top answer:   Please read the following study: Rehana Khalil, Ali E. Mansour, Walaa A. Fadda, Khaled Almisnid, M



Please read the following study:

Don't use plagiarized sources. Get Your Custom Essay on
top answer:   Please read the following study: Rehana Khalil, Ali E. Mansour, Walaa A. Fadda, Khaled Almisnid, M
Just from $10/Page
Order Essay

Rehana Khalil, Ali E. Mansour, Walaa A. Fadda, Khaled Almisnid, Mohammed Aldamegh, Abdullah Al-Nafeesah, Azzam Alkhalifah, & Osama Al-Wutayd. (2020). The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students’ perspectives. BMC Medical Education, 20(1), 1–10.

Consider the challenges discussed in this qualitative study, propose any changes you would make in the study design or additional comments you would offer regarding your experiences during the pandemic while attending online courses and how it aligns with the study findings.   

Be sure to support your statements with logic and argument, use at least three peer reviewed articles and cite them to support your statements.


The sudden transition to synchronized
online learning during the COVID-19
pandemic in Saudi Arabia: a qualitative
study exploring medical students’
Rehana Khalil1, Ali E. Mansour1, Walaa A. Fadda2, Khaled Almisnid2, Mohammed Aldamegh3,
Abdullah Al-Nafeesah4, Azzam Alkhalifah5 and Osama Al-Wutayd1*


Background: The closure of educational activities in the Kingdom of Saudi Arabia due to the ongoing COVID-19
pandemic resulted in an unplanned shift from traditional learning to a setup that exclusively involves digital
teaching and learning. Within this context, the present study aimed to explore undergraduate medical students’
perceptions regarding the effectiveness of synchronized online learning at Unaizah College of Medicine and
Medical Sciences, Qassim University, Saudi Arabia.

Methods: A qualitative study was conducted using virtual focus group discussions synchronously with the help of
a discussion guide consisting of seven open-ended questions. Overall, 60 medical students were recruited using a
maximum variation sampling technique; these students then participated in eight focus group discussions. All
interviews were recorded, transcribed verbatim, and analyzed for thematic contents using the standard (Mayring,
Kiger. M. E. and Braun.V) content analysis framework.

Results: A thematic content analysis yielded four core themes: (1) educational impact, (2) time management, (3)
challenges encountered, and (4) preferences for the future. The online modality was well-received, and all
participants agreed that online sessions were time saving and that their performance was improved due to
enhanced utility of time; however, they indicated that they encountered some challenges, including
methodological, content perception, technical, and behavioral challenges during sessions and online exams. Most
of the preclinical students preferred online learning for the upcoming academic years.

Conclusion: Synchronized online classes were well-accepted by the medical students. This represents significant
and promising potential for the future of medical education. The principles of the online learning model and
learning outcomes should be rigorously and regularly evaluated to monitor its effectiveness.

Keywords: Sudden transition, Online learning, COVID-19 pandemic, Saudi Arabia, Qualitative study, Medical
students, Perspective

© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article’s Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit
The Creative Commons Public Domain Dedication waiver ( applies to the
data made available in this article, unless otherwise stated in a credit line to the data.

* Correspondence: [email protected]
1Department of Family and Community Medicine, Unaizah College of
Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
Full list of author information is available at the end of the article

Khalil et al. BMC Medical Education (2020) 20:285

The Covid-19 pandemic started in December 2019 in
Wuhan, China and spread around the world rapidly
within months. The pandemic affected all areas of life,
including education. As the situation worsened, the glo-
bal lockdown culminated in a lockdown of educational
institutions. This closing of schools, colleges, and univer-
sities resulted in a stressful event for educational admin-
istration with highly limited options. The Saudi Ministry
of Education announced online classes to continue the
learning process in a safe and secure manner. All univer-
sities including medical universities were shifted to on-
line learning within days [1]. This massive unplanned
transition from traditional learning to an exclusively on-
line learning setup has changed the methods of medical
institutions in delivering the courses for their students.
Medical graduates of the twenty-first century are ex-
posed to online textbooks and modules with video lec-
tures and computer-based exams. With this evolution in
teaching modalities, a “flipped classroom” model for
learning has been adopted by many medical schools
around the world [2, 3]. Although these experiences of
medical institutions are not similar, this can at least help
them in accepting synchronized online models in this
critical period.
Online learning is classified as synchronous or asyn-

chronous. Synchronous technology allows for “live”
interaction between the instructor and the students (e.g.,
audioconferencing, videoconferencing, web chats etc.)
while asynchronous technology involves significant de-
lays in time between instruction and its receipt (e.g., E-
mail, earlier video recording, discussion forums etc.) [4].
It has long been acknowledged that online instruc-

tional methods are an efficient tool for learning [5];
however, online learning can be challenging for students
because of the limited non-verbal communication. Other
aspects, such as students’ and professors’ interactions,
accessibility of materials, and time management, can also
affect the opinions of online education participants [6].
To assess students’ performance in an online course, a
representative set of face-to-face courses should be com-
pared to a similar set of online courses. This strategy
was adopted in a study that involved utilizing a dataset
of hundreds of courses being taught at 23 colleges of
Virginia’s community college system; the authors found
that students’ performance was worse in online courses
with respect to both course persistence and end-of-
course grades [7].
Online learning in medical education can lead to more

effective and easier access to a greater quantity of infor-
mation, especially in uncertain global situations such as
pandemics [8]. There is no doubt that the current
COVID-19 pandemic has augmented the focus on online
learning in education, but we anticipate that in the

future, this shift will prove to be a permanent trend in
medical education. The methods used by Unaizah College
of Medicine and Medical Sciences included lectures, case
discussions, 4-box case analysis, clinical case discussions,
online seminars, and dry labs (online laboratory demon-
strations). The largest proportion was covered through
lectures, which was about 60%, while case discussions (in-
cluding 4-box case analysis and clinical case discussions)
consisted of 20%, Online seminars consisted of 10% and
dry laboratories made about 10% of courses. We con-
ducted this qualitative study to assess the effectiveness of
these techniques and [9, 10] the barriers to medical stu-
dents’ engagement in online learning [9]. The foremost
goal of our exploratory study is to determine medical
students’ perceptions and satisfaction level regarding
synchronous online learning methods implemented in
courses during their second semester as an emergency
intervention during the ongoing Covid-19 pandemic in
the Kingdom of Saudi Arabia.

Study design
We employed an online focus group qualitative design
for our study for numerous reasons. Firstly, this design
enables an interactive and in-depth exploration of re-
spondents’ experiences [11, 12]. Secondly, the group
process can help individuals to clarify views that might
not emerge from a one-on-one interview. In addition, it
can uncover extensive opinions that individuals hold
about an issue, as well as perceptive differences among
individuals and groups [12]. Therefore, to effectively ad-
dress the objectives of our study, focus group discussions
were the most suitable choice. The discussions were
conducted online because of the ongoing Covid-19 pan-
demic and social distancing in the Kingdom of Saudi
Arabia and because this approach was cost-effective
[13]. It also ensured a detailed probing of the percep-
tions, expectations, and difficulties and was timed so as
to generate recommendations for improvements and hy-
potheses that can be tested in future research.

Study participants
Participants were purposely sampled. To ensure suffi-
cient diversity of opinion among groups, medical stu-
dents in their first year through final year (attending
online courses during their second semester) studying at
Unaizah College of Medicine and Medical Sciences,
Saudi Arabia, were recruited using a maximum variation
sampling technique [14]. Roll-call lists of medical stu-
dents were used as a sampling frame to select the partic-
ipants. The class leaders of the first-year class through
the final-year class were contacted. The reason for
selecting class leaders first was that they had direct con-
tact with the instructors and their classmates. As a

Khalil et al. BMC Medical Education (2020) 20:285 Page 2 of 10

result, they acted as connectors, and other participants
were selected with the help of those class leaders. Upon
contact, each student had been introduced to the back-
ground of our study and was invited to participate.
Overall, 60 students participated in eight focus group
discussions, and each group had seven to eight partici-
pants. A satisfactory (40/60) male-to-female participant
ratio was maintained in discussions. Focus group discus-
sions were continued unless the saturation of new infor-
mation was encountered.

The students who opted to participate in our study re-
ceived an e-mail with information about the use of the
online focus groups’ forum along with a discussion guide
to generate discussion. Each of them was given a per-
sonal log-in name and password to access the online
forum. For data collection, only the moderators had ac-
cess to the forum. The anonymity of statements in the
transcripts and in the final report was ensured, as well as
the confidentiality and security of the data. Because data
collection was done through the Internet, participants
provided informed consent by clicking a button after
having read all relevant information.

Study setting and data collection
The electronic focus group synchronous discussions
were based on a discussion guide which was developed
by two authors (OW and AM), in consultation with ex-
perts for this study. The guide was revised and approved
by all authors, and piloted with four students. It con-
sisted of seven open-ended questions, allowing partici-
pants to discuss as many elements as possible. The focus
group discussions were conducted during the months of
April and May 2020 by dual moderators.
The forum for each group started with an introduction

and proceeded with questions for participants about
their experiences with online learning, the differences
between online learning and on-campus-learning, diffi-
culties encountered, challenges, level of satisfaction with
online evaluation, and preferences regarding learning
modalities for their next academic year. All students in
each focus group simultaneously took part in a live syn-
chronous session for discussion by logging into the web-
site. The students used an online conferencing website,
and their discussions were audio-recorded. Two modera-
tors were present; one ensured the smooth progression
of the focus group sessions, and the other made sure
that the topics in questions were all covered. Dual-
moderator focus groups resulted in highly productive
sessions. Each group discussion took between 90 and
120 min. During the final two focus groups discussions,
moderators agreed that saturation had been reached and

that the inclusion of more respondents would thus be

Data analysis
Discussions were recorded, transcribed verbatim, and
analyzed by summarizing content analysis developed by
Mayring [15], Kiger. M. E [16], and Braun. V [17]. This
helped to condense the data into essential content in a
systematic manner guided by sequential steps. The main
themes of the data were based on the discussion ques-
tions. An inductive process was used for analysis and to
assign a code for each meaningful sentence and then
gather similar codes in overarching sub-themes. Finally,
similar sub-themes were grouped together under a main
theme reflecting its sub-themes. The data was analyzed
and coded by all authors. Two authors performed a pre-
liminary analysis, with the remaining authors acting as
second coders for the data. Subsequently, the initial cod-
ing was reviewed and compared. It was then contem-
plated and refined until a consensus was achieved
among all authors, which led to a more representative
coding scheme, sub-themes, and themes.

In total, eight online synchronous focus group discus-
sions were conducted. Each group included seven to
eight participants. There were a total of 60 respondents,
and more than half (60%; n = 36) of the participants were
female. The approximate male/female students’ distribu-
tion within Unaizah College of Medicine and Medical
Sciences is 44/56. Half of the sample participants (50%;
n = 30) were between 21 and 22 years old. Almost three
fourth of the participants (72%, n = 43) resided within
the city (Unaizah) where their medical college campus
was located, as indicated in Table 1.
During the analysis, sub-themes were identified and

classified under four major themes, which are summa-
rized below with relevant quotes from the participants.
Four core themes included the following: (1) educa-

tional impact (2), time management (3), challenges en-
countered (4), and preferences for future as indicated in
Table 2.

Theme 1: educational impact
The educational impact of online courses identified by
the respondents of our study are discussed under two
sub-themes, including (1) content understanding and (2)
content perception challenges.
The first sub-theme concerned the experience of con-

tent understanding. Although our study participants
held different opinions about content understanding
through online classes, two-thirds of them agreed that it
works better for some disciplines, which they elaborated
upon in the following statements:

Khalil et al. BMC Medical Education (2020) 20:285 Page 3 of 10

“In my opinion, online classes proved to be an ex-
cellent opportunity for theoretical subjects like basic
sciences but not suitable for clinical subjects like
clinical skills etc.”

Experiences of clinical students were different from
preclinical students. Some of the fourth-year and fifth-
year students found online classes highly beneficial, and
they expressed their views as follows:

“Some online learning courses are very useful, such
as radiology and we were really benefited from on-
line sessions like seminars and case discussions.”

“Online classes provided me with great opportun-
ities to focus on applied courses like radiology, fo-
rensic medicine.”

Almost all of the students regarded it as an opportun-
ity to utilize recorded lectures to better understand and
master the content. They revealed the following:

“Lectures recording option in online learning, bene-
fited us a lot! I can listen to the lecture again and
again, at my convenience and can make notes very
easily. I consider it, a wonderful experience at the
end of this academic year.”

“Yes, there is no doubt that online classes are better
than campus-based classes because recorded

Table 1 Characteristics of the study respondents (N = 60)

Characteristics Frequency (n) Percentage (%)

Age (years)

< 21 7 12

21–22 30 50

23–24 17 28

> 24 6 10


Male 24 40

Female 36 60

Educational Status

Pre-Clinical Years

Premed-2 (Year-1) 7 12

MD-1 (Year-2) 15 25

MD-2 (Year-3) 15 25

Clinical Years

MD-3 (Year-4) 8 13

MD-4 (Year-5) 15 25


Within City 43 72

Outside City 17 28

Table 2 Summary of themes and sub-themes

Themes Sub-themes Description Example

1 Educational impact Content understanding Educational improvement due to better
understanding of information

“Yes, there is no doubt that online classes
are better than campus-based classes because
recorded lectures are very helpful. It helped
me a lot in my academic progress this year.”

Content perception

Difficulties in understanding of the online
delivered information due to variations
in demand of content reception by learners

“I faced difficulty in understanding some of
the lectures, especially those containing x-rays,
were not clear in the online sessions.”

2 Time management _ Improved time organization and utility
due to online learning

“Online sessions provided me with a great
time to study and I experienced better time

3 Challenges


Quality assurance issues in the content
delivery and implementation issues of
the online learning

“There were a lot of lectures scheduled in
one day! Honestly speaking, I didn’t get time
to study them well…”

Technical challenges Difficulties experienced due to
technological hindrances of internet
connectivity and poor utility of
online tools

“Slow internet connectivity and communication
software failure were among frequent technical
issues ….”

Behavioral challenges Barriers in adoption of online learning
influenced by the individual personality

“It’s not suitable for me because I am a visual and
kinesthetic learner. I must admit that even though
online classes helped me in raising my marks, …”

4 Preferences for future _ Students’ choices of learning modalities
for their next academic year

“I would like to continue online classes if system is
fool-proof and well prepared before we start using
it again. I mean the technical part.”

Khalil et al. BMC Medical Education (2020) 20:285 Page 4 of 10

lectures are very helpful. It helped me a lot in
my academic progress this year.”

The second sub-theme which emerged concerned con-
tent perception challenges, which encompass variations
in demand of content reception and learning by different
types of learners. Under this sub-theme, participants’
expressed the following views:

“I faced difficulty in understanding some of the
lectures, especially those containing x-rays, were not
clear in the online sessions.”

“In my opinion, non-verbal communication like eye
contact with the instructor is essential to establish
learning process. Campus learning allows discussion
among students which is very helpful for clearing a
lot of concepts.”

“For me, online lectures are useful only for theoretical
explanation of the content but I miss clinics! Absence
of the clinical practice and labs is problematic for me
to master the practical concepts.”

Theme 2: time management
Participants generally referred to the theme of time
management as a dominant perspective, and they all
agreed that online sessions saved time for them and that
their performance had improved as a result. This is
made evident in the following statements:

“Online sessions provided me with a great time to
study and I experienced better time management.”

“I live away from the college campus and it usually
takes two hours daily to reach college. So, these
online classes saved my time by reducing my daily
exertion of going to campus and coming back

They experienced more contentment with online
courses because of their physical ease and because being
within their comfort zone reduced their anxiety. They
expressed their views in the following statements:

“Online classes had a positive effect on me in terms
of saving time and effort, by reducing the campus-
based distractions like compulsive participation in
conversions, adjustment with unavoidable noise and
waste of time in finding a proper place to study alone.”

“I thoroughly enjoyed online courses. I used to
choose a comfortable place at my home for my
online classes and it also gave me a chance to relax

at my convenience. It really saved my time and
effort to study well.”

“Online learning has a positive impact on my sleep
pattern and I felt more comfortable and balanced.”

Most of the participants were satisfied with online
courses because they were able to spend more time with
their families. One stated the following:

“I experienced an entirely new method of time
management with online sessions. Online classes
allowed me to save time for my studies and I found
more time to sit with my family and enjoy quality
refreshing time, whenever I wanted to take a break
between my studies.”

Theme 3: challenges encountered
The participants encountered some challenges and iden-
tified barriers to the acquisition of knowledge through
online courses. These are discussed under the following
three sub-themes here: (1) methodological challenges
(2), technical challenges (4), and behavioral challenges.
The first sub-theme, which can be regarded as a nega-

tive aspect from the perspective of participants, was
methodological challenges, which included quality assur-
ance issues in the content delivery of the lectures and
implementation issues. Adjustment and engagement in
the new system was perceived as a barrier to the devel-
opment and implementation of online learning, and
there were multiple problems related to the duration
and arrangement of learning sessions. Some participants
expressed their ideas about these issues as follows:

“It felt like, some of the online lectures were
unnecessarily allotted long time! The sequence of
the online lectures was also suboptimal and there
was a frequent change of lecture timing. I felt
difficulty in connecting the information out of
content heaps.”

“There were a lot of lectures scheduled in one day!
Honestly speaking, I didn’t get time to study them
well. Most of the lectures’ content was huge and
was covered within limited time and some of the
instructors were not committed to the time of the
lecture. It felt like we are taking lectures whole day.”

“The duration of some lectures was very long!
Instructors were not committed to the allotted
time of the lectures. Some instructors were late
for the lectures and did not start it on time.
The lectures were frequent during the day and
at night.”

Khalil et al. BMC Medical Education (2020) 20:285 Page 5 of 10

“I noticed a serious communication gap between
students and instructor. At time I needed more
clarification for some lecture content but those
points were left unexplained by the instructors
because of miscommunication. I missed direct dis-
cussions with my instructors and my classmates
during campus-classes.”

Technical challenges faced by the participants are dis-
cussed under the second sub-theme. This includes all es-
sential technical elements, such as internet connectivity
and the use of online tools. Participants listed many
technical issues which they faced during online sessions,
as mentioned in the following statements:

“Slow internet connectivity and communication
software failure were among frequent technical issues
which I faced during whole course. Second big issue
was, most of our instructors have no experience in
delivering online lecture. There was a wastage of time
every day because of technical problems.”

“I used to face very frequent internet disconnection
during online lectures daily and it was very hard for
me to follow lectures with instructors.”

“My participation was greatly affected by issues like
delayed download the lectures and internet lagging!
The technical problems like troubled sound due to
pressure on the internet software was very common
during online sessions.”

“Some instructors were not in a habit of checking
their microphones before starting their lectures, so
there was interrupted voice which led to unnecessary
inconvenience and botheration.”

“Sometimes instructor’s voice was not clear and
they didn’t use appropriate explanatory tools given
in the online software. It led to wastage of time
which could be otherwise avoided.”

Behavioral and acceptability challenges are discussed
under our third sub-theme, which encompasses negative
attitudes towards the adoption of new modes of learning.
Participants’ perspectives about their acceptability of
online learning is quite discernible from the following

“It’s not suitable for me because I am a visual
and kinesthetic learner. I must admit that even
though online classes helped me in raising my
marks, but it did not help me in upgradation of
my knowledge.”

“Even though, I managed to cope up with online
teaching but I desperately missed body language like
eye to eye contact with instructors and writing on
the board. I missed active interactive sessions like
team-based learning sessions, peer instruction skills
and discussion among students. I prefer to study
within campus ambit.”

“Most of the times, I did not find a suitable place at
home for taking my online classes and I felt like
environment is not suitable at home for attending
online lectures.”

“My family did not realize that I am seriously busy
in learning through online system and that put a lot
of pressure on me.”

“If online lectures are continued then, I am afraid
that it will lead to laziness and its negatively affecting
my performance, as it takes me longer to study the

“The best thing about online lectures was “recorded
lectures”, but at the same time the drawback was, I
could not link the theoretical concepts together
through recorded lectures. It simply doesn’t work
for me.”

“Online learning kept me away from my family, and
it feels like I am always busy in my lectures and

“While learning through online sessions, I had no
time to enjoy my social life. I feel like I am busy all
the time with my lectures and I lost interaction with
my classmates.”

Theme 4: preferences for the future
The students were asked about their preferences regard-
ing their next academic year. Mixed responses were con-
veyed. The majority of them preferred online learning,
while others, especially clinical students, expressed inter-
est in the continuation of campus-bound classes and live
clinical participation. The statements in favor of
campus-based classes included the following:

“It is time saving to study together to master some dif-
ficult concepts. Some lectures that need active discus-
sion and eye to eye contact with instructors while
others need joint study like team-based learning skills.”

“Courses that require practical application, such as
women and children health, cannot be taught
though online sessions.”

Khalil et al. BMC Medical Education (2020) 20:285 Page 6 of 10

“It was an unpleasant experience. Please do not
repeat it in any course of next academic year. In my
opinion, college campus and clinics are most
suitable for learning because it provides us with a
special learning environment.”

“Well, it did not help me much in my academic
progress. Clinical practice and direct learning at
campus though live lectures is better, as eyes to
eye contact with the instructors helps in better
understanding of content.”

Online experience of learning was preferred by some
students, but they suggested some conditions in case of
its continuation. The following statements elaborated
upon this:

“I prefer online learning, provided the doctor should
use the online teaching tools like writing on screen,
highlighting the text etc.”

“I prefer to continue with online learning in upcoming
academic year, only in the fields of scientific research
and forensic medicine.”

“I agree to continue online sessions for some
courses like radiology but it cannot be applied in all
courses, especially clinical courses. Excellent in
theoretical courses but unsatisfactory experience in
practical courses.”

“Online learning is better than studying in college
campus and is preferable for female students like
me who lives outside Unaizah.”

“I would like to continue online classes if system is
fool-proof and well prepared before we start using it
again. I mean the technical part.”

“Online learning is excellent and saves time for
studying. I suggest that there should be one day per
week specified for online learning to cover some
theoretical courses but not for whole year’s

Our research study examined undergraduate medical
students’ perspectives and preferences regarding online
modules of synchronized learning. The concept of online
classes is not new in the Kingdom of Saudi Arabia, in
relation to online synchronized learning in medical edu-
cation at the undergraduate level, no research was previ-
ously conducted in the Kingdom.

In our analysis, we have identified the factors influen-
cing the medical students’ assent or dissent in relation
to synchronized online learning. Assenting students in
our study were motivated by the benefit of mastering
the content in less time compared to campus learning.
They utilized updated educational technologies which
fulfilled the requirements of adult learners by promoting
active and student-centered learning. This instructional
method helped empower learners in controlling their
educational needs constructively and provides them with
structured guidance for self-directed learning [18]. Even-
tually, this enables students to utilize their time product-
ively to achieve their individual goals. Additionally, most
of the students in this study found more time to spend
with their families and to improve their sleep pattern.
However, some students mentioned some negative factors
related to managing their time. The overall satisfaction
level with online learning was found to be high in our
study, and students’ attitudes were quite positive towards
online learning as a new teaching modality relative to
traditional didactics. This finding is consistent with previ-
ous research on online learning modalities [19–38].
However, our study assessed the individual learning

experiences using online modules, and we found that
the use of online learning is more productive within the
context of particular medical disciplines, such as for
basic medical sciences or preclinical subjects; this made
it difficult to compare its relative effectiveness with clin-
ical disciplines [19, 20]. That is why more preclinical
students preferred online learning for their future aca-
demic years, as compared to clinical students who
participated in our study. Conversely, Cardall S. con-
ducted a study in 2008 which concluded that preclin-
ical students preferred to have live lectures when
given an option; the authors agreed that online lec-
tures are an efficient method for the acquisition of
knowledge [39].
According to our study participants, the missing elem-

ent in the effectiveness of online learning was clinical
practice. Nothing can replace seeing a patient because
clinical experience and human interaction are extremely
important for the practice of medicine. However, online
learning may serve as an efficient resource for clinical
students if the method is upgraded through the integration
of modalities such as virtual simulation technologies and
computer-based models of real-life processes. This can pro-
duce multiple benefits for clinical learners by providing
controlled opportunities to practice rare and critical events
in safe environments excluding the risk to patients. An in-
structional technology, such as a computer-based virtual
patient program designed to simulate real-life clinical sce-
narios, can be useful for clinical learners to facilitate
history-taking and physical examination and can encourage
diagnostic and therapeutic decision-making [18].

Khalil et al. BMC Medical Education (2020) 20:285 Page 7 of 10

Although the themes that emerged from this study
support the notion that “online learning works for med-
ical students,” this does not imply that online learning
can completely replace in-person live sessions. Our
study participants encountered numerous challenges in
adopting online learning. One of the most common bar-
riers was technical insufficiency, including poor internet
connectivity and deficits in educators’ basic computer
skills. The themes identified in our study complement
numerous previous studies [40–42]. The high-yielding
technological use in medical education depends on the
faculty’s readiness and expertise to employ the technol-
ogy to facilitate learning. Training physicians with these
skills need a divergence from traditional teaching meth-
odology. Hence, it appears that training in educational
technology mastery is a neglected competency in facul-
ties which should be mandatory for the enhancement of
medical universities [2].
Aside from technical issues, our study participants’ ex-

periences were influenced by the individual characteris-
tics of students themselves, such as their learning styles,
acceptance of new learning modalities, and levels of en-
gagement in online classes [43–45]. Other barriers in-
cluded quality assurance issues in the implementation of
online learning by the institution. This finding is consist-
ent with a study performed by Bediang et al. in 2013, in
which the authors concluded that one of the most im-
perative means for implementing online modules is en-
couraging collaboration among all departments and
stakeholders. An organized and clear institutional ap-
proach is required to formulate a well-regulated and effi-
cient system which can facilitate the adoption of
structured methodologies by faculty members while
implementing an online learning module [10].
A lack of non-verbal communication by instructors

was also identified as a significant challenge for our
study participants. According to communication theo-
rists, verbal messages are conveyed through words,
whereas nonverbal messages are conveyed beyond the
actual meaning of words, which typically complements
the spoken words [46]. The psychological closeness
which a student may feel with their instructor is primar-
ily based upon the instructor’s nonverbal clues. Nonver-
bal communication, such as eye contact, gestures, and
posture, comprise a major part of all communications.

Our study concludes that synchronized online learning
was well-received by the medical students. At the same
time, some challenges for our study participants in-
cluded technical issues, individual behavioral charac-
teristics, institutional methodology barriers, and the
absence of non-verbal clues. Moreover, preclinical
students were more likely to opt for online lectures

as their preference for the next academic year com-
pared to clinical students.

There are some limitations to this study. The findings of
this study cannot be generalized because it was con-
ducted in only one medical school. Although four core
themes and a number of subthemes emerged from our
study, the authors are aware that there must be other
potential strengths and weaknesses of this modality for
undergraduate medical students. Secondly, to ensure the
effectiveness of online learning modules for undergradu-
ate medical students, the principles of online learning
model and learning outcomes should be rigorously and
regularly evaluated.

The findings of our research support the evidence re-
garding the effectiveness of online learning for medical
students; however, it is important to realize that it is not
the only mode of transferring efficient knowledge. Of
course, there are other teaching modalities and clinical
teaching which are essential to implement as compul-
sory parts of an ideal undergraduate medical education
model. Thus, the online module’s predominately syn-
chronized learning represents a meaningful and promis-
ing potential for the future of medical education and can
be integrated into the curriculum to enhance the effect-
iveness for lifelong learning.
There is a need for research to identify other effective

online and offline teaching modalities and to formulate a
meticulous model through the integration of an optimal
proportion of online learning in undergraduate medical

Supplementary information
Supplementary information accompanies this paper at

Additional file 1.

COVID-19: Coronavirus disease 2019; MD: Doctor of Medicine

The authors thank all medical students for their time and contribution to the

Authors’ contributions
OW, RK devised the project, the main conceptual ideas, and analysis. AM,
WF, KM, MD data collection, AN and AK drafting of manuscript. All authors
participated in the interpretation of data, drafting and revision of the paper.
All authors read and approved the final manuscript.

No funding was received for this research.

Khalil et al. BMC Medical Education (2020) 20:285 Page 8 of 10

Availability of data and materials
Data sharing is not applicable to this article.

Ethics approval and consent to participate
Ethical approval has been granted by Qassim University (reference number
191103) and verbal consent was obtained.

Consent for publication
Participants gave a verbal consent for direct quotes to be published in this

Competing interests
The authors declare that they have no competing interest.

Author details
1Department of Family and Community Medicine, Unaizah College of
Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia.
2Department of Basic Medical Sciences, Unaizah College of Medicine and
Medical Sciences, Qassim University, Unaizah, Saudi Arabia. 3Department of
Radiology, Unaizah College of Medicine and Medical Sciences, Qassim
University, Unaizah, Saudi Arabia. 4Department of Pediatrics, Unaizah College
of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia.
5Department of Medicine, Unaizah College of Medicine and Medical
Sciences, Qassim University, Unaizah, Saudi Arabia.

Received: 23 June 2020 Accepted: 25 August 2020

1. Tanveer M, Bhaumik A, Hassan S, Ul Haq I. Covid-19 pandemic, outbreak

educational sector and students online learning in Saudi Arabia. J
Entrepreneurship Educ. 2020;23(3).

2. Williams DE. The future of medical education: flipping the classroom and
education technology. Ochsner J. 2016;16(1):14–5.

3. Schwartzstein RM, Roberts DH. Saying goodbye to lectures in medical
school—paradigm shift or passing fad? N Engl J Med. 2017;377(7):605–7.

4. Finkelstein J. Learning in real time: synchronous teaching and learning
online. Washington: DCJossey-Bass; 2006.

5. Aronoff SC, Evans B, Fleece D, Lyons P, Kaplan L, Rojas R. Integrating
evidence based medicine into undergraduate medical education:
combining online instruction with clinical clerkships. Teach Learn Med.

6. Middleton AJ. How effective is distance education? Int J Instr Media. 1997;
24:133–8 Avaiable at URL:

7. Xu D, Jaggars SS. The effectiveness of distance education across Virginia’s
community colleges: evidence from introductory college-level math and
English courses. Educ Eval Policy Anal. 2011;33(3):360–77 Available at URL:

8. Mooney G, Bligh J. Information technology in medical education: current
and future applications. Postgrad Med J. 1997;73(865):701–4.

9. Greenhalgh T. Computer assisted learning in undergraduate medical
education. BMJ (Clinical Research Edition). 2001;322(7277):40–4.

10. Bediang G, Stoll B, Geissbuhler A, Klohn A, Stuckelberger A, Nko’o S, et al.
Computer literacy and e-learning perception in Cameroon: the case of
Yaounde Faculty of Medicine and Biomedical Sciences. BMC Med Edu. 2013;

11. Kitzinger J. Qualitative research. Introducing focus groups. Br Med J. 1995;

12. Berg B. Qualitative research methods for the social sciences, MA: Pearsons
Education Inc: Inc; 2009.

13. Tates K, Zwaanswijk M, Otten R, van Dulmen S, Hoogerbrugge PM, Kamps
WA, Bensing JM. Online focus groups as a tool to collect data in hard-
toinclude populations: examples from pediatric oncology. BMC Med Res
Methodol. 2009;9:15.

14. Cohen L, Manion L, Morrison K. Research methods in education. 8th ed.
Abingdon: Routledge; 2018.

15. Mayring P. [qualitative content analysis. Basics and technics.] qualitative
Inhaltsanalyse. Grundlagen und Techniken. Beltz UTB: Basel; 2003.

16. Kiger. ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No.
131. J Med Teach. 2020.

17. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol.

18. Candler C. Effective use of educational technology in medical education. In
Colloquium on educational technology: recommendations and guidelines for
medical educators. Washington: AAMC Institute for Improving Medical
Education; 2007.

19. Evans DJ. Using embryology screencasts: a useful addition to the student learning
experience? Anat Sci Educ. 2011;4(2):57–63.

20. Kalet AL, Coady SH, Hopkins MA, Hochberg MS, Riles TS. Preliminary
evaluation of the web initiative for surgical education (WISE-MD). Am J
Surg. 2007;194(1):89–93.

21. Malik. U, Kirkby E, Tah V, Bunce C, Okhravi N. Effectiveness and acceptability
of a cataract surgery teaching video for medical students. Med Teach. 2012;

22. Alnabelsi T, Al-Hussaini A, Owens D. Comparison of traditional face-to-face
teaching with synchronous e-learning in otolaryngology emergencies
teaching to medical undergraduates: a randomised controlled trial. Eur Arch
Otorhinolaryngol. 2015;272(3):63.

23. Ball CA, Kurtz AM, Reed T. Evaluating violent person management training
for medical students in an emergency medicine clerkship. South Med J.

24. Belfi LM. Bartolotta RJ, Giambrone AE, Davi C, min RJ. “flipping”the
introductory clerkship in radiology: impact on medical student performance
and perceptions. Acad Radiol. 2015;22(6):794–801.

25. Bösner S, Pickert J, Stibane T. Teaching differential diagnosis in primary care
using an inverted classroom approach: student satisfaction and gain in skills
and knowledge. BMC Med Educ. 2015;15:63.

26. Chapman C, White CB, Engleberg C, Fantone JC, Cinti SK. Developing a fully
online course for senior medical students. Med Educ Online. 2011;06:16.

27. Cipriano SD. Dybbro E, Boscardin CK, Shinkai K, Berger TG. Online learning
in a dermatology clerkship: piloting the new American Academy of
Dermatology medical student Core curriculum. J Am Acad Dermatol. 2013;

28. DiLullo C, Coughlin P, D’Angelo M, McGuinness M, Bandle J, Slotkin EM,
et al. Anatomy in a new curriculum: facilitating the learning of gross
anatomy using web access streaming dissection videos. J Vis Commun
Med. 2006;29(3):99–108.

29. Edmond M, Neville F, Khalil HS. A comparison of teaching three common
ear, nose, and throat conditions to medical students through video
podcasts and written handouts: a pilot study. Adv Med Educ Pract. 2016;7:

30. Goldberg HR. Haase E, Shoukas a, Schramm L. redefining classroom
instruction. Adv Physiol Educ. 2006;30(3):124–7.

31. Gomes AW, Linton A, Abate L. Strengthening our collaborations: building
an electronic health record educational module. J Electron Resour Med Libr.

32. Ilic D, Nordin RB, Glasziou P, Tilson JK, Villanueva E. A randomised controlled
trial of a blended learning education intervention for teaching evidence-
based medicine. BMC Med Educ. 2015;15:39.

33. Khasawneh R, Simonsen K, Snowden J, Higgins J, Beck G. The effectiveness
of e-learning in pediatric medical student education. Med Educ Online.

34. Kumar AB, Hata JS, Bayman EO, Krishnan S. Implementing a hybrid web-
based curriculum for an elective medical student clerkship in a busy
surgical intensive care unit (ICU): effect on test and satisfaction scores. J
Surg Educ. 2013;70(1):109–16.

35. Mojtahedzadeh R, Mohammadi A, Emami A, Rahmani S. Comparing live
lecture, internet-based & computer-based instruction: a randomized
controlled trial. Med J Islam Repub Iran. 2014;28(136).

36. Liu, Q., Hu, R., Zhan, X., Yan, W. Eur Conference e-Learning. Evaluation of
students’ satisfaction and attitudes toward blended learning in medical
education: a survey in randomized controlled trial course URL:https://tinyurl.
com/ychkafst [accessed 2020-04-30].

37. Reis LO, Ikari O, Taha-Neto KA, Gugliotta A, Denardi F. Delivery of a urology
online course using Moodle versus didactic lectures methods. Int J Med
Inform. 2015;84(2):149–54.

Khalil et al. BMC Medical Education (2020) 20:285 Page 9 of 10

38. Ridgway PF, Sheikh A, Sweeney KJ, Evoy D, McDermott E, Felle P, et al.
Surgical e-learning: validation of multimedia web-based lectures. Med Educ.

39. Cardall S, Krupat E, Ulrich M. Live lecture versus video-recorded lecture: are
students voting with their feet? Acad Med. 2008;83(12):1174–8. https://doi.

40. Niebuhr V, Niebuhr B, Trumble J, Urbani M. Online faculty development for
creating E-learning materials. Educ Health. 2014;27(3):255–61.

41. Dyrbye L, Cumyn A, Day H, Heflin M. A qualitative study of physicians’
experiences with online learning in a master’s degree program: benefits,
challenges, and proposed solutions. Med Teach. 2009;31(2):e40–6.

42. Perlman R, Christner J, Ross P, Lypson M. A successful faculty development
program for implementing a sociocultural ePortfolio assessment tool. Acad
Med. 2014;89(2):257–62.

43. Terrell SR, Dringus L. An investigation of the effect of learning style on
student success in online learning environment. J Educ Technol Syst. 2000;

44. Omar ND, Hassan H, Atan H. Student engagement in online learning:
learners attitude toward E-mentoring. Procedia Soc Behav Sci. 2012;67(67):

45. Robinson CC, Hullinger H. New benchmarks in higher education: student
engagement in online learning. J Educ Bus. 2008;84(2):101–9.

46. Manusov V. A history of research on nonverbal communication: our
divergent pasts and their contemporary legacies. In: Matsumoto D, Hwang
HC, Frank MG, editors. APA handbook of nonverbal communication.
Washington, DC: American Psychological Association; 2016. p. 3–15.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.

Khalil et al. BMC Medical Education (2020) 20:285 Page 10 of 10

  • Abstract
    • Background
    • Methods
    • Results
    • Conclusion
  • Background
  • Methods
    • Study design
    • Study participants
    • Procedure
    • Study setting and data collection
    • Data analysis
  • Results
    • Theme 1: educational impact
    • Theme 2: time management
    • Theme 3: challenges encountered
    • Theme 4: preferences for the future
  • Discussion
  • Conclusion
    • Limitations
    • Recommendations
  • Supplementary information
  • Abbreviations
  • Acknowledgements
  • Authors’ contributions
  • Funding
  • Availability of data and materials
  • Ethics approval and consent to participate
  • Consent for publication
  • Competing interests
  • Author details
  • References
  • Publisher’s Note

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
colle writers

Order your essay today and save 30% with the discount code ESSAYSHELP