Online, Face-to-Face, or Blended Learning? Faculty and Medical Students' Perceptions During the COVID-19 Pandemic: A Mixed-Method Study

The design, implementation, and evaluation of a blended (in-person and virtual) Clinical Competency Examination for final-year nursing students

INTRODUCTION

Studies have reported different results of evaluation methods of clinical competency tests. Therefore, this study aimed to design, implement, and evaluate a blended (in-person and virtual) Competency Examination for final-year Nursing Students.

METHODS

This interventional study was conducted in two semesters of 2020-2021 using an educational action research method in the nursing and midwifery faculty. Thirteen faculty members and 84 final-year nursing students were included in the study using a census method. Eight programs and related activities were designed and conducted during the examination process. Students completed the Spielberger Anxiety Inventory before the examination, and both faculty members and students completed the Acceptance and Satisfaction questionnaire.

FINDINGS

The results of the analysis of focused group discussions and reflections indicated that the virtual CCE was not capable of adequately assessing clinical skills. Therefore, it was decided that the CCE for final-year nursing students would be conducted using a blended method. The activities required for performing the examination were designed and implemented based on action plans. Anxiety and satisfaction were also evaluated as outcomes of the study. There was no statistically significant difference in overt, covert, and overall anxiety scores between the in-person and virtual sections of the examination (p > 0.05). The mean (SD) acceptance and satisfaction scores for students in virtual, in-person, and blended sections were 25.49 (4.73), 27.60 (4.70), and 25.57 (4.97), respectively, out of 30 points, in which there was a significant increase in the in-person section compared to the other sections. (p = 0.008). The mean acceptance and satisfaction scores for faculty members were 30.31 (4.47) in the virtual, 29.86 (3.94) in the in-person, and 30.00 (4.16) out of 33 in the blended, and there was no significant difference between the three sections (p = 0.864).

CONCLUSION

Evaluating nursing students' clinical competency using a blended method was implemented and solved the problem of students' graduation. Therefore, it is suggested that the blended method be used instead of traditional in-person or entirely virtual exams in epidemics or based on conditions, facilities, and human resources. Also, the use of patient simulation, virtual reality, and the development of necessary virtual and in-person training infrastructure for students is recommended for future research. Furthermore, considering that the acceptance of traditional in-person exams among students is higher, it is necessary to develop virtual teaching strategies.

The effect of pre-body donor quizzes on student performance in a hybrid anatomy course

Learning human anatomy is essential for Doctor of Physical Therapy (DPT) education. Body donors are traditionally utilized to understand content, but in a hybrid learning environment, students have limited time to use body donors. To improve body donor access and learning, we created online synchronous pre-body donor activities. The impact of these online strategies on students' subsequent exams and final grade were investigated in a non-randomized, observational study. These activities were hypothesized to positively influence students' anatomy performance. In a 16-week semester, DPT students (case [n = 91], control [n = 22]) participated in a hybrid program of asynchronous/synchronous online learning and two in-person immersions. Measures included student course grades and teaching surveys. Spearman's rho correlations analyzed the relationship between four pre-body donor quizzes to body donor exams, written exams, and final course grade. Mann-Whitney U tests assessed differences in grades between cohorts. A linear regression model examined the influence of pre-body donor quizzing on exams/final grades. Correlation tests revealed a strong relationship between the average pre-body donor quiz score and both the first written exam and final course grade (p = 0.0001). The case group achieved significantly higher scores than the control group on the first in-person body donor exam (p = 0.011), the second written exam (p = 0.0001), and the final grade (p = 0.004). The pre-body donor quizzes predicted performance on the subsequent in-person body donor exams, written exams, and the final grade. Implementation of online pre-body donor learning activities was associated with increased academic performance among hybrid DPT students and may aid in learning anatomy concepts for clinical practice.

Effects of Transition from Remote to In-Person Learning in University Students: A Longitudinal Study

Previous studies have shown that the transition from the University environment to remote learning impacted student mental health. Our study aimed to investigate the effects of university environment on anxiety and depressive symptoms in health sciences students. Students at the Technical University of Manabí, Ecuador, with 6-10 in-person semesters, who shifted to remote learning and then returned to face-to-face learning were selected. Students responded to the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). In addition, questions regarding social interaction, physical exercise, mood and sleep habits were also asked. This longitudinal study tracked 323 students during the return to in-person classes and term end. The results showed similar rates of anxiety (GAD-7, p = 0.011-p = 0.002) and depression (PHQ-9 p = 0.001-p = 0.032) among students at week 1 and week 15. Previous diagnosis of depression (OR, 0.171; CI 0.050-0.579, p < 0.005) was shown to correlate with depression levels in week 1, with no changes seen at follow-up. Anxiety levels were shown to be associated with a previous diagnosis of the disorder at week 1, but not at follow-up (OR 0.233; CI 0.085-0.643, p < 0.005). The return to in-person learning among university students maintained levels of anxiety and depressive symptoms, underscoring ongoing vulnerabilities to mental health disorders in this group.

Motivation to learn in university science students studying anatomy: A mixed-methods analysis of what drives learning

Exploring student motivation to learn is a research area that has rapidly expanded over the past decade, especially as the COVID-19 pandemic continues to influence education. In the field of anatomy, most research about motivation to learn targets medical and other health professional students, but little is known about factors that drive students enrolled in science degrees. The aims of this mixed-methods study were to determine: (1) what motivates undergraduate university science students to learn anatomy, and whether motivation differs between cohorts (second- and third-year) and gender; and (2) the impact of COVID-19 on motivation to learn. Students (n = 171) completed a survey (the Science Motivation Questionnaire II [SMQII] and questions about learning experiences during the pandemic) and a subset (n = 12) participated in focus groups/interviews. Quantitative data were analyzed using a combination of parametric and non-parametric statistics, and a general inductive approach was applied to qualitative data. Grade, intrinsic, and career factors were consistently identified as the key components of motivation. No statistically significant differences were found for motivation components between level of study or gender. Students reported that the COVID-19 pandemic negatively impacted motivational components, but it had also fast-tracked the development of online learning, with both positive and negative connotations. Students value traditional in-person lectures but support a blended approach of traditional and online teaching methods for learning anatomy. Educators should utilize these findings when considering how to teach and support science students in ways that embrace motivational components to foster success in those studying anatomy.

Memes Adoption in Basic Medical Science Education as a Successful Learning Model: A Mixed Method Quasi-Experimental Study

Purpose

Basic medical sciences are of a solid abstract nature. Pharmacology is a challenging discipline delivered in all healthcare-related curricula with different aims and goals. Memes are one of aiding instructional designs proved to surge students' performance and satisfaction with the educational process. Apart from assessing medical students' and faculty's perception of meme use in pharmacology learning, the current study aimed to explore the criteria of preferences and factors associated with successful memes' adoption in this discipline as one of the most challenging basic medical sciences.

Methods

A biphasic study was conducted among second-year undergraduate medical students and faculty members. The study involved assessing the perceptions of staff and students, and thematic content analysis was performed on the narrative responses of the participants to explore factors contributing to the success of learning memes. Additionally, students' performance was also analyzed.

Results

The use of memes in pharmacology was well perceived by medical students, with a mean satisfaction rating of 4.5/5 for high-achieving students and 4.33 for low-achieving students. Memes were associated with a performance surge (p = 0.022). Six themes emerged as criteria for a successful learning experience of meme use: previous scientific background on the meme topic, scenario context of the meme, learning concepts tackled by memes, the simplicity of meme's message, the relevance of meme's message to practice, and the modality of meme's use in the topic of education. Regarding the perception of meme use in pharmacology learning, four themes emerged: the mode and engagement of learning experience mode, the feasibility of meme use in pharmacology learning, students' attitudes towards further meme inclusion in their study, and the perceived impact of memes on students' cognitive skills.

Conclusion

The use of memes in pharmacology yields positive learning outcomes. A careful selection of memes is required to ensure a successful learning experience.

Effectiveness of educational interventions in reducing the stigma of healthcare professionals and healthcare students towards mental illness: A systematic review and meta-analysis

AIM

To examine the effectiveness of educational interventions in reducing stigma among healthcare professionals and students towards people with mental illness.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster RCTs.

DATA SOURCES

Articles published from database inception to October 2023 were systematically searched from seven databases (CINAHL, Embase, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Random-effect meta-analyses were conducted. Heterogeneity was evaluated using the I2 statistics and Cochran's Q chi-squared test. A quality appraisal conducted at the study level used the Cochrane risk of bias tool and an outcome-level quality assessment utilized the Grades of Recommendation, Assessment, Development and Evaluation Approach. Publication bias was assessed using the funnel plot.

RESULTS

Twenty-five articles were included in this review. Meta-analysis reported statistically significant medium and small effect sizes for attitudes towards mental illness and attitudes towards people with mental illness respectively, showing the association between educational interventions and improved attitudes among healthcare professionals and students. However, a statistically non-significant effect was reported for knowledge of mental illness. Subgroup analyses indicated that face-to-face and contact-based interventions were particularly effective at reducing stigma. Notably, single-session interventions were just as effective as multiple sessions, suggesting a potential for resource-efficient approaches.

CONCLUSION

Educational interventions demonstrate promise in fostering more positive attitudes towards mental health issues. Future research should aim to determine the long-term effects of these interventions and include patient feedback on the stigmatizing behaviours of healthcare professionals and students, to holistically evaluate the effect of interventions.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a secondary review and does not require relevant contributions from patients or the public. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Face-to-face contact-based educational sessions have proven to be the most effective. Reinforcing learning may be achieved through a series of repeated single-session interventions.

The impact of COVID-19 on medical students

Objective

The outbreak of COVID-19 has disrupted social order and placed a heavy burden on the healthcare system. The pandemic also has an unprecedented impact on medical students.

Methods

We searched PubMed for articles related to COVID-19 and medical students from January 2020 to December 2022. A total of 5358 studies were retrieved and after screening, 176 studies were finally included in this review.

Results

The impact of COVID-19 on medical students is widespread and profound. First reflected in the transformation of educational models. In the early days, education model quickly shifted from offline to online. In terms of clinical exposure, most students have been suspended from internships, while in some areas with staff shortages they have the opportunity to continue clinical work. Scientific research of medical students is also difficult to carry out due to COVID-19. The epidemic has also seriously damaged students' mental health, and this impact won't simply disappear with the improvement of the epidemic situation. The career intentions of medical students may also become firmer or change due to COVID-19. International medical electives have also been negatively affected by COVID-19 due to travel restriction. Even in the postpandemic era, with the gradual resumption of work, production and school, medical students are still affected in some ways by COVID-19.

Conclusion

The COVID-19 pandemic has had a profound impact on both the education of medical students and their personal development. Through COVID-19, we should reflect on what models of medical education should be developed in the future. Based on the experiences learned from COVID-19, we believe that a more flexible blended education model may be the most promising.

Comparison of online to face-to-face instruction for anatomy review in a third-year clinical course

OBJECTIVE

This project compared student learning and satisfaction of an anatomy review delivered by a face-to-face lecture (F2FL) and an online learning module (OLM) for third-year doctor of chiropractic students.

METHODS

This cohort study compared student learning and satisfaction of a pediatric spinal anatomy review delivered via F2FL (cohort 1, n = 23) and OLM (cohort 2, n = 18) in 2 successive 2019 (pre-COVID) course offerings. Previously validated pre- and post-tests were given. Students completed a survey assessing delivery, comfort with online learning and online learning technology, and preference of F2FL vs OLM of review material. Pre- and post-test results were assessed using repeated-measures analysis of variance.

RESULTS

Testing results showed an improvement with both groups (F2FL 53.7%, p < .001 vs OLM 51.8%, p < .001), with no significant difference between the F2FL and OLM groups (p = .53; p = .82). The survey showed: 83.3% of OLM students felt the online method was effective, and 88.9% of the OLM students would prefer online reviews or have no preference between online or face-to-face; meanwhile, 80% of the F2FL group thought the lecture engaging/effective, whereas 60% of the F2FL group would have preferred to have the material presented online.

CONCLUSION

The OLM was found to be as effective as the F2FL for the content assessed. The majority of students would prefer the online method for future anatomy review content presented in the course. This strategy could be applied to provide review materials in other clinical courses, allowing material to be developed and given by content experts while freeing valuable in-class time.

Chinese anatomy educators' perceptions of blended learning in anatomy education: A national survey in the post-COVID-19 era

Blended learning, which combines face-to-face lectures with online learning, has emerged as a suitable teaching approach during the COVID-19 pandemic. This study used a national survey of anatomy educators in Mainland China to evaluate the changes in the implementation of blended learning in anatomical pedagogy. A total of 297 responses were collected from medical schools across all provinces. Respondents included 167 males and 130 females, with an average age of 44.94 (±8.28) and average of 17.72 (±9.62) years of professional experience. The survey showed adoption of online teaching and assessment by Chinese anatomy educators increased by 32.7% and 46.8%, respectively, compared to pre-pandemic levels. Perceptions of blended learning outcomes varied, with 32.3% and 37% educators considering it superior and inferior to traditional teaching, respectively. Faculty training programs related to blended learning increased significantly, fostering a collaborative learning environment; however, challenges remained in achieving satisfactory online assessment outcomes. Anatomy educators' attitudes reflected a strong preference for classroom learning (4.941 ± 0.856) and recognition of the importance of relevant technology (4.483 ± 0.954), whereas online learning received lower acceptance (4.078 ± 0.734). Female anatomy teachers demonstrated effective time management in online teaching. Meanwhile, educators with over 15 years of experience encountered difficulties with relevant technology, consistent with negative attitudes toward blended learning. Overall, this survey highlights the persistent challenges in implementing blended learning in anatomy education and provides insights for enhancing the pedagogical model in the post-COVID-19 era.

Nursing Students' Experiences and Challenges in Their Education During COVID 19 Pandemic: A Mixed-Method Study

Introduction

The COVID-19 outbreak disrupted the nursing education across the world. The nursing students faced many challenges in their learning process.

Objective

The study explored the experiences and challenges faced by nursing students who had virtual education in India.

Methods

The study adopted an exploratory sequential mixed-methods design. The study was conducted as two phases. Phase 1: Qualitative data were collected using direct focus group interview with 18 students. Phase 2: Quantitative data were collected from 477 students using a Likert scale prepared by the investigators of the study on challenges experienced by nursing students on their education. The analysis was done using the descriptive and inferential statistics and thematic analysis.

Results

Phase 1: The analyzed data produced seven themes and 10 sub-themes; (1) technical issues-a concern, (2) regular rhythm in educational training-but not complete, (3) stress and strain, (4) evaluation-a concern, (5) communication, (6) comfort zone, and (7) easy distraction. Phase 2: Majority of the students (54.71%) experienced high-level challenges with the nursing education during pandemic. The overall mean and SD of all the domain-wise challenges were 103.39 + 7.11 with the range from 30 to 150. The mean and SD with educational challenges were (20.27 + 3.04), environmental challenges (6.92 + 1.66), communication challenges (17.61 + 4.01), technical challenges (17.39 + 3.75), evaluation challenges (7.09 + 1.94), physical and mental challenges (20.47 + 4.33), career challenges (7.06 + 1.91), and financial challenges (6.61 + 2.1). The demographic variable gender (P = 0.045) showed a statistically significant association with the challenges.

Conclusion

Considering the experiences and challenges faced by the nursing students, the nursing administrators shall design educational strategies to mitigate these challenges in nursing education during a pandemic.

Implication

Virtual nursing education offers flexibility in teaching and learning, self-paced learning opportunity, lower the costs, career advancement, comfortable learning environment, more opportunities for participation, easier to track documentation and improves skills in technology. Therefore, the challenges in virtual nursing education should be lessened to have successful teaching learning experiences.

Student's perspectives, satisfaction and experiences with online and classroom learning during the COVID-19 pandemic: Findings and implications on blended learning

Objectives

The coronavirus disease 2019 (COVID-19) pandemic disrupted classroom-based learning, necessitating the adoption of online learning in most universities. However, there has been a lack of information on university students' perspectives regarding online learning during the COVID-19 pandemic. This study assessed the perspectives, satisfaction and experiences with online and classroom learning among human health students at the University of Zambia.

Methods

This cross-sectional study was conducted among 737 students at the University of Zambia from October 2022 to April 2023. Data were analysed using Stata version 16.1.

Results

Of the 737 participants, 51.6% were female and 56.5% agreed that blended learning should continue even after the COVID-19 pandemic. However, 78.4% of the students believed that group discussions were more suitable in the classroom than online learning. Most students (67.1%) disagreed that they preferred online learning to classroom learning. Furthermore, 77.6% of the students disagreed that online learning gave more satisfaction than classroom learning.

Conclusions

This study found that most students recommended the continuation of blended learning after the pandemic. However, they believed that follow-up tutorials and assessments were better undertaken in physical classrooms than online learning. These findings are important in sensitising stakeholders in the education sector and governments to consider blended learning as a teaching strategy in the future. There is a need to develop and implement curricula that offer blended learning to students as well as ensure the students have the necessary facilities and equipment to support such learning.

Psychological well-being, stressors, coping strategies and support of undergraduate healthcare students amid COVID-19

Background

Students function better academically when psychologically well. The COVID-19 pandemic proved a new challenge to the mental wellness of undergraduate healthcare students. Students were not only faced with academic changes but also had to complete clinical practice in healthcare facilities amid the COVID-19 pandemic.

Aim

This study investigated the psychological well-being, stressors, coping strategies and support of undergraduate healthcare students amid COVID-19.

Setting

A South African university's faculty of health sciences.

Methods

A survey design through a cross-sectional descriptive approach was used to collect data from the population of 1529 undergraduate healthcare students. One hundred and ninety-six (n = 196) students responded to the online survey.

Results

Participants reported a variety of stressors influencing their psychological well-being. Participants chose mostly adaptive coping strategies to deal with stressors. They gave feedback on the support they received from the faculty and institution. Most of the participants indicated they prefer weekly online communication from the higher education institution.

Conclusion

The COVID-19 pandemic influenced the psychological well-being of undergraduate healthcare students. The psychological well-being of these students is a collective responsibility between students and higher education institutions to enable academic success and positive patient outcomes.

Contribution

This study found that undergraduate healthcare students had academic, psychological, financial and other stressors during the COVID-19 pandemic. Higher education institutions, especially those involved in training undergraduate healthcare professionals, in collaboration with students, need to provide students with targeted continued support and training to use healthy coping behaviours to manage various stressors.

Latent profile analysis on the effectiveness of tutor performance: Influence on medical students' engagement in blended problem-based learning

Tutor performance is a critical factor for the success of a problem-based learning (PBL) curriculum. This study investigated medical students' perceptions of the effectiveness of tutor performance and the relationships with learning engagement (behavioral, emotional, and cognitive engagement) in the blended PBL approach. This study employed a cross-sectional survey and data were collected from 238 first-year and second-year medical students. Latent profile analysis (LPA) was used to investigate how individual students' perceptions of tutor performance can be clustered. Follow-up multiple one-way analyses of covariance (ANCOVA) were performed to examine the relationships with students' learning engagement in PBL activities. The effectiveness of tutor performance perceived by students was classified into lowly, moderately, and highly effective tutors. These clustering profiles were significantly related to the different types of learning engagement in the blended PBL process. Hence, this study highlights that the tutor is one of the key aspects of assessing the implementation of blended PBL since student performance is positively associated with the perception of tutor effectiveness.

The Impact of Tele-Education on Family Medicine Clerkship Students' Learning Outcomes

BACKGROUND AND OBJECTIVES

The COVID-19 pandemic necessitated rapid changes to medical education for student and patient protection. A dearth of published US studies examine resulting clinical education outcomes due to pandemic-induced curricula changes. We describe adaptations made to a family medicine clerkship to move it from traditional in-person delivery to virtual only, and then from virtual to hybrid; and compare educational outcomes of students across delivery types.

METHODS

We stratified 386 medical students in their third year completing their 8-week family medicine clerkship by type of content delivery, including in person, virtual only, and hybrid instruction. We examined the impact of these changes on three clerkship learning outcomes: the midblock assessment score, the National Board of Medical Examiners (NBME) exam score, and the final numeric score (FNS).

RESULTS

In our sample, 164 (42.5%) received content in person, 36 (9.3%) received virtual only, and 186 (48.2%) received hybrid content. Students receiving virtual only (M=76.4, SD=9.1) had significantly higher midblock assessment scores (F=8.06, df=2, P=.0004) than students receiving hybrid (M=71.7, SD=8.8) and in-person training (M=74.5, SD=7.2). No significant differences existed in students' NBME exam scores or FNSs across delivery types.

CONCLUSIONS

Students receiving virtual-only or hybrid content performed at least as well on three clerkship-related educational outcomes as their pre-COVID peers participating in person. Further research is needed to understand how changes to medical education affected student learning and skill development.

Exploring the impact of online and offline teaching methods on the cognitive abilities of medical students: a comparative study

BACKGROUND

Online education has become increasingly popular, but research on the effectiveness of different teaching models in developing cognitive skills is limited. This study investigated the relationship between different teaching models (online and offline) and the development of cognitive skills in clinical medicine students.

METHODS

Survey data were collected from 2018 entry students who participated in online teaching and 2019 entry students in offline teaching at Xiangya School of Medicine, Central South University. National Quality Open Courses (NQROC) were provided to both groups of students. The study examined the total score of physiology final exam, score of each type of question, and NQROC learning engagement in different score segments under the two teaching models. Non-parametric statistical methods were utilized to analyze the total score of physiology final exam, score of each type of question, and the NQROC learning engagement. Spearman's rank correlation was utilized to analyze the relationship between the score of physiology final exam and the students' NQROC learning engagement.

RESULTS

The study found no statistically significant difference in the total score, short-answer questions (SAQs) score, and case study questions (CSQs) score between online and offline teaching models. However, the multiple-choice questions (MCQs) score was higher in the online teaching model (Z=-4.249, P < 0.001), suggesting that online teaching may be an effective way to improve lower-order cognitive skills among students. In contrast, low-achieving students had higher total scores (Z=-3.223, P = 0.001) and scores in both MCQs (Z=-6.263, P < 0.001) and CSQs (Z=-6.877, P < 0.001) in the online teaching model. High-achieving students in the online teaching model had higher total scores (Z=-3.001, P = 0.003) and MCQs scores (Z=-5.706, P < 0.001) but lower scores in CSQs (Z=-2.775, P = 0.006). Furthermore, students' NQROC learning engagement was greater in the online teaching model.

CONCLUSIONS

The results of this study suggested that online teaching was not statistically significantly different from offline in cognitive domains and was more desirable than offline in strengthening lower-order cognitive skills. However, it was important to note that offline teaching may be more effective in reinforcing higher-order cognitive skills among high-achieving students. In conclusion, this study provided important insights into the effectiveness of different teaching models in developing cognitive skills among medical students and highlighted the potential benefits of online teaching in enhancing students' lower-order cognitive skills.

Online Education Improves Confidence in Mechanical Insufflation-Exsufflation

BACKGROUND

Mechanical insufflation-exsufflation (MI-E) is a cough augmentation technique used to support people with an ineffective cough. MI-E can be complex due to the number of different pressure, flow, and temporal setting adjustments needed to optimize cough efficacy. Many clinicians identify inadequate training, limited experience, and low confidence as barriers to MI-E use. The purpose of this study was to determine if an online education course could improve confidence and competence in the delivery of MI-E.

METHODS

An e-mail invitation to participate was disseminated to physiotherapists with a caseload that involved airway clearance for adults. The exclusion criteria were self-reported confidence and clinical expertise in MI-E. The education was created by physiotherapists with extensive experience in the provision of MI-E. The education material reviewed theoretical and practical components and was designed to take 6 h to complete. Physiotherapists were randomized to either the intervention group, who had 3 weeks of access to the education or the control group who received no intervention. Respondents in both groups completed a baseline and a post-intervention questionnaire by using visual analog scales, 0 to 10, with the primary outcomes being confidence in the prescription and confidence in the application of MI-E. Ten multiple-choice questions that covered key components of MI-E fundamentals were also completed at baseline and post-intervention.

RESULTS

The intervention group had a significant improvement in the visual analog scale after the education period with a between-group difference of mean 3.6 (95% CI 4.5 to 2.7) for prescription confidence and mean 2.9 (95% CI 3.9 to 1.9) for application confidence. There was also an improvement in the multiple-choice questions with a between-group difference of mean 3.2 (95% CI 4.3 to 2).

CONCLUSIONS

Access to an evidence-based online education course improved confidence in the prescription and application of MI-E, and may be a valuable tool for training clinicians in the application of MI-E.

Application of Blended Learning to Veterinary Gross Anatomy Practical Sessions: Students' Perceptions of Their Learning Experience and Academic Outcomes

The use of blended learning strategies is increasingly common in health sciences, including veterinary medicine; however, there are very few descriptions of these methods being applied to practicals. We describe here the application of blended learning based on the implementation of flipped classrooms with collaborative learning and gamification to the 2020-2021 veterinary medicine gross anatomy practicals at CEU Cardenal Herrera University (Spain). Students prepared for the sessions by pre-viewing videos and taking a quiz before the start. The sessions were conducted in small groups where students learned through collaborative work and reviewed their learning with a card game. A small but significant increase was observed when comparing the scores of practical exams of the locomotor apparatus with those of 2018-2019 (6.79 ± 2.22 vs. 6.38 ± 2.24, p < 0.05), while the scores were similar (7.76 ± 1.99 vs. 7.64 ± 1.92) for the organ system exams. Students' responses in a satisfaction survey were mostly positive (>80%) regarding the motivating and learning-facilitating effect of this educational method. Our work shows that the application of blended learning in anatomy practicals based on a flipped classroom and with elements of gamification and collaborative work can be an effective way to improve the learning experience of students.

Effectiveness of a blended learning intervention in cardiac physiotherapy. A randomized controlled trial

Background

Blended learning (BL) combines both face-to-face learning (FL) and online learning. This study aims to compare the effectiveness of a BL intervention vs. a FL intervention in relation to the knowledge, competencies, satisfaction, perceptions, usability, and BL acceptance of physiotherapy students.

Methods

An assessor-blinded randomized trial was performed. A total of 100 students were randomly allocated to either the BL group (BLG, n = 48) or FL group (FLG, n = 52). The BLG received face-to-face classes plus access to online resources (online syllabus, Moodle, scientific-based videos and websites, activities, glossary, and apps). The FLG received face-to-face classes and hardcopy resources (hardcopy syllabus, scientific-based information, activities, and a glossary). Knowledge, ethical and gender competencies, satisfaction, perceptions, usability, and BL acceptance were assessed.

Results

The BLG showed higher scores than the FLG for knowledge (p = 0.011), three ethical/gender competencies (p < 0.05), increased motivation to prepare themselves before class (p = 0.005), increased motivation and ability of thinking (p = 0.005), improved understanding of important topics (p = 0.015), course organization (p = 0.017), educational material (p = 0.001), easiness of understanding (p = 0.007), comprehensive coverage of the subject (p = 0.001), and clarity of instructions (p = 0.004), while usability was acceptable.

Conclusion

The BL intervention can be used for improving the knowledge, competencies, perceptions, and satisfaction of the students. In addition, BL acceptance was positive, and usability was found to be acceptable. This study supports the use of BL as a pedagogical approach to foster innovative learning.

Chinese digestive surgery interns' learning quality and English reading proficiency during COVID-19 pandemic: Comparison between face-to-face versus WeChat teaching and learning

Gastrointestinal clinical teaching is of vital important for gastrointestinal surgery interns. However, during COVID-19 pandemic, due to frequent lockdowns and essential social distancing policy implemented in China, face-to-face teaching was interrupted significantly. To find a cost-effective way to deliver medical education to ensure that teaching and learning would be continued and uninterrupted, many social media tools and mobile applications have been used in medical teaching and learning. WeChat has been frequently employed in teaching and learning in many disciplines in Chinese universities due to its powerful functions and free cost. This study compared Chinese digestive surgery interns' learning quality, English reading proficiency, and learning satisfaction in two teaching conditions: the traditional face-to-face teaching versus WeChat teaching via an experiment. The study recruited 60 final year clinical medical students, who were randomly and equally assigned into two groups: traditional face-to-face teaching versus WeChat teaching. Interns' learning quality and learning satisfaction were measured by Likert-scale questionnaires; and their English reading proficiency was measured by the reading section in a standardized English test. The results showed that interns in WeChat group had significantly higher learning quality on understanding mechanisms and current knowledge by both self-assessment and peer-assessment. WeChat group also outperformed face-to-face group on inferencing, details, and main ideas in English reading. With regard to learning satisfaction, WeChat group were higher on learning interests, learning objectives, learning format, and English reading proficiency than face-to-face group. However, interns did not differ in terms of their learning satisfaction on medical skills, which might indicate that WeChat had limitations on training interns' medical practical ability.

The effect of face-to-face versus online learning on student performance in anatomy: an observational study using a causal inference approach

Introduction

This study aimed to estimate the causal effect of face-to-face learning on student performance in anatomy, compared to online learning, by analysing examination marks under a causal structure.

Methods

We specified a causal graph to indicate how the mode of learning affected student performance. We sampled purposively to obtain end-semester examination marks of undergraduate and postgraduate students who learned using face-to-face (pre-COVID, 2019) or online modes (post-COVID, 2020). The analysis was informed by the causal graph. Marks were compared using linear regression, and sensitivity analyses were conducted to assess if effects were robust to unmeasured confounding.

Results

On average, face-to-face learning improved student performance in the end-semester examination in undergraduate students (gain of mean 8.3%, 95% CI 3.3 to 13.4%; E-value 2.77, lower limit of 95% CI 1.80) but lowered performance in postgraduate students (loss of 8.1%, 95% CI 3.6 to 12.6%; E-value 2.89, lower limit of 95% CI 1.88), compared to online learning.

Discussion

Under the assumed causal graph, we found that compared to online learning, face-to-face learning improved student performance in the end-semester examination in undergraduate students, but worsened student performance in postgraduate students. These findings suggest that different modes of learning may suit different types of students. Importantly, this is the first attempt to estimate causal effects of the mode of learning on student performance under a causal structure. This approach makes our assumptions transparent, informs data analysis, and is recommended when using observational data to make causal inferences.

International curriculum for undergraduate sonographer education in China during the COVID-19 era: International remote teaching mode vs. domestic on-site teaching mode

Background

Sichuan University West China Medical School was the first institution in China to develop an undergraduate sonographer education program in 2016. This program was certificated by American Registry for Diagnostic Medical Sonography (ARDMS) and students are qualified for the ARDMS credential verification test. In this 4-year program, the international curriculum of ultrasound physics and hemodynamics was set for students in the third year since 2018. This study is aimed to compare the teaching effect of international remote teaching mode and domestic on-site teaching mode of this international curriculum before and during the COVID-19 pandemic.

Methods

All undergraduate sonographer students after completing ultrasound physics and hemodynamics in the academic years 2018-2019 (30 students; before the COVID-19 pandemic) and 2020-2021 (47 students; during the COVID-19 pandemic) were included in the study. The scores of 77 students were analyzed for their curriculum. Independent samples t-test or Mann-Whitney test was employed to compare students' scores before and during the COVID-19 pandemic. The Chi-square test was used to compare students' feedback about this curriculum through an online self-administered questionnaire. A p < 0.05 was considered statistically significant.

Results

Total scores were comprised of four parts: in-class tests, homework, mid-term, and final exam scores. The mean in-class test score for domestic on-site teaching mode during the COVID-19 pandemic was significantly higher than that for international remote teaching mode before the COVID-19 pandemic. However, there was no observed a statistically significant difference in homework, mid-term, final exam, and total scores between the two types of teaching modes. For questionnaire feedback, no significant difference was observed between the two groups regarding the satisfaction toward teachers, class atmosphere, teaching mode, curriculum content, exam difficulty, scores, and knowledge students gained. For the overall evaluation of the curriculum, 73.3% (22/30) of students were very satisfied before the COVID-19 pandemic, while 44.7% (21/47) of students felt very satisfied during the COVID-19 pandemic (p = 0.02).

Conclusion

The general teaching effect of domestic on-site teaching mode during the COVID-19 pandemic was comparable to that of international remote teaching mode before the COVID-19 pandemic, and domestic on-site teaching mode may provide a better in-class teaching effect.

Checklist-based active learning in anatomy demonstration sessions during the COVID-19 pandemic: Perception of medical students

Human anatomy is an essential component of the medical curricula. Anatomy education has been significantly affected during the COVID-19 pandemic. The aim of this study was to explore student's perceptions on a blended learning approach using Checklist-based Active Learning in Anatomy Demonstration Sessions (CALADS) as a method in comparison to the two previously used methods; namely face-to-face Structured Problem-Related Anatomy Demonstrations (SPRAD) and online anatomy learning. A comparative, cross-sectional, survey-based study was conducted. The survey was composed of 13 questions that explored preference of learning anatomy in demonstration sessions of 4th year pre-clerkship students who have had their anatomy learning through face-to-face SPRAD in year 2 (before the COVID-19 pandemic), online in year 3 (during the COVID-19 pandemic), and CALADS method in year 4. Descriptive statistics were used, and the level of significance was set at P<0.05. The survey exhibited high internal consistency (Cronbach's α=0.953). Validity of the survey was established through exploratory factor analysis. The preferred method for more than half of the students was the CALADS method. Face-to-face SPRAD came next and lastly came the online method. However, more students preferred the online method in comparison to face-to-face method for "learning radiological anatomy". There were no statistically significant differences between male and female students regarding any of the survey questions. CALADS method, as a hybrid, student-centered, interactive learning method of learning practical anatomy, was preferred by pre-clerkship students as a more effective method in understanding anatomy than face-to-face and online learning methods.

Mental Health and Quality of Life among Dental Students during COVID-19 Pandemic: A Cross-Sectional Study

Students are particularly vulnerable from the mental health aspect, which was especially recognized during the COVID-19 pandemic. This study aimed to reveal the impact of COVID-19 on quality of life (QoL) and mental health among dental students. The study was conducted on a sample of 797 students (207 male and 592 female) with an average age of 21.7 ± 2.4, from the School of Dental Medicine, University of Belgrade. The measurements used in the study were the Demographic and Academic Questionnaire, Questionnaire about exposure to COVID-19, COVID-19-Impact on QoL Questionnaire (COV19-QoL), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire (PHQ-9). The mean total score for COV19-QoL was 2.9 ± 0.9, while the diagnostic criteria of GAD-7 and depression met 19.9% and 31.4% of students, respectively. There was a positive and strong correlation between QoL, anxiety, and depression. During COVID-19, predictors for lower perceptions of QoL were female gender and death of close relatives (p = 0.049, p = 0.005, respectively). At the same time, predictors for GAD were female gender, living in dormitories, and death of close relatives (p = 0.019, p = 0.011, p = 0.028, respectively), while for depression they were year of study, living with parents, and death of close relatives due to COVID-19 (p = 0.012, p = 0.008, p = 0.029, respectively). The study showed that students' QoL and mental health during the pandemic were at high risk.

Students' Performance in Face-to-Face, Online, and Hybrid Methods of Teaching and Assessment in Anatomy

In recent times, online teaching and assessment have provided a great opportunity to explore better methods in medical education. There are inconsistent views concerning the effectiveness of online assessment. Hence, the present study aimed to evaluate online teaching and assessment methods in relation to face-to-face methods by comparing students' performances. The students' assessment results in two basic anatomy courses, which are part of the Doctor of Medicine and Biomedical Sciences programs at Sultan Qaboos University, were analysed. We compared the students' mean scores and coefficient of variance in the multiple-choice written exams and the objective structured practical exams during the spring semesters of 2019, 2020, and 2021, containing face-to-face teaching and exams, partial online teaching and online exams, and online teaching and both proctored online and face-to-face exams, respectively. The sudden transition to online teaching and assessment halfway through the semester resulted in higher means and a lower coefficient of variance among students' scores in both theory and practical exams. However, when the fully adopted online method of teaching and assessment was employed, the mean scores decreased, and the coefficient of variance increased to figures close to those witnessed before the pandemic, when teaching and assessment were face-to-face. This trend applied to both the Doctor of Medicine and Biomedical Sciences programs' anatomy courses. The results indicate that online assessment of theoretical and practical anatomical knowledge is comparable to that of face-to-face assessment. However, proper planning and preparedness are mandatory to achieve the desired outcomes.

Impact of Non-Face-to-Face Teaching with Passive Training on Personal Protective Equipment Use in Health Science Students: A Randomized Controlled Trial

BACKGROUND

In the COVID-19 era, there was a call for the transformation of higher education. Universities had to combine non-face-to-face teaching with traditional procedures. This study analyzed the effectiveness and perceived satisfaction in a cohort of health sciences students of non-face-to-face teaching with passive training versus face-to-face teaching with active training in the proper donning and doffing of personal protective equipment (PPE) in a clinical simulation scenario.

METHODS

A total of 142 participants were randomized into two groups: (a) non-face-to-face teaching with passive training; (b) face-to-face teaching with active training. The proper protocol for donning and doffing PPE was assessed. Students evaluated their skills before and after training and satisfaction with training received.

RESULTS

Significant differences were observed for the statements "I felt more confident in donning after receiving this training" (p = 0.029) and "I felt more confident in doffing after receiving this training" (p = 0.042) in the face-to-face teaching with active training group compared to the non-face-to-face teaching with passive training group, whose number of tasks violated was significantly higher (p = 0.020). Satisfaction was significantly higher in the face-to-face and active training group (p = 0.004).

CONCLUSIONS

Face-to-face teaching with active training improves effectiveness and satisfaction more than non-face-to-face teaching with passive training for acquiring skills in donning and doffing PPE properly.

Sustaining blended and online learning during the normal and new normal conditions in a Saudi higher education institution: health science students' perspectives

Background

Higher education institutions (HEIs) shifted from in-person attendance to blended and online learning due to the COVID-19 lockdowns.

Objective

This study investigated the students' perception of satisfaction, convenience, engagement, and learning towards blended and online courses conducted before, during, and after the COVID-19 lockdowns.

Methods

A longitudinal study design was adopted to examine the students' perception of online and blended learning courses before, during, and after the COVID-19 lockdowns. The subjects consist of Health science students (N = 130) belonging to two different colleges of a public university and the study period includes three academic years (i.e., six semesters) (2018–2021). A survey tool was developed to collect data from students studying the computer fundamentals course through blended and online learning modes from 2018 to 2021.

Results

Over 95% of students have been satisfied with the course offered through various blended learning formats since 2018. The blended 0.50-course format is the most preferred one for the students; however, the Blended 0.75-course format is highly rated by the students regarding their satisfaction and engagement than other learning formats during the COVID-19 lockdowns. Following adaption after COVID-19, the students reported a high perception of learning towards the course when delivered through 100% online learning mode.

Conclusion

Students' achievement is significantly associated with the learning modes, exam modes, and various student batches. The blended 0.75-course format group shows a higher achievement than the other three-course format groups. Likewise, those students who appeared in their exams online showed higher achievement than those who appeared physically. Further, the students felt equally convenient with Blended 0.75 and 100% online learning course formats. These findings would also help HEIs choose appropriate learning and examination modes while designing courses.

At the limits of digital education. The importance of practical education for clinical competencies learning in the field of emergency medicine: A controlled non-randomized interventional study

Introduction

A high-quality education of future physicians is essential. Modern approaches interlock the acquisition of theoretical knowledge and practical skills in a spiral curriculum, leading to a mutual learning benefit for knowledge and application. This model was challenged by the elimination of hands-on trainings during the pandemic, which were often replaced by purely digital teaching models. Given the holistic nature of the spiral curriculum, we assumed that a purely digital model would have an impact on knowledge acquisition due to missing hands-on learning opportunities. The aim of the study was to investigate, using an emergency seminar as an example, whether purely digital training leads to a difference in theoretical knowledge compared to the traditional model.

Materials and methods

Study design: We used a two-groups design comparing a sample of medical students taught in 2020 with a purely digital teaching format (DF; n = 152) with a historical control group taught with a traditional format (TF; n = 1060). Subject of investigation was a seminar on emergency medicine, taking place in the 4th year. Outcome parameters: The primary outcome parameter was the students' acquired knowledge, measured by the score achieved in the final exams. Students' evaluation of the seminar was used as a secondary outcome parameter.

Results

Students in the DF group scored significantly lower than students in the TF group in the final exams. Students in the DF group rated the course significantly worse than students in the TF group.

Discussion

The study results illustrate that purely digital education leads to inferior knowledge acquisition compared to the traditional spiral curriculum. A possible explanation may lie in a deeper processing of the information (e.g., understanding the information by experience and analysis) and accordingly a better memory recall. Moreover, the students' critical appraisal of the DF may have had an unfavorable effect on learning performance. Moderating factors may be lower learning motivation or the “zoom fatigue” effect.

Conclusion

These study results clearly illustrate the importance of hands-on teaching for knowledge acquisition. The interlocking of theoretical knowledge and practical skills, as ensured by the spiral curriculum, is essential.

Adaptations of Clinical Teaching During the COVID-19 Pandemic: Perspectives of Medical Students and Faculty Members

BACKGROUND

The COVID-19 pandemic had serious implications on medical schools' programs that necessitated lots of adaptations of teaching, learning, and assessment to guarantee continuity of education in medical schools. Our study aimed to evaluate perspectives of clerkship students and faculty members regarding clinical teaching adaptations implemented during the COVID-19 pandemic.

METHODS

A descriptive, cross-sectional, survey-based study was conducted and targeted 5^th and 6^th year clerkship students and full- and part-time clinical faculty. The survey explored (1) perception of the degree of contribution of implemented adaptations to student achievement of expected clinical competencies, (2) degree of confidence regarding students' achievement of expected clinical competencies through such adaptations, and (3) perception of the effect of implemented educational adaptations on students' learning. Descriptive statistics were used, and statistical significance level was set at p < 0.05.

RESULTS

The survey exhibited high internal consistency. Both students and faculty members felt that most of the adaptations had moderate to high contribution to student achievement of expected clinical competencies. On a 5-point scale, the highest score was given by faculty members to "Interpretation of investigations" (3.93±0.84) while the lowest scores were given by faculty members (3.10±1.21) and students (2.57±1.36) to "Performing clinical procedures". Students and faculty members agreed that the adaptations had positive effect on students' learning except for the statement "Students were able to easily monitor their academic progress" where students gave less scores than faculty members, with a statistically significance difference (p=0.029).

CONCLUSION

Students and faculty members had similar perspectives regarding the implemented adaptations and their impact and contribution to student learning and achievement of the basic clinical competencies. Both of them agreed on the need for and importance of the implemented adaptations. Our findings recommend such adaptations during the times of crises, which can be conducted through integrating online teaching with face-to-face teaching.

Medical students' perceptions and performance in an online regional anatomy course during the Covid-19 pandemic

The present study evaluated the students' psychological well-being, experiences, performance, and perception of learning regional anatomy remotely. A regional anatomy remote learning curriculum was designed and learning materials were delivered virtually to 120 undergraduate medical students at Jinan University, China. All the students consented and voluntarily participated in this study by completing self-administered online questionnaires including the Zung's Self-Rating Anxiety and Depression Scales at the beginning and end of the learning session. A subset participated in focus group discussions. Most of the students (90.0%) positively evaluated the current distance learning model. More than 80% were satisfied with the content arrangement and coverage. Many students preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during the distance learning sessions. However, writing laboratory reports and case-based learning were the least preferred modes of learning as they were only preferred by 23.2% and 14.1% of the students, respectively. There was no significant lockdown-related anxiety or depression reported by students using depression and anxiety scales as well as feedback from focus group discussions. The surveyed students' confidence scores in distance learning were significantly higher after 5 weeks than at the beginning of the session (3.05 ± 0.83 vs. 3.70 ± 0.71, P < 0.05). Furthermore, the present results showed no significant differences between the current group's academic performance in the unit tests as well as the final overall evaluation for different parts of the course compared to that of the previous year's cohort. The findings above were congruent with focus group discussion data that the use of the online teaching platform for regional anatomy significantly improved the students' confidence in virtual and self-directed learning and did not negatively affect their academic performance.

PBL teaching in ultrasonography resident standardization training in the COVID-19 pandemic

OBJECTIVE

To study the effect of the problem-based learning (PBL) method in ultrasonography (US) resident standardization training during the COVID-19 pandemic.

METHODS

Fifty residents were divided into two groups to participate in a 30-day US training program. The residents in the observation group underwent PBL combined with the lecture-based learning (LBL) method, while the residents in the control group experienced the LBL method alone, with 25 residents in each group. A basic theoretical test, practical examination, and questionnaire were used to evaluate the teaching effect of the PBL + LBL method and the LBL method alone.

RESULTS

The basic theoretical pretest score of the observation group was not significantly different from that of the control group. However, the posttest theoretical score and practical score were significantly higher in the observation group than in the control group (P < 0.01). The results of the questionnaire showed that the resident satisfaction level in the observation group with PBL combined with the LBL method was 96%, which was significantly higher than that of the control group with the LBL method alone (80%) (P < 0.05).

CONCLUSION

The combination of PBL with the LBL method has obvious advantages over the LBL method alone in regard to the training of US residents during the COVID-19 pandemic.

Face to face or blended learning? A case study: Teacher training in the pedagogical use of ICT

We are experiencing a transitional period in education: from the traditional, face to face teaching model to new teaching and learning models that apply modern pedagogical approaches, utilize technological achievements and respond to current social needs. For a number of reasons including the recent pandemic covid-19 situation, technology enhanced distance learning, seems to gain ground against traditional face to face teaching and in fact, in a sharp way. Acknowledging that changes in education need time, research and careful steps in order to be successfully applied and established at large scale, in this paper we attempt to compare face to face ("traditional") teacher training with teacher training through a blended learning approach/ model. The latest combines characteristics of both face to face and distance learning models. The case study is based on a large-scale in-service teacher training initiative which has been taking place in Greece for over a decade to train teachers in the utilization and application of digital technologies in the teaching practice (i.e. B-Level ICT Teacher Training). The B-Level ICT Teacher Training was initially based exclusively on face to face teaching but it was later adapted to a specially designed blended learning model which combined both face to face and synchronous distance sessions, accompanied by asynchronous activities and supported by specific e-learning platforms and tools. The comparison refers to the effectiveness of the two models/ approaches, as it derives from teacher trainees' performance, especially in the framework of the certification procedure that takes place through nationwide, independent exams that follow the training and assesses the relevant knowledge and skills acquired. Research findings point out better performances of a small or marginal scale for the teachers of various specialties who participated in blended learning teacher training programs compared to those who participated in traditional teacher training programs. Actually, it is shown that blended learning model trainees i) feel more comfortable to participate in the exams for the certification of knowledge and skills acquired, ii) have some better success rate and iii) get a bit higher grades in these exams. Thus, it can be argued that learning outcomes of the blended learning application in this teacher training initiative, overstep those of the "traditional" model in a small scale and with some slight differentiations among teacher specialties.