Broader access to and cooperative development of these resources would allow medical schools to enhance their clinical curricula. Virtual patient development should include basic science objectives for more integrative learning, simulate the consequences of clinical decision making, and include additional cases in cultural competency. Together, these efforts can enhance medical education despite external constraints on clinical training.

Peer review is the foundation of academic publication and a necessary step in the scrutiny of any scholarly work. Simply defined, peer review is the attentive, unbiased assessment of any scholarly work that is submitted for formal scrutiny. Although medical school faculty increasingly use technology in clinical teaching, e-learning materials are often not subjected to a rigorous peer review process. The authors contrast peer review of e-learning materials with that of print materials, describe peer review issues regarding e-learning materials, propose approaches to address the challenges of peer review of e-learning materials, and outline directions for refinement of the e-learning peer review process. At its core, the peer review of e-learning materials should not differ substantially from that of traditional manuscripts. However, e-learning introduces new demands that impel reviewers to consider aspects that are unique to educational technology, including pedagogy, format, usability, navigation, interactivity, delivery, ease of updating, distribution, and access. Four approaches are offered to ease the burden and improve the quality of e-learning peer review: develop peer review training, embrace multidisciplinary peer review, develop guidelines, and provide incentives and compensation. The authors conclude with suggestions about peer review research.