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Purpose: We aimed to evaluate the disparity between video-based learning and lecture-based learning on Jordanian medical
students’ satisfaction.
Methods: We conducted this cross-sectional study using a web-based questionnaire adapted from Student Evaluation of Educational
Quality survey. Using convenience sampling, medical students studying at the University of Jordan and Jordan University Hospital
were recruited. Participants in either clinical or basic-science years that have completed the entire survey were included in the
final analysis.
Results: We surveyed a total 487 participants among which male to female ratio was 1.19:1. Participants perceived greater benefit
in terms of learning, instructor enthusiasm, content organization, breadth of teaching, and quality and number of assignments when
using video-based learning (all p<0.01). In contrast, face-to-face learning was associated with significantly higher benefits in terms
of group interactions (p<0.01) and capacity for rapport building (p<0.01). There was no significant difference in perceived examination
performance between the two learning modalities (p=0.11).
Conclusion: Video-based learning is the preferred learning modality among Jordanian medical students. Despite its dominance
across multiple domains, it should be implemented as an adjunct to traditional classroom teaching for it is vital in the development
of good communication skills and building rapport in medical students.
Key Words: Lecture, Medical students, Educational measurement, Spatial navigation, Educational technology, Distance education
Received: September 29, 2022 • Revised: November 29, 2022 • Accepted: December 12, 2022 Korean J Med Educ 2023 Mar; 35(1): 21-32
Corresponding Author: Abdallah Al-Ani (https://orcid.org/0000-0002-3517-3601) https://doi.org/10.3946/kjme.2023.246
Office of Scientific Affairs and Research, King Hussein Cancer Center, Queen Rania Street 202, eISSN: 2005-7288
Amman, Jordan Ⓒ The Korean Society of Medical Education. All rights reserved.
Tel: +962.791184320 Fax: +962.799201131 email: [email protected] This is an open-access article distributed under the terms of the
Creative Commons Attribution Non-Commercial License (http://
creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted
non-commercial use, distribution, and reproduction in any medium,
provided the original work is properly cited.
21
Omar Ashour, et al : The impact of video-based learning on medical students
accessibility (e.g., control the flow and speed of the videos) that investigated the preference and efficacy of those
[3,4]. Nonetheless, video-based lectures may decrease live platforms, or compared their effects to live lectures on
lecture attendance which could eliminate more profound student satisfaction. Since video-based resources have
student-teacher interactions [5]. become a well-established resource for medical students,
The literature demonstrates that both video-based we conducted this study to compare the effects of video-
lectures and face-to-face learning had similar test per- based learning and lecture-based learning on students’
formances [3,6-8]. Despite similarities in examination satisfaction among Jordanian medical students.
performance, these studies showed significant disparity in
preference. Several studies showed that students preferred
live lectures in comparison to video lectures [6-8]. None- Methods
theless, these observations are non-consistent throughout
the literature. Ramlogan et al. [9] in 2014 demonstrated
1. Study setting
that mean post-test scores were statistically significantly
higher in students who attended face-to-face lectures This study was conducted throughout September of 2020
compared with those relying on video-based lectures. at the University of Jordan and Jordan University Hospital.
Moreover, it appears that in the greater context of clinical The University of Jordan is the largest and oldest
practice, e-learning modalities, such as video-base lec- university in Jordan harboring more than 50,000 students.
tures, have little to no effect in affecting patient outcomes Medical students go through 3 years of basic medical
or healthcare professionals’ behaviors [10]. sciences learning (i.e., year 1, 2, and 3), then move to
Preparing future healthcare workers for today’s complete their clinical training at the Jordan University
internet-heavy environment calls for the reconsideration Hospital (i.e., year 4, 5, and 6).
of teaching methods. The adoption of online learning frees
2. Implementation of video-based learning
institutions from time and space limitations [11]. However,
it is also influenced by a myriad of barriers including Throughout their medical education, students primarily
administrative issues, social interactions, academic and attend face-to-face lectures. The use of video-based
technical skills, motivation issues, and accessibility gaps lectures is strictly exclusive to supplementary courses
among others. Nonetheless, due to the insurgency of the where attendance is not mandatory. During the COVID-19
coronavirus disease 2019 (COVID-19) pandemic, imple- pandemic, video-based learning was exclusively utilized
menting virtual learning methods became a necessity [12]. in the continuing of medical education. However, as the
E-learning modalities proved to be an accessible and degree of pandemic’s extreme distancing restrictions were
practical method of learning during the pandemic [13]. lowered, video-based learning was officially integrated
Video-based learning can serve as a powerful tool due to within the medical curriculum for both basic sciences and
the widespread use of technology by students [14]. In clinical clerkships.
addition, it can contribute to achieving the necessary Video-based learning was implemented at the Uni-
pandemic-oriented safety measures (e.g., social dis- versity of Jordan and Jordan University Hospital through
tancing) thereby limiting the spread of the disease [15]. two modalities. Firstly, recorded lectures, which are made
To our knowledge, there have not been sufficient studies in the same exact fashion as traditional lecture but lacking
the interactivity component. Post-lecture feedback or domain (three items), and an overall preference domain
forum discussions were not available for these lectures. (two items). The sociodemographic domain pertains to
Recorded lectures were primarily used for continuing basic gender, age, and academic year. The modified SEEQ
sciences education. Secondly, live-lectures were ad- questionnaire was composed of the following sub-
ministered to small batches of medical students per assigned domains: learning (four items), enthusiasm (three items),
groups and topics. All lectures were either provided through organization (four items), group interaction (three items),
Microsoft Teams or Zoom, which enabled moment-to- individual rapport (four items), breadth (four items),
moment interactivity between medical students and their examinations (one item), and assignments (one item). For
lecturers. Live-lectures were primarily used as a temporary the exception of the sociodemographics and overall
replacement for clerkship-oriented learning. preference domains, the questions were asked twice for
In terms of video-based learning extent and depth of both video-based lectures and classroom lectures. A final
usage, recorded lectures were exclusively used instead of free response question pertaining to type of utilized
traditional teaching within some courses (e.g., micro- video-based learning programs was also added. The survey
biology) or was used interchangeably with traditional was tested in a pilot study which received 73 participants,
learning in others (e.g., cardiac and blood vessel phy- not included in the final analysis, and yielded a Cronbach
siology). On the other hand, live-lectures completely α value of 0.736.
replaced traditional teaching during the early phases of
4. Sampling and participants characteristics
the pandemic, then are now used interchangeably with
traditional clerkship learning depending on a variety of Participants that matched the inclusion criteria included
factors including number of students, clinical workload, those in their basic-medical sciences years to trainees at
availability of lecturers, and practical utility of topics the Jordan University Hospital. First year students were
within routine clinical practice. excluded because the study was conducted at the beginning
of the academic year which stripped such students of any
3. Questionnaire development
exposure to either learning methods. A convenience
In this study, we surveyed medical students and trainees sampling technique was used to recruit participants. The
using an online, anonymous, and self-administered ques- students of each class at the University of Jordan are
tionnaire. The questionnaire was composed of a variety members of an online group specific to each batch. The
of question types including a 6-point Likert scale, multiple survey was posted on the group of each class and all
choice, dropdown, and free response questions which participations were voluntary and anonymous. In addition,
amounted to a total of 60 items. Throughout its develop- participants were encouraged to share the questionnaire
ment, we adapted the Student Evaluation of Educational amongst their peers creating a snowball sample. Google
Quality (SEEQ) survey, a reliable and valid instrument forms was used to construct and disseminate the survey.
used to collect students’ evaluations of university teaching, The use of a web-based method of survey administration
as well as several questions derived from a personalized allows for a greater reach and easy accessibility for the
survey [16]. The final survey instrument was composed students. A QR code (quick response code) was developed
of a sociodemographic domain (three items), a modified and disseminated on campus in order to increase the
SEEQ questionnaire (24 items), instructor preference number of responses.
23
Omar Ashour, et al : The impact of video-based learning on medical students
Table 1. The Preferred Method of Learning According to the Age and Educational Level
Variable Total (%) Video-based learning (%) Classroom-based learning (%) p-value
Total 487 (100.0) 325 (68.3) 151 (31.7)
Gender 0.7
Males 222 (45.6) 150 (69.12) 67 (30.88)
Females 265 (54.4) 175 (67.57) 84 (32.43)
Training levela) <0.01
Basic 114 (23.4) 61 (54.0) 52 (46.0)
Clinical 373 (76.6) 264 (72.7) 99 (27.3)
a)
Training level in Jordanian medical schools is divided into basic medical years (years 1 through 3) and clinical training years (years 4 through 6).
Table 2. The Difference between Video-Based and Classroom Teaching Based on Students' Evaluation and Educational Level
Video Classroom
Domain Video Classroom p-value
Basic Clinical p-value Basic Clinical p-value
Learning 16.7±4.1 13.4±4.3 <0.01 16.2±4.2 16.9±4.0 0.12 14.0±3.9 13.2±4.4 0.08
Enthusiasm 16.3±4.0 12.6±4.6 <0.01 15.6±4.4 16.5±3.9 0.05 12.9±4.6 12.5±4.6 0.47
Organization 16.8±3.7 13.4±4.3 <0.01 15.9±3.8 17.1±3.7 <0.01 14.4±3.9 13.4±4.4 0.02
Group interaction 9.0±4.8 14.6±4.9 <0.01 8.7±4.5 9.0±4.9 0.4 15.2±4.6 14.5±4.9 0.16
Individual rapport 11.2±4.6 13.8±4.4 <0.01 11.0±4.4 11.3±4.7 0.56 14.7±3.8 13.5±4.6 0.01
Breadth 14.8±4.1 13.8±4.3 <0.01 14.2±4.3 15.0±4.1 0.08 14.6±3.9 13.6±4.4 0.03
Examinations 3.6±1.2 3.5±1.3 0.11 3.4±1.3 2.7±1.2 0.1 3.8±1.2 3.4±1.3 <0.01
Assignments 3.9±1.1 3.7±1.2 <0.01 4.0±1.1 3.9±1.2 0.44 3.9±1.1 3.6±1.2 0.02
Data are presented as mean±standard deviation or number.
demonstrated by clinical students using video-based Fig. 1. Reasons for Preferring Video-Based Teaching Modalities
platforms (p=0.05 and p<0.01, respectively). In contrast,
students in their basic medical sciences years significantly
perceive greater organization within face-to-face lectures
compared to their clinical counterparts (p=0.02).
Development of student-instructor rapport and fre-
quency of group interactions were perceived to be more
likely within a face-to-face learning environment (all
p<0.01). Our results show that face-to-face rapport was
significantly more perceived by students in their basic
medical sciences years (p=0.01). Perceptions of better
examination scores did not significantly differ between the
two teaching methods (p=0.11).
When examining differences based on the breadth (i.e.,
depth of presented material) and number of assignments comfort as their two main reasons (Fig. 1). In contrast,
of taught medical material, students and trainees signif- those favoring face-to-face classroom learning attributed
icantly leaned towards video-based learning (all p<0.01). their choice to the presence of greater room for inter-
It appears that medical students in their basic years are actions (e.g., discussion with instructor, ability to ask
significantly more appreciative of their material’s breadth questions).
and number of assignments within their face-to-face
lectures compared to clinical medical students (p=0.03 and
p=0.02, respectively). Whereas, these differences were not
Discussion
noted in between different training levels for video-based
learning. The principal purpose of this study was to examine
A total of 128 (26.3%) reported a clear preference to student preference and satisfaction between video-based
one of the given teaching methods. Participants favoring and face-to-face classroom-based teaching. Our findings
video-based learning (76.6%) report convenience and showed significant differences across nearly all domains
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Omar Ashour, et al : The impact of video-based learning on medical students
for the exception of perceived examination score benefits. appreciative of such enthusiasm. These findings can be
Substantial disparity favoring video-based teaching lied explained by inherent differences and challenges faced by
centrally within the following domains: quality of learn- instructors preparing either format. Historically and
ing, instructor enthusiasm, organization of provided ma- conventionally, Jordanian medical students are assigned
terials, depth, and number of assignments. On the other to short clinical rotations that are maximally 2 months in
hand, frequency and magnitude of instructor-student length, throughout which each rotation is given by a
interactions, and buildup of instructor-student rapport randomly assigned clinical instructor covering a myriad
were the major factors influencing preference and satis- of clinical topics and skills. Those instructors are not
faction with face-to-face classroom-based teaching. exclusive teachers but rather medical practitioners that
Our results demonstrated that students perceive greater often rely on giving in-round lectures due to their ex-
value from video-based learning in terms of improved tremely busy schedules.
interest, enhanced understanding, and intellectual stim- The high workload, manifesting due to a variety of
ulation. This can be attributed to the recurrent theme of reasons (e.g., hospital nature), often forces instructors to
convenience that accompanied video-based lectures conduct in-round seminars with barely any visual aids
among our participants. The ability to view lectures at the (e.g., presentations). Furthermore, even if such aids are
student’s own pace in a more familiar and comfortable present, their content, organization style, and depth are
setting empowers the learner to focus and understand the rarely, if ever, updated or given considerable attention.
material in a comprehensive manner. Videos provide On the other hand, video-based learning, whether part of
students with the option to view lectures at any playback the university’s efforts to battle the pandemic or when
speed, pause and repeat the content to their liking. There- sought within subscription-based platforms (e.g., Boards
fore, improving students’ efficiency by revisiting certain and Beyond) provide content/materials (i.e., presenta-
aspects that they may find difficult and strengthen any tions, seminars, flashcards, or quizzes) that are meti-
weak links. An assessment of undergraduates at the culously made and are often the product of the consensus
Harvard Medical School and the Harvard School of Dental of many experts within the field. Therefore, its only
Medicine demonstrated that video-based learning is expected that these teaching modalities exhibit greater
preferred for its efficiency and capability to save time [4]. degrees of quality. The breadth of content, in terms of
Previous studies portray that the flexibility of online its origins, implications, and future development, when
learning, when implemented and proctored under a presented in an organized and accessible fashion plays a
specific set of quality standards, contributes to a variety major role in building interest in the covered material and
of advantages including increased self-direction and facilitates taking more meaningful notes, therefore
autonomy [17-19]; this form of increased learner inde- amplifying the level of understanding.
pendence is regarded as both a goal and desirable adverse The opportunity to discuss the content of the lecture
effects of computer-assisted learning [18]. and interact with the lecturer remain vital aspects of the
We demonstrated that medical students perceive greater learning process. As students get to ask questions, high-
instructors’ enthusiasm, more profound content, and im- light personal weaknesses, and hear other students’
proved content organization within video-based learning, outlooks, they tend to acquire a better grasp of concepts.
in which clinical students/trainees are significantly more Our results demonstrate that instructor-student interac-
tion was perceived more positively within face-to-face adjuncts to traditional teaching, offering a more per-
teaching. Moreover, the majority of students who pre- sonalized learning experience. Interestingly, mean scores
ferred face-to-face classroom-based lectures value the for perception of rapport were significantly higher within
ability to participate in live and instantaneous interactions traditional, face-to-face, learning methods. It appears that
with mentors through in-depth class discussions or merely students use the classroom as a mean to achieve relational
through asking questions regarding vague topics of in- goals, these are, being liked and accepted [22]; the ac-
terest. These findings are consistent with previous studies complishment of which could bolster learning outcomes.
and confirm the importance of having an expert for Furthermore, education research shows that instructor
discussion [18,20]. rapport is a consistent predictor of learning and par-
We demonstrated that there was no disparity in per- ticipation, ultimately promoting affective learning, re-
ceptions of examinations scores across between video and ducing student anxiety, and providing a suitable learning
face-to-face learning. Nonetheless, students in their basic environment through the facilitation of better in-class and
medical sciences years perceive better examination scores out-of-class communication [23]. Thus, it appears that
when utilizing classroom-based learning compared to ability of traditional teaching methods to fill psychological
their clinical counterparts. Such phenomenon might be needs of students renders its existence rather imperative.
explained by the nature of exam development between This notion is particularly pronounced during the
those two training stages. Clinical examinations are COVID-19 pandemic. Azlan et al. [24] in 2020 demon-
developed by all physicians who participate in the teaching strated that Malaysian post-graduates preferred traditional
process and often need to target specific concepts that a classroom teaching over a variety of e-learning modalities,
general practitioner must know for future practice. On the possibly due to dramatic social life changes incurred over
other hand, basic medical sciences are often developed by the pandemic leading to an intense psychological burden
the instructor that provides lectures, thus, such exams will manifesting as loneliness, anxiety, stress, or even de-
mostly reflect and be adapted from the lecturer’s own pression. Similar attitudes were demonstrated by medical
perception of important topics or concepts. Thus, at- students in the United Kingdom and Libya [25,26]. In
tendance of these “biased” lectures could possibly in- addition to the psychosocial burden, pandemic-related
fluence students’ examination scores. disdain of digital learning could also be a product of the
Nonetheless, the lack of meaningful differences in sudden shift to exclusive online learning, under pre-
educational outcomes (i.e., examination scores) may paration of online curriculums, negative attitudes from
indicate that both modalities of teaching are equally instructors towards digital technology, or technical dif-
effective. This notion has been portrayed by a multitude ficulties inherently associated within an unoptimized
of trials comparing the effectiveness of different learning digital infrastructure [27].
modalities to traditional didactic lectures [21]. However, Nonetheless, an overall consensus on the acceptability
it should be noted that such observation may not stand of distant learning during the pandemic is yet to be
consistent throughout the literature due to disparity in reached. In contrast to the aforementioned studies, there
assessment methodologies or biases. The literature dem- exists a body of literature which demonstrates favorable
onstrates that alternative learning methods such as perceptions by all stakeholders involved in the medical
video-based learning are most effective and accepted as educational process [28-30]. Undergraduates, both me-
27
Omar Ashour, et al : The impact of video-based learning on medical students
dical and pre-medical, post-graduate students, and in- are aware of their capacity to develop professionalism
structors showed positive behaviors, dedicated learning, through e-learning modalities [36,37]. In fact, self-
and high satisfaction from utilizing different forms of discipline and commitment to assignments were among the
distant learning. This positive reception is further sup- most recognized factors leading to success in online
plemented by a systematic review which showed that learning [38]. However, a survey of Polish medical stu-
health professions students’ perceptions, acceptance, mo- dents demonstrated that online learning results in less
tivation, and engagement toward e-learning are pre- activity and is often associated with lack of discipline
dominantly positive and are similar to pre-COVID-19 era which was primarily noted in junior students [39].
literature targeting this very same topic [31]. Overall, a systematic review examining the effects of
Interestingly, the impact of COVID-19 on education is offline digital education on medical students demonstrated
yet to be determined. Various commentaries speculate on that digital education is effective in influencing the
the meaningful role of e-learning during the post- knowledge and skill-set of medical students, with the
pandemic era [32,33]; speculations that are rather am- latter having a greater impact [40]. Despite the great
bitious and positive. However, there is a dearth of studies heterogeneity and high risk of bias reported by the authors,
investigating post-pandemic perceptions of students to- the potential of offline digital education lies within its
wards e-learning. Sharma and Alvi [34] in 2021 demon- scalability, cost-effectiveness compared to building an
strated that students’ perception of post-pandemic learn- online digital infrastructure (e.g., virtual reality), and its
ing methods (i.e., web-based learning) are negative com- acceptance among health professionals [40,41]. Thus, it
pared to their pre-pandemic perceptions of blended could serve as a major teaching tool in low resource
learning methods. These results may not hold consistent countries and an alternative in developed nations. None-
grounds for different populations as they might the net theless, the potential of digital education, even if offline,
result of low-preparedness of targeted students to use could be hindered by the quality of hardware, resource
technology in learning or accessibility issues (e.g., lack investment and acceptance of the paradigm change by
of reliable internet services). Moreover, Guppy et al. [35] policy makers and institutions, and most importantly,
in 2022 provides evidence on the congruence between access to the internet for download. As of 2021, nearly
educators and students on the adaption of blended/hybrid 3 billion people have never used the internet [42]. It should
learning post COVID-19 and the increase in online be noted that effectiveness of digital education is measured
courses. However, students were more skeptical about only in the short-term as no trials exist measuring the
such changes [35]. long-term adverse effects of primarily using such teaching
While convenience might act as the primary drive for modality.
students’ acceptance of e-learning, the examination of It appears that the utility of e-learning transcends that
professionalism is vital to continuing education among of providing medical students with lectures in different
medical students as it seeks to ensure that students abstain formats but was also shown to be effective in promoting
from unethical practices. Professionalism is a topic technical skills. The body of literature shows promising
characterized by a variety of dimensions such as in- results across the following topics: laboratory skills [43],
formation literacy, commitment to values, and respon- electrocardiogram visualization and interpretation [44],
siveness to name a few. Studies demonstrate that students chronic wound management [45], fundus examination [46],
and general ward examination skills (e.g., cannulation, communication skills and building rapport, both of which
physical examination) [47]. It should be noted that the are the foundations of a good physician and amplify the
effectiveness of teaching such skills must be within a mental fortitude of students. Taking into account the
blended/hybrid context between e-learning and tradi- recent COVID-19 pandemic, a shift towards video-based
tional feedback teaching. Based on our results, we re- learning was inevitable during times of social isolation.
commend the implementation of a learner-centered This has put the capacity of video-based learning to the
teaching module in which the student is initially exposed test, highlighting major advantages and drawbacks. Cer-
to the required concepts through offline video-based tainly, a long road lies ahead towards perfecting the use
lectures that are coupled with traditional live lectures of this learning tool. However, the integration of video
throughout which experts assess understanding of said lectures has proved to be of great benefit, as it has recently
concepts and illuminate on advanced concepts (i.e., become a more appealing option to students which may
asynchronous blended teaching). Such flipped pedagogical improve student learning and interest.
process has shown promise in enhancing student
performance [48,49].
ORCID:
1. Limitations
Omar Ashour: https://orcid.org/0000-0001-6813-4740;
Our results should be considered with great caution. The Ahmad M. Alkhatib: https://orcid.org/0000-0002-7758-8864;
cross-sectional nature of the design and its associated Qusai Al Zureikat: https://orcid.org/0000-0002-2933-769X;
sampling technique may show the preferences of only a Mustafa Al-Shaikhli: https://orcid.org/0000-0001-7916-0370;
sub-set of medical students at the University of Jordan. Basel Bani Ata: https://orcid.org/0000-0002-8124-479X;
The usage of a web-based survey might introduce selection Talal Massad: https://orcid.org/0000-0002-6989-5987;
bias which attracts students that are likely users of Leen Al-Huneidy: https://orcid.org/0000-0002-5751-1210;
web-based learning. Furthermore, despite the University Mohammed Q. Al-Sabbagh: https://orcid.org/0000-0002-4872-7116;
of Jordan having the largest and oldest medical school in Abdallah Al-Ani: https://orcid.org/0000-0002-3517-3601
Jordan, our results may not be representative of all medical Acknowledgements: none.
students across Jordan’s other five medical schools. Funding: No financial support was received for this
Finally, due to the diversity of quality provided by video- study.
based teaching modalities, participants answers might be Conflicts of interest: No potential conflict of interest
only a reflection of their personal experiences with a relevant to this article was reported.
subset that does not represent the entire platform. Author contributions: Conceptualization: OA; formal
analysis: MQA, LA, and AA; Writing-original draft: OA,
2. Conclusion
AMA, QA, MA, BB, TM, and MQA; and writing-review
In light of what’s above, video-based learning was the & editing: LA and AA.
preferred method among students at the University of
Jordan across multiple domains, yet, it should not act as
substitute to traditional didactic lectures. Face-to-face
classroom-based lectures aid in the development of good
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Omar Ashour, et al : The impact of video-based learning on medical students
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