Professional Documents
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Advan 00155 2017
Advan 00155 2017
doi:10.1152/advan.00155.2017.
Popovic N, Popovic T, Rovcanin Dragovic I, Cmiljanic O. A Open eClass are open source and, therefore, free to download
Moodle-based blended learning solution for physiology education in and use. Moodle (modular object-oriented dynamic learning
Montenegro: a case study. Adv Physiol Educ 42: 111–117, 2018; environment) is a web-based platform for course management
doi:10.1152/advan.00155.2017.—This study evaluates the impact of
that is translated into more than 30 languages and used all over
web-based blended learning in the physiology course at the Faculty of
Medicine, University of Montenegro. The two main goals of the study the world (11, 12). In 2013, Moodle was adopted by 23% of the
were: to determine the impact of e-learning on student success in higher education institutions in the United States, making it the
mastering the course, and to assess user satisfaction after the intro- second most common web-based course management system
duction of e-learning. The study compared a group of students who next to Blackboard (7).
attended the physiology course before, with a group of students who The application of web-based course management platforms
attended the physiology course after the Moodle platform was fully can be conducted in forms of blended learning and distance
implemented as an educational tool. Formative and summative learning (4). Blended learning combines traditional face-to-
assessment scores were compared between these two groups. The face education with computer-mediated delivery of educational
impact of high vs. low Moodle use on the assessment scores was
analyzed. The satisfaction among Moodle users was assessed by
material, as opposed to distance learning, which is mostly
the survey. The study found that attendance of face-to-face lectures computer mediated. Compared with a traditional style of learn-
had a positive impact on academic performance. The introduction of ing, web-based learning has been reported to have numerous
Moodle in the presented model of teaching increased interest of advantages: it increases flexibility when choosing the time and
students, attendance of face-to-face lectures, as well as formative and place to study, and it can improve communication among
summative scores. High frequency of Moodle use was not always students, as well as between students and the course instructor.
associated with better academic performance, suggesting that the In addition, it develops critical thinking though the use of
introduction of a new method of teaching was most likely equally multimedia presentations and additional links to useful web-
accepted by low- and high-achieving students. Most of the students
sites. It diversifies the means of student assessment and allows
agreed that Moodle was easy to use and it complemented traditional
teaching very well, but it could not completely replace traditional the course instructor to provide feedback to the students in a
face-to-face lectures. The study supports continuing the use of web- more efficient and timely manner (16). Nevertheless, one of the
based learning in a form of blended learning for physiology, as well main concerns expressed by the instructors is that attendance of
as for other courses in medical education. face-to-face lectures will decrease if the lecture notes are made
readily available through web-based course management plat-
blended learning; Moodle in physiology; web-based learning manage-
ment systems forms (15). This further raises the question of whether de-
creased attendance would affect student grades, considering
the fact that some researchers have reported a positive corre-
lation between attendance and academic performance, whereas
INTRODUCTION some could not confirm such correlation (9, 14). Despite these
concerns, web-based course management systems are being
The development of information technology at the end of the introduced at graduate and postgraduate levels of medical
20th century had a significant impact on many aspects of our education, as well as continuing medical education. Medical
lives. In accordance with this, the internet is perceived as one schools using Moodle as a platform in teaching physiology
of the most important sources of new information by many (8). reported a generally positive experience. Improvement of ac-
Therefore, web-based learning is becoming a newly accepted ademic performance after the introduction of the web-based
standard in the process of education. For example, Massachu-
learning management system was observed by some of these
setts Institute of Technology attempted to offer all of its
groups (15), whereas others noted that, while learner satisfac-
courses online in 2003 (17). Some of the course management
tion generally increased, grades did not change significantly (3,
systems designed to aid web-based learning are sold as com-
5, 6). At the University of Montenegro, an e-learning concept
mercial packages (e.g., Blackboard). Others like Moodle and
using Moodle as a platform for course management was
established in 2007 (13). Most of the courses at the University
Address for reprint requests and other correspondence: N. Popovic, Faculty
of Montenegro use Moodle as a simple repository for lecture
of Medicine, University of Montenegro, Kruševac bb, 81000 Podgorica, notes, some additionally use it for administration of exams and
Montenegro (e-mail: npopovic@ac.me). tests, and only a few use it for streaming lectures and deliver-
1043-4046/18 Copyright © 2018 The American Physiological Society 111
Downloaded from journals.physiology.org/journal/advances (036.073.175.125) on September 4, 2023.
112 BLENDED LEARNING SOLUTION FOR PHYSIOLOGY EDUCATION
ing the complete course in an online form (13). Physiology is feature was available, but was not used. During practical classes, a
the first course offered at the Faculty of Medicine to use this great number of laboratory exercises were replaced by video clips and
type of web-based learning technology since 2016. laboratory simulations, 45.5% of the total number of hours of practical
The two main goals of our study were to determine the classes. This way, recorded demonstrations could be watched indi-
impact of blended web-based learning via Moodle on student vidually as many times as necessary during the class, which made the
learning process more flexible and adjustable to each students’ learn-
success in mastering the physiology course, and to assess user
ing speed. Students were still obligated to personally perform those
satisfaction after the introduction of e-learning. laboratory exercises that were focused on developing essential skills
for work with patients (for example: performing exam of deep tendon
MATERIALS AND METHODS reflexes, recording ECG, measuring blood pressure). In addition,
Organization of the Physiology Course paper-based practical quizzes that were conducted at the end of each
practical class for group 1 were replaced by computer-based practical
Students enrolled at the Faculty of Medicine are accepted to the quizzes, which made classes more streamlined. Participation in prac-
program based on the merit and entrance exam scores. Accepted tical quizzes was mandatory.
students can enroll into one of the three professional tracks: School of
Medicine, School of Dentistry, or School of Pharmacy. In this paper, Formative Assessment
we present results collected on the students enrolled into the School of
Medicine. The study program at the School of Medicine lasts 6 yr, To evaluate the student learning progress for group 1, two term
and, after completion of this program, students earn a Medical Doctor tests in paper form were conducted during the course of the Fall
degree. Similar criteria have been used for acceptance of the students semester, and three computer-based tests were administered during
into the School of Medicine every year. the Spring semester through Moodle. To evaluate student learning
Physiology is a mandatory course for all students in this program progress for group 2, all five term tests were conducted in comput-
during their second year of studies. Passing the final exam in physi- erized form through Moodle in the classrooms of the Faculty of
ology is a condition for advancing to the third year of studies. Medicine.
Physiology is a two-semester course, with each semester lasting 15 Both paper-based and computer-based tests were in the same
wk. Students are required to take 11 credits of physiology in the Fall format: there were 60 multiple-choice questions that were randomly
and 11 in the Spring semester. The physiology course consists of chosen from a large comprehensive base of questions. Participation in
face-to-face theory lectures, practical classes, and seminars on se- all term tests was mandatory. Students were allowed to complete each
lected topics in medical physiology and biomedical physics. During test only one time. In the study presented here, the scores of those five
seminars, students are required to prepare material on a given topic test grades for each student are averaged and expressed as a percent-
and to present it in front of the student audience. The difficulty level age of correctly answered questions.
of the course and number of credit hours based on the European Credit
Transfer System did not change in the 2-yr period during which the
study was conducted. Feedback After Formative Evaluation
For group 1, paper-based term tests were graded within 2–3 days,
Participant Groups and Implementation of Information and feedback on incorrectly answered questions was provided at the
Technologies students’ request during the student consultation time. After taking
the computer-based test, the students would get feedback and review
The study included a group of 49 students enrolled in the physi-
ology course in the 2015–2016 academic year (group 1: 31% men, the term test results immediately after the test was completed while
69% women, average age 22 yr, age range from 19 to 30 yr), and a they were still in the classroom.
group of 42 students enrolled in the physiology course in the 2016 –
2017 academic year (group 2: 43% men, 57% women, average age 21 Summative Assessment
yr, age range from 19 to 24 yr).
It is important to emphasize that group 1 relied very little, whereas The final grade at the end of the course was a sum of student
group 2 relied heavily, on the use of Moodle as the web-based course activity during the year: attendance and participation in the face-to-
management system during the school year. Moodle was used, but face lectures and practical classes (20% of the grade), term test scores
only for test taking during the Spring semester 2015–2016 academic (30% of the grade), the final practical exam (5% of the grade), and the
year. However, for group 2, Moodle was fully introduced as an final oral exam (45% of the grade). Grades were expressed on a
educational tool at the very start of the 2016 –2017 academic year. six-grade scale from 5 to 10, with grade 5 being the failing grade and
There were no major changes in the teaching staff, curriculum, and grade 10 being the excellent grade.
schedule of classes between the two groups.
Group 1 had face-to-face theory lectures, and the lecture notes were Online Activity Logs as a Measure of Moodle Use
available for students to download from a password protected website
repository. During practical classes, students observed laboratory To define high-, mid-, and low-volume Moodle users, we counted
demonstrations in groups and were obligated to personally perform the total number of times each student in group 2 accessed lectures
some of the laboratory exercises. Laboratory simulations and video and other features offered through Moodle during the academic school
recordings of laboratory demonstrations were used only occasionally, year. The distribution of Moodle usage data points was verified by
8.33% of the total number of hours of practical classes. finding quartiles. Data points belonging to the first quartile repre-
For group 2, lectures were still delivered face to face. Thanks to sented low-volume, those in the second and third quartile represented
Moodle, students had access to complete curriculum chronologically mid-volume, and in the fourth quartile represented the high-volume
organized by weeks and published online, and to all of the lecture Moodle user group. Additionally, the number of clicks could represent
notes, some of them supplemented with video clips and links to a measure of the students’ active participation in education through
informative websites. The lecture notes were published on the day of Moodle by taking tests and quizzes. Nevertheless, this analysis was
the lecture, often a couple of hours before the lecture, so students not included in the paper, because all of the term tests and quizzes
could review the notes before the class. Students had the chance to test were mandatory, so all students participated in them to a similar
their knowledge by taking online practice tests. A student forum extent.
Demographic data. During the 2-yr period in which we Impact of Moodle on Attendance of Face-to-Face Lectures
conducted the study, there were 91 students enrolled in the and on Student Grades
physiology course. Out of that, 63.74% were women and
The results show that attendance of face-to-face physiology
36.26% were men. The average age of all students enrolled in
lectures is associated with better academic performance of
the physiology course was 21 yr, with the age range being from
19 to 30 yr. The survey participation was voluntary and students. This may be due to the fact that students with higher
anonymous. Sixty-four students (or 70.33%) participated in the grades tend to have better work ethics and, therefore, attend
survey in total; out of that 62.50% were women and 37.50% classes more regularly, regardless of the mode of delivery of
were men. The average age of the students who took the survey lecture notes. However, this finding also underscores the im-
was 21 yr, with the age range from 19 to 25 yr. portance of attending face-to-face lectures regularly. The in-
In addition, the survey showed that a great majority of the troduction of Moodle was associated with increased attendance
students reported their computer skills as average or better of the face-to-face lectures, which was contrary to expectations
(Fig. 6A). Most of the students reported that their internet of some course instructors. In accordance with this, the stu-
connection at home was adequate, whereas 3.13% students did dents in group 2 achieved higher formative and summative
not have internet connection at home and had to use computers grades compared with those in group 1.
in the public library (Fig. 6B). Moreover, 72% of students
regularly accessed Moodle over their smart phone, confirming Impact of Frequency of Moodle Use on Student Grades
that a large number of students accepted the innovation readily,
Frequency of Moodle use generally decreased during the
and that the change fit very well with their daily habits.
course of the academic year. This was most obvious when we
Questions using 5-point Likert scale. The summary of sur-
looked at the number of times weekly lectures were accessed
vey results is shown in Table 2. The results are presented as a
during the year. This observation agrees with the findings of
percentage of the total number of surveyed students who
other researchers (15) and might be related to two factors. First,
answered that particular question. The two most common
the students’ schedules and responsibilities relevant to other
answers to each question are in bold.
Open-ended questions. When asked what they liked about subject courses change in Spring, and academic pressure in-
the use of the web-based learning management system in the creases as the school year begins to come to an end. Second, all
physiology course, 35.94% students answered they liked the of the students were first-time Moodle users. By Spring semes-
easy access to notes, 39.06% quick feedback, and 28.13% liked ter, they became very proficient users of this online system,
how easy it was to use. When asked what they did not like, requiring less online accesses to achieve the same result. It is
6.25% students did not like outdated computers and equipment also possible that the attractiveness of the novelty decreased
in the classrooms of the Faculty of Medicine, and 4.69% with time.
students did not see any advantage in using Moodle during the Whereas introduction of Moodle did have a positive impact
physiology class. on academic performance, increased frequency of Moodle use
was not always associated with improved academic perfor-
Table 1. Moodle online activity mance. This finding was in accordance with other reports (6,
15) and might suggest that all students (low and high achiev-
Items Offered Online Through Moodle No. of Times Item Was Accessed ers) accepted the introduction of Moodle with a similar level of
interest and motivation. It is also possible that increased
Lectures 121 (per lecture on average)
Seminar topics information 52 frequency of Moodle use significantly affects only a subset of
Final oral exam list of questions 197 the student population, as suggested by the study by Antonoff
Final practical exam list of questions 74 et al. (1). This study showed that academic performance of
Course organization 120 individuals with mid-range scores did improve by increased
Useful links 19 (per link on average)
frequency of use of the Moodle-based online curriculum.
Survey Results satisfied with these innovative changes. These results are in
agreement with findings of others (6, 15). The study shows that
The survey results supported the finding that attending blended learning, or combining the traditional face-to-face
face-to-face lectures is important, even when a web-based lectures with a web-based course management program, might
course management system is used. The survey showed that
be the best way to improve the quality of education. The real
65% of students thought the information technologies com-
value of this educational innovation might be in the introduc-
plemented traditional methods of learning. However, only
tion of the same model of blended learning in other subject
44% of students agreed that information technologies can
classes, which will allow creation of links and cross-references
completely substitute for the traditional style of learning,
of the physiology course with clinical and other basic medicine
and 46% of students did not agree with this statement. Most
students agreed on several benefits of this innovation in subjects. This will increase motivation of students to learn and
learning: Moodle was easy to use (90%), it allowed prompt develop a critical way of thinking.
feedback (90%), improved their time management (59.38%), One of the limitations of our study is that the study com-
and improved communication between students and the pared a group of students who had mostly face-to-face lectures
teacher (59%). Seventy-eight percent of students recom- with minimal use of Moodle, with the group of students who
mended further use of Moodle in the physiology course, and had significantly more Moodle-based resources available
68% stated they would recommend use of Moodle in other throughout the year combined with face-to-face lectures. How-
subject classes. ever, the study did not examine groups of students in two
Based on the experience of the teaching staff, Moodle is extreme learning environments: a group with an access to
easy to use, has great flexibility with regards to editing and exclusively face-to-face lectures with no access to Moodle, and
changing the web page, and it does not require any previous a group with an access to online notes with no access to
experience in web page programming. The use of Moodle face-to-face lectures. This was not done because it could
decreased expenses related to supplying and maintaining potentially affect students’ overall performance in a negative
laboratory material and equipment, and it saved time in test way. Another limitation of the study is that the forum feature
preparation and grading. It also enabled course instructors to in Moodle was not used, which was reflected in the results of
monitor activity of students during the course in a more the student survey that showed only 31% of students felt
efficient way and provided quick feedback if the students Moodle improved communication among students, whereas
achieved their learning milestones on time. 36% felt it did not improve communication among students at
Collectively, these results suggest that students and course all. Seluakumaran et al. (15) used the forum feature and
instructors perceive the implementation of information tech- reported it to be most frequently accessed among all features
nologies in the physiology course as useful, and that they were offered through Moodle. However, the students still felt
A B
Fig. 6. A: computer skills as reported by
Internet connection
students in the survey (70.31% average,
23.44% above average, 6.25% below average
computer skills). B: internet connection qual-
ity at home as reported by students in survey
(48.44% excellent, 26.56% good, 17.19% av-
erage, 4.69% below average internet connec-
tion, and 3.13% of students stated that they
do not have internet connection at home).
Moodle did not improve their communication. In addition, • Students recommended that the use of Moodle for blended
Anwar et al. (2) reported that interaction via social media learning in physiology should be continued in the future.
platforms, such as Facebook, can successfully be used as a tool They also agreed that similar solutions should be adopted for
for blended learning in their neuroscience class. To improve other subject courses, which could enable linking between
communication among the students in the future, the forum physiology lectures with related modules from other subject
feature offered though Moodle should be redesigned, so its courses.
structure resembles the design and functionality of popular • Our next step will be to enable the forum feature of the
social media platforms. Alternatively, forum-type activities in Moodle and to explore possibilities utilizing social media
Moodle could be completely performed though Facebook platforms to improve communication among the course
pages. participants.
Conclusion
ACKNOWLEDGMENTS
The study presented here shows multiple benefits of the
The authors thank Dr. Bozo Krstajic and Aleksandra Radulovic for
use of blended, web-based course management programs in
all suggestions regarding web tools and for technical help with Moodle
physiology education compared with the traditional style of setup.
learning. The main contributions are summarized as fol-
lows:
DISCLOSURES
• The paper describes a case study of implementing a Moodle- No conflicts of interest, financial or otherwise, are declared by the
based blended learning solution for the physiology course authors.
curriculum, which resulted in improved academic perfor-
mance of the students. AUTHOR CONTRIBUTIONS
• The study shows that, although the use of the web-based
N.P. conceived and designed research; N.P., I.R.D., and O.C. performed
learning management systems was very well received by the experiments; N.P., T.P., and I.R.D. analyzed data; N.P. interpreted results
students and course instructors, they all agreed that, for the of experiments; N.P. and T.P. prepared figures; N.P. drafted manuscript;
best performance, these tools should still be combined with N.P. and T.P. edited and revised manuscript; N.P. approved final version of
traditional face-to-face teaching. manuscript.
1. Strongly 5. Strongly
Graded Answers Disagree 2. Disagree 3. Neutral 4. Agree Agree
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