A comparative analysis of the impact of online, blended, and face-to-face learning on medical students’ clinical competency in the affective, cognitive, and psychomotor domains

Abstract

Background: The Coronavirus Disease-2019 (COVID-19) pandemic in South Africa compelled medical schools to switch to a purely online curriculum. The innovative changes transformed the standard clinical skills curriculum to increase learning transfer to bridge the theory-practice gap. The efficacy of this intervention remains unknown. This study aims to measure medical students’ clinical competency in the affective, cognitive, and psychomotor domains by assessing clinical skills knowledge retention and transfer from the online platform compared to face-to-face and blended learning. Methods: A non-random cross-sectional quasi-experimental study assessed third-year medical students’ knowledge retention and learning transfer in three domains of clinical skills competence. Data were obtained using a score sheet during a directly observed formative and a trial online summative assessment. One hundred and one third-year medical students volunteered for the formative onsite assessment that tested the psychomotor domain. Two hundred and thirty-nine students were evaluated on the affective and cognitive domains in the summative online trial mini-objective structured clinical examination (tm-OSCE). The OSCE scores were analysed using descriptive statistics. The significance of the findings was evaluated by comparing OSCE scores with the pre-pandemic 2019 third-year medical students. Results: Statistically significant differences were found between the two cohorts of medical students from both years (p < 0.05). The 2021 blended group’s (n = 101) medians were 90%, 95%CI [86, 92], 82%, 95%CI [80, 85], and 87%, 95% CI [84, 90] for the psychomotor, affective, and cognitive skills, respectively. The e-learning group’s affective and cognitive skills medians were 78%, 95%CI [73, 79] and 76%, 95%CI [71, 78], respectively. The 2019 face-to-face cohort (n = 249) achieved medians of 70%, 95% CI [69, 72] and 84%, 95%CI [82, 86] for the affective and psychomotor skills, respectively. Conclusion: Medical students demonstrated near and far transfer bridging the theory-practice gap in three clinical skills domains. The blended group performed significantly better than the e-learning and face-to-face groups. Medical schools and educators play a vital role in overcoming learning challenges and achieving higher transfer levels by adopting multiple student-centered teaching delivery approaches and arranging immediate application opportunities. This study offers medical educators suggestions that encourage the transfer of online learning to face-to-face practice, decentralising medical education with a revised blended learning strategy.

Effectiveness of a Blended Simulation Education Program on Advanced Cardiac Life Support for Nursing Students Using the PARTNER Model

“…This method of learning has a positive effect on clinical performance by systematically exploring the subjects themselves and inferring complex clinical situations based on logical consistency [41]. In medicine and nursing, where practical training is important, the effectiveness of blended education can be enhanced when repeated learning is combined with prior and face-to-face learning [42]. Therefore, the blended learning method, which provides web-based simulation in the pre-learning stage and applies high-delity simulation after prelinked learning, has proven effective in improving clinical performance by analyzing clinical situations and developing nursing problem-solving skills.…”

Novel teaching–learning and assessment tools to complement competency-based medical education in postgraduate training

“…[ 4 ] The advantages of combining the traditional teaching approach with virtual teaching have already been recognised and are termed blended teaching. [ 5 ] The use of digital technology has also blurred the geographical boundaries. Renowned experts in the field across the globe can be involved in online educational sessions, and traditional seminars can be converted to webinars for enriched content, more comprehensive outreach, and fruitful discussions.…”

A Capstone Experience for International MDs: Preparing UAE Graduates for UME to GME Transitions post COVID Pandemic

“…The available studies generally described positive associations between eLearning and acquisition of competence, with a focus on assessment of the knowledge/cognitive domain (Miller's knows and knows how), with only four studies including a hands-on assessment (Miller's shows how). Of these four studies, only two examined (11,20) psychomotor skills (pap smear, and head and neck examination). In the former, the experimental group consolidated their online learning with in-person training; in the latter, the students were provided with some instruments to perform the examination skills, and the results showed improved outcomes in some but not all aspects of the head and neck exam.…”