a specific and appropriate research design, providing a clear report of findings and sufficient data to sup- port the interpretations and appropriate analysis.15 Methodo- logical quality assessment was carried out with data simultaneously. Table 4 shows the five steps to quality assessment guide- lines as a framework that is used in research to assess the quality of articles and perform the final synthesis. Results & Discussion The aim of the present research was to identify, investigate, analyze and integrate models, theories and frameworks related to the concept of virtual university in the field of medical sciences and health system. A total of 13 articles were identi- fied in the data extraction stage. The articles were reviewed using on a checklist. Pedagogical, technology, managerial, educational design, technology implementation, and educa- tional-administrative management components were referred to in 5, 5, 4, 7, 6 and 4 articles, respectively. The research team performed the thematic analysis of the extracted models based on two theoretical and operational dimensions (Figure 2), which include Table 4. Qualitative assessment of articles Review stage Criteria Inclusion criteria To include a model/theory or framework in a study, a mechanism should be defined in which the main components of a virtual university in the health system and the relationship between them were clearly shown. Literature search The review included multiple forms of formal electronic and manual searches and citation tracking to follow the development and impact of known theories on subsequent relevant literature. Data extraction Spreadsheets were created from the data extracted from the models. Quality control The review of models and theories did not involve conducting a standardized critical evaluation. Synthesis They were graded according to the review question as well as by checking the details or originality. 1. Theoretical dimension: This dimension includes three main components: • Pedagogical component. • Technology component. • Management component. 2. Operational dimension: This dimension considers the strategies, actions and procedures based on which subsystems of a university operate and includes three main components: • Educational design. • Technology implementation. • Administrative-educational management. All these dimensions and the relationship between them will be explained separately. It is also necessary to mention that the operational components of this framework are seman- tically placed among the theoretical dimensions of the frame- work considering their operational nature, and therefore, each of these components will be explained in combination with the theoretical components. Theoretical dimension Pedagogy and Educational Design Pedagogy is defined as guiding the child and is known as the art and science of teaching children. Pedagogic techniques for effective content transfer include learning content, learning style, time of learning, learning with the help of the instructor, and responsible instructor.16 Fig. 2 Components of the virtual university. 289J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 S. Ahmady et al. Original Explaining the Conceptual Considerations of Virtual University in Medical Education Such definition is based on the perspective of theorists in the field of education and is thus consistent with the “teacher- centered approach” at the school level. Developments in the field of education and learner-centered and learning-centered approaches, emphasis on the facilitating role of the teacher, as well as the development of pedagogy in higher education have led to the redefinition of pedagogy. Also, the current under- standing of pedagogy is not limited to child education, but is considered as a basic teaching concept for in all academic courses. Considering such a definition of the pedagogy and looking at the extensive changes made in different pedagogic concepts, the change of the educational paradigm is reflected in this component of the proposed framework. Here, the cur- riculum is seen as a continuum where the main importance is acquired competencies, not just completed assignments. Besides, assessment becomes an important element in the teaching and learning process and is not merely a punishment or a factor for determining grades. The main focus of this component is on learning modules, communication, interac- tion and cooperation between learners, and the use of the latest information and communication technology is also emphasized. Technologies that provide the possibility of aca- demic networking between students and professors. In this component, a “learning unit” as a wide conceptual area includes three basic elements, namely “content”, “interac- tion” and “evaluation”.17 As these elements play an important role in the learning process and the type of their evaluation based on the theory of active learning. The content, level of interaction and types of communication activities are deter- mined by the learning objectives. Then, the educational design layer is placed as one of the operational components of the framework at a higher level where the basic planning, design and implementation of teaching-learning processes, especially the learning units and related activities are determined.17–19 Educational design as a basic component of the frame- work is carried out in six separate but related steps: 1. Specifying and explaining the available educational and technological options: In this step, the learning needs are identified, the target audience is defined, the human and financial resources and the existing technological infra- structure are evaluated. In other words, possible options are identified and selected for a successful educational design. 2. General design of the course (main program): In this step, goals, background, prerequisites, themes, content and keywords are determined for each educational course. In a general view, this step includes deciding on the struc- ture of the course and summarizing the anticipated activ- ities and strategies, as well as compiling the course timetable and relevant bibliography. 3. Designing course units: In this step, teaching and learning units are designed along with units related to modular learning. The educational strategies for each unit, as well as the content and calendar of activities are determined according to the duration of the course. 4. Interactive system design: In this step, learning activities, their dynamic level, the sequence, the resources and tools used, as well as the writing of practical guides and other teaching strategy elements are designed to ensure their proper implementation. 5. Designing a feedback system: Here, while emphasizing the educational effect of the concept of feedback, the aim is self-evaluation design, systematic and final evaluation of the course, for continuous and interactive feedback during the teaching-learning process. 6. Final design and presentation of general information: Upon reaching the final step, the final evaluation of the entire process will be implemented. In this step, there is the possibility of final adjustment of the general program and its reorganization according to individual activities (second and third steps) as well as the evaluation program (fourth step).17-20 After expanding the concept of the pedagogical compo- nent and identifying some of its most important elements, the present framework proposes the following schematic view as the pedagogical components of the virtual university in the health system (Figure 3). Fig. 3 Pedagogical components of the virtual university in the health system. 290 J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 Explaining the Conceptual Considerations of Virtual University in Medical Education Original S. Ahmady et al. Technology Components and Technology Implementation Today, all users of virtual networks have become active pro- ducers of knowledge by using open-source software as well as a variety of information technology tools with different levels of complexity. From this point of view, the most important fea- tures of the virtual university technology component in the health education system include “interactivity” and the possi- bility of reusing technology. In this component, the technology implementation element has a strong presence as one of the elements of the operational component of the framework. The implementation of information technology generally consists of a number of successive steps including requirements anal- ysis, project design, testing, establishment and maintenance. Although documentation and training are often added to these steps.36,38,41,43 In these components, three basic parts that work together were identified: Part 1: Technological Support Online and technical support services are very necessary to speed up the education process for all users, teachers and stu- dents. On the other hand, information technology support has an important effect on knowledge process capabilities; because it allows knowledge creation and sharing at lower costs and is considered a key component in knowledge management. Therefore, the concept of support in a virtual university goes beyond mere provision of different principles and guides and has a direct impact on the process of knowledge management in a virtual university. In the current frame- work, this part is considered as a basis for providing other services, and its components and tools are shown separately in Figure 4.19-21-22 Part 2: Data This part focuses on accepted international protocols and standards, which, in addition to validating university activi- ties, provide the possibility of cooperation between educa- tional and service institutions, as well as information retrieval. E-learning standards are a set of laws that not only ensure coordinated provision of education everywhere; but also, it provides a common language for the learning management system and e-learning courses, so that they can share informa- tion with each other and work together. In fact, components of the training course or training objects are identified and defined using these rules.23 Fig. 4 Technological support. E-learning standards are divided in different ways from the meaning point of view. Here, first, they are divided from the perspective of content coverage they provide, and then the most important e-learning standards for use in a virtual uni- versity will be discussed. 1. Meaning: This field focuses on the general concepts of understanding: semantics, pragmatics, etc. 2. Quality: This field includes all aspects of quality manage- ment, including development, assurance of results, pro- cesses and potentials. 3. Didactics: This area focuses on issues related to educa- tional questions: methods, learners and learning environments. 4. Educational technology: This area focuses on all techno- logical solutions that have been created for educational purposes: such as information exchange, interfaces and accessible questions. 5. Learning content: This area includes all aspects related to e-learning objects and collects resources and packaging. 6. Context: The main purpose of this area includes all disci- plines and information related to electronic education, including laws and regulations (49). Table 5 shows the most common standards in electronic education. Our conceptual advancement in the technology compo- nent and its expansion gives a more complete picture of the framework (Figure 5). Part 3: Services This part of the technological component indicates the ser- vices provided by a virtual university to users, learners and faculty members. These educational services should promote and support an open and collaborative environment. The portal is known as the most basic service for providing virtual university services, but according to the proposed framework, the university portal should act in such a way as to provide access to various resources and services and communication and collaboration tools for all users. It also allows interaction between students, faculty members and users who are inter- ested in the field of healthcare and health sciences as a whole. Such a portal facilitates interaction, communication, study and discussion about clinical cases. Services are also provided by electronic learning manage- ment system. A learning management system creates a com- munication channel between instructors and learners and helps instructors manage online learning. Software are able to manage all types of content, including videos, courses, docu- ments, etc., and allow students to communicate with learning 291J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 S. Ahmady et al. Original Explaining the Conceptual Considerations of Virtual University in Medical Education Fig. 5 Adding the data part to the Part 1. Table 5. E-learning standards Standard Developer Important component Website IMS IMS Global Learning Consortium Standard packaging (www.imsproject.org) SCORM ADL A combination of several standards (Scorm; www.adlnet.org/Scorm/history/2004/ index.cfm) LTSC IEEE Content relevance (LTSA; http://ltsc.ieee.org/wg1/files/ IEEE_1484_01_D09_LTSA.pdf ) LOM IEEE Metadata (LOM; http://ltsc.ieee.org/wg12) PAPI IEEE Learner profile (www.edutool.com/papi/drafts/08/) AICC AICC Supply, control, presentation and follow-up of results between educational management systems and online courses www.aicc.org management system software through any device. Instructors can also evaluate learners by using features such as receiving their assignment reports, progress status and similar cases. Such a system will be the backbone of a virtual university. Here we are dealing with a web-based software and program that manages, documents, follows up, reports, and provides educa- tional courses and educational programs. This software allows the instructor to provide the content of the educational course as easily as possible to the participants and students, to hold quizzes, tests and exams offline or in person (online in class), assign related assignments to students in a web-based system, follow up student status, and access other such facilities in an internet-based system. Online classes are one of the other educational facilities that can be held with the help of the university’s learning man- agement system. The virtual classroom is an educational tool that is based on communication networks and can replace the traditional classroom and solve the associated problems. Although the virtual classroom does not change the channels of information transmission, it tries to use appropriate tools to carry out this information transfer in the best possible way.17 In addition to increasing the educational quality, such optimization also reduces educational costs. The virtual class- room is, in fact, a discussion group whose topic is the same as the lesson subject. A discussion group whose title is the same as the lesson title is created on the network, and the students become members of the discussion group. Then, the faculty member who is also a member of the group, will present the related course materials at regular intervals. They should also be designed as an interactive learning space that simultane- ously pursues formal and informal educational activities. Rather being related to educational content, interaction in this class means interaction and mutual effect of educational activ- ities and communication. The virtual clinic is another interactive space that is iden- tified in the proposed framework, and all learners and faculty members will be able to use its services from the moment they enter the university. Education is provided in this space based on diagnostic discussions (a virtual space in which people dis- cuss the cases of interest to make a definitive diagnosis online), clinical pathology topics (topics related to the postmortem findings of pathologists) and presentation of clinical cases. Education through the presentation of clinical cases and sce- narios is currently recognized as one of the leading and effec- tive methods in the field of medical sciences. The use of the case-based learning method prepares students with diverse experiences such as problem solving, building knowledge 292 J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 Explaining the Conceptual Considerations of Virtual University in Medical Education Original S. Ahmady et al. in the presence of each other, communication and group participation. Just like traditional universities, another element of the framework that guarantees the success of virtual universities is a virtual library. The virtual library makes it possible to pro- vide all the appropriate information that are supposed to be exchanged between students and faculty members of the vir- tual university and to support the researches of the virtual university. Such a library helps users to find the required information through the resources available in the library databases and performs the tasks of information collection, accessibility and dissemination. The virtual attribute mostly refers to the lack of spatial dimension of this type of library. This type of library does not exist physically, is created on computer networks and enables the access of virtual university users to electronic and network resources.24 In this framework, it is recommended to use blockchain technology and launch the digital library of the virtual univer- sity of medical sciences in such a network.25 By definition, blockchain refers to a database consisting of a list of transac- tion records, which are always growing and increasing in number. These records are called blocks, which are connected to each other through cryptography. Blocks are placed in a chain of nodes with a peer-to-peer network, and the resulting storage is called a digital ledger.26 This meaning fits well with what librarians have always done, that is to collect, keep, and share authoritative informa- tion. Blockchain can help librarians achieve this goal, espe- cially in the world of scientific publications. One of the potential applications of blockchain is to create verifiable and scheduled copies of journal articles. Another potential appli- cation of blockchain in libraries is a digital rights management tool.25 Digital resources are inherently reproducible, which in turn creates issues for libraries and publishers. Because block- chain creates a unique verifiable record that anyone can access, it can be attached to digital material and used as a way to show the “provable scarcity” of that resource. This enables digital materials to be uniquely identified, controlled and transferred. Publishers can be also assured that there have been no copies of them. Web 2.0 Tools Web 2.0 is a set of programs and digital technologies that enable users to interact and collaborate with each other and share their content and information. Unlike Web 1.0, which is called a static and read-only network, Web 2.0 is a dynamic network that can read and write content. This technology allows the user to add, play, evaluate and change information. Although these technologies have not been formed with the approach of educational application, they have formed new conceptualizations regarding the dynamics of virtual univer- sity education (Figure 6). Web 2.0 challenges the existing models of designing web-based curricula, entails new episte- mological considerations, and proposes a different theoretical basis. In this type of learning, the way educational content is produced and published is similar to Web 2.0. In other words, the content does not follow the traditional method of produc- tion, organization and distribution, instead it is a collaborative effort (Table 6).19-21-22 Finally, the technology component is displayed in the form of a conceptual pyramid after putting different parts together (Figure 7). Management components and Administrative-educational Management These components are identified with the following four basic elements in the current framework: 1. Vision: Vision, which is called perspective, view, imagined future, or ideal and desirable future, is a description of future conditions, in other words, it is an vision of the future state of a group, when goals and strategies are achieved. The vision of the organization should be brief, memorable, desirable and ideal and should take into account all levels (17-26-27). Furthermore, such a university is recognized as a vir- tual campus with a networked, open-source learning method based on real health care processes that are approved by the Ministry of Health and Medical Education. Fig. 6 Types of web and its applications. Table 6. Classification of Web 2.0-based technologies based on the educational design parts of the framework Subcategories Technologies related to each subcategory Teaching planning and design 1. Mihanblog 2. Blogfa 3. Crocodile 4. Huppa 5. Rubistar 6. Irubric 7. Ning 8. Edmodo 9. Moodle 10. Google 11. Sketchup 12. Gliffy 13. Google 14. Sites 15. salam.ir 16. Parsijoo.ir 17. Audacity Presentation and teaching methods 1. FlashcardExchange 2. Wordnik 3. Del.icio.us 4. Flickr 5. Google 6. salam.ir 7. Parsijoo.ir 8. Webspiration 9. Slideshare 10. Gliffy 11. Paint 12. Audacity 13. Evernote 14. Community 15. Walk 16. Footnote 17. Googlemap 18. Create a Graph 19. Movie maker 20. Wordle 21. Viber 22. Telegtam 23. Youtube 24. SurveyMonke 25. PollDaddy 26. PollEveryWhere 27. Prezi 28. Protagonize 29. Glogster 30. Blogfa 31. Mihanblog 32. Powerpoint Assessment Edmodo, Ning, Moodle, PollEverywhere Google Trends, Crocodile, Huppa, Viber, Bubble.us Quizstar Telegram, Paint, Footnote, Microsoft office word 293J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 S. Ahmady et al. Original Explaining the Conceptual Considerations of Virtual University in Medical Education Fig. 7 Technology component and its elements. 2. Planning: The implementation strategies of a virtual uni- versity in the health education system are considered in this element: • Building and maintaining an educational virtual space for online interaction, learning and work in order to develop the professional competencies and qualifica- tions of medical students. • Training of human resources for the efficient applica- tion of information and communication technology in the fields of education and health. • Strengthening the educational capacities of academic institutions and health service providers. • Integration and systematization of national health information and knowledge management. • Using information and communication technology for online education, based on the technical capacity avail- able in academic health services institutions. • Methodological development of clinical training related to the health needs of Iran. 3. Operational management: Project management is a goal- based management model that defines the demarcation of different decisions, allocation of resources and assign- ment of responsibilities based on different components (courses, clinical topics, etc.) in different academic and service institutions. In this sense, management takes place in two different parts. • The first case is pedagogical management, which is related to the teaching-learning process and basic functions of faculty members such as educational design and creation of educational resources. • The second case is institutional management, which deals with administrative and executive processes, where leaders and managers act at institutional and local levels, including the creation of logistics coordi- nation and training regarding virtual learning environ- ments (42-40-34). 4. Process quality evaluation: In this proposed framework, follow-up, control and evaluation are carried out to improve the quality of the program process through pro- cess analysis, academic results and the quality of services provided by the university. In this evaluation, managers’ self-criticism has been identified as a fundamental pillar of process improvement. Also, continuous surveying of different university groups (faculty members, students, users) makes it possible to improve the quality of cur- ricula and services at both institutional and curriculum levels. Conclusion The results of the present study emphasize that the six compo- nents of pedagogy, technology, management, educational design, technology implementation and administrative-edu- cational management are essential in the establishment and development of virtual universities of medical sciences. Vir- tual university of medical sciences plays an important role in the development of electronic learning, the realization of edu- cational justice and the creation of various educational oppor- tunities in virtual form. In this regard, the process quality assessment framework can be used to improve the education process in these universities. Conflict of Interest None.  294 J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 284–294 Explaining the Conceptual Considerations of Virtual University in Medical Education Original S. Ahmady et al. References 1. Barnett R. Realizing the University (London, Institute of Education, University of London). Blake, R. Smith, and P. Standish (1998) The Universities We Need: Higher Education After Dearing. 1997. 2. Anderson M. Virtual universities: Future implications for students and academics. In 16th annual conference of the Australasian Society for Computers in Learning in Tertiary Education (ASCILITE), Brisbane, Australia. Retrieved September 1999 (Vol. 17, p. 2003). 3. Robins K, Webster F, editors. The virtual university? knowledge, markets, and management. Oxford University Press; 2002 Nov 7. 4. Rada R. Understanding virtual universities. Intellect Books; 2001. 5. Ahmad R, Piccoli G. Virtual learning environments: An information technology basic skills course on the Web. AMCIS 1998 Proceedings. 348. 6. Harasim LM, Hiltz SR, Teles L, Turoff M. Learning networks: A field guide to teaching and learning online. MIT press; 1995. 7. Leidner DE, Jarvenpaa SL. The use of information technology to enhance management school education: A theoretical view. MIS quarterly. 1995 Sep 1:265–91. 8. Anastasiades PS. Virtual universities: A critical approach. InInternational Conference on Computers in Education, 2002. Proceedings. 2002 Dec 3 (pp. 1170-1171). IEEE. 9. Dabous FT, Rabhi FA, Ray PK, Benatallah B. Middleware technologies for b2b integration. Annual Review of Communications. 2003 Nov;56(3). 10. Slaughter S, Leslie LL. Academic capitalism: Politics, policies, and the entrepreneurial university. 1999. 11. Cornford J. The virtual university is... the university made concrete? Information, Communication & Society. 2000 Jan 1;3(4):508–25. 12. Hean S, O’Halloran C, Pitt R, Green C, Temple J. A systematic review of the contribution of theory to the development and delivery of effective interprofessional curricula in health professional education. Hentet fra https://www. bemecollaboration.org/downloads/1243/HEAN_Protocol_ DEC2012. pdf. 2013. 13. Booth A, Harris J, Croot E, Springett J, Campbell F, Wilkins E. Towards a methodology for cluster searching to provide conceptual and contextual “richness” for systematic reviews of complex interventions: case study (CLUSTER). BMC Medical Research Methodology. 2013 Dec;13(1):1–4. 14. Votruba N, Ziemann A, Grant J, Thornicroft G. A systematic review of frameworks for the interrelationships of mental health evidence and policy in low-and middle-income countries. Health Research Policy and Systems. 2018 Dec;16(1):1–7. 15. Campbell M, Egan M, Lorenc T, Bond L, Popham F, Fenton C, Benzeval M. Considering methodological options for reviews of theory: illustrated by a review of theories linking income and health. Systematic Reviews. 2014 Dec;3(1):1–1. 16. Pedagogical perspectives, inspirational horizons in the higher education curriculum. Bi-Quarterly Journal of Higher Education Curriculum Studies.; 10 (19): 171–93. 17. Méndez JB. The Virtual Health University: An eLearning Model within the Cuban Health System. MEDICC review. 2008 Mar 28;10(1):22–8. 18. Ivanova G, Smrikarov A. Methodology for design of virtual learning environments–virtual universities. In E-learning II Conference, Berlin, Germany 2005. 19. Conole G, Wills G, Carr L, Vadcard L, Hall W, Grange SS. Building a virtual university for orthopaedics. InEdMedia+ Innovate Learning 2003 (pp. 22- 27). Association for the Advancement of Computing in Education (AACE). 20. Abdollahi D. A study of pedagogical aspects of a virtual university. International Journal of Educational and Psychological Researches. 2018 Jan 1;4(1):12. 21. Mbam BC, Odachi GN. Modelling of web-based virtual university administration for Nigerian universities. AFRREV STECH: An International Journal of Science and Technology. 2014 Jul 3;3(2):86–107. 22. Cecil J, Gupta A, Pirela-Cruz M, Ramanathan P. An IoMT based cyber training framework for orthopedic surgery using Next Generation Internet technologies. Informatics in Medicine Unlocked. 2018 Jan 1; 12:128–37. 23. Fallon C, Brown S. E-learning standards: a guide to purchasing, developing, and deploying standards-conformant e-learning. CRC Press; 2002 Nov 25. 24. Van Drie JH, Lajiness MS. Approaches to virtual library design. Drug Discovery Today. 1998 Jun 1;3(6):274–83. 25. Mackey TK, Shah N, Miyachi K, Short J, Clauson K. A framework proposal for blockchain-based scientific publishing using shared governance. Frontiers in Blockchain. 2019 Nov 15; 2:19. 26. Gupta SS. Blockchain. IBM Online (http://www. IBM. COM). 2017. 27. Flores RR, Vértiz-Osores RI, Ochoa GL, Romero AA. Virtual university education in the context of the health emergency due to COVID-19: Challenges in the evaluation processes. International Journal of Early Childhood Special Education (INT-JECSE). 2020;12(1):467–77. 28. Shahtalebi S, Shatalebi B, Shatalebi F. A strategic model of virtual university. Procedia-Social and Behavioral Sciences. 2011 Jan 1; 28:909-13. 29. Bradley C, Oliver M. The evolution of pedagogic models for work-based learning within a virtual university. Computers & Education. 2002 Jan 1;38(1-3):37–52. 30. Khayal IS, Farid AM. A dynamic model for a cyber-physical healthcare delivery system with human agents. In2017 IEEE International Conference on Systems, Man, and Cybernetics (SMC) 2017 Oct 5 (pp. 3624-3629). IEEE. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly. https://doi.org/10.22317/jcms.v8i5.1253