Keywords

1 Background

The declaration of COVID-19 as a pandemic on March 11, 2020, had vast repercussions on the economy, healthcare delivery, and education activities worldwide [1]. The effects on education were robust as universities were challenged by the abrupt closure of onsite classrooms and the transition to online learning under considerable time pressure. The unprecedented closure of in-person classes necessitated the universities to adopt online learning platforms to ensure the continuous delivery of education. These effects led to the rapid development of alternate, innovative approaches to ensure quality education [2].

Although online learning is not new to the medical field, not many medical universities were actively implementing it before the pandemic. However, the outbreak of the pandemic prompted academia to restructure the curriculum and introduce online learning methods [3].

As described by Howlett, online learning uses electronic technology and online content to support and enhance learning [4]. As the new generation of students is highly interested in technology-based learning, online learning can be a suitable alternative to traditional didactic learning. However, 100% online learning is not recommended in the medical field as it is difficult to nurture the necessary communication and clinical examination skills in a virtual environment [5]. Moreover, online teaching cannot address all the benefits of onsite learning, such as peer interaction and providing instant feedback on their performance. Onsite laboratory experience enables the learners to effectively engage with instructors and the course material. Therefore, blended or hybrid learning has emerged as a promising approach in medical education.

In the hybrid approach, traditional face-to-face learning is supplemented with virtual learning. Compared to onsite learning, this approach has minimal limitations of time and space and enables universities to expand their educational opportunities [6]. The hybrid approach enhances learning by providing the students with an integrated learning experience that fosters proactive self-directed learning [7].

The COVID-19 pandemic provided us with a unique opportunity to use the University of Sharjah (UOS) Blackboard tool to its fullest potential by implementing the hybrid model in our curriculum. Most studies have documented favorable perceptions of hybrid learning. However, the efficacy of such teaching methods for laboratory experiments partly remains elusive [8].

This study aimed to understand the student perspectives and experience of the hybrid approach in human physiology experiments. We hypothesize that hybrid teaching may be superior to traditional onsite or online teaching in effectively delivering the lab contents. To test this hypothesis, we used online questionnaires investigating the opinion of medical students at the UOS about the course contents of Physiology lab experiments.

2 Methods

It is a cross-sectional study among Years 1, 2, and 3 medical students. Cross-sectional method was used to prevent potential bias due to repeated measurements. Data was collected through an online survey via a self-administered electronic questionnaire. The students were invited to participate in the study via emails from the administrative office. The email included a hyperlink to access the questionnaire. The students were informed that the participation was voluntary and anonymous, and it was not linked to any form of student evaluation. The questionnaire comprised 11 questions including 2 open-ended questions. Students were asked to answer the questions using a 5-point Likert scale (1 = ‘strongly disagree’, 2 = ‘disagree’, 3 = ‘neither agree nor disagree’, 4 = ‘agree’, and 5 = ‘strongly agree’). Data was expressed in percentages and analyzed using a one-sample t-test using Graph-Pad Prism version 8.01. A p-value of <0.05 was considered statistically significant.

We addressed various attributes of the hybrid model, such as the reinforcement of concepts learned, the usefulness of prelab videos and online assignments, time efficiency, ease of accessing online resources, and the role of hybrid teaching in promoting self-directed learning. It included open-ended questions to highlight the merits of the hybrid model and suggestions to improve the quality of the lab.

3 Study Design

Traditionally, students were divided into small batches for individual sessions. In the first part of the session, the faculty showed the entire experiment procedure. In the second part of the session, the students took turns performing the experiment, followed by a small discussion and submission of the report. The duration of the entire session was about 2.5 h.

With the beginning of the pandemic, it was critical to implement preventive measures and decrease the contact period between students and instructors. We designed a hybrid teaching model that combines onsite and online learning to provide hands-on experience to medical students without compromising the COVID-19 preventive measures. This model is a stepwise approach that includes a video recording of the practical session using simulated patients followed by a prelab discussion to make the onsite experience time efficient (Fig. 1).

Fig. 1
A flow chart in 8 blocks. Video recording and preparing practical handbook lead to uploading the video and the handbook in the blackboard. It leads to online student activity through short online tutorial session and onsite practical session. It further leads to assignment and feedback.

Depiction of the hybrid model of delivering the physiology practical sessions

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In the first step, the instructor described the instruments used and performed the entire experiment using real subjects, which were video recorded. In the second step, a manual of the whole experimental procedure was prepared and uploaded alongside the video recording a week before the onsite session. The third step included a short online tutorial session with the students to discuss potential doubts about the experimental procedure. This was followed by the actual onsite lab, where the students were divided into small batches of 4 to directly perform the experiment without any onsite demonstration in the presence of the instructors (Step 5). Later, the students went through the online resource materials related to the practical session and submitted an online assignment (Steps 6 and 7). After completing the lab, a feedback form was provided to the students to share their experiences and improve the quality of the practical session (Step 8).

4 Results

The hybrid model was applied to all the physiology practical sessions conducted for Years 1, 2, and 3 medical students. Participation in this study was voluntary, and we received 130 responses.

We first investigated the perception of the students about the ability of the hybrid model to enhance practical skills, and the most frequent response was 4 (Fig. 2). 70% of the students chose responses 4 and 5. Next, we investigated the use of Prelab demonstration videos in making the lab interesting and easy to perform. The most frequent response was 5 (Fig. 3). 80% of the students chose responses 4 and 5. Furthermore, the students were asked to rate the use of online prelab discussions in increasing their preparedness for the onsite hands-on experience. 63% of the students agreed that the hybrid lab increased their preparedness (Fig. 4). Next, we evaluated whether the online assignments were useful in reinforcing the concepts taught during the lab. 45% of the students chose responses 4 and 5. However, 34% of the students preferred to remain neutral (Fig. 5). In the next question, we assessed the satisfaction rate of the content delivered through the hybrid lab. 66% of the students were satisfied, and the most frequent response was 4 (Fig. 6). Later, we assessed if the hybrid model of conducting physiology lab was time-efficient and allowed students to study at their own pace. 68% of the students agreed to this, and the most frequent response was 4 (Fig. 7).  In addition, we wanted to investigate if the hybrid model of conducting physiology lab promoted active self-learning. 73% of the students felt that their self-learning skill was improved with the hybrid lab (Fig. 8). Following this, we measured students’ opinions about the easy availability of online resources regarding the physiology lab. 50% of the students strongly agreed with this, and the most frequent response was 5.82% of the students had a positive response (Fig. 9). When the students were asked if they would recommend the hybrid model for teaching physiology experiments in the future, 65% of the students recommended the hybrid model for future practice (Fig. 10).

Fig. 2
A bar graph with horizontal error bars plots percent of students versus 5 response categories. The highest bar reads at (5, 45). Nine error bars are marked above the bars, most of them with datapoints toward the right. The longest error plot extends from 1 to 4.8. Values are approximate.

The bar chart representation of the responses obtained for the question that addresses the ability of the Hybrid model of the lab to enhance students’ clinical skills

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Fig. 3
A bar graph with horizontal error bars plots percent of students versus 5 response categories. The highest bar reads at (5, 35). Six error bars are marked above the bars, most of them with datapoints in the center. The longest error plot extends from 1.2 to 4.8. Values are approximate.

The bar chart representation of the responses obtained for the question investigating the use of Prelab demonstration videos in making the lab interesting and easy to perform

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Fig. 4
A bar graph with horizontal error bars plots percent of students versus 5 response categories. The highest bar reads at (5, 35). Six error bars are marked above the bars, most of them with datapoints toward the left. The longest error plot extends from 1 to 4.8. Values are approximate.

The bar chart representation of the responses obtained for the question that addresses the use of online prelab discussions in increasing their preparedness for the onsite hands-on experience

Full size image
Fig. 5
A bar graph with error bars plots percent of students versus 5 response categories. The highest bar reads at (3, 35). Seven error bars are marked above the bars, most of them with datapoints at the center.

The bar chart representation of the responses obtained for the question that evaluated whether the online assignments were helpful in reinforcing the concepts taught during the lab

Full size image
Fig. 6
A bar graph with horizontal error bars plots percent of students versus 5 response categories. The highest bar reads at (5, 35). Seven error bars are marked above the bars, three with datapoints toward the left. The most prolonged error plot extends from 1 to 4.8. Values are approximate.

The bar chart representation of the responses obtained for the question that assessed the satisfaction rate of the content delivered through the hybrid lab

Full size image
Fig. 7
A bar graph with horizontal error bars plots percent of students versus 5 response categories. The highest bar reads at (4, 35). Seven error bars are marked above the bars, most of them with datapoints at the center. The most prolonged error plot extends from 1 to 4.7. Values are approximate.

The bar chart representation of the responses obtained for the question that assessed if hybrid learning enabled students to learn at their own pace

Full size image
Fig. 8
A bar graph with horizontal error bars plots percent of students versus 5 response categories. The highest bar reads at (5, 45). Six error bars are marked above the bars, most of them with datapoints at the center. The longest error plot extends from 1 to 4.8. Values are approximate.

The bar chart representation of the responses obtained for the question that addresses the ability of the hybrid model of conducting physiology lab to promote active self-learning

Full size image
Fig. 9
A bar graph with horizontal error bars plots percent of students versus 5 response categories. The highest bar reads at (5, 35). Seven error bars are marked above the bars, most of them with datapoints at the center or slightly inclined toward the right. The longest error plot extends from 1 to 4.8. Values are approximate.

The bar chart representation of the responses obtained for the question that measured students’ opinions about the easy availability of online resources regarding the hybrid physiology lab

Full size image
Fig. 10
A bar graph with horizontal error bars plots percent of students versus 5 response categories. The highest bar reads at (4, 38). Eight error bars are marked above the bars, most of them with data points inclined toward the right. The longest error plot extends from 1 to 4.9. Values are approximate.

The bar chart representing the responses obtained for the question if the students recommended the hybrid model for future practice

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In the last segment, we had two open-ended questions. We asked the students what they liked most about the Hybrid model of the lab and if they had any suggestions to improve the lab.

They expressed their views as follows:

  • “Shows the real setting of the lab”.

  • “We can study at our own pace and place”.

  • “We like hybrid because it has the best of both online and onsite learning”.

  • “We liked working in small groups”.

  • “We had the prior knowledge before coming to the lab. So, it was easy to practice”.

  • “Co-ordinate with other lab timings”.

5 Discussion

Our research study evaluated undergraduate medical students’ perspectives and attitudes regarding the hybrid model of performing physiology lab experiments. Our study results revealed that students had positive perceptions about hybrid learning during the COVID-19 pandemic, and most of the students recommended continuing with the hybrid model post pandemic.

Overall, our study findings are consistent with other studies in medical education that have also documented students’ positive perceptions toward hybrid learning during the pandemic [9].

As clinical skills are essential to the practice of medicine, students must practice and master these skills to be professionally competent. The model allows students to have face-to-face interactions and hands-on experience to improve their practical skills. Most of our students cited that they were happy to come back to the campus to perform the experiments and enhance their clinical skills. The hybrid model enabled the students to apply their prelab knowledge during practical operation increasing learning efficiency. Our study results supported other studies which proved the efficiency of the hybrid model to enhance students’ clinical skills through effective student–teacher interaction and practical training [10].

In this study, we evaluated the advantage of uploading prelab videos and conducting prelab discussions to increase students’ preparedness. Making students aware of the learning objectives in advance promotes and supports deep learning. Most of the students strongly agreed that the prelab activities enabled them to be well prepared during the onsite lab. Our results were like other studies which demonstrated Hybrid learning as an effective tool to improve student preparedness [11].

The medical profession requires lifelong learning for continuous professional development, and the skills of self-directed learning must be nurtured during the basic medical training years. Furthermore, hybrid learning enhances intrinsic motivation and provides opportunities for self-learning by giving the students the responsibility for their learning journey. Over one-third of our students opined that the hybrid model allowed them to take an active part in the learning process and build their self-directed learning skills. This aligns with other literature that reported hybrid learning as an effective tool to enhance self-directed learning [12].

Formative assessments enable students to identify knowledge gaps and enhance their performance in summative assessments. It helps in critical self-reflection and fosters lifelong learning. In this study, most of the students reported that the online assignments at the end of the lab enabled them to identify their weaknesses and helped in a deeper understanding of the course content [13].

Another advantage of the hybrid model, as highlighted by this study, is the availability of online resources. More than 80% of the students agreed that the hybrid model enabled them to access the course materials and resources at their convenience. This agrees with other studies that reported that the hybrid model allows the students to plan the learning journey at their comfort as most of the resources are stored and easily accessible [14].

In the open-ended questions in the survey, students commented that enhanced flexibility is one of the greatest advantages of hybrid learning. They explicitly mentioned that the hybrid model allowed them to work at their own pace and place, which put them at ease, enhancing self-care and mental wellbeing. Our findings agree with other studies that have also demonstrated that hybrid learning enhances flexibility in the learning process [15].

The students mentioned collaboration between departments as one of the limiting factors in the efficiency of the hybrid model. It is essential to have a pre-implementation meeting between various departments for the smooth functioning of the lab. In addition, the results of our study showed that performing physiology experiments by implementing the Hybrid model enhanced student engagement, increased their self-learning skills, and ensured the physiology lab's quality.

6 Conclusion

In conclusion, our findings highlight the advantages of the hybrid model during the COVID-19 pandemic and suggested that using this model post pandemic will enhance students’ learning experience in a more advanced and convenient manner.

7 Limitations

This study was constrained by small sample size and the lack of evaluation of the efficiency of the hybrid model. Future focus includes expanding the hybrid model of teaching in other departments and evaluating the efficiency of the model by comparing student grades.