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Blended learning effectiveness statistics change management healthcare

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Most of the participants agreed that online teaching methods may not help achieve the intended learning outcomes compared to face-to-face teaching. A faculty member believed that responding to questions by students is easier during face-to-face teaching.

Clinical faculty members confirmed that it was clear that clinical skills are difficult to be imparted online. They believed that the theoretical teaching is only a part of clinical training, while it would require students to be present and practically perform a procedure in front of their tutors to learn a particular clinical skill.

Direct feedback on clinical examinations and procedures can only be given when they are conducted face-to-face in front of the tutors. Similarly, faculty members and students unambiguously identified problems with the problem-based tutorial sessions conducted online, as they believed that these sessions are best conducted face-to-face with direct interaction between students with each other and students with their teachers.

Apart from the claim that the problem-based tutorial sessions are useful face-to-face, the students believed that they are also more enjoyable because sitting physically with colleagues gives an opportunity to students to get to know and meet with their friends.

Theme 3 : Interaction in online sessions is limited:. Students' perceptions of quality of theoretical teaching sessions they used to have face-to-face in the classrooms before the shift to the online mode during the pandemic showed that they value more interaction. Faculty members and students discussed how valuable was interaction out of the classroom and that they missed talking to their peers since online teaching was implemented during the COVID pandemic.

Being present in the campus helps students interact with other students and build relationships that are difficult to be built online. Faculty members believed that nurturing communication skills in medical undergraduate students through physical interaction is crucial for them to be prepared to face patients in the future.

Theme 4 : Problems and challenges of online examinations:. Online examinations were administered through an online student assessment application that supports remote proctoring and browsers lockdown. Although one version of each exam paper is prepared and used for all the students, presetting the application to shuffle the multiple-choice questions and their options makes the exam paper unique for each student. Faculty members were concerned about the quality of the examinations held online and whether the online examinations can properly assess students' knowledge.

The first concern about examinations was whether the student knowledge has improved as reflected by the inflated marks they get in online examinations. Faculty members believed that the students were securing most of their marks in multiple-choice question-based examinations because these were much easier compared to on campus examinations conducted before. Another participant informed that almost one third of the students could secure full marks, which has never happened before.

Participants justified the inflated results by the fact that the online examinations do not contain supply-type questions where the students need to write the answers, not selecting them from a list of options as in selection-type questions in which students used to lose marks. A faculty member believed that the inflated marks could also have resulted from the online assessment of some clinical skills, in which students received higher marks.

Students were concerned about the online examinations as they appeared to be dissatisfied with the time allocated for completing them, which is shorter than in the normal conditions where the exams are on campus and proctored.

Another issue they identified was that they were not able to go back to a previous question to correct it whenever needed, a feature that is adjusted in online examinations application to prevent or reduce cheating possibilities. Theme 5 : Technical issues and challenges of online education:. Communication technology issues were listed, by both the faculty members and students alike, as one of the main challenges of online education that took place in response to the sudden shift from face-to-face to online education.

Initially, faculty members were recording their lectures through adding voice to the PowerPoint slides and sharing the recording with the students through cloud sharing platforms. Shortly, faculty members started to conduct synchronous live sessions with their students, where they could interact with them and could answer their questions and provide further instructions whenever needed.

The important issue that popped up at that stage was the unstable internet speed that affected the live streaming of educational sessions. This study employed a mixed method design and aimed at exploring the overall experience of both medical students and faculty members of online and face-to-face learning, and their preference of the mode of learning online, face-to-face, or blended after the pandemic. The study also explored the perceptions of participants regarding the improvements based on this experience that might enhance the learning experience in the post-COVID era.

Comparing the perception of the faculty members and students of face-to-face and online learning regarding the studied domains Social Presence and Interaction, Collaborative Learning, and Satisfaction and the Overall Experience revealed consistently higher mean scores for face-to-face learning than online learning. Outputs from FGDs support these results, where generally both faculty members and students preferred face-to-face learning over online learning. This is especially true when it comes to clinical and practical sessions, which is expected as physical examination skills cannot be learned without physical contact between students and real or simulated patients.

The FGDs failed to suggest alternative strategies to replace face-to-face learning in this regard. More than half of the students preferred face-to-face learning to online and even blended learning modes.

This also agrees with a recent study conducted during the pandemic and found that half of the students preferred face-to-face learning rather than online and blended learning A recent study by Muthuprasad et al.

One reason for that might be that online and blended learning modes are new to the students and they are not fully aware of the benefits of something they have not tried before. Another reason may be students' feeling that in a medical school everything should be taught face-to-face. However, a notable percentage of students in our study preferred online learning. This might be related to the fact that a big number of students in our college come from at least five countries to live and study in the college in Bahrain.

Those students most probably prefer online learning because it allows them to study while they are at their home countries enjoying their families' significant moral and social support Also, an explanation might be that students in online learning have access to more resources and they can study on their own pace.

In a pre-COVID study conducted on a large sample of Austrian students by Paechter and Maier 21 , it was found that students appreciated online learning for its potential to provide a coherent structure of learning and supporting self-regulated learning.

However, they preferred face-to-face learning for providing better communication and interaction, in addition to establishing better interpersonal relations and allowing for cooperative learning. This is clear from the lower mean scores of students' perception in most survey statements that are related to interaction, social relations, and learning environment. On the other hand, most of the faculty members preferred blended learning.

This is supported by the results of a study by Lapitan et al. This might be due to the flipped nature of blended learning, where the students can learn the theoretical part of lessons before coming to the classroom to do practical exercises facilitated by the teachers 48 , This is supported also by results from focus group discussions, where teachers reported that it would be better to mix between online learning for the theory parts of lessons where students can do on their own pace before class and face-to-face learning for deeper and more practical teaching in the classroom.

However, more than one third of faculty members preferred face-to-face teaching. Reasons might be that this is the mode with which they are familiar and the fact that they were not ready for teaching online. The five themes generated from the FGDs, in general, cover the different aspects of perceiving face-to-face and online learning by both faculty members and students and indicates a more positive attitudes toward face-to-face learning, which complements and confirms the results of the survey and analysis of students' performance in face-to-face and online exams, which indicates the consistency of the study results.

In theme 1 of the FGDs Transforming the way theoretical teaching sessions are given , faculty members believed that a notable part of the curriculum theoretical part can be taught online. This is supported by several recent studies 6 , 50 , 51 that reported adaptation and smooth transition to online teaching in theoretical content during the pandemic.

Students also believed in the usefulness of online learning. This is congruent with the results of a number of studies that explored the perception of the medical students toward online learning during the pandemic 8 , 52 , However, they think that online learning should better be kept as a standby option in case of crises.

In a similar study, Al-Balas et al. Also, Wallace et al. However, in a pre-pandemic study, Gormley et al. Regarding Theme 3 of the FGDs Interaction in online sessions is limited , both faculty members and students indicated the value of direct interaction between them inside and outside the classroom, which they missed in online learning. This is congruent with findings of a study by Wut and Xu 57 , who reported poor student-to-teacher and student-to-student interaction in online settings.

They added that interaction in traditional classrooms was important for the students to directly discuss with their classmates to obtain and exchange ideas, insights, and suggestions, which is quite difficult in online settings.

The importance of that interaction is explained by the social presence theory Results in relation to Theme 4 of the FGDs Problems and challenges of online examinations indicated that faculty members perceived a few challenges in online examinations, most importantly the inflated marks gained by the students in online examinations compared to usual traditional exam marks before the pandemic which might not be indicative of the real achievement of the students. Such inflation may be explained by the higher possibility of cheating in online examinations, as was found by Jocoy and DiBiase 59 , Michael and Williams 60 , Lucky et al.

However, it may also be explained by the decreased examination anxiety in online settings, as indicated by Stowell and Benett 64 , or the use of innovative technologies and digital resources in distance learning, which made the students more confident and led to their better performance in online exams, as indicated by El Refae et al. Concerns raised by the students in this regard were related to the shortened time of the online exams and the inability of the students to move freely between questions; strategies employed by the college to decrease the possibility of cheating.

Both faculty and students reported that technology issues were important challenges in online education, as indicated in findings from Theme 5 of the FGDs Technical issues and challenge of online education. Challenges faced by both faculty members and medical students in our study can be summarized in poor quality of recordings and unstable internet connection.

This is supported by several studies that reported technology problems as important challenges that face using technology in education 23 , 66 , This study has some limitations. One of the limitations is the low response rate from the students. This might be because the survey was distributed online and there was not enough follow up with the students to complete the survey. However, the sample was fairly enough to give statistically valid results.

A third limitation was that the study did not compare between the perception of students of different school years, which was due to insufficient samples from individual school years to give valid comparative results.

The study revealed that although online learning is the possible educational adaptation during the pandemic, faculty and students still prefer face-to-face and blended learning.

Qualitative analysis supported the quantitative results and revealed that both faculty and students agree on the benefits of online learning but prefer face-to-face and blended modes for their higher benefits. Educational adaptation in the form of online learning is obligatory during pandemics and suspension of traditional face-to-face education as an alternative to maximize the safety of all stakeholders and provide an easy and timely access to educational material and sessions, but this will not make such adaptation the future norm, especially in the study of medicine.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

All authors have reviewed and approved the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. We would like to thank the faculty members and students who volunteered to participate in the study.

We are grateful to the administration of the university that facilitated our work and to the assistant staff who helped in transcribing the recordings of the focus group discussions. Mustafa N. Impact of the coronavirus pandemic on education.

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Turkish Online J Distance Educ. The univariable and multivariable logistic regressions were used to determine the independent predictors for passing the final exam and knowledge test on the first attempt, adjusted for prior academic performance, study duration, and gender.

All tests were two-tailed. The achieved statistical power for the study was 0. Four hundred forty of medical students passed the final statistics exam during the —14 school year.

Eighty seven students The average final statistics score was The majority of students passed the final statistics exam upon first attempt at the earliest available date Descriptive statistics of student characteristics and outcome measures for all students, and according to the groups blended vs.

There were no statistically significant differences in sex and study duration between the groups. The current GPA was significantly higher in the blended group.

As can be seen in Table 2 , exam scores for the blended learning group were statistically significantly higher than for the on-site group for both final statistics and knowledge test scores.

The calculated effect sizes for the final score and knowledge test difference were 0. The dropout rates i. However, there were no statistically significant differences between the groups in passing the final exam upon first attempt at the earliest available date and knowledge test on the first attempt.

There was a difference in the mean final scores for students with a low GPA between the on-site and blended learning groups In the univariable linear regression analysis, the variables of the learning method, study duration, current GPA, and knowledge test scores were significantly associated with final statistics scores. In a multivariable regression model, only current GPA and knowledge test scores were significantly associated with the final score, after adjusting for study duration and learning modality.

Students with a higher current GPA and better knowledge test scores had higher final scores than those with poor current GPA and lower knowledge test scores Table 3. According to the results of the univariable analysis, factors associated with passing the final statistics exam upon first attempt at the earliest available date were study duration, current GPA and knowledge test score. In a multivariable logistic regression model, passing the final statistics exam upon first attempt at the earliest available date was positively related with GPA and knowledge test score, after adjusting for study duration Table 3.

Learning method, study duration, and current GPA were significantly associated with the knowledge test score. In a multivariable regression model, only current GPA was significantly associated with the knowledge test score, after adjusting for study duration and learning method. Factors associated with passing the knowledge test during the first attempt were study duration and current GPA.

In a multivariable logistic regression model, passing the knowledge test during the first attempt was positively related only to GPA, after adjusting for study duration and learning modality Table 4. This study provides further evidence supporting the effectiveness of a blended learning format for biostatistics classes for undergraduate medical students.

Overall, student performance was higher in those using blended learning than in the traditional on-site training group with a medium effect size. A knowledge gain favoring the blended learning model was detected for the final statistics and knowledge test scores. An important finding was that students with higher GPA scores more often chose an online classroom learning environment, indicating a preference for learning formats that are more information and communication technology oriented.

It also was demonstrated in our student population, that GPA and knowledge test scores were associated with final statistics scores, after adjusting for study duration and learning method, as potential confounding factors. It is suggested that the advantages of online learning include its simplicity, its flexibility in fitting the needs of the user, reducing the problem of time management, with less anxiety and high problem solving efficacy.

Having the flexibility to fit user preference is probably the biggest advantage of online classroom, but its effectiveness lies in its backbone:—The asynchronous ability to exchange information, cost-saving, personalized learning, increased accessibility, ease of distribution and updating content are just some examples of the advantages possessed by the online classrooms. In a study carried out by Hui et al. McGready et al. Although online learning has clearly displayed advantages compared to its traditional counterpart [ 24 , 25 ], no clear evidence has existed until recently to indicate whether blended or strictly online courses are better.

Some authors have reported no difference in outcomes between these models of knowledge delivery [ 26 — 29 ]. Lim et al. So and Brush were investigating the influence of collaboration with faculty and other students on course performance, and discovered that students who were exposed to a more collaborative environment tended to be more satisfied with their distance course than those who perceived lesser levels of exposure to collaborative learning [ 31 ].

Kiviniemi demonstrated that well implemented blended learning models may have strong potential for improving student learning outcomes in health sciences studies [ 32 ]. Similarly, a study by Delilaoglu found that the students had similar levels of achievement, after adjusting for pre-test and GPA scores, which is consistent with our results [ 33 ]. The research done by Larson reported no significant differences among the three education delivery methods on-site, online and blended learning as measured by exam scores and final grades.

Consequently, they concluded that online and blended methods are at least equivalent to the face-to-face method, but no data were reported about previous GPA [ 26 ]. A rare study which compared traditional and blended class types in the field of statistics directly demonstrated the conclusion that there is no significant influence of gender, ethnicity, age or class type, but there is a significant influence of student incoming GRE Quantitative scores on student performance [ 34 ].

A comprehensive meta-analysis recently conducted by Teachers College, Columbia University [ 5 ], indicated that students studying in online classrooms had moderately better performances than those receiving instruction in traditional classrooms, which is similar to the effect size from our study. The difference was significant when comparing blended learning to that of the traditional classroom, although no major differences were found when comparing it to the purely online classroom.

The important finding of this study which cannot be ignored is that there is confounding of the results with respect to involving more learning time, additional instructional resources, as well as course elements that encourage interactions among learners for blended learning format.

This finding leaves open the possibility to study these and other additional practice variables that may contribute to the positive outcomes for blended learning, and necessitates further research into the development of different blending formats for different types of learners. Statistics is often portrayed as the most difficult, anxiety-provoking, and a critical subject for the average medical student.

It, therefore, is expected to be the most revolutionary in its efforts to improve the learning environment [ 35 , 36 ]. Blended courses appear optimal to facilitate learning statistics, and are comparable to their traditional counterparts. Students are still left with the choice of the learning model which will suit them best, whether traditional or blended.

Data suggest that students with higher GPA scores tend to choose blended learning. This could be explained by the fact that blended learning provides maximum productivity with minimum wasted time in the overall very time-consuming studies of medicine. However, the implementation of hybrid educational methods can be demanding on the teaching staff, especially when it comes to organization and the clarity of course requirements [ 37 ]. Lastly, the educators must be capable of anticipating problems that arise during this interactive educational activity and be able to develop strategies for their resolution.

The demonstrated diverse capabilities of web-based technologies support the development and implementation of blended learning curricula in various educational settings, one of which may be medical statistics. Study results should be interpreted taking into account our study limitations. Our study is a single center experience and the study design was not truly experimental. Future research is needed to examine other important outcomes, such as knowledge retention, student satisfaction and its effect on educators with respect to attitudes and effort involved.

This study provides empirical evidence to provide different learning environments for teaching medical statistics to undergraduate medical students. Blended and on-site training formats in medical statistics led to similar knowledge acquisition. Factors associated with medical student statistics learning outcomes are GPA and knowledge test score. Implementation of blended learning approaches can be considered as an attractive, cost-effective, and efficient alternative to on-site classroom training in medical statistics.

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Although recent studies report on the benefits of blended learning in improving medical student education, there is still no empirical evidence on the relative effectiveness of blended over traditional learning approaches in medical statistics.

Methods This was a prospective study conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed of the final exam of the obligatory introductory statistics course during — Results Mean exam scores for the blended learning student group were higher than for the on-site student group for both final statistics score Conclusion This study provides empirical evidence to support educator decisions to implement different learning environments for teaching medical statistics to undergraduate medical students.

Data Availability: All relevant data are within the paper. Background There are ongoing changes in the utilization of modern information and communication technologies in medical education [ 1 — 4 ]. Method This was a prospective trial conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed of the final exam of the obligatory introductory medical statistics course taught — Download: PPT.

Table 1. The elements of the traditional and blended learning methods in medical statistics. Statistical Analysis Descriptive statistics were calculated for the baseline student characteristics and outcome measures, knowledge test and final scores. Results Four hundred forty of medical students passed the final statistics exam during the —14 school year.

Table 2. Descriptive statistics of students characteristics and learning outcomes. Table 3. Variables associated with student statistics achievement—final statistics score. Table 4. Variables associated with student statistics achievement—knowledge test.

Discussion This study provides further evidence supporting the effectiveness of a blended learning format for biostatistics classes for undergraduate medical students. Study limitations Study results should be interpreted taking into account our study limitations.

Conclusion This study provides empirical evidence to provide different learning environments for teaching medical statistics to undergraduate medical students.

References 1. A pediatric digital storytelling system for third year medical students: the virtual pediatric patients. BMC Med Educ. Smucny J, Epling JW. A Web-based approach to teaching students about diagnostic reasoning. Fam Med.

Web-based learning in undergraduate medical education: development and assessment of an online course on experimental surgery. Int J Med Inform. A Web-based clinical curriculum on the cardiac exam. Acad Med. View Article Google Scholar 5. Teach Coll Rec. View Article Google Scholar 6. Web-based curriculum. J Gen Intern Med. Internet-based learning in the health professions: a meta-analysis.

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We also aimed to explore factors that could explain differences in learning effects across study designs, participants, country socioeconomic status, intervention durations, randomization, and quality score for each of these questions.

Studies in any language that compared blended learning with no intervention or nonblended learning among health professional learners and assessed knowledge acquisition were included.

Two reviewers independently evaluated study quality and abstracted information including characteristics of learners and intervention study design, exercises, interactivity, peer discussion, and outcome assessment. Results: We identified 56 eligible articles. For studies comparing knowledge gained from blended learning versus no intervention, the pooled effect size was 1. For studies comparing blended learning with nonblended learning pure e-learning or pure traditional face-to-face learning , the pooled effect size was 0.

Although significant publication bias was found, the trim and fill method showed that the effect size changed to 0. In the subgroup analyses, pre-posttest study design, presence of exercises, and objective outcome assessment yielded larger effect sizes. Thus, 56 publications were included, among which one publication compared blended learning with both no intervention and nonblended instruction Figure 1.

In the meta-analysis, we included 13 publications representing 20 interventions published from , which compared blended learning with no intervention and included health professional participants. The number of participants ranged from 6 to , and the duration of the intervention ranged from 24 hours to one semester. We included 44 publications representing 56 interventions comparing blended learning with nonblended learning published from to that covered health profession participants.

There was 1 pre-posttest one-group intervention, 27 posttest-only two-group interventions, and 28 pre-posttest two-group interventions.

Table 1 summarizes the key features and e-Table 3 in Multimedia Appendix 1 describes the detailed information. The mean SD quality score was 3. As effect sizes, larger than 0. Exclusion of any single study did not change the overall result, which ranged from 1. The pooled effect size SMD 0. The publication bias may have been towards larger studies with generally large magnitudes of effects. The trim and fill method indicated that the effect size changed to 0. Based on risk of bias, publication bias, and large effect, we graded the quality of evidence as low.

Exclusion of any single study did not change the overall result, which ranged from 0. This meta-analysis shows that blended learning has a large consistent positive effect SMD 1.

Moreover, we also found that blended learning had a large effect SMD 0. This means that blended learning may be more effective than nonblended learning, including both traditional face-to-face learning and pure e-learning. Possible explanations could be as follows: 1 compared with traditional learning, blended learning allows students to review electronic materials as often as necessary and at their own pace, which likely enhances learning performance, and 2 compared with e-learning, blended learning learners are less likely to experience feelings of isolation or reduced interest in the subject matter.

However, publication bias was found in the nonblended learning comparison group, and the trim and fill method showed that the pooled effect size changed to 0. To the best of our knowledge, this may be the first meta-analysis to reveal the effectiveness of blended learning for knowledge acquisition in health professions, which includes all those directly related to human and animal health.

However, large heterogeneity was found across studies in both no-intervention and nonblended comparisons, and the subgroup comparisons partially explained these differences. The heterogeneity may be due to variations in study design, outcome assessment, exercises, conflict of interest, randomization, and type of participants. We found that effect sizes were significantly higher for studies using pre-posttest designs than posttest-only designs, which suggested that the former improved learning outcomes relative to the latter.

As pretests, may inform instructors about the knowledge learners have acquired before the course, which is considered to be one of the most important factors influencing education, they allow instructors to determine learning objectives and to prepare course materials accordingly. Therefore, it is necessary for educators to administer pretests to learners to prepare well for courses. We also found that studies with objective assessments yielded a larger effect than those with subjective assessments.

In contrast, Cook et al. This is probably due to differences in personality traits of learners, as people with greater confidence tend to give higher ratings on subjective assessments than people who are less confident. Additionally, effect size was found to be significantly larger for blended courses with exercises versus no exercises, which was consistent with the results of a previous study conducted by Cook et al.

Thus, it is necessary for educators to include exercises in their teaching, such as cases and self-assessment questions. However, we failed to confirm our hypothesis that presence of peer discussion and high interactivity would yield larger effect sizes.

Although we found statistical differences between the RCTs and NRS in the no-intervention comparison, it could probably be due to chance as there were only two RCTs participants included. Differences between studies with conflicts of interest and those without conflicts of interest in nonblended comparisons could be also due to chance, as only two studies with conflicts of interest participants were included.

The remainder of the high heterogeneity may arise from other characteristics, such as individual learning styles, study intervention, assessment instrument, and ongoing access to learning materials, for which detailed information was not available in the included studies. As Wong et al cited in their review, different modes of course delivery suit different learners in different environments.

Our samples consisted of various health professional learners nurses, medical students, nursing students, physicians, public health workers, and other health professionals across a wide variety of health care disciplines, such as medicine, nursing, ethics, health policy, pharmacy, radiology, genetics, histology, and emergency preparedness. Moreover, we found medium or large effects for the pooled effect sizes of almost all subgroup analyses exploring variations in study design, participant type, randomization, quality scores, exercises, interactivity, and peer discussion.

Thus, our results suggest that health care educators should use blended learning as a teaching component in various disciplines and course settings. Evaluations of the effectiveness of blended learning for health professions are timely and very important for both medical educators and learners.

We intentionally kept our scope broad in terms of subjects and included all studies with learners from health professions. We searched for relevant studies in manifold research databases up to September First, although we searched gray literature in two databases CENTRAL and ERIC , gray literature indexed by other databases may have been missed, which could be the reason for the observed publication bias.

Second, the quality of meta-analyses is dependent on the quality of data from the included studies. Although the standard deviation of eight interventions was not available due to poor reporting, we used the average standard deviation of other included studies and imputed effect sizes with concomitant potential for error.

Third, despite conducting the review and extraction independently and in duplicate, the process was subjective and dependent on the descriptions of the included articles instead of direct evaluation of interventions. Fourth, although the modified Newcastle—Ottawa scale is a useful and reliable tool for appraising methodological quality of medical education research and enhances flexibility for different study designs, it increases the risk of reviewer error or bias due to a certain amount of rater subjectivity.

Then, results of subgroup analyses should be interpreted with caution because of the absence of a priori hypotheses in some cases, such as study design, country socioeconomic status, and outcome assessment. Moreover, although the subgroup analyses showed the variability of participant types, socioeconomic status of country, intervention duration, interactivity, peer discussion and study design of RCT or NRS did not make a difference in the overall results, the large clinical heterogeneity and inconsistent magnitude of effects across studies makes it difficult to generalize the conclusions.

In addition, as variability of study interventions, assessment instruments, circumstances and so on, which were not assessed, could be potential sources of heterogeneity, the results of both meta-analyses should be treated with caution. Although we used the trim and fill method for adjustment, the results should be treated with caution. Our study has implications for both research on blended learning and education in health professions. Despite the fact that conclusions could be weakened by heterogeneity across studies, the results of our quantitative synthesis demonstrated that blended learning may have a positive effect on knowledge acquisition across a wide range of learners and disciplines directly related to health professions.

In summary, blended learning could be promising and worthwhile for further application in health professions. The difference in effects across subgroup analyses indicates that different methods of conducting blended courses may demonstrate differing effectiveness. Therefore, researchers and educators should pay attention to how to implement a blended course effectively.

This question could be answered successfully through studies directly comparing different blended instructional methods. Studies comparing blended learning with no intervention suggested that blended learning in health professions might be invariably effective. However, although observational studies yielded a large effect size, the quality of evidence was lower due to their inherent study design limitations.

Additionally, owing to the small number of RCTs, the meta-analysis did not meet the optimal size imprecision and therefore, quality of evidence was ranked lower. Thus, despite the consistency of effect and no significant reporting bias, the evidence of the no-intervention comparison was of moderate quality, which means further research is likely to have an impact on our confidence in the estimate of effect and may change the estimate, and RCTs with large samples may modify the estimates.

Thus, there is still great value in further research comparing blended learning with no intervention, and RCTs with large samples may modify the estimates. For nonblended comparisons, pooled estimates showed that blended learning is more effective than or at least as effective as pure e-learning and pure traditional learning.

However, due to publication bias towards larger studies with generally large magnitudes of effects, the evidence was of low quality, which means further research is very likely to change our estimate. Therefore, the effect of blended learning especially in comparison with e-learning should be evaluated in future research, and studies with small magnitudes of effect should merit publication.

Blended learning appears to have a consistent positive effect in comparison with no intervention and appears to be more effective than or at least as effective as nonblended instruction for knowledge acquisition in health professions. We have the conviction that Kaenz, will improve your health and well-being, being a great investment, to reduce expenses for medications, hospitalizations and avoid surgeries, we invite you to experience this first virtual aquatic therapist, which will change your habits, recharging energy, toning your body, keeping you young and positively impacting your quality of life, sharing with your loved ones.

Effectiveness of aquatic exercise for musculoskeletal conditions The following research the aquatic exercise and…. Review article: Water exercise and health promotion The following research the water exercise and…. Abstract Background: Blended learning, defined as the combination of traditional face-to-face learning and asynchronous or synchronous e-learning, has grown rapidly and is now widely used in education.

Due to the large heterogeneity, the conclusion should be treated with caution. Introduction Electronic learning e-learning has quickly become popular for health education, especially since the emergence of the Internet has allowed its potential to be realized. Moreover, blended learning has shown rapid growth and is now widely used in education.

Eligibility Criteria: Inclusion criteria for studies were based on the PICOS population, intervention, comparison, outcome, and study design framework. Studies in any language and of any publication type were included. Reviews, editorials, or meeting abstracts without original data were also excluded. E-Table 1 in Multimedia Appendix 1 describes the complete search strategy for each database.

The last date of search was September 25, In addition, all references of included studies were screened for any relevant articles.

Study Selection: Using these criteria, QL and FZ independently screened all titles and abstracts and reviewed the full text of all potentially eligible abstracts. Quality Assessment: Recognizing that many nonrandomized and observational studies would be included, the methodological quality of the studies was evaluated using a modified Newcastle-Ottawa Scale also called the Newcastle-Ottawa Scale-Education , which is an instrument used to appraise the methodological quality of original medical education research studies, typically in the process of a literature review of a field or topic in medical education.

Selection: the comparison group was drawn from the same community as the experimental cohort 1 point. Blinding: outcome assessment was blinded 1 point. Data Synthesis: Analyses were carried out for knowledge outcomes using Stata Version The I 2 statistic was used to quantify heterogeneity across studies.

Meta-analyses were conducted and forest plots were created. Moreover, we performed sensitivity analyses to test the robustness of findings. Results Study Selection: The search strategy identified citations from the databases, and duplicates were removed. After scanning the titles and abstracts, were found to be potentially eligible. Then, full texts were read for further assessment, and 62 remained.

No more relevant articles were found by reviewing the references of the included articles. Study Characteristics: In the meta-analysis, we included 13 publications representing 20 interventions published from , which compared blended learning with no intervention and included health professional participants. The number of participants ranged from 14 to , and the duration ranged from 1 hour to 1 year.

For most studies, there was no delay between the end of the intervention and the posttest. Study Quality: All of the intervention groups in the included studies were representative of average learners.

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WebJul 2,  · Blended learning is a powerful approach to corporate training, learning, and development that has several clear benefits for businesses. Whether you want live virtual . WebBlended learning provides the necessary communication, collaboration, and learning technology to quickly and efficiently keep employees up-to-date on new procedures and . WebFeb 9,  · Although several studies report the benefits of using blended learning [17,18], there is still little empirical evidence as to its relative effectiveness compared to .

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