Research code: IR.IUMS.REC.1401.490
Ethics code: IR.IUMS.REC.1401.490
Clinical trials code: IR.IUMS.REC.1401.490
Ali Tayebi 
, Shabahang Jafarnejad , Mahya Naderkhani * , Ali Arjmand Tajoddini , Fateme Nouri Abhari , Faranak Olamaeian , Shahin Keshtkar Rajabi , Alireza Zakaryaei
, Shabahang Jafarnejad , Mahya Naderkhani * , Ali Arjmand Tajoddini , Fateme Nouri Abhari , Faranak Olamaeian , Shahin Keshtkar Rajabi , Alireza Zakaryaei
*Emergency Medicine Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran , naderkhani.m@iums.ac.ir
Abstract: (686 Views)
Background:
An emerging disease surfaced in China in December 2019, manifesting as acute respiratory syndrome, rapidly evolving into a global pandemic (1-3). The cause was identified as the severe acute respiratory syndrome coronavirus (SARS-CoV-2), designated COVID-19 by the World Health Organization on January 30, 2020 (4). In response to its high fatality rate and contagiousness, countries worldwide implemented widespread closures, including Iran, where all administrative, commercial, and educational activities ceased. Consequently, virtual education gained prominence to mitigate academic setbacks and ensure continuity (5). This shift necessitated educators, many inexperienced in virtual teaching, to adapt quickly (6). Medical education also adapted to these conditions, with significant impacts on student learning in hospital settings. Face-to-face teaching in hospitals and clinics was curtailed due to the disease burden in Iran, leading to substantial changes in medical education (7, 8). Studies in Iran have yielded conflicting findings on the pandemic's effects on medical education, highlighting both the efficacy of online and virtual medical courses and varying outcomes (8-12). Recognizing the significance of the semiology course for medical students, crucial for learning clinical examinations and patient interaction skills before entering hospital departments, emphasizes the need for structured training in semiology. This foundational unit underpins medical and clinical education, playing a vital role in future patient care and healthcare management (13). The current research was designed with the aim of investigating the level of students' satisfaction and students' views on different aspects of practical semiology unit courses in two groups of students who completed the course in person and virtual.
Methods:
This study was a meticulous examination conducted among medical students enrolled at Iran University of Medical Sciences (IUMS) in Tehran throughout the year 2022. To ensure ethical standards, the study commenced following approval from the IUMS Ethics and Research Committee (approval number: IR.IUMS.REC.1401.490). Participants in this study were enrolled using convenience sampling into two groups: a virtual learning group and a face-to-face learning group, both meticulously matched in demographic characteristics such as age, gender, and academic semester. The sampling strategy employed convenience sampling, categorizing participants into two distinct groups: face-to-face and virtual learning environments. This stratification aimed to maintain demographic equilibrium concerning variables such as age, gender, and academic semester, thereby mitigating potential confounding factors. Adequate sample sizes were computed to uphold statistical power, mandating a minimum of 193 participants encompassing both groups: 65 in the virtual cohort and 128 in the face-to-face cohort. The practical semiology curriculum was tailored based on specific needs identified among students at Iran University of Medical Sciences (IUMS). For the virtual course, educational content included 57 carefully crafted instructional videos sourced from expert lectures and practical demonstrations. These resources were made available on the IUMS online platform prior to the course commencement, ensuring accessibility and preparation for virtual learners. Conversely, the face-to-face course was conducted in a spacious, well-ventilated facility equipped with 15 dedicated learning stations. Each station accommodated 5-9 students, an instructor, and occasionally a simulated patient actor when required. These stations were fully stocked with essential tools and educational aids, facilitating hands-on learning experiences under direct educator supervision. The curriculum spanned three intensive modules over 12 days, covering critical topics such as clinical history-taking, physical examinations, and technical competencies including surgical techniques and invasive procedures. Outcome measures centered on evaluating student perceptions of the learning environment and overall satisfaction levels. This assessment was conducted using the Dundee Ready Education Environment Measure (DREEM) (14) questionnaire, a validated tool designed to assess educational climate effectiveness across domains like learning, teaching quality, academic self-perception, educational atmosphere, and social conditions. The DREEM questionnaire assesses students' perceptions across several dimensions: learning, teachers, academic ability, educational atmosphere, and social conditions of education. Each component uses a 5-point Likert scale, with scores categorized into poor, moderate, and high levels based on predefined score ranges. Additionally, student satisfaction with the semiology course is evaluated through a separate 10-question online questionnaire, also using a 5-point Likert scale, with scores classified into poor, moderate, and high satisfaction levels. Statistical analysis of collected data utilized SPSS software, employing standard metrics such as mean ± standard deviation for continuous variables and percentages for categorical data. Comparative analysis included Mann-Whitney U tests, independent sample t-tests, and chi-square tests as appropriate, with significance set at P ≤ 0.05. These rigorous analytical approaches aimed to discern significant differences and draw robust conclusions regarding the efficacy of each educational modality in fostering student learning and satisfaction in semiology training at IUMS.
Results:
A total of 325 medical students were included in this study. 22.8% of the students (n=74) had participated in virtual training and 77.2% of the students (n=251) had participated in the face-to-face semiology course. The average age of students was 22.65 ± 2.75 years and ranged from 20 to 38 years (P=0.8). 54.2% (n=176) were male students and 45.8% (n=149) were female students (P=0.01) (Table 1).
Table 1. Demographic Characteristics of the Participants by Type of Learning Groups.
The relationship between the type of students' training course (face-to-face or virtual) and their level of satisfaction was investigated. Statistical analysis did not show a significant relationship between these two variables (P=0.1) (Table 2).
Table 2. Satisfaction of the Participants by Type of Learning Groups.
The dimensions of the DREEM questionnaire were examined, Overall, poor perception had a very low prevalence (0-1.4%). In contrast, high perception in students showed a prevalence of more than 90% in all dimensions in face-to-face education and between 77 and 91.9% in virtual education. Except for SPSCE, in other dimensions, the level of high perception was significantly higher in students with face-to-face education (P<0.05) (Table 3).
Table 3. Examining and Comparing the Dimensions of Students' Perception by Type of Learning Groups.
Conclusion:
In general, according to the DREEM index, the level of satisfaction with education in general and in all its dimensions was reported to be high and suitable for both learning groups. The overall score of satisfaction and perception with education based on DREEM, for a group of students who participated in face-to-face learning, in all dimensions including: SPL, SPT, SPAA, SPEA and SPSCE was more than the virtual group. This study showed that although virtual training has high satisfaction among students, the face-to-face training method caused higher academic satisfaction and perception. Therefore, considering the nature of the semiology course and its clinical importance, it is suggested that this course and, in general, courses that have a high clinical aspect, be taught face-to-face. It is recommended to compare the final test results of students in two face-to-face and virtual groups of semiology course in other studies.
An emerging disease surfaced in China in December 2019, manifesting as acute respiratory syndrome, rapidly evolving into a global pandemic (1-3). The cause was identified as the severe acute respiratory syndrome coronavirus (SARS-CoV-2), designated COVID-19 by the World Health Organization on January 30, 2020 (4). In response to its high fatality rate and contagiousness, countries worldwide implemented widespread closures, including Iran, where all administrative, commercial, and educational activities ceased. Consequently, virtual education gained prominence to mitigate academic setbacks and ensure continuity (5). This shift necessitated educators, many inexperienced in virtual teaching, to adapt quickly (6). Medical education also adapted to these conditions, with significant impacts on student learning in hospital settings. Face-to-face teaching in hospitals and clinics was curtailed due to the disease burden in Iran, leading to substantial changes in medical education (7, 8). Studies in Iran have yielded conflicting findings on the pandemic's effects on medical education, highlighting both the efficacy of online and virtual medical courses and varying outcomes (8-12). Recognizing the significance of the semiology course for medical students, crucial for learning clinical examinations and patient interaction skills before entering hospital departments, emphasizes the need for structured training in semiology. This foundational unit underpins medical and clinical education, playing a vital role in future patient care and healthcare management (13). The current research was designed with the aim of investigating the level of students' satisfaction and students' views on different aspects of practical semiology unit courses in two groups of students who completed the course in person and virtual.
Methods:
This study was a meticulous examination conducted among medical students enrolled at Iran University of Medical Sciences (IUMS) in Tehran throughout the year 2022. To ensure ethical standards, the study commenced following approval from the IUMS Ethics and Research Committee (approval number: IR.IUMS.REC.1401.490). Participants in this study were enrolled using convenience sampling into two groups: a virtual learning group and a face-to-face learning group, both meticulously matched in demographic characteristics such as age, gender, and academic semester. The sampling strategy employed convenience sampling, categorizing participants into two distinct groups: face-to-face and virtual learning environments. This stratification aimed to maintain demographic equilibrium concerning variables such as age, gender, and academic semester, thereby mitigating potential confounding factors. Adequate sample sizes were computed to uphold statistical power, mandating a minimum of 193 participants encompassing both groups: 65 in the virtual cohort and 128 in the face-to-face cohort. The practical semiology curriculum was tailored based on specific needs identified among students at Iran University of Medical Sciences (IUMS). For the virtual course, educational content included 57 carefully crafted instructional videos sourced from expert lectures and practical demonstrations. These resources were made available on the IUMS online platform prior to the course commencement, ensuring accessibility and preparation for virtual learners. Conversely, the face-to-face course was conducted in a spacious, well-ventilated facility equipped with 15 dedicated learning stations. Each station accommodated 5-9 students, an instructor, and occasionally a simulated patient actor when required. These stations were fully stocked with essential tools and educational aids, facilitating hands-on learning experiences under direct educator supervision. The curriculum spanned three intensive modules over 12 days, covering critical topics such as clinical history-taking, physical examinations, and technical competencies including surgical techniques and invasive procedures. Outcome measures centered on evaluating student perceptions of the learning environment and overall satisfaction levels. This assessment was conducted using the Dundee Ready Education Environment Measure (DREEM) (14) questionnaire, a validated tool designed to assess educational climate effectiveness across domains like learning, teaching quality, academic self-perception, educational atmosphere, and social conditions. The DREEM questionnaire assesses students' perceptions across several dimensions: learning, teachers, academic ability, educational atmosphere, and social conditions of education. Each component uses a 5-point Likert scale, with scores categorized into poor, moderate, and high levels based on predefined score ranges. Additionally, student satisfaction with the semiology course is evaluated through a separate 10-question online questionnaire, also using a 5-point Likert scale, with scores classified into poor, moderate, and high satisfaction levels. Statistical analysis of collected data utilized SPSS software, employing standard metrics such as mean ± standard deviation for continuous variables and percentages for categorical data. Comparative analysis included Mann-Whitney U tests, independent sample t-tests, and chi-square tests as appropriate, with significance set at P ≤ 0.05. These rigorous analytical approaches aimed to discern significant differences and draw robust conclusions regarding the efficacy of each educational modality in fostering student learning and satisfaction in semiology training at IUMS.
Results:
A total of 325 medical students were included in this study. 22.8% of the students (n=74) had participated in virtual training and 77.2% of the students (n=251) had participated in the face-to-face semiology course. The average age of students was 22.65 ± 2.75 years and ranged from 20 to 38 years (P=0.8). 54.2% (n=176) were male students and 45.8% (n=149) were female students (P=0.01) (Table 1).
Table 1. Demographic Characteristics of the Participants by Type of Learning Groups.
| Characteristics | face-to-face learning group (n=251) |
Virtual learning group (n=74) |
P value[1] |
| Gender, n (%) Male Female |
127 (50.6%) 124 (49.4%) |
49 (66.2%) 25 (33.8%) |
0.01 |
| Age, years (SD)[2] | 22.49 (2.4) | 22.97 (2.9) | 0.8 |
The relationship between the type of students' training course (face-to-face or virtual) and their level of satisfaction was investigated. Statistical analysis did not show a significant relationship between these two variables (P=0.1) (Table 2).
Table 2. Satisfaction of the Participants by Type of Learning Groups.
| Characteristics | face-to-face learning group (n=251) |
Virtual learning group (n=74) |
P value[3] |
| Satisfaction, n (%) Poor Moderate High |
0 (0) 16 (6.4) 235 (93.6) |
1 (1.3) 7 (9.5) 66 (89.2) |
0.1 |
The dimensions of the DREEM questionnaire were examined, Overall, poor perception had a very low prevalence (0-1.4%). In contrast, high perception in students showed a prevalence of more than 90% in all dimensions in face-to-face education and between 77 and 91.9% in virtual education. Except for SPSCE, in other dimensions, the level of high perception was significantly higher in students with face-to-face education (P<0.05) (Table 3).
Table 3. Examining and Comparing the Dimensions of Students' Perception by Type of Learning Groups.
| Characteristics | face-to-face learning group (n=251) |
Virtual learning group (n=74) |
P value3 |
| Students' perception of learning, n (%) Poor Moderate High |
1 (0.4) 23 (9.2) 227 (90.4) |
0 (0) 17 (23) 57 (77) |
0.006 |
| Students' perception of teachers, n (%) Poor Moderate High |
0 (0.4) 12 (4.8) 239 (95.2) |
0 (0) 14 (18.9) 60 (81.1) |
0.001> |
| Students' perception of their academic ability, n (%) Poor Moderate High |
0 (0) 13 (5.2) 238 (94.8) |
1 (1.4) 11 (14.9) 62 (83.8) |
0.003 |
| Students' perception of educational atmosphere, n (%) Poor Moderate High |
0 (0) 8 (3.2) 243 (96.8) |
1 (1.4) 8 (10.8) 65 (87.8) |
0.005 |
| Students' perception of the social conditions of education, n (%) Poor Moderate High |
0 (0) 14 (5.6) 237 (94.4) |
0 (0) 6 (8.1) 68 (91.9) |
0.4 |
Conclusion:
In general, according to the DREEM index, the level of satisfaction with education in general and in all its dimensions was reported to be high and suitable for both learning groups. The overall score of satisfaction and perception with education based on DREEM, for a group of students who participated in face-to-face learning, in all dimensions including: SPL, SPT, SPAA, SPEA and SPSCE was more than the virtual group. This study showed that although virtual training has high satisfaction among students, the face-to-face training method caused higher academic satisfaction and perception. Therefore, considering the nature of the semiology course and its clinical importance, it is suggested that this course and, in general, courses that have a high clinical aspect, be taught face-to-face. It is recommended to compare the final test results of students in two face-to-face and virtual groups of semiology course in other studies.
[1] *P-values indicate differences between students by type of learning groups. P < 0.05 was considered statistically significant.
[2] Abbreviation: SD, standard deviation.
[3] *P-values indicate differences between students by type of learning groups. P < 0.05 was considered statistically significant.
Type of Study: Research |
Subject:
medical education
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