Evaluating Blended Teaching Models in Medical Colleges: Preferences and Influential Factors for Teachers and Students

Introduction

The use of computer multimedia and network technology in education has become increasingly popular, especially during the COVID-19 pandemic.¹ This period witnessed rapid growth in massive open online courses and small-scale restricted online course platforms.² Online teaching modes have become essential for universities to maintain educational quality. Following the Ministry of Education’s directive to “suspend classes without halting learning or teaching”, universities have adopted online and blended teaching as key strategies for classroom reform.³ These new teaching modes are transforming the teaching and learning processes. The choice between offline, online, and blended modes is fundamental to teaching reform efforts at universities.⁴

Offline education typically depends on face-to-face interactions between teachers and students, which helps keep students engaged in the classroom and enables teachers to provide immediate answers to questions. However, this form of communication is constrained by various factors such as class duration and venue; additionally, some teachers’ rote teaching methods may hinder the development of students’ independent thinking and creativity.⁵ Online education utilizes the internet and information resources to present complex and often dry knowledge points through case studies, animated videos, and digital textbooks, thereby stimulating students’ interest in learning. Modern students have increasingly diverse learning needs, with many preferring the flexibility to choose their study time and location. Online platforms provide personalized content and difficulty levels, allowing students to select resources for previewing and skill training, repeatedly review key and challenging concepts, and break free from the constraints of time and space. Teachers can also supply timely supplementary materials based on student feedback, thereby enhancing teaching quality and extending classroom learning indefinitely. Furthermore, online education enables students in remote and resource-limited areas to access quality educational resources, promoting educational equity. However, online education can be impacted by network and equipment issues, making it difficult to ensure consistent teaching quality for all students. Teachers may also find it challenging to monitor students’ learning status in real-time. If students lack self-discipline, they may be easily distracted and unable to complete their learning tasks.⁶

Blended learning can stimulate students’ interest and engagement by presenting knowledge in a more vivid manner and encouraging active participation, all while making full use of fragmented time. Online and offline teaching complement each other by combining virtual simulations with practical internships, enabling teachers to select quality resources that enhance the classroom experience. Simultaneously, blended learning emphasizes student initiative and creativity, allowing students to create their own learning paths and access online materials anytime and anywhere, thereby achieving a student-centered, personalized teaching approach.⁷ In medical education, integrating theoretical learning with clinical practice is essential; however, the willingness of faculty and students in medical colleges to adopt blended learning models and the factors influencing this choice remain unclear. This study examines the preferences of Hubei University of Medicine’s faculty and students regarding different teaching modes and analyzes the factors influencing these preferences. The findings will inform the development of post-pandemic educational reform strategies in medical schools.

Methods

Study Design and Population

The subjects of this study, conducted in August 2020, comprised medical teachers and students at Hubei University of Medicine. We employed an anonymous online survey conducted via the Questionnaire Star platform (http://www.wjx.com), supervised by uniformly trained class counselors. Stratified sampling was used to selected participants from the Department of Clinical Medicine and the School of Pharmacy and Nursing, with questionnaires tailored to profession and academic year. The platform ensured that only one response was allowed per IP address and excluded responses submitted in less than 60 seconds or more than 600 seconds.

Self-Designed Questionnaire as a Survey Tool (see supplementary materials for details). The content of the survey questionnaire was developed based on feedback from the Academic Committee and the Student Union of the school. The teacher’s questionnaire included: 1) basic personal information (gender, age, teaching experience, academic rank); 2) online teaching evaluation, encompassing quality self-assessment and challenges (difficulty monitoring student progress, lack of interaction, absence of classroom atmosphere); 3) preferred teaching modes: offline, online, or hybrid. The student questionnaire included: 1) personal information (gender, age, department, major, academic year); 2) online learning assessment, addressing effectiveness and challenges (rigid content, limited teaching methods, restricted communication); 3) preferred learning modes: offline, online, or hybrid. Scores for online teaching quality and learning effectiveness were rated on a 10-point scale: 1 (very poor), 6 (pass), and 10 (excellent).

Statistical Analysis

We utilized SPSS version 21.0 for statistical analysis. Descriptive statistics, including frequency and proportion, were used to analyze basic subject information. Group comparisons were conducted using chi-square tests and one-way analysis of variance (ANOVA). Multinomial logistic regression was employed for multivariate analysis, with a P-value of < 0.05 indicating statistical significance.

Results

Statistical Material

We collected 250 teacher questionnaires; after excluding those with logical errors and duplicates, 235 valid responses remained, resulting in a 94% response rate. Similarly, of 1600 student questionnaires collected, 1501 were valid after exclusions, yielding a 93.8% response rate. Of the 235 teachers, 51 were male (21.7%) and 174 were female (78.3%). The age distribution included 166 under 40 years (70.6%), 36 between 40 and 50 years (15.3%), and 33 over 50 years (14.0%). Regarding academic titles, 26 were junior (11.1%), 136 were intermediate (57.9%), 57 were associate high (24.3%), and 16 were high (6.8%). Among the 1,501 students, 370 were male (24.7%) and 1,131 female (75.3%). The age distribution included 492 under 20 (32.8%), 838 aged 20 to 21 (55.8%), and 171 over 21 (11.4%). Yearly breakdown: 1,019 in years 1 to 3 (67.9%) and 482 in years 4 to 5 (32.1%).

Univariate Analysis

In this study, 14.0% of teachers expressed a willingness to adopt online teaching, while 34.5% preferred a hybrid online-offline approach. No statistically significant differences were observed in preference for offline or online teaching across variables such as gender, age, experience, education level, academic title, or online teaching duties (P > 0.05). Significant variations were noted in self-assessed online teaching quality, with the highest scores reported by those preferring hybrid teaching (P < 0.001), as detailed in Table 1. Challenges in online teaching, such as difficulty in monitoring student progress, limited interaction, a poor classroom atmosphere, and home distractions, significantly influenced teachers’ mode preferences (P < 0.05), as outlined in Table 2.

Table 1 Univariate Analysis of Medical School Teachers’ Preferences for Offline/Online Teaching Modes [n (%)]

Table 2 Impact of Issues Encountered During Online Teaching on Preferences for Offline/Online Teaching Modes Among Medical School Teachers [n (%)]

Among medical students, 12.8% expressed a willingness to adopt online learning, while 33.7% preferred a hybrid approach. No significant differences in learning mode preferences were observed among students based on gender, age, major, or academic year (P > 0.05), as shown in Table 3. However, factors such as rigid course content, monotonous teaching methods, limited interaction, low learning efficiency, and susceptibility to distractions significantly influenced students’ learning mode preferences (P < 0.05), as detailed in Table 3 and Table 4.

Table 3 Univariate Analysis of Medical Students’ Preferences for Offline/Online Learning Modes [n (%)]

Table 4 Impact of Issues Encountered During Online Lectures on Students’ Preferences for Offline/Online Learning Modes [n (%)]

Multivariate Logistic Regression Analysis

Variables that were significant in the univariate analysis were included in the regression model. The results indicated that online teaching quality and teacher-student interaction significantly influenced teachers’ preferences for hybrid teaching (P < 0.05). For students, factors such as limited interaction, low learning efficiency, and susceptibility to distractions significantly affected their decision to adopt online learning (P < 0.05). Students’ choice of hybrid learning was significantly influenced by online learning tools, the singularity of teaching methods, low learning efficiency, and online learning effectiveness (P < 0.05), as shown in Table 5. Therefore, enhancing the quality of online teaching and fostering communication between teachers and students are essential for improving students’ learning efficiency and attracting more participants to blended teaching models.

Table 5 Multivariable Logistic Regression Analysis of Factors Influencing Teaching Mode Preferences Among Medical School Faculty and Students

Discussion

In this survey, 34.5% of medical school teachers and 33.7% of students preferred a hybrid online-offline teaching model. Dika notes that individuals generally have more positive attitudes toward familiar activities.⁸ Nemalynne et al found that teachers with online teaching experience were more likely to embrace hybrid teaching post-pandemic, indicating that such experience during the pandemic helped establish a foundation for teaching model reform in medical schools.⁹ However, the preference for hybrid teaching among medical school teachers, at only 34.5%, is low compared to other universities, where over three-quarters favor a blended approach.

Medical students’ preferences for learning modes—53.5% prefer offline, 12.8% prefer online, and 33.7% prefer hybrid—reflect patterns observed in previous studies.¹⁰ This similarity may arise from the specific demands of medical education, which includes practical skills, lab work, and clinical internships—areas where current teaching models struggle to blend online and offline methods effectively.

Two approaches may address these challenges: model exploration and technology empowerment. Adapting teaching modes to meet medical education needs involves implementing self-regulated flipped classroom models,¹¹ WeChat-based flipped classrooms,¹² and integrating humanities and social sciences into course instruction.¹³ These methods have shown promising results. The rise of smart education, driven by advancements in technology and big data, leverages recent 5G innovations to significantly decrease latency. This facilitates real-time interactions and immersive experiences through extended reality, providing students and teachers with virtually simulated, lifelike educational environments.

Furthermore, teachers who rate their online teaching quality higher and students who perceive their online learning as effective are more likely to favor hybrid teaching in the post-pandemic context. Research by Meyer JH and Jong indicates a significant correlation between teachers’ educational experiences and their selected teaching methods.^14,15 Teachers who focus on effectiveness are likely to invest more effort and maintain their engagement, leading to better outcomes and sustained innovation in education. Similarly, medical students who are dissatisfied with online teaching or who experience poor learning outcomes tend to prefer offline teaching.¹⁵ This underscores the need for an effective feedback evaluation system in online teaching to improve ongoing assessments and keep teachers informed about student learning outcomes and feedback. Such a system would not only improve the teaching experience and enhance assessment quality but also enrich students’ learning experiences. Establishing this dynamic feedback system requires administrative guidance and technical support from universities.

Challenges in teacher-student interaction during online sessions have caused some medical teachers to prefer traditional offline methods over hybrid teaching. Numerous studies indicate that faculty struggled with interaction and adapting to external environments during online teaching driven by the pandemic.¹⁶ The initial extensive phase of online teaching during the pandemic posed significant challenges for college faculty, who often lacked experience and training in online teaching.^1,17 Teaching remained teacher-centric, simply shifting offline content online without effectively integrating student participation or interaction. In the post-pandemic era, university teachers should reevaluate the teaching-learning relationship, transitioning from regulatory to more collaborative, interactive, and feedback-oriented methods.¹⁸

A limitation of our study is that it only included data from the faculty and students of one medical school. To enhance the representativeness of the research, we recommend collecting data from multiple medical schools in various regions. Additionally, the data were collected using a questionnaire, which is a relatively singular approach. Future research should consider combining field surveys with questionnaires to create a more comprehensive approach. Lastly, the questionnaire only addressed common factors influencing the willingness of faculty and students to choose their teaching modes, omitting some important influencing factors. Previous studies have indicated that combining Transactional Distance Theory and Bloom’s Taxonomy Theory and online learning platforms can enhance students’ academic achievements and satisfaction.¹⁹ We look forward to conducting similar multi-center studies in the future that involve large sample sizes and yield more comprehensive data.

Conclusion

In summary, the hybrid online-offline teaching model is gaining acceptance among university faculty and students. Key factors influencing new teaching models include teacher-student interaction, the learning environment, and overall efficiency. Maximizing students’ sense of academic achievement and satisfaction is essential for enhancing blended teaching models. With advancements in information technology and big data, post-pandemic medical education should treat the crisis as an opportunity. It should leverage the experiences gained from online teaching during the pandemic, focus on enhancing teacher-student interaction, and adopt collaborative, interactive, and feedback-oriented methods. Fully leveraging the advantages of the hybrid model can guide the exploration of diverse teaching mode reforms in the post-pandemic era.