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Do Students Effectively Learn Physiology through Distance Online

Instruction? Medical Students' Perceptions and Academic Performance
Article in AJP Advances in Physiology Education · November 2021

DOI: 10.1152/advan.00098.2021
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Online Medical Physiology Learning: Accepted and Effective?
1 Do Students Effectively Learn Physiology through Distance Online
2 Instruction? Medical Students’ Perceptions and Academic Performance
5 Rima Abdul Razzak*1, Tariq Al-Shaibani2, Yahya Naguib3,4
6
*1
7 Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf
8 University, Road 2904 Building 293 Manama, 329, Bahrain.
9 Email: reemala@agu.edu.bh Tel: +97339966703.
10 ORCID: 0000-0002-0106-0481
11
2
14 Email: tareqas@agu.edu.bh
15
3
18 Email: yahyamn@agu.edu.bh
19 ORCID: 0000-0001-5851-7238
4
20 Department of Medical Physiology, Faculty of Medicine, Menoufia University, Shibin
21 El Kom, Menoufia, Egypt
22
23
24
Downloaded from journals.physiology.org/journal/advances (191.101.112.089) on November 28, 2021.

25 Abstract
26 This an account of student feedback on the distance online tools adopted at the onset of the
27 CoVid-19 pandemic for teaching the cardiovascular (CVS) Physiology to Year 2 medical
28 students within a problem-based learning (PBL) medical curriculum. Students’ achievement
29 upon assessment of CVS Physiology theory content was also evaluated. Most students were
30 ready for online learning in terms of the appropriate equipment and internet connectivity.
31 Most students expressed preference for face-to-face learning of CVS Physiology, however
32 they relied on recorded videos mainly for learning, instead of real-time attendance of
33 Physiology learning activities. Most students also reported a negative experience of distance
34 online learning of CVS Physiology during the lockdown, and only few students expressed
35 connection with their instructor through the Physiology learning activities. Students
36 undertaking online learning and examination during the pandemic achieved comparably to
37 prior year’s cohort of PBL students learning in-person and undertaking paper-based
38 assessment. This indicates that our medical students preferred asynchronous learning during
39 the pandemic confinement, and that they sufficiently achieved their learning outcomes in
40 CVS Physiology, displaying resilience in their adaptation to the online learning and
41 examination format.
42
43
44
45 Key Words: COVID-19 pandemic, Online teaching and Online Assessment, Cardiovascular
46 Physiology, PBL, Medical students
47
48
49

50
51 Introduction
52 The Covid-19 pandemic has put the global education system to the test by forcing face-to-
53 face learning environments to quickly move online. To continue the education of our
54 medical students since the onset of the pandemic, at the College of Medicine and Medical
55 Sciences (CMMS) in the Arabian Gulf university (AGU), multiple education solutions, all
56 of which are based on remote online teaching/learning, have been forcibly deployed for the
57 purpose of confinement and restriction of the spread of the pandemic. Online solutions
58 usually carry some disadvantages for student learning, including technical problems such as
59 poor internet connection, or failures of overloaded servers and communication platforms;
60 few opportunities of face-to-face interaction with teachers and peers, difficulties engaging
61 such as having problems with concentration or loss of motivation (1, 3), and feeling
62 disconnected, isolated, or not actively involved (1, 4). On the other hand, online learning
63 carries with it some positive aspects, including increased convenience with time, more
64 flexibility with study schedule, and during the Covid-19 pandemic, safety by avoiding
65 contacts and potential exposure to infection (1, 2).
66
67 CMMS follows a problem-based, student-centered, and community-based curriculum. The
68 problem-based learning (PBL) curriculum is of six years duration consisting of three phases:
69 Phase I (Year 1), where teaching comprises foundation courses to prepare students for
70 studying medicine; Phase II or pre-clerkship phase (Year 2-Year 4) is a Unit-System-based
71 program with PBL as the main strategy of instruction, and Phase III or clerkship phase
72 (Years 5 and 6) where teaching is in the form of clinical rotations in hospitals and primary
73 health care centers in Bahrain. For Phase II or pre-clerkship phase (Year 2-Year 4), there is
74 horizontal integration between basic and clinical sciences in the context of weekly medical

75 problems presented to students in the form of clinical health scenarios. During this phase,
76 students cover 90 health problems across 9 system-based units, with three units per year.
77 The distribution of the units and number of associated medical problems along the three pre-
78 clerkship years is included in Supplementary Table 1. A description of the PBL process is
79 included at the end of the Methods section.
80
81 In our PBL medical curriculum, online instruction has never been a part of the
82 teaching/learning methodology at CMMS within any of the nine PBL units. This applies to
83 our Year 2 medical students, who at the onset of the pandemic, had already completed two
84 units (20 medical problems) via face-to-face learning and were about to begin the unit on the
85 cardiovascular (CVS) system. However, to abide with the decision of online distance
86 learning, the unit on the CVS system was delivered through online/distance methods. A
87 pitfall of this decision was that students had to abruptly transition from an instructional
88 method based on face-to-face learning to distance online learning.
89
90 There is currently limited Covid-19 literature on effect of the sudden transition to online
91 learning, exclusively on student performance in assessments, and to the best of our
92 knowledge, studies on both student perceptions and student academic performance are rare.
93 The potential impact of this transition for our medical students is yet to be described, as the
94 medical courses at CMMS, AGU were not designed for online learning from the outset.
95 Since the way online courses are delivered and taught can be a determinant factor for
96 students’ online learning and affect their opinions, it is essential to evaluate our medical
97 students’ acceptability of the newly introduced online instructional methods and their
98 effectiveness on their learning success. Such evaluation can highlight any shortcomings and
99 required future online educational improvements, as online teaching may prove to be a

100 permanent trend in medical education, especially for basic medical sciences during the pre-
101 clerkship phase.
102 As academic members of the Physiology department, it was crucial for us to determine
103 whether our students achieved a sound grasp of their learning needs on physiological
104 mechanisms, since this is integral for their understanding of the association of signs and
105 symptoms with diseases and can help in their future diagnostic skills and success (5). We
106 briefly describe the online instructional methods for the Physiology module, delivered
107 online to Year 2 medical students as part of the unit on the cardiovascular system. We also
108 include evaluation of students’ perceptions to the different online tools for teaching CVS
109 Physiology, and students’ achievement of Physiology learning outcomes by assessing their
110 performance on the CVS Physiology component in the end-unit exam.
111
112 Materials and Methods
113 This study received ethical approval from the Research Ethics Committee at CMMS, AGU
114 (Ref No. E005-PI-10/20).
115
116 Online tools and modes of delivery for CVS Physiology
117 PowerPoint recorded slideshows
118 During the first week of the unit which is 12-weeks (medical problems) long, we prepared
119 resources (lectures) using PowerPoint (PPT) and recording the slideshow enriched with
120 audio explanations and annotations to clarify theoretical concepts of CVS Physiology in
121 each slide. Later, the PPT presentations were uploaded onto the free open-source learning
122 management system, Moodle (Modular Object-Oriented Dynamic Learning Environment).
123 All students had access to the PPT presentations on Moodle. Initial feedback from students
124 to the Medical Education office revealed that they were not satisfied with this method and

125 preferred to have the PPT presentation as part of a video, so that they can rewind and
126 forward to the extent they desired on the slideshow recording.
127 Open Broadcaster Software (OBS)
128 To address students’ concerns for the PPT, we decided in the second week of the unit and
129 onwards to record lectures on video and upload them to the e-learning platform, Moodle.
130 The e-learning experts proposed OBS Studio as a suitable option. OBS is an open-source
131 software designed for capturing, recording, and streaming video content, efficiently. OBS
132 Studio is suite for broadcasting everything on the computer/laptop screen. The control panel
133 has options for starting/stopping a stream or recording. We utilized this software for creating
134 videos of the PPT presentations, along with audio and annotations. All that was carried out
135 by the instructor on the screen was captured in video format. Recordings of video files were
136 uploaded onto AGU’s One Drive (Microsoft) for student access and creating multiple
137 playback opportunities.
138
139 Zoom for reviews and Physiology clinical case discussions
140 Students requested review sessions of the online taught course content, so instructors at the
141 Physiology department decided to provide such sessions for every three or four medical
142 problems or weeks. However, we wanted to create engaging active learning sessions using
143 open response and drawing features. For such a task we adopted the online conferencing
144 software Zoom, which enabled flawless video and audio, instant screen sharing, and cross-
145 platform instant messaging. To introduce clinical relevance to the basic CVS Physiology
146 concepts, we conducted with students, clinical case discussions pertinent only to CVS
147 Physiology-Pathophysiology in real-time Zoom sessions, which were later uploaded for
148 students on Moodle.
149

150
151
152 Sampling and Sample Size
153 For the survey, the target respondents were all Year 2 medical students who learned the unit
154 on the cardiovascular system through online methods at the onset of the Covid pandemic.
155 The number of students enrolled then was 202.
156
157 The student sample size for analysis of exam performance on CVS Physiology represents
158 Year 2 students who sat for the end-unit CVS exam in the academic year prior to (n = 183)
159 and at the onset of the pandemic (n = 195).
160
161 Survey instruments and dissemination
162 Assessment of students’ satisfaction and acceptability of the different online Physiology
163 teaching tools was through an in-house constructed survey. The anonymous student
164 survey consisted of 12 dichotomous response type “Yes-No” questions that evaluated
165 students’ attitudes towards the described online instructional methods in CVS
166 Physiology (Table1). The student survey was designed to assess three major
167 domains: 1) Readiness for online learning in general, 2) Effectiveness of online CVS
168 Physiology delivery modes, and 3) Overall CVS Physiology online learning experience.
169
170 The survey was constructed with Google Forms and disseminated through a web
171 link sent to the students. By selecting the option “Limit to 1 response”, we ensured there
172 were no duplicate submissions. In addition, respondents were not allowed to edit after
173 submission of the completed form. There were no incentives offered to students for
174 completing the survey.

175
176 One week before the actual survey was disseminated, it was piloted on 10
177 randomly selected participants from the Year 2 student cohort to ascertain if the
178 questions were well defined, easy to understand, and presented in a consistent
179 manner. This pilot survey allowed us to test the comprehensiveness and
180 appropriateness of the questionnaire. The questionnaire was modified according
181 to the pilot study results. To assess the validity of the questionnaire, two
182 independent specialists, a biostatistician, and a Medical Education expert,
183 reviewed the survey. All participants were interviewed online through Zoom,
184 and the format and purpose of the questionnaire were explained to them in
185 detail.
186
187 Evaluation of student performance on CVS Physiology
188 Evaluation of student performance in CVS Physiology was by quantitative analysis of exam
189 scores and comparison to performance of prior year’s (pre-COVID year) cohort of students,
190 who experienced face-to-face learning and paper-based assessment. Examination blueprint
191 was used to sample learning objectives to ensure that both exams covered the same learning
192 needs in CVS Physiology.
193
194 The online platform Exam Soft was purchased for the purpose of conducting the exam.
195 Exam Soft’s testing software, Examplify is an application downloaded to a computer that
196 ensures students can complete an assessment in a stable and offline environment. Students
197 had a formative exam, so that they would be familiar with Examplify software before the
198 exam date. They were asked to download the exam one day ahead of the exam date, in
199 anticipation of any internet connectivity mishaps on the day of the exam. They could not

200 access the exam except with a password that was provided to them at the time of the exam.
201 To ensure fairness of students during the exam, personnel from the Assessment Office
202 provided all means of remote monitoring (through video camera and recording the exam
203 sessions) of students. The exam session for each student was recorded, then a whole team of
204 invigilators examined the recordings to identify any possible incidents of unfairness by
205 students.
206
207 The end-unit written (theoretical) exam is a mixture of questions in all basic science and
208 some clinically integrated content covered throughout the unit and usually comprised of
209 written component in the form of 85 A-type multiple-choice questions (MCQs) and 3 short
210 answer questions (SAQs). During the Covid pandemic year, it was decided that the learning
211 needs tested by the written SAQ component substituted by 15 extra MCQs, for ease of
212 correction and analysis by the examination software, increasing the number of MCQs to
213 100.
214
215 The CVS unit has a major Physiology component, and the Physiology questions comprised
216 30% (25 /85) of tested MCQ items for the pre-Covid year and 26% (26/100) for the Covid-
217 19 academic year. It is worth mentioning that most Physiology questions were stand-alone
218 MCQs, but a very few were part of an integrated clinical-scenario (case cluster) MCQs.
219 Such cluster MCQS compare favorably to stand-alone MCQs and provide opportunities for
220 the integration of different disciplines and assessment in keeping with PBL (6).
221
222 Statistical Analysis

223 Data from the survey were imported into a Microsoft EXCEL spreadsheet file, and
224 quantitative data derived from the “Yes-No” questions were analyzed descriptively. The
225 percentage of students who answered with “Yes” to each item in the survey was calculated.
226
227 In the end-unit CVS exam, the item of interest and obtained through exam result analysis,
228 was the percentage of students answering a certain percentage of Physiology questions
229 (MCQs) correctly. This item was then compared between the Covid and pre-Covid year’s
230 student cohorts with a Chi-Square Test of Independence, to determine whether there is an
231 association between pandemic context and performance on CVS Physiology assessment.
232
233 The PBL process
234 PBL occurs in small-group tutorial sessions that are usually implemented face to face, with
235 the tutor working as the facilitator of discussions among students (7). With PBL, learning
236 takes place after introduction of the problem, with students initially formulating hypotheses
237 that might explain the problem, and then identifying their own learning needs to better
238 understand the problem. Students then independently research and gather information which
239 ultimately help them generate new personal understandings about the problem. A
240 collaborative understanding is arrived at through sharing of these personal understandings
241 within the group.
242
243 In our PBL curriculum, other learning activities complement each weekly medical problem
244 and enable students to achieve the educational learning needs identified during the PBL
245 tutorial sessions. Two activities integral for learning the theory component include resource
246 session/s in basic medical sciences and, in some disciplines like Physiology, clinical case
247 discussions specific to that discipline. Even though not as comprehensive as full lectures, the
10

248 resource sessions still provide the basic scientific information required for students to build
249 their knowledge on for further self-learning. The complementary practical activities include
250 basic science laboratory sessions, professional clinical skills, and community health activities.
251 Obviously, students could not conduct these activities remotely during their confinement.
252
253
254
255 Results
256 Survey analysis
257 118 out of 202 students (58.5%) responded to the survey. Table 1 shows in the right column
258 the percentage of students who answered with “Yes” to each item within the three categories
259 evaluated by the survey. Most items received favorable responses except the items
260 addressing the connection between students and their instructor during lecture recordings,
261 whether CVS Physiology concepts were comprehensible through Zoom sessions of reviews
262 and case-based discussions, and whether online learning of CVS Physiology was a good
263 experience for students during the lockdown. Interestingly, almost 70 % of responding
264 students relied on asynchronous learning for the resource sessions and revisions / clinical
265 case discussions.
266
267 Student academic performance
268 The Chi-square Test of Independence revealed a lack of significant association between
269 pandemic context and the percentage of students answering a certain percentage of CVS
270 Physiology questions correctly, X2 (1, 6) = 3.59, P = 0.73. As shown in Figure 1, there was
271 no difference in student performance between the pandemic year and prior year. This
272 indicates that being in a face-to-face learning environment and taking a paper-based exam
11

273 did not put students at an advantage of learning Physiology, in comparison to their
274 counterparts studying and conducting the examination online during the Covid-19 pandemic.
275
276 The all-exam average combined MCQ scores were 68.81% and 69.5% for the pre-Covid
277 paper-based and the Covid online exam, respectively. The Kuder-Richardson Formula 20, or
278 KR-20 for the whole exam was almost identical for both exams (pre-Covid paper-based
279 exam: 0.89, Covid online exam: 0.91). KR-20 measures reliability for a test with binary
280 variables, where reliability refers to how consistent the results from the test are, or how well
281 the test is measuring what it is required to measure. Such high KR-20 values indicate that
282 each of the exams is likely to correlate with alternate forms (8).
283
284 Table 1. In-house constructed/validated medical student perception survey on online learning
285 of cardiovascular Physiology during the Covid-19 pandemic.
%
Readiness for Online Learning in General
1. I had appropriate equipment (computer/laptop) to participate in online learning. 77.9
2. I had good internet connection during online learning. 69.1
3. I have sufficient computer knowledge and skills to manage my online learning. 77.9
4. Training to use online tools was provided at the onset of online teaching. 66.3
Effectiveness of online CVS Physiology Delivery Modes

5. I relied mainly on real-time attendance of CVS Physiology activities. 32.5
6. Recorded PowerPoint (PPT) slideshows audio explanations clarified concepts of 70.5
CVS Physiology.
7. PPT presentation as part of a video is preferable to recorded slideshows for learning 70.5
CVS Physiology.
8. Lecture videos in which I could pause and rewind to the extent I desired was 93.7
beneficial for my learning of CVS Physiology lectures.
9. I felt connected with the instructor when learning CVS Physiology through PPT 38.8
12

slide shows and PPT video recordings.

10. Zoom sessions of reviews and clinical case discussions added to my understanding 54.7
of CVS Physiology.
Overall CVS Physiology Learning

11. Online learning of CVS Physiology was a good experience for me during the 53.7
lockdown.
12. I prefer the traditional face-to face learning of CVS Physiology than online 79.5
methods in a PBL setting.
286
287
288 INSERT FIGURE1 HERE
289
290 Discussion
291 The student body at the Arabian Gulf university (AGU) is heterogeneous with students
292 enrolling from most GCC countries. Although AGU is based in Bahrain, most students were
293 from Saudi Arabia and Kuwait, and fewer students from Oman and Bahrain. As the severe
294 acute respiratory syndrome coronavirus 2 (SARS-CoV-2; Covid-19) met the
295 epidemiological criteria of a pandemic in March 2020 by the WHO (9 - 12), students were
296 advised by university management and their country representatives to return to their
297 families in their home countries, in line with the main public health recommendation of
298 remaining at home and staying safe (13).
299
300 During the Covid-19 pandemic, online learning has become a critical lifeline for education,
301 as institutions seek to minimize the potential for community transmission (14). As in other
302 programs, the Covid-19 pandemic forced a massive and rapid shift in the way medical
303 education is delivered. However as for any educational shift, it is critical to evaluate whether
304 such a transition is effective for students’ learning. We sought to determine whether
13

305 teaching/learning of CVS Physiology with our abruptly adopted online teaching tools was as
306 effective as the conventional face-to-face method, for students to achieve the required
307 learning outcomes in a PBL setting.
308
309 Being the most important component of distance e-learning, students’ readiness for online
310 learning was also evaluated, considering that lack of infrastructure, technology tools for
311 students, internet access, and poor quality of internet services may be obstacles that impact
312 students (15, 16) and create a negative attitude towards online learning in general. This is
313 corroborated by recent studies in which medical students reported that the lack of internet
314 facility, poor IT skills, and improper facilitation by the faculty hindered their progress
315 towards achieving good online medical education (4, 17). Fortunately, most students in the
316 current study acknowledged having appropriate tools, efficient internet connection,
317 and receiving proper training to use online platforms such as Moodle and Zoom for online
318 learning of CVS Physiology.
319
320 Most students were fairly satisfied with the recorded PPT slideshows for their lectures,
321 however they found it limiting as they were not able to pause the recording on each slide and
322 take notes gradually. Every time, they had to repeat the slide to be able to catch up to where
323 they stopped, and it was time consuming on their part. This was corroborated by the high
324 percentage (almost 90%) of students favoring the PPT presentations as part of a video
325 recording, by which they can rewind and forward to the extent they desired on the slideshow
326 recording. This is probably associated with the greater control by students over the learning
327 process and skipping or accelerating through concepts as they choose (2, 14).
328
14

329 The new decision by our college for provision of access to lecture recordings, while
330 attendance was not mandatory may have contributed to the preference of students for
331 asynchronous learning and skipping real-time Physiology learning activities. The
332 asynchronous approach provides flexibility in study habits for students, such as the ability to
333 learn at their own pace and to manage their schedule from wherever and at whatever time.
334 This is speculative on our part since previous studies on the impact of availability of pre-
335 recorded lectures on lecture attendance have produced conflicting results. One study on
336 attendance of Physiology lectures by medical students reported that most students view
337 recorded lectures as useful revision tools rather than as a replacement for live lectures (18),
338 however, other studies reported that a greater percentage of medical students indicated they
339 watched online lectures instead of attending class, with the majority indicating that online
340 lectures are just as effective as or more effective than live class lectures (19, 20). Another
341 factor for preference of asynchronous learning could be our students’ involvement and
342 exposure to a PBL setting, in which they are accustomed to self-directed learning and ability
343 to take more responsibility in their learning process (21). Such attributes are even more
344 required during online education, in comparison with traditional teaching (1).
345
346 In the current study, most of our students did not support the notion that online learning of
347 CVS Physiology was as effective as the face-to-face method, and most of them (69.5%)
348 expressed their preference to face-to face learning of CVS Physiology. This preference
349 could be due to two factors, the first being the low level of interaction between students and
350 their instructor. In fact, most students in the current study reported insufficient connection
351 with their instructor, when going over the PPT slideshows and the recorded videos of the
352 PPT presentations. This is in agreement with other studies reporting lack of connection and
353 isolation among medical students during their online studies (1, 4). This preference however
15

354 does not explain students’ choice of asynchronous approach to online learning through
355 recordings, when it is well established that synchronous education mediums also provide
356 opportunities for simultaneous feedback, discussions, and question-answer activities as in
357 face-to-face environments (22).
358
359 The other factor to consider could be the psychological impact of confinement. In fact, many
360 of our students reported a negative experience with online learning during the lockdown,
361 which may not necessarily be dependent on educational influences. Recent findings suggest
362 that students in 2020, the time of our study, may have been experiencing psychological
363 effects from the outbreak of Covid-19 and confinement, such as anxiety, sedentary lifestyle,
364 depression (23, 24), and mainly worry and uncertainty regarding academic success, future
365 careers, and social life during college (25, 26).
366
367 Despite our students’ preference of face-to-face learning, their academic achievement was
368 not significantly affected by the educational paradigm shift, indicating that our distance
369 online tools for instruction of CVS Physiology were mostly effective, even though most
370 students accessed these tools for asynchronous learning. This finding is in line with other
371 studies reporting no apparent difference in association between live lecture attendance or
372 accessing lecture recordings and academic outcomes in majority of pre-clinical medical
373 courses (27, 28), especially when lecture recordings are prepared well. Additionally, our
374 students seem not to have been influenced by the forced introduction of the online
375 examination format, while recent findings indicate that students have more anxiety owing to
376 online examinations in comparison to coronavirus induced anxiety (29). The resulting
377 equivalent exam performance between the two student cohorts indicates that our PBL
16

378 students, undertaking distance online learning, were equally able to achieve the required
379 learning needs covered in CVS Physiology learning activities.
380
381 Limitations and Conclusions
382 A limitation of this study is the relatively low survey response rate, which may not be
383 representative of the student cohort, but it is well-known that online surveys typically elicit
384 lower response rates than in-person administration of surveys (30). We also did not compare
385 exam performance between students who attended the online Physiology learning activities
386 in real-time with those who relied mainly on asynchronous online learning of CVS
387 Physiology.
388 This study emphasizes the preference of face-to-face learning of CVS Physiology. A
389 relatively low satisfaction level with online learning of CVS Physiology within our PBL
390 setting did not equate with poor achievement for our students. Notwithstanding the
391 differences in methods of instruction and administering the test for two cohorts of students,
392 the outcome is similar. Regardless of the comparable achievement, we still aim to make
393 digital instruction more successful and create better online experiences within a PBL setting.
394 This is because the long-term impact of this digital transformation in the post-Covid era is
395 uncertain, but the trend might be blended learning.
396
397
398
399 Acknowledgements
400 I thank Prof. Reginald Sequeira for his support and assistance in editing this manuscript.
401
17

402 Disclosures
403 Funding Details: This work did not receive any funding.
404 Competing Interests: The author reports no conflicts of interest of financial or non-financial
405 nature. The author alone is responsible for the content and writing of this article.
406 Acknowledgement: I thank Prof. Reginald Sequeira for his support and assistance in editing
407 this manuscript.
408
409
410
411
412
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21

503
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515
516 Figure 1. The color-key above represents the percentage of Physiology MCQs answered
517 correctly. Each bar represents the percentage of students answering a certain percentage of
518 Physiology MCQs correctly. The exam for the pre-Covid year was paper-based, and
519 teaching was face-to-face. The exam during the pandemic academic year (2019-2020) was
520 online, and instruction was through remote online methods. Chi-square test of independence:
521 X2 (1, 6) = 3.59, P = 0.73.
522
523 Data supplements can be found here:
524 https://figshare.com/articles/journal_contribution/Supplementary_Table_1_docx/16785748
525
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22

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543 Supplementary Table 1. Distribution and duration of the PBL Units across the pre-
544 clerkship years.
Title Number of
Weeks/Problems
YEAR 2
 Unit I Man & His Environment 12
 Unit II Respiratory System 8
 Unit III Cardiovascular System 10
YEAR 3
 Unit IV Endocrine, Metabolism & Reproductive Systems 9
 Unit V Gastrointestinal & Renal Systems 11
 Unit VI Hematopoietic & Immune Systems 9
YEAR 4
 Unit VII Integumentary & Musculoskeletal Systems 9
 Unit Nervous System, Special Senses & Human Behavior 12
VIII Multi-System Integration 10
 Unit IX
23

545
546
24

< 40 % 40 - 50 % 50 - 60% 60 - 70% 70 - 80% 80 - 90% 90 - 100 %
28
24
23.1
PERCENTAGE OF STUDENTS
ANSWERING CORRECTLY
20
19.2
19.2
15.4
11.5
12
7.7
8
3.8
4
PRE-COVID-19 YEAR COVID-19 YEAR

Table 1. In-house constructed/validated medical student perception survey on online learning of
cardiovascular Physiology during the Covid-19 pandemic.
%
Readiness for Online Learning in General

1. I had appropriate equipment (computer/laptop) to participate in online learning. 77.9
2. I had good internet connection during online learning. 69.1
3. I have sufficient computer knowledge and skills to manage my online learning. 77.9
4. Training to use online tools was provided at the onset of online teaching. 66.3
Effectiveness of online CVS Physiology Delivery Modes

5. I relied mainly on real-time attendance of CVS Physiology activities. 32.5
6. Recorded PowerPoint (PPT) slideshows audio explanations clarified concepts of 70.5
CVS Physiology.
7. PPT presentation as part of a video is preferable to recorded slideshows for learning 70.5
CVS Physiology.
8. Lecture videos in which I could pause and rewind to the extent I desired was 93.7
beneficial for my learning of CVS Physiology lectures.
9. I felt connected with the instructor when learning CVS Physiology through PPT 38.8
slide shows and PPT video recordings.
10. Zoom sessions of reviews and clinical case discussions added to my understanding 54.7
of CVS Physiology.
Overall CVS Physiology Learning

11. Online learning of CVS Physiology was a good experience for me during the 53.7
lockdown.
12. I prefer the traditional face-to face learning of CVS Physiology than online 79.5
methods in a PBL setting.

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Do Students Effectively Learn Physiology through Distance Online

Article in AJP Advances in Physiology Education · November 2021

Rima Abdul Razzak Tarik Al-Shaibani

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1 Do Students Effectively Learn Physiology through Distance Online

2 Instruction? Medical Students’ Perceptions and Academic Performance

5 Rima Abdul Razzak*1, Tariq Al-Shaibani2, Yahya Naguib3,4

8 University, Road 2904 Building 293 Manama, 329, Bahrain.

9 Email: reemala@agu.edu.bh Tel: +97339966703.

13 University, Road 2904 Building 293 Manama, 329, Bahrain.

17 University, Road 2904 Building 293 Manama, 329, Bahrain.

21 El Kom, Menoufia, Egypt

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28 students within a problem-based learning (PBL) medical curriculum. Students’ achievement

46 Physiology, PBL, Medical students

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59 poor internet connection, or failures of overloaded servers and communication platforms;

65 contacts and potential exposure to infection (1, 2).

67 CMMS follows a problem-based, student-centered, and community-based curriculum. The

70 studying medicine; Phase II or pre-clerkship phase (Year 2-Year 4) is a Unit-System-based

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78 clerkship years is included in Supplementary Table 1. A description of the PBL process is

79 included at the end of the Methods section.

88 method based on face-to-face learning to distance online learning.

91 learning, exclusively on student performance in assessments, and to the best of our

99 required future online educational improvements, as online teaching may prove to be a

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101 clerkship phase.

110 performance on the CVS Physiology component in the end-unit exam.

112 Materials and Methods

114 (Ref No. E005-PI-10/20).

116 Online tools and modes of delivery for CVS Physiology

117 PowerPoint recorded slideshows

122 management system, Moodle (Modular Object-Oriented Dynamic Learning Environment).

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126 forward to the extent they desired on the slideshow recording.

127 Open Broadcaster Software (OBS)

137 playback opportunities.

139 Zoom for reviews and Physiology clinical case discussions

148 students on Moodle.

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152 Sampling and Sample Size

155 The number of students enrolled then was 202.

159 and at the onset of the pandemic (n = 195).

161 Survey instruments and dissemination

174 completing the survey.

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180 appropriateness of the questionnaire. The questionnaire was modified according

182 independent specialists, a biostatistician, and a Medical Education expert,

187 Evaluation of student performance on CVS Physiology

192 needs in CVS Physiology.

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222 Statistical Analysis

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