The Effectiveness of Blended Learning in the Field of Medical Education: Explaining Dimensions and Components Based on Stakeholder Experiences

Background & Objective: Blended learning is the thoughtful integration of e-learning and face-to-face learning, which has been accepted in the field of medical education. Given the importance and complexity of this novel educational system, this study aimed to recognize and gain an in-depth understanding of the factors and dimensions affecting the effectiveness of blended learning based on the experiences of stakeholders in this area. Materials and Methods: In this qualitative research, content analysis approach was applied. Subjects included seven faculty members of Iran University of Medical Sciences with a history of teaching through virtual education systems for a minimum of two years and eight MSc students in medical disciplines, selected by convenience sampling. Data analysis was performed applying the seven-step Colaizzi method. Results: In this study, five categories, including student capabilities, teacher competencies, technical aspects, pedagogical field, and supportive environment, and 40 subcategories were obtained. Conclusion: The importance of teaching-learning and increasing demand for access to education from one hand and emphasis on the effectiveness of education from the other hand are among the major challenges of all educational systems. According to the results of the study, the desirable position of this type of training could be found by the fundamental review of acceptance of students and professors and providing the necessary technical facilities. D ow nl oa de d fr om z um s. ac .ir a t 4 :4 7 IR S T o n S at ur da y N ov em be r 2n d 20 19 43 Mirmoghtadaie & Ahmady Journal of Medical Education Development, Vol 12, No 33 Spring, 2019 Introduction Considered a relatively new term, the concept of blended learning has existed in areas including virtual education for several decades (1). Generally, the term blended learning' refers to the third generation of distance-education systems, described as a technique used to maximize the educational benefits of in-person learning and multiple technologies for learning (2). This type of education is the thoughtful integration of classroom face-to-face learning experiences with online learning experiences (3). This method is exploited to optimize learning outcomes and cost effectiveness (4). Providing only virtual training to a group of audiences with diverse specialized and intellectual backgrounds may not be sufficiently effective for all people. As such, blended learning aims at providing opportunities for students to use both actual and virtual spaces to make better use of learning (5). The field of medical education, which is a part of higher education responsible for providing a large volume of knowledge, attitude, and skills to students for the acquisition of professional qualifications (6), is no exception and requires the use of novel techniques (7). Evaluation of research institutes and universities such as Stanford and Tennessee regarding the mechanism of blended learning in the medical field provides interesting information to enthusiasts. Research suggests that blended learning is preferable to traditional practices, ensuring that not only this type of education can transfer learning materials more efficiently, but also is a more effective educational approach (8). Given the ability to provide the benefits of both traditional and virtual methods, blended learning is a proper technique to achieve the teaching-learning goals in medical education. The interdependence of teaching and learning is confirmed since while teaching is the teacher's activity, the result of learning depends on the student. Therefore, effectiveness must be assessed from both the viewpoints of students and instructors to demonstrate more complete results. Despite the assessment of the status of blended training and comparison of existing problems by several researchers, no research has been conducted on the aspects and efficacy of blended training. With regard to the importance and complexity of this modern learning system, this study aimed to recognize and have a deeper understanding of factors and dimensions affecting the efficacy of D ow nl oa de d fr om z um s. ac .ir a t 4 :4 7 IR S T o n S at ur da y N ov em be r 2n d 20 19 Effectiveness of blended Learning in Medical Education 44 Journal of Medical Education Development, Vol 12, No 33 Spring, 2019 blended learning based on the experiences of students and instructors in this field. Materials and Methods Content analysis was used in this study. Qualitative content analysis is an approach for the subjective interpretation of the content of text data through the systematic classification process of coding and identifying themes or patterns (9). In this approach, categories are derived directly from the text data, and the researcher obtains an in-depth understanding of a phenomenon (10). In the present study, qualitative content analysis was primarily exploited to discover meanings, priorities, attitudes, and perceptions of students and faculty members of effective blended learning by analyzing their linguistic messages. Participants included seven faculty members of Iran University of Medical Universities with a history of applying the virtual education system for a minimum of two years and eight MSc students in fields of medical sciences selected by purposeful and convenience sampling. Inclusion criteria were having an experience of teaching or learning by virtual education, availability, willingness to participate in the study, eloquence based on the initial meeting, and the ability to respond. Data collection tools included semi-structured interviews with subjects (duration=30-45 min), which were carried out individually. All interviews were recorded and transcribed word-for-word to be analyzed. The primary questions were, as follows: What is your opinion about blended learning and its implementation method? In your opinion, what are the challenges of blended learning? What is the feasible technique to improve and enhance this type of learning according to the existing context? During interviews, exploratory questions were also raised based on the responses of participants. Data analysis was carried out using the seven-step Colaizzi method. This technique includes familiarizing with the data through reading the important findings, identifying the significant statements with direct relevance to the phenomenon under study, formulating meanings to extracted statements, clustering themes and concepts obtained, referring to the original contents and comparing the data, describing the phenomenon under study and seeking verification of the fundamental structure to assess the reliability of the results. This process is accompanied by the coding and extraction of the main categories and D ow nl oa de d fr om z um s. ac .ir a t 4 :4 7 IR S T o n S at ur da y N ov em be r 2n d 20 19 45 Mirmoghtadaie & Ahmady Journal of Medical Education Development, Vol 12, No 33 Spring, 2019 subcategories (11). In this research, credibility, dependability, and confirmability were assessed to ensure the rigor of findings (12). Credibility was obtained through various methods, including ability, sufficient experience and scientific capability of the researcher based on level of education, from the aspect of engagement prolong as a collaborative engagement with data to increase the breadth and depth of information, persistent observation by reading the data several times and analysis of the data and use of integration in data collection through group discussion method and face-toface unstructured observation, and member checks to validate the extracted content. In another session, the information extracted was checked with students and faculty members to receive their final opinions and suggestions. Data acceptance was obtained through sufficient experience of the researcher and constant involvement and continuous observation, and the writings of the participants were confirmed Finally, there was evidence for disconfirming searching, which led to the use of disconfirming results of other studies to increase credibility (12). Moreover, the reports and research notes were provided to another leading scholar in virtual education to ensure the similarity of the results by two researchers, thereby confirming the objectivity of the data. To obtain dependability of the results (similar to reliability in quantitative research), another researcher who was not related to the research was employed as an external observer. In the end, dependability was approved based on a similar perception of the findings. Data analysis was performed in MAXQDA10 software. In order to observe ethical considerations, the research objectives and method of implementation were explained to all participants and a written informed consent was obtained prior to the research. In addition, the subjects were allowed to withdraw from the research, and they were ensured of the confidentiality terms regarding their personal information (anonymous audio files). The questionnaires and the consent form were sent by email. Results The results of the qualitative research are presented in the table below in five categories and 40 sub-categories: D ow nl oa de d fr om z um s. ac .ir a t 4 :4 7 IR S T o n S at ur da y N ov em be r 2n d 20 19 Effectiveness of blended Learning in Medical Education 46 Journal of Medical Education Development, Vol 12, No 33 Spring, 2019 Table 1: Demographic characteristics of participants Variable Faculty Members Students Male:2 Female:5 Male:3 Female:5 Mean Age 52.3 26.8 Table 2: The categories and subcategories of factors affecting effective blended learning according to faculty members and students of medical sciences CATEGORY SUB CATEGORY Student Capabilities Metacognitive Skills Information literacy Personality Dimensions Netiquette Teacher Merits Content Expertise Professional Commitment Information literacy Netiquette Verbal & Non-Verbal Communicati