Blended Learning (bLearning) supported by digital technology and competence-based medical education (CBME) are transforming professional education in the 21st century. Several publications discuss the possibilities and challenges associated with this trend. They show the usefulness of bLearning in making learning more meaningful both at the personal level and at the social level (Hew & Cheung, 2014; Prat-Corominas, Palés-Argullós, Nolla-Domejó, Oriol-Bosch, & Gual, 2010).
Information and communication technologies allow for relatively easy access to knowledge in a variety of areas outside of educational institutions (Castells, 2006; Martín-Barbero, 2002). For higher education institutions in particular, the use of this modality provides an opportunity to transform pedagogical approaches, thus allowing students to create knowledge in collaboration with others (Hopenhayn, 2003; Márquez & Jiménez-Rodrigo, 2014) and to understand how to use information in a specific context. Additionally, this creates the need for more flexible learning environments that allow people to acquire knowledge anywhere, anytime, and at their own pace. bLearning, understood as a mixture of face-to-face and distance learning, has become an answer to this need, because it combines and integrates the best strategies of each modality (Galvis & Pedraza, 2013).
Numerous cases suggest the benefits of the bLearning modality and the possibilities it offers to boost the development of skills in different disciplines. Sánchez (2015) describes various cases across disciplines in which students from different areas (communication sciences, graphic design, public relations and advertising) who were taking part in a bLearning course were tracked throughout their learning processes. Another study by Aguado, Arranz, Valera-Rubio, and Marín-Torres (2011) describes a program based on this approach which was designed for a group of professionals from a company belonging to the electricity sector.
The CBME approach promotes both individual and collaborative knowledge creation thus allowing students to integrate information that will be used in different contexts and experience learning as meaningful. Both of the aforementioned are key aspects of the constructivist paradigm (Prat-Corominas et al., 2010). In other words, this model promotes situated and contextualized learning which prepares students for real life issues consequently acquiring the professional skills that are the goal of CBME (Trujillo & Zambrano, 2015). Additionally, CBME assessment seeks a more complete and authentic approach to evaluating the student’s performance; it applies different strategies and assessment tools that facilitate the observation of student achievement on the proposed professional competencies (Pinilla-Roa, 2013).
Although there are several approximations to the implications of CBME, Frank et al. (2010) summarize the principal ideas. CBME has: 1. a curricular structure focusing on outcomes, and measureable skills and development of competencies through the use of clear evaluation criteria; 2. a learner-centered process which places emphasizes on the needs of society and the student’s context; 3. a concern for individual differences of the learner, especially allowing the student to learn at his or her own pace, hence fostering an individual learning process.
With regard to the development of competencies, it has been found that developing competencies is more difficult in completely virtual settings than in blended ones. Through reading or participating in forums exclusively fewer people can develop skills such as negotiation techniques or leadership proficiencies (Aguado et al., 2011). As a result, bLearning modalities allow for the combination of online methods with face-to-face learning which boost the development of target competencies. As is described by Turpo (2012), p. 129, “in operational terms, bLearning includes online activities in both its instructional design and in its face-to-face activities both of which are structured pedagogically such that competencies/objectives are achieved” (author translation).
These changes in educational and research perspectives have shown that physicians trained under the CBME model have performed better in a globalized world (Frank et al., 2010; Palés-Argullós, Nolla-Domenjó, Oriol-Bosch, & Gual, 2010). Therefore, different resources have been allocated to transform the curriculum designs in medical education.
The purpose of this study was to explore the way in which the transformation of the Social Medicine course to a bLearning modality impacted the achievement of target skills in second year medicine students from the Universidad de los Andes (Colombia). The pedagogical transformation and the course learning outcomes will be described in the next sections.
The transformation of the social medicine course: bLearning and competence-based learning
The course considered for this study was mainly organized around lecture classes in which students were guided through the essential concepts about health, health promotion, disease prevention, and predictors for disease. The revision of the course syllabus emerged from the instructor’s pedagogical reflection about her conceptions and educational practices. This reflection, which was both an individual and collaborative process, was crucial for the improvement of educational practices. The reason for this is that a reflective practice leads the instructor to transform their daily practices and therefore modify students’ learning (Gómez, Ternent de Samper, Alba, & Ghitis, 2013).
Initially, we decided to review the course program beginning with the analysis of the core competencies we planned to foster in the students. The methodology and approaches to assessment were adjusted in keeping with the curriculum alignment proposed by Biggs (2006). Later on, the virtual and face-to-face settings were decided upon and a course which promoted autonomy and collaborative work was created. Fourteen face-to-face sessions that lasted two hours each were designed. The course’s key concepts were addressed through workshops, discussion panels with experts, interventions in educational institutions and final papers. Throughout the course, ten two-hour virtual sessions were implemented as well. In these virtual sessions, students completed different tasks that reinforced face-to-face session outcomes. These included videos and readings from visiting professors and student participation in a Wiki, where they displayed their learning using the thinking routine connect-expand-challenge on the reviewed materials (Krechevsky, 2012). It is important to note that students also used the Wiki to construct their project and to carry out the self and peer evaluation of their group work.
At a second stage of the implementation, the design was carried out for one semester. Using different methodological strategies, an evaluation process was conducted. Before participating, participants signed an informed consent. The information gathered led to a new adjustment of the program, the face-to-face and online spaces, and also of the digital platform design. This was done with the objective of improving the course’s learning atmosphere and, in consequence, the students’ learning processes.
It is important to note that the use of Blackboard®, the virtual platform in which this course is based, changed significantly. Before the pedagogical transformation, it served only as a repository for different readings, to publish assignments, show grades to students and facilitate email exchange between the instructors and the teaching assistants. Thanks to the new design, available Web 2.0 tools were put into use, especially Wikis and teamwork dynamics. This led to better interaction with the available resources and the creation of collaborative work dynamics among students. Communication between students and the team of instructors and teacher’s assistants also improved.
Today the course aims at developing four competencies in second-year medicine students (Table 1), and this is accomplished through their participation within two specific projects. In these projects, they have contact with different health problems and risky scenarios in individual, family and community contexts. The methodology used is called Problem-Based Learning Organized by Projects (PBL-OP).
Table 1 Competencies in the Social Medicine course in the first semester of 2015
The first project consisted in creating an intervention focusing on the promotion of mental health for students from different programs at the Universidad de los Andes. The impetus for this particular intervention was based on a study of social determinants of health and issues that had been prioritized by the Dean of Students and the student body of the university. The second intervention project was based on a case study of a student with learning disabilities at a public high-school in Bogotá. In this case, the ecological model was used on the basis of which the students’ health status could be analyzed. Taking it from there a feasible proposal to both school and families could be developed to improve the students’ well-being.
Finally, assessment processes revealed what students had learned in the course and permitted us to monitor the achievement of the target competencies. Assessments were conducted individually and collectively both online and face-to-face throughout the project phase of the course. Each time the students submitted their work, they were provided with an assessment rubric that included specific scoring criteria based on the learning objectives (Tables 2 and 3). The use of these assessment tools led to the early detection of students with low academic performance, which in turn, allowed us to give them timely, appropriate guidance to help them acquire the competencies proposed for the course.
Table 2 Assessment rubric for “Health-Promoting University” project
Table 3 Assessment rubric “Learning Disabilities” project