Remote online learning reimagined: perceptions and experiences of medical students in a post-pandemic world | BMC Medical Education

The aim of our study was to explore the perceptions and experiences of undergraduate medical students regarding blended learning in medical education. This includes an attempt to understand how blended learning has been received in educational settings across 15 institutions from seven countries (Qatar, Sudan, Saudi Arabia, Sweden, United Kingdom, France, and Jordan) in the context of the COVID-19 pandemic. The study also sought to analyze global trends in blended learning and compare pre- and post-pandemic educational landscapes, with an eye on future implications for medical education.

Overall, the findings of our study highlight potential benefits of blended learning and areas where it may fall short, from the perspectives of medical students. The study revealed that blended learning was generally preferred among respondents (47.78% preferred a blended approach to learning while 41.48% favored face-to-face instruction). This aligns with previous literature where blended learning was valued for its flexibility, accessibility, and ability to combine the best elements of online and traditional face-to-face education [1, 10, 35].

The results also showed that while medical students appreciate the flexibility and convenience of online learning, traditional face-to-face learning still holds significant appeal, particularly for clinical training and practical skills. This is consistent with other studies that found a stronger preference for face-to-face learning, as students valued direct interactions with lecturers, group work, and peer engagement, all of which are perceived to be limited in blended learning environments [4, 23] also reported a preference for online learning among faculty members, whereas more than half of the students favored face-to-face learning. Notwithstanding the benefits of online learning, face-to-face learning may be more appropriate in certain educational contexts, particularly those involving practical skills. Similarly, Ruiz et al. [30] argues that while online learning components can enhance flexibility and access, they are often viewed as supplementary rather than a replacement for direct, experiential learning. The literature also converges on the fact that a stronger favorable stance towards online learning hinges on a developed digital infrastructure and well-prepared faculty [13, 33]. The mixed reception in this study suggests that the effectiveness and acceptance of blended learning are both highly context-dependent and may vary considerably based on local resources, faculty readiness, student demographics, and social environment [34].

There were gender differences in resource usage, albeit lacking statistical significance. Our observation is consistent with findings from Venkatesh et al. [34], who reported that male students demonstrated higher computer self-efficacy and hence overall greater satisfaction with blended learning. Participants used a range of online resources, with online question banks, digital flashcards, and video tutorials receiving similar effectiveness rates, while live tutorials were less favored. This is consistent with findings from literature that reported the popularity of these resources in enhancing student learning [18, 20, 36, 37]. The lower preference for live online tutorials suggests that synchronous components may not be as valued, possibly due to technical difficulties or perceived lack of engagement. This in turn reinforces the need for careful planning and alignment of teaching and learning resources with student needs and learning outcomes.

Participants identified key barriers to effective online learning, including internet connectivity issues (57.96%), family distractions (57.04%), and inconvenient timing of tutorials (39.44%). They also reported that the lack of space, devices, and engagement hindered the success of blended learning. Similar challenged were reported by Aji et al. [1] where students and teachers experienced difficulties due to network issues. These technological limitations may undermine the potential benefits of blended learning. It is also important to note that geographical and socioeconomic factors may play a significant role in shaping the experiences and perceptions of blended learning including the reported challenges.

Interactivity in online teaching sessions was another area of mixed feedback; 31.48% of respondents found sessions lacking in interactivity, while 30.93% considered them interactive). Opportunities to interact via chatbox, speaking directly, and live quizzes were identified as key conducive elements for interactivity. Engagement during virtual sessions was a notable concern, mirroring in findings from other studies such as Ali et al. [2] where only 25.6% of students rated online sessions as sufficiently interactive. Zhang et al. [39] also observed that offline learning creates a more conducive environment for real-time interaction, which is often lacking in online settings. This suggests the need for intentional design to enhance the interactivity of online learning.

A significant proportion of respondents (69.26%) felt online learning did not sufficiently replace clinical experiences involving direct patient contact, and 64.81% asserted that practical skills could not be effectively learned online. Atwa et al. [4] stated that while online learning can be useful for theoretical instruction, it falls short when it comes to clinical skills development, which requires direct, in-person interaction. This points to limitations in current blended learning models in that they complement traditional clinical training, but they may not fully replace the hands-on experience necessary to develop and master practical skills. Zhang et al. [39] also noted that online education, while flexible, cannot fully replicate the hands-on and interactive nature required for effective clinical teaching. A similar skepticism was expressed by educators who noted that teachers in blended learning environments frequently voiced doubts about the capability of online methods to match the learning outcomes of traditional face-to-face interactions [31].

When gauging participants’ preferences and satisfaction levels with specific aspects of online learning, respondents appreciated the comfort (69.07%), flexibility (68.15%), and the elimination of travel (66.11%) but fewer found it engaging (18.70%) or stimulating (13%). This is corroborated by previous studies which showed that blended learning often lacks social elements, such as peer engagement and class involvement, aspects which are naturally embedded in face-to-face environments [23]. Consistent with our study, Atwa et al. [4] also found that both students and faculty members experienced significant limitations with online learning, especially regarding interaction and achieving intended learning outcomes. Aji et al. [1] also noted that students and teachers perceived challenges in maintaining interaction and engagement, suggesting that blended learning models must incorporate more social elements to enhance student experience. This was also mirrored in the study conducted by Shelly et al. [32] where students noted that e-learning platforms often lacked sufficient interactive elements and synchronization. Venkatesh et al. [34] also echoed this trend and reported that limited opportunities for social interaction in blended learning environments could lead to student frustration and a diminished sense of community. This common concern points to the need to design online learning experiences that are not only convenient but also highly engaging. Indeed, educational strategies must go beyond mere content.

The findings of the current study offer some important insights when viewed through the lens of constructivist learning theory. Online activities allow incorporation of constructivist practices and with appropriate planning and delivery, educators can ensure that students not only achieve the ILOs but also engage meaningfully with the learning process. Our results suggest that online learning supports flexible, self-directed learning, which promotes autonomy, critical thinking, and deeper learning [8]. Tools like video tutorials and online question banks, perceived in our study as highly effective, have been previously shown to enhance understanding and accommodate different learning styles, paving the way for a more inclusive and learner-centered educational experience [16].

The lack of interactivity in online sessions could impact the alignment between intended learning outcomes and the instructional methods in blended environments as it may not sufficiently support the social constructivist aspects of learning provided by traditional peer engagement and face-to-face interaction. The same argument can be extended for blended learning falling short of replacing the experiential learning required to develop practical skills and clinical competencies. It is paramount that blended learning approaches enhance interaction and meaningful engagement for deeper learning as emphasized by Biggs’ framework [9]. Constructive alignment between ILOs, teaching and learning activities, and assessments requires careful consideration of which elements can be achieved remotely and may need to limited to didactic teaching, and knowledge-based assessments, and written assignments. Face-to-face learning environment is essential for learning and assessment of practical skills, and clinical experience with real patients.

This study also sheds light on shifts in perceptions and experiences of remote online learning in medical education between pre- and post-COVID-19 phases. Before the pandemic, blended learning was often seen as complementary approach to traditional education, with a potential to become a predominant model [10]. The onset of COVID-19 dictated a rapid shift towards online learning to comply with social distancing, which profoundly altered attitudes toward these models. According to a comprehensive bibliometric analysis, research on blended learning has surged in recent years, especially from 2019 onwards, due to the growing need for flexible and adaptive learning environments [33]. The mixed reception to blended learning from our participants highlights identifies persistent reservations about online learning’s effectiveness, particularly for clinical training in the post-pandemic landscape. Taken together, these findings suggest that there is a need for a balanced and contextualized approach that aligns with local contexts and infrastructural capabilities.

For medical educators, the successful and effective integration of online and face-to-face components requires thoughtful design that employs evidence-based strategies in active learning environments. An example is the flipped classroom model where preparatory content is delivered online, which creates more opportunities for interactive activities with deeper learning during in-person sessions [38]. Educational institutions should prioritize training faculty, allocating sufficient resources, including technical support, and ascertaining technological readiness to support effective blended learning. The substantial barriers reported herein, including internet connectivity issues and lack of devices, suggest that equitable access to reliable digital infrastructure is crucial. Our findings could also help in shaping future educational policies by putting more emphasis on flexible curriculum design that adapts to different learning styles and environments. Policies should also support collaborative networks among institutions to share best practices and resources.

A key strength of this study is that it offers a broad, multi-institutional perspective on blended learning in medical education, with data drawn from multiple geographic regions, including Europe, the Middle East, and Africa. This element enhances the generalizability of the findings and their relevance across different contexts. The study also offers an opportunity to understand the shifts in perceptions and adaptations of blended learning in response to global crises.

However, several challenges and limitations warrant acknowledgment. First, the use of convenience sampling introduces the risk of sampling bias. Participants were selected based on accessibility and their availability rather than adopting a randomized sampling approach, which could impact the representativeness and generalizability of the findings across broader populations. The scope of the study was limited to specific institutions, potentially overlooking other variations and adaptations in blended learning experiences in other parts of the world. This limited focus may reduce the applicability of the findings to global settings. The reported levels of engagement, satisfaction, or challenges with remote online learning were analyzed from self-reported data, which could skew the collated perceptions given the potential of overestimation or underestimation. This aspect could impact the reliability and accuracy of the data, particularly in areas where there is a social desirability bias. It is also noteworthy that, while the study provides key cross-sectional insights, it does not capture the longitudinal impact of blended learning on educational outcomes.

Future research can effectively build on our findings by conducting longitudinal studies that track the medium- and long-term effects of remote online learning. Moreover, data collection tools which encompass learner experiences in both face-to-face and remote online learning more comprehensively should be used. This will help in gaining deeper insights into how sustained exposure to blended learning environments affects student performance and levels of engagement and interaction. Such studies will also help in guiding interventions to maximize the long-term benefits and overcome the identified barriers. Qualitative studies that explore both student and faculty perceptions and experiences in-depth could offer valuable perspectives that complement the cross-sectional survey approach, particularly when investigating the specific challenges and opportunities to enhance the effectiveness of blended learning environments. To advance the global applicability and scalability of blended learning, we recommend conducting studies on specific populations or regions that were not included in the current study. This will help educators, institutions, and policymakers to identify more relevant best practices and design contextualized blended learning frameworks.