Hybrid teaching after COVID-19: advantages, challenges and optimization strategies | BMC Medical Education

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Student preferences for future teaching modalities

By 2022, hybrid-teaching method, which combined online and offline teaching, had been employed in Physiology teaching at Harbin Medical University for about 4 years for the reason of COVID-19 pandemic. In the process of implementing hybrid teaching, the effect of online teaching and the feedback from students on this modality has been in dispute. To gain a clearer understanding of students’ true opinions, questionnaires were performed in both 2020 and 2022.

First, we compared students’ preferences for Physiology teaching methods post-pandemic. Beyond our expectation, the preference of choosing online teaching remained relatively unchanged, while the rate of choosing hybrid teaching method decreased largely from 2020 to 2022, albeit without reaching statistical significance (53.9% in 2020 vs. 42.0% in 2022, P = 0.07) (Fig. 1). This result suggested that students may not be fully satisfied with the hybrid teaching approach. It was imperative for us to delve deeply into the reasons behind this dissatisfaction.

Students’ scores in the past three years

Generally, final exam score is a crucial metric for assessing teaching efficiency. To evaluate the impact of Hybrid teaching method, final exam scores were compared among the past 3 years (2020 ∼ 2022) from four-year and five-year students. The final exam was composed of two parts, i.e. subjective and objective questions. However, the final examination of 2022 had to be performed on a mobile App and it was only consisted of single-choice questions (i.e., objective questions). This modification was carried out as a national precautionary measure in response to the ongoing preventative measures against COVID-19. Therefore, we compared the objective scores of students major in Pharmacy and Clinical pharmacy separately from 2020 to 2022 as a representative. Our results showed that the average score of students in 2022 decreased significantly compared to those in 2020 and 2021, both in Pharmacy and Clinical pharmacy students (Pharmacy: 70.7 ± 1.27% in 2020, n = 92; 70.9 ± 1.58% in 2021, n = 85; 59.5 ± 1.28% in 2022, n = 94, ES = 0.591, P < 0.01 in ANOVA; Clinical pharmacy: 71.2 ± 1.5% in 2020, n = 86; 76.2 ± 1.23% in 2021, n = 88; 60.3 ± 1.47% in 2022, n = 88, ES = 0.596, P < 0.01 in ANOVA, see Fig. 2). This observed decline in academic performance may indicate the teaching effect gradually decreased with the extension of hybrid teaching time.

Advantages and disadvantages of online teaching

To figure out why students’ confidence in hybrid teaching gradually waned over the years, we analyzed related data from questionnaires from 2020 to 2022. Our results showed an obvious increase in the ratio of students thinking that it was convenience for recording the teaching content (62.5% in 2020 vs. 75.0% in 2022, Fig. 3A), despite insignificant differences in evaluation advantages of hybrid teaching. Besides, there were also decreases in “Broaden horizon (37.5% in 2020 vs. 28.0% in 2022)”, “Convenient for interaction and communication (35.2% in 2020 vs. 27.0% in 2022)” and “Increase of information gain (53.1% in 2020 vs. 44.5% in 2022)” (Fig. 3A).

To find out whether the advantages can effect students’ choices, we conducted a crossover statistic which can illustrate the relationship between students’ preferences for teaching methods and their perceived advantages (Fig. 3B). While the results did not reveal any significant statistical differences, a notable trend emerged that students who thought it was convenient for interaction and communication preferred hybrid teaching method.

Analysis of disadvantages about hybrid teaching revealed significant differences between the results of 2020 and 2022. There was an obvious decrease in the option of “Internet resources cannot be distinguished good or bad” (54.7% in 2020 vs. 35% in 2022, see Fig. 4A) and students in 2022 who chose this option tended to choose hybrid teaching method (41.4% in offline, 4.3% in online and 54.2% in hybrid teaching, see Fig. 4B). There was also a clear increase in the option of “Unable to communicate with teachers face to face” (35.9% in 2020 vs. 45.5% in 2022, see Fig. 4A) and students in 2022 who chose this option tended to choose offline teaching method (54.0% in offline, 4.0% in online and 33.0% in hybrid teaching, see Fig. 4B). These results highlight the crucial role of face to face communication with teachers in influencing students’ choices.

Fondness for styles of hybrid teaching

In 2020 to 2022, the COVID-19 pandemic had significantly influenced the teaching styles adopted in our courses, resulting in various hybrid teaching approaches. We surveyed the relationship between different hybrid teaching styles and the choice of learning method in students of 2022. The data revealed that most of the students who liked live class tended to choose offline teaching method (63.8%) and students who liked recorded lectures preferred hybrid teaching method (71.4%). The remaining students showed similar preferences for hybrid and offline teaching (Fig. 5).

Improvement of learning ability

Since the hybrid teaching method was designed to improve students’ autonomous learning ability, we assessed effects of our hybrid teaching on their learning ability. Unfortunately, the result revealed a significant increase in the proportion of students who thought that hybrid teaching didn’t help improving their learning ability (17.2% in 2020 vs. 29.0% in 2022) and a decrease in the ratio of students who thought that hybrid teaching improved autonomous learning ability greatly (43.0% in 2020 vs. 34.0% in 2022)(Fig. 6A). There was also a significant difference in the cross-analysis. Students who thought hybrid teaching didn’t help improving learning ability preferred offline teaching compared to students who thought hybrid teaching help improving learning ability (69.0% in students who thought a little help, 40.5% in students who thought same with usual and 50.0% in students who thought great improvement, P < 0.05 in Fisher’s Exact Test, see Fig. 6B).

Duration of autonomous learning

Upon the survey of 2020 and 2022, there was a significant difference in the duration of students’ autonomous learning. The ratio of students spending 10 ∼ 30 min in autonomous learning increased in 2022 (35.9% in 2020 vs. 52.5% in 2022) and ratios of students spending 30 ∼ 60 min and 1 ∼ 2 h decreased (Fig. 7A). Although there was no difference between learning duration and students’ choices in the cross-analysis, it was noteworthy that student spending 30 ∼ 60 min on autonomous learning preferred hybrid teaching method, while student spending 10 ∼ 30 min on autonomous learning tended to prefer offline teaching method (Fig. 7B).

Burden of learning

Burden of learning refers to the combination of workload, stress levels, and overall demands experienced by students during the learning process, which is a crucial factor influencing students’ preferences for teaching methods [13]. A high symptom burden from the acute stress response according to the COVID-19 pandemic is common among healthcare students [14]. We analyzed the relationship between learning burden and the choice of learning method in students of 2022. Our findings revealed that students who felt increased learning burden from hybrid teaching method preferred to choose offline teaching (Strongly increased, 75.0%; Increased 58.8%), while students who thought online teaching didn’t increase or reduce their learning burden preferred to choose hybrid teaching (Reduced, 50.0%; Fair, 52.3%) (Fig. 8A).

So where did the burden originate and whether the duration of autonomous learning played an important role? From the survey, we could see there was no significant difference between the duration of autonomous learning and learning burden. Unexpectedly, the smallest ratio of students choosing “hybrid teaching strongly increased learning burden” was among those who spent 30 ∼ 60 min in autonomous learning. This observation underscores that learning duration may not be the sole or decisive factor influencing the learning burden (Fig. 8B).