A Literature Review of Barriers and Opportunities Presented by Digitally Enhanced Practical Skill Teaching and Learning in Health Science Education

Figures & data

Table 1. Search strategy for EBSCO Host using subject terms (SU)

[SU Education, Distance OR ‘Computer Assisted Instruction’ OR TI (‘“Blended Learning”’ OR ‘“Computer Uses in Education”’ OR ‘“Distance Education”’ OR ‘“Educational Technology”’ OR ‘“Electronic-Learning”’ OR ‘“Web Based Instruction”’ OR ‘online learning’ OR ‘e-learning’ OR ‘“distance education”’ OR ‘“distance learning”’ OR ‘flipped classroom’ OR ‘remote learning’ OR ‘“computer based training”’ OR “‘online instruction’ OR ‘“virtual learning”’ OR ‘“web-based learning”’ OR ‘“technology-enhanced learning”’ OR ‘educational technology’)] AND [SU ‘Medical Education’ OR TI (‘“Medical Education”’ OR ‘“Allied Health Occupations Education”’ OR ‘“Health Science*”’ OR ‘“Medical School”’ OR ‘“Medical Student*”’ OR physiotherap* OR nurs* OR dent* OR surgical OR “‘health education’“)] AND [SU Clinical Competence OR TI (‘“Skill Development”’ OR ‘“Skill* Training”’ OR ‘practical skill*’ OR ‘clinical skill*’ or ‘skill acquisition’ or ‘skill development’ or ‘skill learning’ OR ‘“Clinical Experience”’ OR ‘surgical skill*’)] AND [SU (‘Barrier* and Facilitator*’ OR ‘Teacher Attitudes’ OR ‘Student Attitudes’ OR ‘Facilitators (Individuals)’ OR Barriers OR Opportunities OR ‘Student Satisfaction’) OR TI (‘Barriers and Facilitators’ OR ‘Student Attitudes’ OR ‘Student Teacher Attitudes’ OR ‘Teacher Attitudes’ OR ‘student satisfaction’ OR ‘Perception*’) OR AB (‘Barriers and Facilitators’ OR ‘Student Attitudes’ OR ‘Student Teacher Attitudes’ OR ‘Teacher Attitudes’ OR ‘student satisfaction’ OR ‘Perception*’)]

Figure 1. PRISMA flowchart of the screening process.

Figure 2. Example of visual mapping of codes for generating themes.

Table 2. Summary of Included Articles

Reference Number	Author, Year (Country)	Aim	Participants	Skill	Data Collection Tools
6	Pei & Wu, 2019 (USA, UK, Spain, Brazil, Germany, China, Iran, Indonesia, India)	Exploring the efficacy of online learning in meeting learning outcomes compared to traditional teaching	Undergraduate medical students	Knowledge and skills	Systematic review and meta-analysis
7	Gamage et al., 2020 (Global)	Review of online teaching and lab practices pre-Covid and student experiences	Students and staff generally	General skills teaching	Review
10	McGann et al., 2021 (USA)	Explore the feasibility and efficacy of an online lab in teaching surgical skills	3rd and 4th yr medical students (N = 86)	Identification of instruments, knot-tying and suturing	Survey of student knowledge, skill acquisition and competency
19	Björklund & Silén, 2021 (Sweden)	Explore student learning of interprofessional communication while working collaboratively with a virtual patient	Occupational therapy and physiotherapy students (N = 8)	Interprofessional communication	Recorded and transcribed student conversations and non-verbal communication
27	Dhar et al., 2021	Literature review of virtual reality implementation, and student experiences, in medical training	Medical students	General practical and clinical skills, communication and physical examination	Review
28	Sebbani et al., 2021 (Morocco)	Explore student attitudes towards online learning	Health science students (N = 111)	General clinical skills	Questionnaire of student attitudes
29	Muflih et al., 2021 (Jordan)	Explore students’ attitudes towards online learning	Medical students (N = 1210)	General clinical skills and core competencies	Survey of student attitudes
30	Bdair, 2021 (Saudi Arabia)	Investigate student and staff perspectives of distance learning	Nursing students (N = 10) and staff (N = 10)	Psychomotor skills and core competencies	Semi-structured interviews
31	Bloomfield & Jones, 2013 (UK)	Attitudes and experiences of blended learning approach to clinical skills training	Postgraduate nursing students (N = 83)	Hand decontamination, oral medication administration, injection technique, physical hygiene, feeding a patient, aseptic technique, elimination needs, skin assessment and pressure area care	Questionnaire and focus groups for feedback on student perception and experience
32	Abbasi et al., 2020 (UAE, USA, UK, Australia, Canada, Egypt, Iraq, Malaysia, Nigeria, Pakistan, Saudi)	Explore student attitudes and satisfaction towards online learning during Covid-19	Health science students (N = 1255)	General clinical and technical skills	Questionnaire on attitudes, perceptions, satisfaction
33	Abdelaziz et al., 2011 (Egypt)	Evaluate the effectiveness of an online learning programme against traditional teaching	2nd year nursing students (N = 276)	Central venous pressure and electrocardiogram procedures	Questionnaire on knowledge, attitudes, opinions. Checklist on procedural steps
34	Rodriques-Fernandes et al., 2020 (Global)	Systematic review of digital microscopy as a learning and assessment tool	Medical and dental students	Identify and differentiate clinical features, diagnoses of specimens	Objective measures of student achievements, perceptions
35	Woodham et al., 2015 (UK)	Inform the development and use of virtual patients	Medical students (N = 119), teaching staff (N = 18)	Clinical reasoning skills	Surveys of student/staff perceptions
36	Reinhart et al., 2021 (Germany)	Explore student and staff attitudes and experiences with online learning	5th yr medical students (N = 16) and teaching staff (N = 8)	Patient history taking, physical examination	Focus group discussions
37	Lehmann et al., 2013 (Germany)	Explore student and staff attitudes towards blended learning using virtual patients for skills training preparation	5th yr medical students (N = 617)	Lumbar puncture, paediatric life support, bladder puncture	Student clinical examination, staff interviews
38	Londgren et al., 2021 (Europe and North America)	Investigate the efficacy of the FC approach in preparing students for clinical skill lab	Veterinary educators (N = 101)	General clinical skills	Survey of educator attitudes
39	Choi et al., 2021 (South Korea)	Evaluate the feasibility of using FC to provide respiratory system assessment content and explore student-centred learning pre- and post-FC	2nd yr nursing students (N = 91)	Respiratory system assessment	Questionnaire with open-ended questions
40	Ali & John, 2019 (Bahrain)	Efficacy of online videos in for clinical skill competency and satisfaction	Nursing students (N = 26)	Hand washing, surgical bed making and nasogastric tube deeding	Competency skill evaluation checklist, satisfaction questionnaire, and focus group discussion.
41	Jang & Kim, 2014 (South Korea)	Explore student experience and attitudes towards using online videos for learning clinical skills	Medical students (N = 411)	Unspecified clinical skills	Semi-structured interviews and questionnaires of student attitudes
43	Zamberg, Schiffer, & Stoermann-Chopard, 2021 (Switzerland)	Explore student perceptions of and satisfaction with an online learning module in renal semiology	2nd yr medical students (N = 105)	Renal semiology/nephrological semiology	Survey with open-ended questions. Video conferencing call to gather feedback on student perceptions and satisfaction
44	Posey & Pintz, 2017 (USA)	Explore student and faculty perceptions of a blended learning experience and student digital literacy skills	Nursing students (N = 36) and staff (N = 6)	Communication skills, collaboratively building patient cases, digital literacy	Student surveys of attitudes, pre- and post-program assessment of digital literacy, staff interviews
45	Dolan, Hancock & Wareing, 2015 (UK)	Evaluate the efficacy of delivering an ECG skills laboratory using online and traditional learning approaches	1st yr health science students (N = 22)	ECG electrode placement and interpretation	MCQ and practical examination
46	Badowski, Rosslet & Reiland, 2021 (USA)	Examine student attitudes towards use of traditional clinical and manikin-based simulation experiences to meet learning outcomes	Nursing students (N = 97)	Communication skills	Clinical Learning Environment Comparison Survey
47	Wotton et al., 2010 (Australia)	Evaluate student experiences with high-fidelity simulations	3rd yr nursing students (N = 300)	General clinical skills	Evaluation form with open questions
48	Schoening, Sittner & Todd, 2006 (USA)	Explore student attitudes towards a pre-term labour patient simulation compared to traditional teaching	Nursing students (N = 60)	Perform physical assessment, develop a care plan, critical thinking, delivery of preterm infant	Survey of learning objectives, open box comment for student perceptions
49	Reilly & Spratt, 2007 (Australia)	Student and staff perceptions and experiences of high-fidelity simulation to prepare for clinical practice.	2nd yr nursing students (N = 41) and teaching staff (amount unspecified)	Patient care, communication skills	Survey and focus group discussion of perceptions
50	Kleinert et al., 2007 (USA)	Improve student self-efficacy and decrease perceived difficulty of treating children with developmental disorders	Dental students (N = 51)	Communication skills	Pre- and post- knowledge test, usability scale
51	Wise, McIvor, & Mangione, 2016 (USA)	Assess student usage and perceived value in using web-based simulation in medical education	Medical students (N = 138)	Clinical use of pulmonary artery catheters	Survey response of student perception
52	Arslan et al., 2018 (Turkey)	Student satisfaction with watching educational videos pre- or post- practical skills lab	Nursing students (N = 213)	Wound care	Questionnaire on satisfaction

Table 3. Mapping recommendations to barrier and opportunity themes

Recommendation	Barrier theme	Opportunity theme
1 Provide physical and technological supports	1. Inaccessibility and Inequity of Online Learning 3. Technological Challenges 6. Negative Attitudes Towards Online Learning	3. Efficacious Use of Class Time 4. Access to Education
2 Support the continued professional development of those who teach and share resources	1. Inaccessibility and Inequity of Online Learning 2. Digital Literacy Among Staff 3. Technological Challenges 5. Lack of Staff-Student Interaction 6. Negative Attitudes Towards Online Learning	4. Access to Education
3 Collaborate with software developers as key stakeholders	2. Digital Literacy Among Staff 3. Technological Challenges 5. Lack of Staff-Student Interaction 7. Skill Suitability	6. Diverse Range of Learning Materials
4 Develop procedures to promote high quality effective online education	3. Technological Challenges 4. Lack of Engagement with Preparatory Material Hinders Practical Learning 5. Lack of Staff-Student Interaction 6. Negative Attitudes Towards Online Learning	1. Facilitates Higher Order Learning 3. Efficacious Use of Class Time 6. Diverse Range of Learning Materials 7. Promotes Autonomous Learning
5 Make full use of online tools and possibilities	1. Inaccessibility and Inequity of Online Learning 4. Lack of Engagement with Preparatory Material Hinders Practical Learning 5. Lack of Staff-Student Interaction 6. Negative Attitudes Towards Online Learning	1. Facilitates Higher Order Learning 3. Efficacious Use of Class Time 4. Access to Education 5. Learning Brought to Life 6. Diverse Range of Learning Materials 7. Promotes Autonomous Learning
6 Seek feedback	3. Technological Challenges 5. Lack of Staff-Student Interaction 6. Negative Attitudes Towards Online Learning 7. Skill Suitability