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Background This study aimed to evaluate the effectiveness and efficiency of PBL–CBL combined teaching in thyroid surgery and make observations from the students’ perspectives, based on their satisfaction with the learning process. Methods We prospectively enrolled 354 fourth-year students majoring in clinical medicine, along with 232 residents, from September 2014 to June 2019. These participants were randomly allocated into either the combined PBL–CBL teaching group or the traditional lecture-based classroom group to attend a course about thyroid nodules. Both pre- and post-class quizzes were conducted. An anonymous questionnaire was also administered to both groups to evaluate the students’ perceptions and experiences. We compared the two teaching methods among all the students as well as with the fourth-year students and residents in subgroups. Results The traditional group’s pre-class quiz scores were significantly higher than the PBL–CBL group’s (as determined by a two-tailed t-test at a 95% confidence interval, T  = 16.483, P  < 0.001). After class, in the PBL–CBL group, the mean total quiz score and the basic knowledge and case analysis scores increased significantly ( P  < 0.001). The PBL–CBL group’s performance improvement was significantly higher than the traditional group’s (increasing from 52.76 to 70.51 vs. from 67.03 to 71.97). Furthermore, the scores for learning motivation, understanding, student–teacher interaction, the final examination, communication skills, clinical thinking skills, self-learning skills, teamwork skills, and knowledge absorption, as measured by the survey, were significantly higher in the PBL–CBL group than in the traditional group ( P  < 0.001). Meanwhile, the survey scores representing the amount of students’ free time the course consumed were significantly lower in the PBL–CBL group than in the traditional group ( P  < 0.001). Conclusions PBL combined with CBL may be an effective method for improving medical students’ and residents’ performance and enhancing their clinical skills.

Background Recently, much attention has been given to e-learning in higher education as it provides better access to learning resources online, utilising technology – regardless of learners’ geographical locations and timescale – to enhance learning. It has now become part of the mainstream in education in the health sciences, including medical, dental, public health, nursing, and other allied health professionals. Despite growing evidence claiming that e-learning is as effective as traditional means of learning, there is very limited evidence available about what works, and when and how e-learning enhances teaching and learning. This systematic review aimed to identify and synthesise the factors – enablers and barriers – affecting e-learning in health sciences education (el-HSE) that have been reported in the medical literature. Methods A systemic review of articles published on e-learning in health sciences education (el-HSE) was performed in MEDLINE, EMBASE, Allied & Complementary Medicine, DH-DATA, PsycINFO, CINAHL, and Global Health, from 1980 through 2019, using ‘Textword’ and ‘Thesaurus’ search terms. All original articles fulfilling the following criteria were included: (1) e-learning was implemented in health sciences education, and (2) the investigation of the factors – enablers and barriers – about el-HSE related to learning performance or outcomes. Following the PRISMA guidelines, both relevant published and unpublished papers were searched. Data were extracted and quality appraised using QualSyst tools, and synthesised performing thematic analysis. Results Out of 985 records identified, a total of 162 citations were screened, of which 57 were found to be of relevance to this study. The primary evidence base comprises 24 papers, with two broad categories identified, enablers and barriers, under eight separate themes: facilitate learning; learning in practice; systematic approach to learning; integration of e-learning into curricula; poor motivation and expectation; resource-intensive; not suitable for all disciplines or contents, and lack of IT skills. Conclusions This study has identified the factors which impact on e-learning: interaction and collaboration between learners and facilitators; considering learners’ motivation and expectations; utilising user-friendly technology; and putting learners at the centre of pedagogy. There is significant scope for better understanding of the issues related to enablers and facilitators associated with e-learning, and developing appropriate policies and initiatives to establish when, how and where they fit best, creating a broader framework for making e-learning effective.

Background The use of flipped classroom approach has become increasingly popular in health professions education. However, no meta-analysis has been published that specifically examines the effect of flipped classroom versus traditional classroom on student learning. This study examined the findings of comparative articles through a meta-analysis in order to summarize the overall effects of teaching with the flipped classroom approach. We focused specifically on a set of flipped classroom studies in which pre-recorded videos were provided before face-to-face class meetings. These comparative articles focused on health care professionals including medical students, residents, doctors, nurses, or learners in other health care professions and disciplines (e.g., dental, pharmacy, environmental or occupational health). Method Using predefined study eligibility criteria, seven electronic databases were searched in mid-April 2017 for relevant articles. Methodological quality was graded using the Medical Education Research Study Quality Instrument (MERSQI). Effect sizes, heterogeneity estimates, analysis of possible moderators, and publication bias were computed using the C omprehensive M eta -A nalysis software. Results A meta-analysis of 28 eligible comparative studies (between-subject design) showed an overall significant effect in favor of flipped classrooms over traditional classrooms for health professions education (standardized mean difference, SMD = 0.33, 95% confidence interval, CI = 0.21–0.46, p  < 0.001), with no evidence of publication bias. In addition, the flipped classroom approach was more effective when instructors used quizzes at the start of each in-class session. More respondents reported they preferred flipped to traditional classrooms. Conclusions Current evidence suggests that the flipped classroom approach in health professions education yields a significant improvement in student learning compared with traditional teaching methods.

Background As COVID-19 has been declared as a pandemic disease by the WHO on March 11th, 2020, the global incidence of COVID-19 disease increased dramatically. In response to the COVID-19 situation, Jordan announced the emergency state on the 19th of March, followed by the curfew on 21 March. All educational institutions have been closed as well as educational activities including clinical medical education have been suspended on the 15th of March. As a result, Distance E-learning emerged as a new method of teaching to maintain the continuity of medical education during the COVID-19 pandemic related closure of educational institutions. Distance E-Learning is defined as using computer technology to deliver training, including technology-supported learning either online, offline, or both. Before this period, distance learning was not considered in Jordanian universities as a modality for education. This study aims to explore the situation of distance E-learning among medical students during their clinical years and to identify possible challenges, limitations, satisfaction as well as perspectives for this approach to learning. Methods This cross-sectional study is based on a questionnaire that was designed and delivered to medical students in their clinical years. For this study, the estimated sample size ( n  = 588) is derived from the online Raosoft sample size calculator. Results A total of 652 students have completed the questionnaire, among them, 538 students (82.5%) have participated in distance learning in their medical schools amid COVID-19 pandemic. The overall satisfaction rate in medical distance learning was 26.8%, and it was significantly higher in students with previous experience in distance learning in their medical schools as well as when instructors were actively participating in learning sessions, using multimedia and devoting adequate time for their sessions. The delivery of educational material using synchronous live streaming sessions represented the major modality of teaching and Internet streaming quality and coverage was the main challenge that was reported by 69.1% of students. Conclusion With advances in technologies and social media, distance learning is a new and rapidly growing approach for undergraduate, postgraduate, and health care providers. It may represent an optimal solution to maintain learning processes in exceptional and emergency situations such as COVID-19 pandemic. Technical and infrastructural resources reported as a major challenge for implementing distance learning, so understanding technological, financial, institutional, educators, and student barriers are essential for the successful implementation of distance learning in medical education.

Background A flipped classroom with team-based learning is a blended educational strategy that guides active learning inside and outside the classroom. This study aimed to verify the effects of this innovative blended educational strategy on knowledge, problem-solving ability, and learning satisfaction of undergraduate nursing students undergoing public healthcare education. Methods The subjects were undergraduate nursing students enrolled in H University in South Korea. The experiment was conducted over a period of 8 weeks in the public healthcare course. Two groups, blended learning (A flipped classroom with team-based learning) which was the experimental group and traditional lecture-based classroom group, the control group, were assessed. In the blended learning group, the students had pre-class, in-class (including team-based learning elements), and post-class learning elements. The two groups were compared on the following learning outcomes: knowledge, problem-solving ability, and learning satisfaction. Results Results showed that the blended learning instructional methods, in comparison with traditional lectures, enhanced the students’ knowledge, problem-solving ability, and learning satisfaction in the public healthcare course. Conclusions This study supports the feasibility of the flipped classroom with team-based learning as a blended learning strategy, able to produce improvements in nursing students’ learning outcomes. Blended learning approaches may be an effective alternative to conventional approaches in nursing education.

Recognition of the factors affecting the medical students’ academic success is one of the most important challenges and concerns in medical schools. Hence, this study aimed to investigate the mediating effects of metacognitive learning strategies and learning-related emotions in the relationship between academic self-efficacy with academic performance in medical students. Methods The present study was carried out on 279 students of medicine studying at Shiraz University of Medical Sciences. The students filled out three questionnaires: academic emotions (AEQ), metacognitive learning strategies, and academic self-efficacy questionnaires. The data were analyzed using SPSS and Smart PLS3. Results The results of structural equation modeling revealed that the students’ self-efficacy has an impact on their learning-related emotions and metacognitive learning strategies, and these, in turn, affect the students’ academic performance. Moreover, learning-related emotions influence the metacognitive learning strategies, which in turn mediate the effect of emotions on academic performance. Discussion The results of this study revealed that metacognitive strategies and learning-related emotions could play a mediating role in the relationship between students’ self-efficacy and academic performance.

Background Virtual reality (VR) is an innovation that permits the individual to discover and operate within three-dimensional (3D) environment to gain practical understanding. This research aimed to examine the general efficiency of VR for teaching medical anatomy. Methods We executed a meta-analysis of randomized controlled studies of the performance of VR anatomy education. We browsed five databases from the year 1990 to 2019. Ultimately, 15 randomized controlled trials with a teaching outcome measure analysis were included. Two authors separately chose studies, extracted information, and examined the risk of bias. The primary outcomes were examination scores of the students. Secondary outcomes were the degrees of satisfaction of the students. Random-effects models were used for the pooled evaluations of scores and satisfaction degrees. Standardized mean difference (SMD) was applied to assess the systematic results. The heterogeneity was determined by I 2 statistics, and then was investigated by meta-regression and subgroup analyses. Results In this review, we screened and included fifteen randomized controlled researches (816 students). The pooled analysis of primary outcomes showed that VR improves test scores moderately compared with other approaches (standardized mean difference [SMD] = 0.53; 95% Confidence Interval [CI] 0.09–0.97, p  < 0.05; I 2  = 87.8%). The high homogeneity indicated that the studies were different from each other. Therefore, we carried out meta-regression as well as subgroup analyses using seven variables (year, country, learners, course, intervention, comparator, and duration). We found that VR improves post-intervention test score of anatomy compared with other types of teaching methods. Conclusions The finding confirms that VR may act as an efficient way to improve the learners’ level of anatomy knowledge. Future research should assess other factors like degree of satisfaction, cost-effectiveness, and adverse reactions when evaluating the teaching effectiveness of VR in anatomy.

Background The aim of this study is to review the literature on known barriers and solutions that face educators when developing and implementing online learning programs for medical students and postgraduate trainees. Methods An integrative review was conducted over a three-month period by an inter-institutional research team. The search included ScienceDirect, Scopus, BioMedical, PubMed, Medline (EBSCO & Ovid), ERIC, LISA, EBSCO, Google Scholar, ProQuest A&I, ProQuest UK & Ireland, UL Institutional Repository (IR), UCDIR and the All Aboard Report. Search terms included online learning, medical educators, development, barriers, solutions and digital literacy. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed with inclusion/exclusion criteria. A consensus was drawn on which articles were included. Data appraisal was performed using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist and NHMRC Appraisal Evidence Matrix. Data extraction was completed using the Cochrane Data Extraction Form and a modified extraction tool. Results Of the 3101 abstracts identified from the search, ten full-text papers met the inclusion criteria. Data extraction was completed on seven papers of high methodological quality and on three lower quality papers. Findings suggest that the key barriers which affect the development and implementation of online learning in medical education include time constraints, poor technical skills, inadequate infrastructure, absence of institutional strategies and support and negative attitudes of all involved. Solutions to these include improved educator skills, incentives and reward for the time involved with development and delivery of online content, improved institutional strategies and support and positive attitude amongst all those involved in the development and delivery of online content. Conclusion This review has identified barriers and solutions amongst medical educators to the implementation of online learning in medical education. Results can be used to inform institutional and educator practice in the development of further online learning.

Background Digital learning designs have the potential to support teaching and learning within higher education. However, the research on digital learning designs within physiotherapy education is limited. This study aims to identify and investigate the effectiveness of digital learning designs in physiotherapy education. Methods The study was designed as a systematic review and meta-analysis of randomized and non-randomized trials. A search of eight databases on digital learning designs and technology was conducted. Study selection, methodology and quality assessment were performed independently by three reviewers. The included studies were mapped according to the types of digital interventions and studies. For similar interventions, the learning effects were calculated using meta-analyses. Results Altogether, 22 studies were included in the review (17 randomized controlled trials and five cohort studies). A blended learning design was used in 21 studies, a flipped classroom model in five and a distance learning design in one. Altogether, 10 of the 22 articles were included in meta-analyses, which showed statistically significant effects for flipped classrooms on knowledge acquisition (standardized mean difference [SMD]: 0.41; 95% confidence interval [CI]: 0.20, 0.62), for interactive websites or applications (apps) on practical skills (SMD: 1.07; 95% CI: 0.71,1.43) and for students self-produced videos on a practical skill in a cervical spine scenario (SMD: 0.49; 95% CI: 0.06, 0.93). Overall, the effects indicated that blended learning designs are equally as or more effective than traditional classroom teaching to achieve learning outcomes. Distance learning showed no significant differences compared to traditional classroom teaching. Conclusions The current findings from physiotherapy education indicate that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching. The meta-analyses revealed significant effects on student learning in favour of the interventions using flipped classrooms, interactive websites/apps and students self-produced videos. However, these results must be confirmed in larger controlled trials. Further, research should investigate how digital learning designs can facilitate students’ learning of practical skills and behaviour, learning retention and approaches to studying as well as references for teaching and learning in digital learning environments.

Background Evidence-based practice (EBP) is imperative for ensuring patient safety. Although teaching strategies to enhance EBP knowledge and skills are recommended, recent research indicates that nurses may not be well prepared to apply EBP. A three-level hierarchy for teaching and learning evidence-based medicine is suggested, including the requirement for interactive clinical activities in EBP teaching strategies. This literature review identifies the teaching strategies for EBP knowledge and skills currently used in undergraduate nursing education. We also describe students’ and educators’ experiences with learning outcomes and barriers. Methods We conducted literature searches using Medline, Embase, CINAHL, ERIC and Academic Search Premier. Six qualitative studies and one mixed-method study met the inclusion criteria and were critically evaluated based on the Critical Appraisal Skills Programme. Using Braun and Clarke’s six phases, the seven studies were deductively and thematically analysed to discover themes. Results Four teaching strategy themes were identified, including subthemes within each theme: i.e., interactive teaching strategies; interactive and clinical integrated teaching strategies; learning outcomes; and barriers. Although four studies included a vague focus on teaching EBP principles, they all included research utilisation and interactive teaching strategies. Reported learning outcomes included enhanced analytical and critical skills and using research to ensure patient safety. Barriers included challenging collaborations, limited awareness of EBP principles and poor information literacy skills. Conclusion Four of the seven analysed studies included a vague focus on the use of EBP teaching strategies. Interactive teaching strategies are used, but primary strategies focus on searching for and critically appraising research for practice-based application. Although this review included a relatively small sample of literature, the findings indicate a need for more qualitative research investigating interactive and clinically integrated teaching strategies towards further enhancing EBP undergraduate nursing students’ knowledge and skills.