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Table of Contents
Year : 2021  |  Volume : 3  |  Issue : 1  |  Page : 62-66

Blended learning in health professional education

Department of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Date of Submission02-Jun-2021
Date of Decision21-Jun-2021
Date of Acceptance12-Jul-2021
Date of Web Publication31-Jul-2021

Correspondence Address:
Dr. Narasimman Swaminathan
Professor in Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), No.1 Ramachandra Nagar Porur, Chennai - 600 116, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_45_21

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Use of information, communication, and technology in higher education is known to enhance learning experience. Thoughtful mixing of online and face-to-face activities is identified as blended learning (BL). Owing to its advantages, health professional education programs adapted this method globally. Understanding the concept of BL will be useful for Health Professional Educators (HPEs) in improving learner's engagement. The objective of this article is to introduce the concept of BL in HPE and to discuss its advantages and disadvantages based on available evidence.

Keywords: Blended learning, Health Professional Education, physiotherapy

How to cite this article:
Swaminathan N, Ravichandran L, Ramachandran S. Blended learning in health professional education. Indian J Phys Ther Res 2021;3:62-6

How to cite this URL:
Swaminathan N, Ravichandran L, Ramachandran S. Blended learning in health professional education. Indian J Phys Ther Res [serial online] 2021 [cited 2022 Nov 29];3:62-6. Available from: https://www.ijptr.org/text.asp?2021/3/1/62/322919

  Introduction Top

The students of current generation depend heavily on digital technologies for information gathering and for their social and professional interactions.[1] Availability of Web 2.0 technologies, social network sites, and content-sharing sites provide opportunity to learners to acquire knowledge and collaborative learning. The judicious use of digital technologies improves the quality of higher education.[2] Internet communication technology facilitates flexible learning environment and collaborative learning. Ministry of Human Resource department, Government of India encourages higher education institutes to adopt digital technology through various initiates.[3] The National Assessment and Accreditation Council encourages the higher education institutes of India, to use Learning Management Systems (LMSs).

LMS provides opportunity for the learners to access the contents as and when required and provides flexibility in learning. Effective usage of LMS with traditional face-to-face teaching will enhance educational experience. Combination of online learning activities and face-to-face communications is referred to as blended learning (BL).[4] BL method caters learning needs of the students with various learning styles. Online discussions with peers create possibilities for collaborative learning.[5],[6],[7] This article intends to discuss the possibilities of utilizing BL in health professional education. The advantages, disadvantages, and challenges in designing and implementing BL in Health Professional Educators (HPE) are discussed.

  Characteristics of Current Generation Learners Top

The influence of generational differences in higher education has been extensively debated in the literature.[8] Learners are classically divided by the various factors including age, gender, terrestrial area, revenue, etc., Understanding learner's characteristics is important for the educators as it guides in designing teaching learning methods. Gaming, E-mail, web browsing, smart phones, and messaging are the essential parts of their lives. Training the current generation learners demands the educators to use the digital tools.[9] Change in the learner's characteristics and availability of digital technologies have made higher education institutes to incorporate information and communications technologies (ICTs) in more robust manner than before. The effective use of ICTs to facilitate learner engagement is one of the hallmarks of BL.[10]

  Defining Blended Learning in Health Professional Education Top

BL integrates face-to-face and online learning activities in a seamless way than early adding an online element to a routine course that is not considered as BL. BL is now considered as pedagogical and technical innovation in higher education in its wider perspective. There are various definitions for BL in the literature. Garrison and Vaughan defined Blended learning as “the organic integration of thoughtfully selected and complementary face-to-face and online approaches.”[11] Manjot Kaur complied the definition of BL from various perspectives. Educational perspective defines BL as “courses that integrate online with traditional face-to-face class activities in a planned pedagogically valuable manner and where a portion of face-to-face time is replaced by the online activity.”[12] For the purpose of this article, the definition by Garrison and Kanuka “BL is the thoughtful integration of classroom face-to-face learning experiences with online learning experiences”[2] is adopted.

  Literature Review on Bl in Health Professional Educators Top

This section summarizes the findings of various studies pertaining to BL in health professional's education under the following headings: (i) improving competencies, (ii) students' perception, (iii) teachers' perception, and (iv) institutional impact. Critical analysis of each paper is summarized.

A systematic review explored the role of BL in the clinical education of health-care students. Studies published from the 2000 to 2010 were accessed. Out of 71 retrieved articles, only seven articles were included in the review. The research question was restricted to the impact of BL health-care students' clinical competencies. Studies used BL only in clinical education were included.[7] These studies explored training the student's clinical competencies. Milanese et al. investigated the effect of BL through a systematic review. This review included four systematic reviews and 14 primary studies. The included studies were appraised using the CASP tool. This review concluded that BL may improve learning outcomes and provides flexibility in learning. However, the outcomes used in the included studies were not uniform. This review included studies used distance and E-learning as interventions.[13]

Shorey et al. studied the effect of BL in the communication module in undergraduate nursing students. This quasi-experimental study design involved 124 undergraduate nursing students with the duration of the blended course being 13 weeks. The lecture materials were provided online along with face-to-face sessions for tutorials. Online discussion forums, quizzes, and reflection exercises were used to improve the student's engagement. Role plays and problem-based learning were used during the tutorial sessions. Students' satisfaction was assessed using the blended learning (BL) Satisfaction Scale, which demonstrated significant improvement in communication skills score and blended learning satisfaction scale (BLSS).[14]

Liu et al. summarized the quantitative aspects of BL through a systematic review, that included HPE programs along with CPD programs excluding the qualitative studies.[15] Another systematic review analyzed evidence on the effects of BL in imparting clinical skills among nursing students. This review identified that clinical skills may be used to impart through online.[16]

Snodgrass demonstrated the effects of combining Wiki activities to face-to-face training in improving critical thinking in physiotherapy students.[17] Kiviniemi study focused on the effect of BL in a graduate level public health course. In quasi-experimental study, observed students who were trained using the traditional method that was compared with BL mode. The BL mode excluded online sessions that were integrated with face to sessions. The study demonstrated learners' performance to be better in BL mode that when compared to the traditional method of teaching with majority of the students preferring BL mode compared to the traditional method. The results of this study need to interpreted cautiously as the sample size used in this study was (traditional teaching - 28 and BL - 38). Students were not assigned randomly to the groups. Students engagement with the course was not compared.[18]

A pilot study conducting an economic evaluation delivering interuniversity course through the blended mode on research methodology in a South African University identified that the blended course as an expensive method of teaching when compared to the class room teaching. This was a pilot study. However, the results of this study need to interpreted cautiously since the course was delivered for the first time. Preparation of digital tools for the first session and training the faculty members might have escalated the cost.[19]

A qualitative study using focus group discussion identified the challenges faced in executing BL. This study concluded that although BL seems to be effective in imparting knowledge and skills to nursing students, training teachers in digital tools and teaching methods are a challenge.[20] A structured evaluation of a nursing program offering a blended mode documented that the BL improves active participation of students and adds values to educational experience. However, it is challenging to train faculty members in teaching methods and creating necessary infrastructure to design and deliver BL in nursing education.[21]

  Trademarks of Blended Learning Top

BL plan should have the following components.

Continuous blending of online and face-to-face session

Students should be able to realize the connection between online and face-to-face learning activities. Facilitators integrate online component to face-to-face session as per the predetermined plan.

Flexibility in learning

Learners should be able to access contents through online at their convenience. Online learning activities such as discussion forums, blogs, and wikis to engage learners are a part of BL. Students should be able to participate in online activities on their own place and convenient time.

Learners' accessibility to their facilitators:

There should a clear mechanism by which learners receives constant feedback from facilitators. The teachers are expected to be available online to facilitate learning. This could be achieved by creating chat sessions, providing automated feedback through LMS, and organizing synchronous interaction as per predetermined schedules.

Effective use of face-to-face time for higher order learning:

Since lower order learning can be facilitated through online activities, it is important for teachers to plan face-to-face activities more meaningful and engaging. The objective of onsite sessions should emphasis on higher order learning.

  Components of Blended Learning Top

There should be seamless integration between the online component and face to session in BL. Learners access contents online asynchronously through LMS. Hence, creating learner centred online contents is the first cornerstone. The second major component of BL is to facilitate collaborative learning. There should be prospects for students to collaborate with their peers and facilitators. Online assessment and feedback are the third component of BL. Face-to-face session should be used for in-depth learning not merely for knowledge sharing. [Figure 1] summarizes the components of BL.
Figure 1: Components of blended learning

Click here to view

  Factors That May Affect Blended Learning Top

Learning style and adaptability

The success of any innovative teaching learning depends on the learning style of the students and their ability to adapt for newer methods. Learning styles of current generation learners rest heavily on digital tools. Correct mixture of online and face-to-face learning might be effective. Students may adapt faster to BL as they are inclined toward the use of technology. Health professional students' adaptation to online learning during this pandemic may be considered as proof for readiness toward BL. Higher education institute may consider this as an opportunity to introduce BL curriculum

Expected learning outcome

Aligning online and face-to-face learning activities with predetermined learning outcome is the mandatory for the success of BL. Assessment should also planned in alignment with learning outcomes. Since online component provides more flexibility, learners can get engaged and understand the basic concepts. Face-to-face activities need to be planned in achieving higher order learning outcomes

Online learning environment

The success of BL is heavily depending on online learning environment, especially LMS. Ideal LMS should provide easy access to contents along with collaborative tools such as discussion forum. It should also provide opportunities for online interactions and feedback on learning. Learner's progress should be able to tracked by facilitators and students themselves.

Teaching skills of facilitators

Facilitators required to be trained in the online activities. The presence of teacher throughout online sessions is one of the hallmarks of BL. Providing timely feedback and facilitating discussions during the online activities require specific skills. Face-to-face sessions should be repurposed to focus on higher order learning as discussed earlier. Judicious use of digital tools to engage learners by facilitators will enhance learning experience. It is important to constructively align learning outcome with online as well as face-to-face activities and assessment methods.

  Advantages of Blended Learning Top

Literature document the various advantages of BL.[11],[18] The following are the summary of advantages of BL from the perspectives of various stakeholders:

From the learner's perspective BL

  1. Encourages active learning
  2. Provides flexibility
  3. Increases collaborative learning
  4. Increases accessibility to learning resources
  5. Inculcates the 20th century skills (collaboration, communication, critical thinking, and creativity).

From the educator's perspectives BL helps in

  1. Repurposing the face-to-face time for higher order learning
  2. Close monitoring of learner's performance through analytics
  3. Reduced face-to-face sessions.

From the leaderships perspective

  1. Effective use of physical infrastructures
  2. Economical higher education.

  Conclusion Top

Health professional programs impart reasoning and clinical skills along with necessary knowledge. The online component of BL is useful in imparting basic knowledge and collaborative learning while the face-to-face sessions can be used to facilitate higher order learning and skill acquisition. Adopting BL method in HPE professional education requires the creation of appropriate learning environment including LMS and faculty training. The effectiveness of BL in HPE needs to explored further using well-designed studies.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Prensky M. Digital Natives, Digital Immigrants. On the Horizon MCB University Press. 2001; 9(5):1-6.  Back to cited text no. 1
Garrison DR, Kanuka H. Blended learning: Uncovering its transformative potential in higher education. Internet High Educ 2004; 7:95-105.  Back to cited text no. 2
National Convention on digital initiatives for higher education [Internet]. Ugc.ac.in. 2017: p 15 [cited 12 July 2021]. Available from: https://www.ugc.ac.in/pdfnews/9208605_Brochure-%28National- Convention-on-Digital-Initiatives-for-Higher-Education%29.pdf.  Back to cited text no. 3
Okaz AA. Integrating blended learning in higher education. Procedia Soc Behav Sci 2015; 186:600-3.  Back to cited text no. 4
Glogowska M, Young P, Lockyer L, Moule P. How 'blended' is blended learning? Students' perceptions of issues around the integration of online and face-to-face learning in a continuing professional development (CPD) health care context. Nurse Educ Today 2011; 31:887-91.  Back to cited text no. 5
Munir Ahmed R, Prem Kumar D. Implementing blended learning into the academic programs of Rajiv Gandhi University of Health Sciences, Karnataka. J Complement Integr Med 2014; 11:147.  Back to cited text no. 6
Rowe M, Frantz J, Bozalek V. The role of blended learning in the clinical education of healthcare students: A systematic review. Med Teach 2012; 34:e216-21.  Back to cited text no. 7
Jonassen D, Spector MJ, Driscoll M, Merrill MD, van Merrienboer J. Handbook of Research on Educational Communications and Technology: A Project of the Association for Educational Communications and Technology. United Kingdom: Routledge; 2008. p. 927.  Back to cited text no. 8
Sandeen C. Boomers, xers, and millennials: Who are they and what do they really want from continuing higher education? Contin High Educ Rev 2008; 72:11-31.  Back to cited text no. 9
Salajan FD, Schönwetter DJ, Cleghorn BM. Student and faculty inter-generational digital divide: Fact or fiction? Comput Educ 2010; 55:1393-403.  Back to cited text no. 10
Garrison DR, Vaughan ND. Blended Learning in Higher Education: Framework, Principles, and Guidelines. New York: John Wiley and Sons, Incorporated; 2011.  Back to cited text no. 11
Kaur M. Blended learning-Its challenges and future. Procedia Soc Behav Sci 2013; 93:612-7.  Back to cited text no. 12
Milanese SF, Grimmer-Somers K, Souvlis T, Innes-Walker K, Chipchase LS. Is a blended learning approach effective for learning in allied health clinicians? Phys Ther Rev 2014; 19:86-93.  Back to cited text no. 13
Shorey S, Kowitlawakul Y, Devi MK, Chen HC, Soong SKA, Ang E. Blended learning pedagogy designed for communication module among undergraduate nursing students: A quasi-experimental study. Nurse Educ Today 2018; 61:120-6.  Back to cited text no. 14
Liu Q, Peng W, Zhang F, Hu R, Li Y, Yan W. The effectiveness of blended learning in health professions: Systematic review and meta-analysis. Med Internet Res J Med Internet Res 2016; 18(1):e2. doi: 10.2196/jmir.4807.  Back to cited text no. 15
McCutcheon K, Lohan M, Traynor M. A systematic review protocol on the use of online learning versus blended learning for teaching clinical skills to undergraduate health professional students. High Educ Pedagog 2016; 1:82-8.  Back to cited text no. 16
Snodgrass S. Wiki activities in blended learning for health professional students: Enhancing critical thinking and clinical reasoning skills. Australas J Educ Technol 2011, 27(4): 563-580  Back to cited text no. 17
Kiviniemi MT. Effects of a blended learning approach on student outcomes in a graduate-level public health course. BMC Med Educ 2014; 14:47.  Back to cited text no. 18
Jokinen P, Mikkonen I. Teachers' experiences of teaching in a blended learning environment. Nurse Educ Pract 2013; 13:524-8.  Back to cited text no. 19
Posey L, Pintz C. Transitioning a bachelor of science in nursing program to blended learning: Successes, challenges and outcomes. Nurse Educ Pract 2017; 26:126-33.  Back to cited text no. 20
Gough D. Weight of evidence: A framework for the appraisal of the quality and relevance of evidence. Res Pap Educ 2007; 22:213-28.  Back to cited text no. 21


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