الفهرس 
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Abstract
This study was conductedto compare undergraduate students’ achievement in, and satisfaction with, a blended (hybrid) e-learning otology course versus traditional classroom teaching in Otorhinolaryngology department, Alexandria Faculty of Medicine.
Aninterventional study design was applied to 4th year under-graduate students in Otorhinolaryngeology (ORL) department in the academic year 2010/2011.Out of 8 ORL rounds, four were randomly selected to be included in this study. The selected four groups were selectively assigned into two groups: The intervention/experimental group (taught by the blended/hybrid course), and the control group (taught by the traditional face-to-face class teaching).
An otology e-course was constructed, delivered as a blended (hybrid) course combined with traditional classroom teaching (lectures and clinical teaching sessions). Students’ grades in otology course (knowledge-based and skills-based) in the experimental group (N=306) were compared with that of the control group (N=288).
A cross-sectional survey was conducted, using a structured predesigned questionnaire, to explore students’ and staff (N=20) attitudes and perceptions of e-learning, to identify barriers to effective use of e-learning in AFM educational context, and to collect information about the level of students’ computer literacy and internet usage skills.
The mean score of overall student achievement (both knowledge-based and skills-based assessment) in the blended course was insignificantly higher compared to that in the traditional course (p=0.295). However, the blended course proved to be more effective than traditional course in improving clinical skills/competencies as denoted by significantly higher mean scores attained in OSCEs (p<0.05). No significant difference was observed regarding knowledge-based assessment (total MCQs).
Regarding students’ satisfaction, the students’ overall rating of the value of course resources, materials and activities, in facilitating learning, was significantly higher for the blended course compared to the traditional course (as denoted by the mean composite score and percentage satisfaction index, where p<0.05). Specifically, students rated the blended course significantly higher compared to the traditional course as regards the value of the department book, staff-student interaction using e-mail, internet links to external resource, as well as the course assignments (p<0.05). Difference in students’ judgment regarding the value of the instructor in facilitating learning was statistically insignificant (p=0.107).
Students experiencing average workload (7-12 hours/week) and aboveaverage/high workload (13-18 hours/ week and >18 hours/ week), were significantly lower among blended course students (59.2%) as compared to those in the traditional course (73.6%), where p<0.05).
Sixty two percent of the blended course students had some or average problems/difficulties in dealing with the e-course learning management system. Only a minority (6.6%) confronted either much or great difficulties (3.0% and 3.3%, respectively).
Comparing students’ satisfaction with Blended and Traditional Otology Courses revealed that the mean composite score of global students’ satisfaction with the blended course (31.05.4) was significantly higher (p<0.05) as compared to the traditional one (26.55.9). Consequently, the percentage satisfaction index was also higher among blended course students as compared to those in the traditional course. Difference was statistically significant, where (p <0.05).
The blended course students were more likely to feel that the course content was challenging and meeting their expectations (p<0.05). Blended course students were more satisfied with the role of the instructors, teaching the course, in: presenting of information(p<0.05), guiding the learners(p<0.05) and practicing(p<0.05). No significant difference was observed regarding students’ satisfaction with the role of the instructors in assessing learning (p=0.058). In general, blended course students were significantly more satisfied with the overall course, the instructors’ interest, enthusiasm and performance (p<0.05).
A considerable proportion of the studied students demonstratedpositive attitudes towards computer- and web-based learning, where 66.4% emphasized the necessity of its use in medical teaching. About three-fourths of the students (75.3%) believed that computer- and web-based training should play a more important role, and it should be made available to supplement lectures and exercises (75.6%).
Correspondingly, the participant staff members also showed positive attitudes towards computer- and web-based learning, where the majority of the studied members (95%) emphasized the necessity of its use in medical schools to supplement classroom teaching, believed that e-Learning should be active and ‘interactive’. The majority of the students as well as the staff members disagreed withthe misbelief that web-based learning programs are able to replace lectures.About 37% of students felt it easier to participate in a discussion in an online-forum rather than a classroom discussion. In contrast to students’ opinions, 75% of the studied staff members preferred to participate in a classroom discussion than in an online-forum.
The studied students proved to be very familiar with the use of computers and other technologies as part of their day-to-day life.The study findings revealed that the majority of students were frequent computer users, having access either to a personal computer (67.9%), or shared a computer with the family (26.2%). The majority of students had also easy access to internet (about 95%) at their own homes. Only a minority depended either on the college IT facilities or internet café as the only way to access computer and internet.
Barriers to implementation and use of e-learning as perceived by students were:
At the institutional level: lack of proper policy, planning and supportive culture.
At the staff level: resistance to change, difficulty in measuring the effectiveness of e-learning outcomes, lack of technical capability and sufficient time by the staff together with lack of computer competence.
At the student level: negative perceptions of e-learning, insufficient computer and internet skills, and lack of self-learning and time management skills.
Responses to the open-ended questions in the staff questionnaire revealed that the main barriers to implementation and use of e-learning, as viewed by staff, were the lack of staff and students’ awareness of such courses, staff adaptation to web-based learning programs, and inadequate resources (computer labs and internet facilities) in proportion to the large number of students. Other concerns included the issue of private lessons, students’ familiarity with traditional classroom teaching/learning methods where the students are passive learners rather than being active learners in blended courses, students’ lack of basic computer skills. Some believed that application of such courses might negatively influence students’ attendance to classroom face-to-face teaching, thus emphasized that web-based training should be made available to supplement but not to replace lectures and classroom teaching.
Some solutions were suggested by staff members such as the need for more training of staff in designing e-courses through the learning management systems, e-learning awareness campaigns for both staff and students, provision of adequate IT resources (computer and internet facilities) in relation to large number of students, the necessity of students to have the ICDL before admission to Faculty of Medicine.