Computers & Education 59 (2012) 1215–1223

Contents lists available at SciVerse ScienceDirect

Computers & Education

journal homepage: www.elsevier.com/locate/compedu

Attitudes of college students enrolled in 2-year health care programs

towards online learning
Dalya Abdulla*
Pharmacy Technician Program, Sheridan Institute of Technology and Advanced Learning, 7899 McLaughlin Road, Brampton, ON L6Y 5H9, Canada

a r t i c l e i n f o a b s t r a c t

Article history: Colleges offering 2-year diplomas to high-school graduates were among the forefront leaders in online
Received 31 January 2012 learning however studies illustrating appropriate course construction for such student populations are
Received in revised form scarce. Pharmacy Math (MATH16532) is a core course for students enrolled in the Practical Nursing (PN)
6 June 2012
and Pharmacy Technician (PT) programs at Sheridan Institute. PT and PN students enrolled in
Accepted 10 June 2012
MATH16532 during their first term were surveyed to determine student attitudes and skills gained from
participating in an online course. Students were then followed up during their second term studies to
Keywords:
determine transferability of skills gained. Initially, students did not exhibit a positive attitude towards the
Online learning
Online learning attitudes online version of Math16532. Participation in the online version of MATH16532 however allowed
Post-secondary education students to enhance their written ability and critical appraisal skills, gain time management skills, and
Teaching/learning strategies become independent learners. PT and PN students preferred an orientation session at the beginning of
the course and a well organized, easy-to-navigate course. Even though considered as predominantly
digital native students, both student groups remained anxious throughout the course regarding the
online delivery and preferred a hybrid mode of delivery. Despite the initial resistance to an online math
course, students indicated that they would retake the course again in an online format towards the end
of the course and there appeared to be a trend to enrol in another online course. Several recommen-
dations regarding the design and construct of online courses in a 2-year college program are provided to
facilitate acceptance of online learning for students enrolled in such programs.
Ó 2012 Elsevier Ltd. All rights reserved.

1. Introduction

The need for online learning in the medical field is based on faculty shortages, space limitations, increased student numbers, and student
self-directed learning (Bourne & Davison, 2006; Buckley, 2003; Cantrell, O’Leary, & Ward, 2008; Frith & Kee, 2003; Halstead & Coudret,
2000; Moore & Hart, 2004; Zsohar & Smith, 2008). Despite the fact that mode of delivery is not a determinant of learning outcome
achievement (Buckley, 2003), many challenges are typically experienced in the conversion of a Face-to-Face (F2F) course into an online
platform. A key success factor for online learning is mental preparedness of students and instructors, which can partly be achieved through
availability of the required computer system, reliable internet connectivity, and knowledge in the utilized learning platform (such as WebCT
or Blackboard) (Zsohar & Smith, 2008). It is also important to cater the course to the student learner and not apply a “universal template” to
ensure that students obtain the desired learning outcomes from enrolling in an online course (Kozlowski, 2004). This requires instructors
with a solid basis in technology since faculty can no longer depend on “digital naiveté” towards online learning especially in light of the
substantial influx of digital native students in the classroom (Bleich, 2009).
Colleges offering 2-year diplomas to high-school graduates were among the forefront leaders in online learning; studies illustrating
appropriate course construction for such student populations on the other hand are scarce. The purpose of this study was therefore to
determine the opinion and attitudes of college students towards online learning and provide real-time classroom relevant information on
the appropriate construction of an online course in the college environment based on the conversion of MATH16532 from a F2F into an

Abbreviations: MATH16532, Pharmacy Math; ESL, English as a Second Language; F2F, Face-to-Face; PN, Practical Nursing; PT, Pharmacy Technician; SLATE, Sheridan
Learning and Teaching Environment; LMS, Learning Management System; ANOVA, Analysis of Variance; IT, Information Technology.
* Tel.: þ1 905 459 7533x5298; fax: þ1 905 874 4376.
E-mail address: dalya.abdulla@sheridanc.on.ca.

0360-1315/$ – see front matter Ó 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.compedu.2012.06.006
1216 D. Abdulla / Computers & Education 59 (2012) 1215–1223

online format. Traditionally taught in a F2F format, Pharmacy Math was converted into an online format to enhance student learning
experiences. Other perceived student benefits from an online pharmacy math course include flexible access to course material, working and
learning at the student’s pace, reduction in student travel time, providing students with additional time (if needed) to review the course
material, and providing students the opportunity to learn independent study skills (Bourne & Davison, 2006; Buckley, 2003). MATH16532 is
a core course requirement for students enrolled in the Pharmacy Technician (PT) and Practical Nursing (PN) programs at Sheridan Institute
of Technology and Advanced Learning (Sheridan Institute). Pharmacy Math is typically perceived as a challenging topic and plays an integral
aspect in the patient care process (Balen & Jewesson, 2004; Brown & Hanggi, 2007).

1.1. Theoretical background

Computers play an essential role in hospital settings, community health agencies, and many medical settings (Leski, 2009). A survey by
the American Organization of Nursing Executives revealed a need to incorporate information technology in the nursing curriculum to allow
adequate preparation of nursing students in the workplace (McCannon & O’Neal, 2003). Advances in technology are also demanding that an
increased number of pharmacists be able to incorporate information technology in their daily practice (Freeman, Schrimsher, & Kendrach,
2006). Diverse fields such as biology and toxicology are also capitalizing from the benefits of online learning (Huggins, Morris, & Peterson,
2005; Thompson, Nelson, Marbach-Ad, Keller, & Fagan, 2010). It is therefore paramount that potential health care professionals have
adequate career-specific and relevant technical skills; this can be partially achieved by introducing online learning early in the program for
such student groups. Since students in the medical field tend to perceive their self-assessed technical skills within the basic or intermediate
range, online courses catered to them must be well-organized, easy to navigate, and based on solid teaching-learning principles (Cantrell
et al., 2008; Kazlowski, 2006). One of the determinant factors of online course success is the efficient aptitude of students and faculty with
computer skills (Kozlowski, 2004); this therefore necessitates that adequate training be provided to students and faculty on the learning
management system utilized by the educational institution to deliver online courses. Student learning experiences can further be enhanced
if online courses are designed with clear guidelines that ensure both students and instructors are adequately prepared, both mentally and
physically, prior to course enrolment (MacLaren & Shukla, 1999; Zsohar & Smith, 2008).
The resistance reported by students towards online learning is based on student views that online courses tend to be intimidating,
formidable, and challenging (Halstead & Coudret, 2000; Zsohar & Smith, 2008). Even though web-based learning has been established as
a flexible method to teach pharmaceutical math, resistance towards this subject remains an issue among students regardless of mode of
delivery mainly due to the zero tolerance for error in pharmaceutical math calculations (Bourne & Davison, 2006). This is further amplified
by the fact that students tend not anticipate the tremendous time requirement inherent in online courses and have been accustomed to
passive learning (online environments typically require highly active learners) with the expectation that learning content be provided in
a lecture format (Freeman et al., 2006; Kozlowski, 2004). It is however this active involvement in the learning process that renders students
enrolled in online classes to be able to out-perform their peers in the F2F version of the course (Gore, 2000). Studies have also shown that
students who prepare for exams using online practice tools typically perform better compared to students who practice using pen and paper
(Johnson, 2008). Such enhanced test performance would be useful for students in the health care field required to take centralized licensure
tests.
In order to reduce potential anxiety levels associated with online learning, it is essential that student learning preferences be taken into
account during the course design process (Wang & Newlin, 2002). Students should also be provided with information on the online course
prior to course initiation as this would ensure they are able to attain the maximum perceived benefits from the online course and fully
understand course demands and time requirements (Gore, 2000; Huggins et al., 2005; Zsohar & Smith, 2008). High anxiety levels in an
online course usually result from a disparity between what students see and their perceived expectations (Kozlowski, 2004). Provision of
immediate, relevant, and continuous communication and feedback can also partially relieve student anxiety and allow the achievement of
maximum student benefit and satisfaction from the online course (Frith & Kee, 2003; Halstead & Coudret, 2000; Zsohar & Smith, 2008).
Once students become comfortable with the online course delivery mode, studies have shown that the participation in online courses
enhances independent learning, improves course material reflection, and increases critical thinking skills; in fact, students typically report
learning as much, if not more, material from an online course compared to the regular F2F version (Kozlowski, 2004; Thiele, 2003).
Despite being predominantly digital native students (Bleich, 2009), studies have shown a tendency among students to prefer the ability
to see their colleagues and instructors during the delivery of an online course (Buckley, 2003). Since there is a trend among colleges to
increase online course quotas, guidelines and strategies should be established that can enhance the acceptance of online courses within the
institution and ensure that online learning is viewed as a valued learning medium among both faculty and students (Kozlowski, 2004). This
includes college support though the Mission Statement and provision of adequate orientation to both faculty and students (Gore, 2000;
Zsohar & Smith, 2008). Colleges should also consider the establishment of a help desk that would allow students access to prompt responses
from support staff for course and technical inquires (Halstead & Coudret, 2000).

2. Methods

2.1. Research question and objectives

The main research questions for this study were “how can PT and PN students be prepared for an online pharmacy math course” and
“what skills do PT and PN students gain and retain after participating in an online pharmacy math course”; a series of objectives were
therefore constructed to determine:

1. The level of preparation required from college students enrolled in an online pharmacy math course
2. The attitude of the college student towards online learning in general and specifically towards an online pharmacy math course.
3. The essential student skills gained through participation in an online pharmacy math course.
4. The preparatory actions required to accommodate college student preferences participating in an online pharmacy math course.
 D. Abdulla / Computers & Education 59 (2012) 1215–1223 1217

2.2. Course format

In its traditional F2F format, Pharmacy Math (MATH16532) was taught in 3-h weekly lectures for 14 weeks with 4 quizzes, 5 assignments,
1 project, and a Final Examination. In the online format, the course was delivered using Sheridan Learning and Teaching Environment
(SLATE), a WebCT password-protected Blackboard environment accessible through the internet. The online version of the course consisted
of a series of 6 learning modules and 2 orientation modules spanning 14 weeks. The 6 learning modules covered topics such as basic math
review, dimensional analysis, unit conversions, and dosage calculations (oral, parenteral, geriatric, paediatric, and intravenous). An
orientation session was provided at the beginning of the course. Conversion of a course from F2F to online format is highly regulated at
Sheridan College and requires satisfying various criteria integrated in an internal rubric utilized for online course approval; this method is
well accepted in the literature as a means to ensure the delivery of quality controlled online courses (Blood-Siegfried et al., 2008).
The marking scheme for the online course included online discussions and assessments (quizzes), collaborative projects, and an in-class
Final Examination (administered on the last week of class). Online assessments and discussions allowed students to illustrate their ability to
understand course content. The online assessments consisted of multiple-choice and matching questions and were timed to allow students
1–2 min per question. Discussions required students to respond to a question and comment on their peers. A signup sheet was provided
online to facilitate student participation in group projects; the projects allowed students the opportunity for peer interaction throughout
the course. The final examination was an in-class proctored examination taken without the use of calculators. Passing grades for both F2F
and online courses were set at 70%. The learning material for the course was administered through SLATE with the aid of voice-over
PowerPoint presentations, graded and ungraded discussions, graded and ungraded online assessments, websites (weblinks), calendar,
general announcements, and PDF documents. Each learning module contained one graded assessment and one graded discussion grouped
together under an “Assessments” section. An orientation session was provided at the beginning of the class with a review session scheduled
before the Final Examination. Students had access to the faculty member by means of online chat sessions, F2F appointments, and email
messaging. All students were required to purchase a textbook for the course, which was used as a supplemental learning tool.

2.3. Student sample

The sample consisted of first-term students enrolled in MATH16532 either through the PT or PN 2-year diploma program. MATH16532 is
a mandatory course for students enrolled in both programs and is a prerequisite for other higher term courses. Second-term students from
both programs were followed up to determine transferability of skills gained from participation in MATH16532 in its online format. Second-
term PT students completed the survey through their Biology course while the second-term PN students completed the survey through their
Pharmacology course; both courses are regular F2F courses utilizing minimal (less than 10%) SLATE components. Among the PT students,
55% of the students were female while the female percentage among the PN group was 88%. Regardless of gender, 69% and 47% of the first
term students in the PT and PN programs, respectively, were under the age of 25 years old. The percentage of first term students in the 25–35
year old age group was 19% and 23% in the PT and PN groups, respectively. First term students older than 35 years old constituted 12% and
29% in the PT and PN programs, respectively. The average survey response rate across both terms among first term PT students ranged from
24 to 92% as follows: 40–92%, 24–52%, and 28–44% for survey1, survey2, and survey3, respectively. The range of participants across both
terms from first term PN students ranged from 25 to 95% as follows: 35–95% in survey1, 25–65% in survey2, and 30–60% in survey3.

2.4. Surveys and data analysis

Three surveys were conducted using two separate first-term student groups (terms) registered in MATH16532. Surveys probed student
attitudes and perceptions towards online learning in general and more specifically towards the online MATH16532 course. The three
surveys were administered at the beginning of the course (weeks 2–3), midway through the course (weeks 7–9), and towards the end of the
course (weeks 13–14). Student participation in the surveys was voluntary and anonymous. Students who progressed to the second term of
the program were followed up to determine transferability of skills using a survey similar in format to the first-term surveys. Questions from
several sources (Buckley, 2003; Forman & Pomerantz, 2006; Gore, 2000; Hale, Mirakian, & Day, 2009; Halstead & Coudret, 2000; Johnson,
2008; Wang & Newlin, 2002; Zsohar & Smith, 2008) were adapted to construct a survey that was applicable to students registered in online
courses at Sheridan Institute (full surveys provided in Fig. 1). All surveys consisted of multiple choice questions and were conducted through
SLATE with the use of announcements as participation reminders. Results are presented as percentages of the raw data responses. Unless
otherwise noted, data and statistical analyses from first-term surveys represent combined data from both terms. For the second-term
surveys, the results from a single term were combined for both PN and PT students and statistics performed on the combined student
groups. Responses requiring a Yes/No answer were analysed using paired t-tests (pairing was required to ensure responses for each section
remain paired together). Responses requiring students to select the most appropriate statement (with more than two statements provided)
were analysed using a paired one-way Analysis of Variance (ANOVA). Pairing was required to ensure responses for each section remained
paired; a Bonferroni multiple comparison post-hoc analysis was utilized to compare across multiple responses. The independent variable for
all ANOVA analyses was the conversion of MATH16532 from a F2F format into the online format while dependent variables consisted of
student comfort levels, student anxiety, skills gained, student preparedness, participation in course components, course presentation
preferences, and student attitudes. For all statistical analyses, the level of statistical significance was set at 5%.

3. Results

3.1. Student skill evaluation at the beginning of the course

Students were asked to rate their comfort level with their mathematical and technical skills using a scale of 1–5 (5 representing extreme
comfort with the skill) during their first semester in the program. On average, all students rated their computer knowledge as 3.70 (PT
knowledge level was 3.74 while PN level was 3.68). Students also rated their SLATE knowledge level as 3.54 (PT level was 3.48 while PN level
1218 D. Abdulla / Computers & Education 59 (2012) 1215–1223

Fig. 1. Surveys utilized to probe student attitudes towards online learning during first-term and second-term.
 D. Abdulla / Computers & Education 59 (2012) 1215–1223 1219

was 3.58) and their overall math knowledge as 3.40 (PT level was 3.47 while PN level was 3.36). In addition, students did not have prior
knowledge of SLATE (75.4%  12.1% with no prior SLATE knowledge) prior to taking pharmacy math in its online format. This result was
statistically significant for all students, PT students (85.1%  11.4% with no prior SLATE knowledge), and PN students (69.8%  9.0% with no
prior SLATE knowledge).

3.2. Required student preparation prior to course delivery

Most surveyed students did not know that the course was offered online (72.8%  12.8%). These results were statistically significant and
similar among PT (78.2%  15.2% did not know the course was offered online) and PN students (69.8%  11.3% did not know the course was
offered online). Among all surveyed students from both terms, 79.6%  15.7% found attending the course-specific orientation session useful.
This result was statistically significant with similar results obtained among both PT (82.6%  8.7% found the orientation session useful) and
PN students (77.9%  19.1% found the orientation session). In addition, 76.7%  5.4% of all students surveyed from both terms felt that
receiving SLATE training before starting the course would have made them more comfortable with the online version of the course. This
result was statistically significant and a similar result was obtained with PT and PN students; 79.6%  3.4% and 75.0%  5.9% of PT and PN
students, respectively, indicated that they would feel more comfortable with the course if they had received SLATE training prior to course
initiation. When surveyed about whether a SLATE manual would help the students in the course if made available at the beginning,
47.8%  10.7% of PT students felt that such a manual would help them in the course. These results were different among the PN students,
where 70.7%  10.0% of PN students felt that such a manual would help them in the course.

3.3. Student preferences regarding course organization

When surveyed about course accessibility, 85.8%  19.0% of all surveyed students from both terms enjoyed accessing the Modules and
their grades online with “a click of the mouse” and completing the course work at their own pace. This result was statistically significant and
also observed among the PT and PN students: 89.3%  12.5% and 83.9%  22.6% of PT and PN students, respectively, enjoyed ease of online
accessibility and working at their own pace. Based on results from one term only, 72.2%  18.4% of all surveyed students found the presence
of a completed Calendar at the beginning of the course useful. This result was statistically significant and similar among both PT and PN
students, with 65.6% and 75.5%, respectively, of students finding the presence of a completed calendar at the beginning of the course useful.
In terms of Learning Module content, 82.0%  14.6% of all students surveyed from one term only felt that the Learning Modules contained
adequate information and 96.5%  5.5% of all surveyed students felt that the Learning Modules were organized (both results were statis-
tically significant with similar results observed among PT and PN students as well). 93.6%  7.4% of students surveyed from one term only
also felt that the course was organized (result statistically significant with similar results among both PT and PN students).

3.4. Student preferences regarding course content and tool usage

Among all students surveyed from one term only, 65.2%  10.8% listened to the voice-over PowerPoint components in the Learning
Modules (similar results were obtained among both PT and PN students). In addition, results from one term only indicated that
61.9%  13.7% of students felt that the presence of instructor videos in addition to voice-over PowerPoints would enhance their learning
experiences (similar results obtained among PT and PN students surveyed from one term only). 59.1%  9.9% of all students surveyed from
one term indicated the use of the Calendar to keep track of all course events (Quizzes, Discussions, and other course events); similar results
were observed among PT (63.0%) and PN (57.1%) students. Additionally and based on results of one term only, 98.6%  3.4% of all surveyed
students found the Announcements extremely useful throughout the course (result statistically significant with similar percentages ob-
tained among PT and PN students when surveyed separately). When students from a single term were surveyed about their preference for
hand-marked assignments being uploaded as PDF documents, 57.8% and 42.7% of PT and PN students, respectively, preferred hand-marked
assignments uploaded as PDF documents. In terms of rubric use, 68.4%  15.4% of all students surveyed from one term preferred the use of
online rubrics (compared to 29.2%  12.9% who preferred printed out rubrics and 2.4%  5.8% who did not use rubrics at all); similar results
were also observed among PT and PN students.

3.5. Student anxiety levels and comfort during course delivery

Among all surveyed students from two terms, 64.5%  16.2% of students felt more comfortable about taking quizzes online after
completing the first few online. Similar results were obtained among PT and PN students, with 71.1%  15.4% and 60.7%  16.5% of PT and PN
students, respectively, feeling more comfortable completing quizzes online. When surveyed about their current anxiety levels,
52.5%  18.7% of all students surveyed from both terms felt more relaxed about the course after completing the first module while
47.5%  18.7% of the students remained anxious about the course; similar results were obtained among PT and PN students when surveyed
independently, with 46.7%  12.2% and 47.9%  22.6% of PT and PN students, respectively, still feeling anxious about the course.

3.6. Student preferences regarding course mode of delivery

When surveyed at the beginning of the term, 54.1%  16.1% of all students from both terms indicated that they would take the pharmacy
math course again in its online format; similar results were obtained among PT (54.3%  17.9%) and PN (53.9%  16.4%) students. During
mid-term, the percentage of all students from both terms willing to take MATH16532 again in its online format was 50.4%  18.7% (similar
results were obtained among PT (50.4%  24.0%) and PN (50.4%  17.1%) students). Towards the end of the term, 57.9%  10.5% of all students
from both terms indicated that they would take the pharmacy math course again in its online format (result statistically significant).
Although not attaining statistical significance, a similar percentage of students from the PT (56.0%  5.2%) and PN (59.0%  12.9%) programs
were also willing to re-take MATH16532 again in its online format. When surveyed about course format at the beginning of the term,
1220 D. Abdulla / Computers & Education 59 (2012) 1215–1223

a statistically significant component of students (77.9%  7.9%) surveyed from both terms preferred a hybrid (combination of online and F2F
material) format; similar statistically significant percentages were obtained among the PT (83.2%  3.7%) and PN (74.9%  8.3%) students.
Mid-way through the course, 50.8%  19.6% of all students surveyed indicated a preference towards a hybrid mode of delivery (compared to
27.4%  16.5% who preferred the class in a complete F2F format and 21.7%  17.9% who preferred the class in an online format). A similar
result was also observed among the PT and PN students when surveyed independently, with 50.5%  29.0% of PT students and 51.0%  14.9%
of PN students preferring a hybrid mode of delivery. A statistically significant component (65.0%  18.0%) of all students did not like the fact
that they were not able to see their instructor and colleagues during the course (similar results were obtained when PT (62.3%  23.6%) and
PN (66.6%  15.9%) students were surveyed independently). By the end of the term, 68.3%  14.9% of all students surveyed from both terms
felt that the course delivery method was appropriate (result was statistically significant and similar among PT (65.2%  10.5%) and PN
(70.0%  17.5%) students).

3.7. Student course satisfaction

A statistically significant component of all students (89.3%  10.4%) surveyed from both terms felt that the course content and material
presented were appropriate and relevant (similar results were observed among PT (90.3%  12.1%) and PN (88.8%  10.3%) students).
77.9%  15.8% of all students surveyed from both terms felt that the use of SLATE was appropriate for both quizzes and discussions. This
result was statistically significant with similar results obtained for PT (69.3%  24.0%) and PN students (82.8%  7.6%). Finally, when asked
about whether MATH16532 would help them in their future studies in the program, a statistically significant component of all surveyed
students (86.0%  11.1%) from both terms were able to see the course helping them in their future studies. This result was also seen among
PT (90.6%  12.0%) and PN (83.3%  10.5%) students.

3.8. Student skills obtained during course delivery

When surveyed about skills attained from participating in MATH16532 in an online format, students from both terms agreed that
participation in discussions allowed them to enhance their written abilities and gain critical appraisal skills (Fig. 2A and B). Students
surveyed from both terms also agreed that the online MATH16532 helped them become independent learners and gain time management
skills (Fig. 2C and D). Results obtained from students surveyed in one term only also revealed a trend among students (64.0%  16.4%) to have
increased confidence in F2F class participation after participating in online discussions (similar trends were obtained among PT and PN
students when surveyed independently). Finally, among all students surveyed from both terms, 59.0%  14.7% responded positively when

Fig. 2. Career essential skills gained by first-term students during MATH16532. Means and standard deviations provided for (A) critical appraisal skills (B) enhanced written abilities
(C) time management skills and (D) independent learning (* represents a statistically significant result (P < 0.05) for “Yes” response compared to the “No” response).
 D. Abdulla / Computers & Education 59 (2012) 1215–1223 1221

asked whether they would take another online course. This percentage was slightly higher among PT students (61.6%  8.8%) compared to
57.6%  17.7% of PN students willing to take another online course.

3.9. Skill retention following completion of the online course

A statistically significant (86.7%  6.4%) component of second term surveyed students were comfortable with SLATE based on usage in
the previous term. When asked to rate their comfort level with SLATE using a scale of 1–5 (with 5 referring to “exceptional”), the average
score for all second term students was 4.15. Additionally, 86.3%  5.2% of surveyed students from the second term felt that prior knowledge
of SLATE was helping them in their current courses (result was statistically significant). 77.2%  9.3% of surveyed second term students felt
confident using SLATE without asking for help (16.7%  3.9% needed to ask for some help when using SLATE while 6.0%  5.7% had to
constantly ask for help when using SLATE). 81.2%  8.3% of the surveyed second term students enjoyed seeing SLATE content in their current
classes (result statistically significant). Among all second term surveyed students, 74.4%  3.9% felt that they had maintained their inde-
pendent learning skills after participating in an online course using SLATE while 66.4%  12.5% felt that they were still applying the time
management skills they had learnt from the previous term towards their current second term (both results statistically significant). Only
54.6%  10.8% of second semester students had increased critical analysis skills after participating in discussions from the previous semester
and 35.2%  20.3% of the surveyed students felt that their reading skills in second semester had improved after participating in MATH16532
in its online format. In terms of math skills, 54.2%  11.2% of the surveyed second semester students felt that they had retained their math
skills following the completion of MATH16532. In addition, a statistically significant component of surveyed second semester students
(66.4%  12.5%) felt that the grade they obtained for MATH16532 accurately reflected their knowledge. Finally, there was a tendency
(56.1%  13.6%) among second term students to enrol in another online course if offered the opportunity.

4. Discussion

4.1. General student attitudes towards online learning

Colleges offering 2-year diplomas were among the first institutions to capitalize on the advantages of online learning (such as enhanced
student learning and efficient classroom space usage). In this study, pharmacy math (a core requirement in both PT and PN programs) was
converted from a F2F platform into an online mode of delivery with only one F2F course-specific orientation session provided at the
beginning of the course. Initially, students in the PT and PN programs did not exhibit a positive attitude towards taking an online math
course; many of PT students were concerned that they would miss critical information about the course while the PN students felt it vital to
be able to interact with their peers and professor in a classroom setting (personal communication with students). Students tend not to
anticipate the tremendous time requirement of online courses and have been accustomed to passive learning (Freeman et al., 2006;
Kozlowski, 2004). Students from both groups were concerned about an inability to see mathematical problems being solved in “real-time”
and transparency of grading within the online version of the course. These issues were raised predominantly by first-term students
surveyed during the first term the course was offered online; first-term students surveyed during the second term were generally less vocal
about the online nature of the course.

4.2. Required student preparation prior to course delivery

Online courses can enhance student learning, however courses must be designed with clear guidelines to ensure both students and
instructors are adequately prepared prior to course initiation (MacLaren & Shukla, 1999; Zsohar & Smith, 2008). Most first term surveyed
students did not have prior knowledge of SLATE; this therefore implies that it is imperative for colleges to construct online courses using
a clear and easy to navigate system catered towards student learning preferences to accommodate students with beginner LMS knowledge
levels. In this study, a higher proportion of PT students did not have prior knowledge of SLATE compared to PN students. One possible reason
for this could be that a higher proportion of PN students attend the new student orientation session (offered a week before the start of the
term) where students are informed about the delivery mode of their first term courses. Once aware of an impending online math course,
students may feel compelled to learn how to use SLATE prior to course initiation, implying that PN students would therefore have higher
SLATE knowledge prior to course start. The provision of ample training on the fundamental skills of computer and SLATE usage to both
faculty and students will also ensure success is achieved by all student groups in the PN and PT programs enrolled in online MATH16532. To
facilitate student acceptance of online learning and ensure online courses are considered as a valued learning medium for both students and
faculty, colleges should increase the amount of courses offered in an online or hybrid format, encourage the incorporation of online
components in current F2F courses, and enhance faculty training on how to create and maintain an online course. Such strategies can result
in more satisfied online learners with reduced frustration and anxiety levels and enhanced success of online courses (Kozlowski, 2004).
To ensure students attain maximum benefit from an online pharmacy math course, they should be well oriented regarding the course
structure. This is especially important since MATH16532 is an essential and mandatory course within the program. Results from this study
revealed that a higher proportion of PN students knew that MATH16532 was offered online compared to PT students. In addition to
attending the new student orientation session, PN students tend to socialize more often amongst each other and therefore a higher
proportion would know about the online nature of their MATH16532 course. It was also observed that college students required a course
specific orientation session to prepare them for the upcoming online course in addition to the presence of many training documents, SLATE
training sessions, and manuals to aid them throughout the course (especially for the PN students). This is reasonable since both student
groups taking MATH16532 are in their first semester of the program and require reminders of course deadlines and requirements. A higher
proportion of PT students found attending the orientation session useful compared to PN students; this is expected since PT students had
less prior knowledge of SLATE and a lower proportion did not the course was offered online. There were mixed results between PT and PN
students in terms of interest in the availability of a course-specific manual outlining how to use SLATE at the beginning of the course, with
PN students preferring the presence of such a manual. This could in part be related to the requirement of course–content interaction by PN
1222 D. Abdulla / Computers & Education 59 (2012) 1215–1223

students with detailed step-by-step instructions on course access and navigation. Involvement of the Information Technology (IT)
department in student and instructor preparation for an online course should be considered and can include the provision of detailed
training documents on the learning platform and troubleshooting for common areas of concern. This will ensure that student computer and
SLATE knowledge are at least at an 80% level, allowing students to attain maximum benefits from online courses.

4.3. Student preferences regarding course organization and tool usage

Students in the medical field enrolled in online courses tend to prefer an easy to navigate course (Cantrell et al., 2008; Kazlowski, 2006).
In line with literature and despite their high anxiety levels, students enjoyed the ease of access of math course material with “a click of
a mouse”. A holistic approach to course advancement should be undertaken; revisions should not be driven by technology alone and should
incorporate “out-of-the box” applications (Leski, 2009). An example involves the use of assessments as course quality improvement tools
(such as Application Cards to determine what the student has learnt from a Learning Module or a Start-Stop-Continue Survey). Assessments
can also be designed as student-faculty contracts that ensure students understand the time intensive aspect ingrained within an online
course upon completion of the assessment. PT and PN students appreciated the provision of general course announcements throughout the
course along with access to a complete and comprehensive calendar prior to course initiation. It is essential that colleges embarking on
converting courses into an online or hybrid format organize Learning Module content with adequate amounts of information and in a way
that facilitates easy course navigation and information dissemination. Students also enjoyed the presence of the Calendar tool and preferred
the use of online rubrics. There was a tendency among students to listen to the voice component of the PowerPoint presentations and to feel
such video components adequate for the course. PT students expressed concern regarding grading transparency in an online version of
pharmacy math at the beginning of the course and therefore it was not surprising that the same student group expressed a preference
towards uploaded PDF hand-marked assignments.

4.4. Student satisfaction with course material and delivery

Students typically have perceived expectations about online courses; discrepancies between their perceptions and the reality of the
course can result in high student anxiety levels (Kozlowski, 2004). PT and PN students expressed many concerns about an online version of
MATH16532 and required continuous encouragement throughout the course; this included email reminders and regular announcements
regarding required course work and deadlines, up-to date calendars, regular announcements, and prompt email responses. This allowed
students to become more comfortable writing online quizzes after gaining experience with the course and completing a few quizzes online.
This is especially true for the PT students, where the proportion of students comfortable taking quizzes online after completing the first few
was higher. When surveyed at the beginning of and mid-way through the course regarding re-taking MATH16532 in its online format,
students remained inclined towards a hybrid course format (since students felt it important to see their peers and instructor during the
course). Interestingly enough, when surveyed towards the end of the course, students were inclined towards re-taking the MATH16532
course in an online format. This indicates that despite high anxiety levels, students became more comfortable with the online nature of the
course towards the end of the term. Towards the end of the course, students felt that the course content and material were appropriate and
relevant with appropriate use of SLATE for quizzes and discussions. It is interesting to note that a lower proportion of PT students felt SLATE
was appropriately used for quizzes and discussions compared to PN students and that the course delivery was appropriate. A possible
explanation for this could be that PN students gained more confidence in course navigation towards the end of the course compared to PT
students. This is further supported by the fact that more PT students were interested in a hybrid format of course delivery compared to PN
students.

4.5. Gained and retained student skills

PT and PN students gained critical appraisal skills and improved written abilities through participation in the online pharmacy math
course (Fig. 2); such skills are essential for academic and future career success, especially with increasing enrolment of international and
English as a Second Language (ESL) students in 2-year colleges. Additional skills also indicative of program and career success include the
ability to foster independent learning and time management skills, both identified as skills gained by PT and PN students through
participation in the online version of MATH16532 (Fig. 2). Additionally, first term students from both programs were more inclined towards
taking another taking another online course. Discussions are an integral component in an online course as they allow learner engagement
even among normally quiet students (MacLaren & Shukla, 1999; Zsohar & Smith, 2008). Results from one term revealed a trend among
students that participation in online discussions increased their confidence in participation in normal F2F classes.
When the same group of first semester students were surveyed during second semester, the majority of students felt extremely
comfortable and confident using SLATE without asking for help and enjoyed seeing SLATE content in their current second term courses.
SLATE is an essential component of all F2F and online courses taught at Sheridan College and therefore providing students with the
opportunity to learn how to use SLATE comfortably during the study program is a substantial benefit to introducing an online course early
during the course. Studies have shown an enhancement in student learning after participation in an online course (Kozlowski, 2004; Thiele,
2003). In line with this, the majority of surveyed second term students conferred that they maintained their independent learning and were
still utilizing their time management skills going into their second term, indicating that these two skills are tangibly transferable as a result
of taking an online MATH16532 course in the first semester. Despite identifying critical analysis as a tangible skill from participating in an
online course from the first semester, second semester students did not feel that this skill was transferable into second semester. The same
was true for reading skills, which students did not feel was improved in their second semester. Even though second semester felt that the
grade obtained from their online MATH16532 course accurately reflected their math knowledge, not many students felt that they had
retained their math skills. This was slightly supported based on results from the first-term students, where more PT students felt that
MATH16532 would help them in their future studies in the program. Pharmacy math is a challenging subject for students and therefore
introducing students to the material in a form that allows them to foster independent learning and time management skills will allow
 D. Abdulla / Computers & Education 59 (2012) 1215–1223 1223

progression of students with stronger math skills into successive semesters in the program. To increase retention of math skills among
students entering their second semester of the program, perhaps more F2F sessions should be provided within the online course to allow
students greater chances to review and feel more comfortable with the material. Finally, there was a tendency among second term students
to enrol in another online course if offered the opportunity. Since many continuing education programs offer students ongoing knowledge
opportunities after graduation with specialized topics provided in a distance education form, students who have completed online courses
during their education have higher chances of success in such courses and will be able to embrace rapidly occurring changes in the health
care field.

5. Conclusion

Despite an abundance in the literature on university student preparation for online learning (Anders, 2001; Damazo, Shovein, Huston, &
Fox, 2002; Gore, 2000; Kozlowski, 2004; Leski, 2009; MacLaren & Shukla, 1999; Wang & Newlin, 2002), limited information is available on
how to appropriately construct and deliver an online course to college students enrolled in 2-year diploma programs. Students in both PT
and PN programs did not exhibit a positive attitude towards taking an online math course and remained anxious about enrolling in an online
course, preferring the ability to interact with their instructor and peers throughout the duration of the course. This initial attitude, along
with results from this study probing student attitudes towards online learning, indicated that students predominantly preferred a hybrid
method of delivery for pharmacy math (incorporating both online and F2F materials). Another important aspect that can ensure successful
completion of pharmacy math in an online form includes preparation of students prior to course delivery; this involves training students on
computer and learning management system usage along with a thorough orientation on course structure and deadlines. PT and PN students
did however enjoy many components of the online course and felt that the course content and material presented were appropriate and
relevant for their knowledge. Students gained essential career skills through participation in an online pharmacy math course, such as
critical appraisal skills, time management and independent learning skills, and enhanced written abilities. Two of these gained skills
(independent learning and time management skills) were also transferable into the second term of studies for PN and PT students, indicating
both short-term and long-term benefits from introducing online learning early in the program for PT and PN students.

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