Facilitators and barriers to online group work in higher education within health sciences – a scoping review

Figures & data

Figure 1. The community of inquiry framework. Image used with permission from the community of inquiry website and licensed under the CC-BY-SA International 4.0 license (https://creativecommons.Org/licenses/by-sa/4.0/). The original image is located at https://www.thecommunityofinquiry.org/framework.

Table 1. Eligibility criteria based on population, concept, context, and main aim.

	Inclusion	Exclusion
Population (Students in higher education within health sciences)	Students (any age) in higher education within health sciences Students in programs/courses in health care and health sciences (including education of authorized health personnel)	Students in non-credited higher education courses/programs – (i.e., continuing education/short courses at the workplace) Students in programs/courses not within health sciences Interns or residents (graduated from medical school) are the only participants PhD-fellows/candidates Veterinary students
Concept (group work)	Studies specifically addressing independent group work as a voluntary or obligatory learning activity in credited higher education within health sciences. Including but not limited to collaboration, cooperation, discussions and tasks and work assignments Studies addressing learning models in which independent group work is a fundamental part	Studies not specifically addressing group work Studies addressing learning models in which group work is not essential Small group teaching (instructor/tutor/facilitator/teacher continuously present as part of the group)
Context (online)	All variations of students working together in digital learning contexts/environments including but not limited to synchronous, asynchronous, blended or hybrid solutions. Group work takes place solely online meaning ‘not in-person’	Fully physical learning environment Student’s group work taking place in-person (even if preparations or part of the course are online)
Facilitators or barriers to online group work	Reporting findings on student or faculty’s experience, opinions of potential facilitators or barriers to online group work Reporting effect or associations between potential facilitators or barriers and online group work	Not addressing or reporting any potential facilitators or barriers to online group work Group work is regarded as a facilitator or barrier to learning in a course, but has not been investigated further

Figure 2. PRISMA flow chart of the study selection.

Table 2. Study characteristics of 39 included articles.

First author (year) Country	Purpose	Design and data collection methods	Health professional study field	Online mode	Type of assignment	Duration of group work	Group size
Abdelhakim, H. E [32]. (2022) UK	ʽTo explore student’s perspectives towards IPE education and to use that information to improve the design of these sessions in the future.ʼ	Quantitative and qualitative; Surveys (Likert scale and open-ended)	Pharmacy (MPharm), Medicine and Surgery (MBBS)	Synchronous	Case studies, discussion (second case in breakout rooms)	3-hour session	≤8
Adwan, J [33]. (2016) US	ʽTo investigate the effectiveness of using a dynamic Google Forms peer evaluation form in online group activities in improving group work outcomesʼ	Descriptive comparative design; Surveys (Likert scale and open-ended)	Nursing students – Health informatics course	Synchronous and asynchronous	Produce online Voice Thread presentations	1 semester	5
Ambrose, M [34]. (2017)Australia and Indonesia	ʽTo explore the experiences of medical students in Australia and Indonesia who participated in a reciprocal intercultural participatory peer e-learning activity (RIPPLE) in global health.ʼ	Surveys (Pre- and post; Likert scale and open-ended)	Medical	By choice	Produce a 500-word structured literature review in abstract format	2 weeks	≤8
Breen, H [35]. (2015)US	ʽUnderstanding the usefulness of Online Collaborative Learning Theory (Harasim) for the assessment of collaborative discussions in nursing education.ʼ	Qualitative Constant comparative Transcript analysis	Nursing	Asynchronous (discussion forums)	Development of nursing action plan to respond to the needs of agreed-upon members of the virtual community	1 week following 1 week in whole class collaboration	4–5
Bristol, T. J [36]. (2012)US	ʽTo explore the effect of size and strategy on asynchronous discussions in a small baccalaureate nursing program.ʼ	Descriptive correlational and quasi-experimental methodology; Surveys (Likert scale and open-ended)	Nursing, Second-semester adult medical-surgical course and obstetrics/pediatrics course	Asynchronous	Asynchronous discussion homework assignments	16-week semester	11 and 12 vs. 23
Bybee, S [37]. (2022) US	ʽTo [1] address health science students’ attitudes toward group work and peer assessment [2], apply evidence-based recommendations and student suggestions to the adaptation of a PAR, and [3] determine the rubric’s effectiveness for educators and acceptability among students.ʼ	Evaluation; pre- and post-surveys	Nursing, Pharmacy, Dental and Medical students 1) Palliative care course 2) Ambulatory care course (Zoom- ambulatory)	Prework asynchronous, synchronous	Ambulatory: Group session in 4-hour workshop- in person or virtually Palliative care: Group work incorporated throughout the semester	Ambulatory: Group session in 4-hour works Palliative care: Throughout the semester	5–7 (Ambulatory groups)
Darici, D [38]. (2021) Germany	ʽTo evaluate the implementation of a histology course previously taught in a classroom setting into an online-only format based on video conference software.ʼ	Evaluation; pre- and post-surveys (Likert scale and open-ended)	Medical, digital Histology course	Synchronous	Work-sessions in smaller groups (breakout rooms) – solving specific problems.	10–25 minutes per group session, 2–3 group sessions per course session throughout 1 semester (19 course days)	5–10
Ferguson, C [39]. (2016) Australia	ʽTo explore first year Bachelor of Nursing student nurses’ experiences with social media in supporting student transition and engagement into higher education.ʼ	Qualitative; Focus group interviews.	Nursing	Asynchronous and synchronous	NA	NA	NA
Floren, L. C [40]. (2020) US	ʽTo develop and evaluate a mobile learning module to support knowledge construction between medical and pharmacy students through structured dialogue prompts.ʼ	Quantitative and qualitative feedback on CBL; Scoring student work	Medical and pharmacy	Asynchronous	Virtual interactive case in three phases,	two-weeks	2
Ganotice, F. A [41]. (2022) China	ʽTo distinguish the characteristics of high- and low-performing teams, and examine whether self-determined motivation could predict group membership in high- and low-performing teams.ʼ	Quantitative; Survey and test scores	Chinese Medicine, Medicine, Nursing, Pharmacy, Undergraduate Social Work and Master’s Social Work, Interprofessional educational module	Asynchronous and synchronous	Work as a team to solve a complex problem (Case-based learning, Care plan, independent team meeting, breakout meeting, peer-evaluation)	10 days	5–8
Garratt-Reed, D [42]. (2016) Australia	ʽTo compare student grades and satisfaction, as well as retention rates, in online and face-to-face versions of an introductory psychology unit.ʼ	Quasi-experimental methods; Marks; Student feedback (Likert scale and open-ended)	Psychology	Asynchronous	Group Presentation Assignment	Submission before the end of week 12, but not stated if the assignment ran from the start of the semester.	Not stated, student comments suggest one group was approximately 3 students
George, T. P [43]. (2019) US	ʽTo determine student perceptions about collaborative learning activities between prelicensure BSN and MSN students.ʼ	Survey (Likert scale and open-ended)	Nursing	Hybrid or blended asynchronous – BSN students on campus, MSN students online	Create low-literacy pamphlets for community sites based on community assessment. Use pamphlets in educational sessions at community sites	1 semester	Not stated
George, T. P [44]. (2021) US	ʽTo implement a virtual synchronous debate in an online graduate nursing course and to determine whether students’ ability to communicate professionally about ethical issues in health care improved after participating in the learning activity.ʼ	Survey (Likert scale and open-ended)	Nursing, course in advance practice nursing	Synchronous	Online debate	1 semester: 1 debate session (active participation) 2 debate sessions (attendance only)	3
Govindarajan, S [45]. (2022) India	ʽTo implement and evaluate online TBL among first year MBBS students in Biochemistry.ʼ	Implementation and evaluation of TBL; Feedback (Likert scale and open-ended)	Medical, Bachelor of Surgery (MBBS) Biochemistry course	Synchronous	Online TBL session	3 sessions, 2 hours	10
Hastuti, A. A. M. B [46]. (2022) Indonesia and foreign countries (Vietnam, Philippines, Malaysia, Cambodia, Taiwan, Japan, Nepal, Pakistan, Iraq, Uganda, Saint Kitts and Nevis)	ʽTo determine the feasibility of using the virtual world platform of SL to deliver an IPE experience focused on palliative care topics.ʼ	Mixed methods; Questionnaire (Likert scale and open-ended)	Medical, Nursing, Nutrition, Physical Therapy and Social work students, Online summer course on traditional medicine	Synchronous and asynchronous	Discussion sections in synchronous activities and asynchronous project assignments	10 working days, 9 hours per day	Not stated
Haugland, M. J [47]. (2022) Norway	ʽTo describe, explore and discuss how the students collaborated in small groups in an online course to learn.ʼ	Case study; Focus group and individual interviews	Philosophy of science, ethics, and research methods, Master’s-level health programs	Synchronous and asynchronous	Problem-based assignments	Not stated	3–5
Hovlid, E [48]. (2022) Norway	ʽTo explore students’ experiences and perceptions of learning Quality improvement (QI) competence after participating in the virtual learning module, and to identify factors that promote or inhibit virtual learning of QI competence.ʼ	Exploratory case study design; Focus group interviews.	Healthcare and social services postgraduate course, Health professionals	Synchronous	Case and presentation	1 day	4–6
Keynejad, R [49]. (2013) UK and Somaliland	ʽTo share knowledge and experiences between medical students in Somaliland and the United Kingdom, for psychiatry education and cross-cultural exchange … . assess the usefulness and feasibility of online, instant messenger, peer-to-peer exchange for education in psychiatry between cultures.ʼ	Questionnaires and surveys (Likert scale and open-ended)	Medical, Psychiatry	Synchronous	Discussions of suggested themes (psychiatry topics)	Eight 1-hour meetings	2
Keynejad, R [50]. (2016) UK and Somaliland	ʽFirst to examine attitudes to psychiatry pre- and post-participation in peer-to-peer global mental health e-learning; second, to examine stigmatized attitudes in medical students pre- and post-participation; and third, to assess students’ subjective reports of learning arising from this partnership. This study had two further methodological aims: to qualitatively assess the practical applicability of this e-learning model and to explore improvements to address implementation problems.ʼ	Mixed methods; Survey (Likert scale and open-ended)	Medical	Synchronous	Discussions of suggested themes (psychiatry topics)	Ten 1-hour meetings every second week	2
Kor, P. P. K [51]. (2022) China	ʽTo explore undergraduate nursing students’ self-regulated learning experiences, satisfaction, and attitudes toward older persons in a gerontological nursing course using online self-regulated enquiry-based learning (EBL) during the COVID-19 pandemic.ʼ	Sequential explanatory design; Surveys (Pre- and post, Likert scale); Focus groups	Nursing, Gerontological nursing course	Synchronous (and asynchronous? Not clearly stated)	Using video-based scenarios: Explaining the problem, develop mind map and discuss it with peers, analyze the problem, find solution, present evidence.	3 months	10–12
Kwon, K [52]. (2014) US	ʽExplored what social interactions students exhibited during collaborative learning, and analyzed how the social interactions evolved in a computer-supported collaborative learning (CSCL) environment.ʼ	Ex post facto design; Descriptive analysis; Cluster analysis	Health science	Asynchronous	Online discussions and Wiki. To develop a clinical ethics case scenario and act out the roles of the stakeholders.	16 weeks (1 semester)	5–6
Liu, Y-H [53]. (2018) US	ʽTo answer the following questions: 1. Are there differences between groups in terms of individual work experience, online learning experience, and group process in early collaboration? 2. How were the individuals’ work experience, online learning experience, and the group process in the early collaboration phase associated with student perceptions of the overall group collaboration.ʼ	Ex post facto design; Surveys (Likert scale)	Prehealth professional programs, Course in clinical ethics required in	Not stated	Co-writing a Clinical ethics case	Week 4–16 in a 1 semester, 16 weeks course	3–6
Mayordomo, R. M [54]. (2015) Spain	ʽTo (i) identify the processes of collaborative knowledge construction and the processes of organization and coordination of work in a small group collaborative virtual task which has a written product; (ii) compare both types of processes among groups with low and high levels of performance in the task; and (iii) explore possible relationships between the types of organization and coordination of work used by the groups and the levels of collaborative knowledge construction they reach in the development of the task.ʼ	Single case exploratory study; Students’ documents and written communication	Instructional psychology course	Not stated, but asynchronous is implied	Small group virtual task The final product of the task was a global report on the work done and the results obtained	5 weeks	4
Nicklen, P [55]. (2016) Australia	ʽTo compare the effect of remoteonline CBL (ROCBL) with traditional facetoface methods on learning outcomes of undergraduate physiotherapy students. The secondary aims were to explore student satisfaction and response, and perceived depth of learning with ROCBL.ʼ	RCT; Survey; Focus group interviews	Physiotherapy	Synchronous via web-conferencing	CBL sessions	2 CBL sessions (approximately 90 min per session) and outcome assessment, 1 week	4–6 (only stated in control)
Onrubia, J [56]. (2015) Spain	To ʽpresent a teaching innovation experience that sought to promote individual and group regulated learning in university students who work in a computer- mediated collaborative environment. ʼ	Teaching innovation intervention; Questionnaire (Likert scale and open-ended)	Psychology, Educational psychology course	Blended	Topic based case studies and creation of conceptual maps	12 weeks (three topic areas, each lasting about four weeks)	4–6
Palmer, R. H [57]. (2022) US	ʽTo evaluate the impact of synchronous hybrid instruction on pharmacy students’ engagement in a pharmacotherapy course.ʼ	Mixed methods; Survey (Likert scale and open-ended)	Pharmacy, Pharmacotherapy course at College of Pharmacy	Synchronous hybrid	Develop patient care plans	1 semester	4–6
Peterson, A. T [58]. (2016) US	To ʽexamine the independent and interactive effects of four CSCL strategies: social interdependence, summarizing, scripts, and synchronicity.ʼ	Experimental-control design; Questionnaires (Likert scale)	Nursing, online graduate nursing course	Synchronous, asynchronous	Case studies	16-week semester	3–5
Prosser, M [59]. (2021) UK and Somaliland	ʽTo explore the experiences of students participating in the Aqoon programme, including their experiences of reflective practice.ʼ	Qualitative; Students’ writing and focus group interviews	Medical (medical school)	Synchronous and asynchronous	Case-based discussions	1-hour sessions weekly, 7 weeks	3 (2 from Somaliland, 1 from UK)
Raymond, A [60]. (2016) Australia	ʽTo examine students’ opinions of the experience of peer group online learning.ʼ	Qualitative; Questionnaire (Open-ended)	Nursing, Pharmacology course	Not specified	Activities in group online forum sessions and assessment tasks	Not stated	6–8
Raynault, A [61]. (2021) Canada	ʽTo 1) demonstrate how interprofessional teams of students mobilize framework competencies and care approaches during online and face-to-face collaborative learning activities; and 2) analyze how students collaborate during a hybrid IPE course using a patient partnership approach.ʼ	Qualitative; Students’ work and questionnaire (Open-ended)	Audiology [1], occupational therapy [7], kinesiology [1], medicine [11], dental medicine [1], nursing [14], nutrition [3], optometry [3], speech therapy [2], pharmacy [9], physiotherapy [1] and social work [6] programs.	Synchronous, asynchronous and face-to-face workshop	Co-create two activities (a therapeutic education and an interprofessional vignette) in the online collaborative journal.	Not stated	5
Rogo, E. J [62]. (2014) US	ʽTo explore student experiences in a graduate dental hygiene program contributing or impeding the development and sustainability of online learning communities.ʼ	Qualitative Case study; Individual interviews	Dental hygiene	Asynchronous, in addition to 2 campus visit (1 week each)	Group activities and projects, or peer review activities.	Not stated (group activities and projects, or peer review activities throughout the 3-year graduate program)	Not stated
Ropero-Padilla, C [63]. (2021) Spain	ʽTo explore nursing students’ experiences and perceptions of the use of game elements in two full-nursing subjects using a blended-learning teaching strategy.ʼ	Qualitative; Focus group interviews	Nursing students, Adult and Elderly Health Programmes and Chronic Processes	Blended, online and practice classes	Team-based activities and Team-based game sessions	45 hours distributed over 23 sessions	5–6
Sand, J [64]. (2021) US	ʽTo describe an implemented online interprofessional course that meets the needs of undergraduate students from a variety of clinical and nonclinical health programs.ʼ	Course evaluation; Questionnaire (Likert sand open-ended)	Health information management (HIM), interprofessional capstone course, including environmental and occupational health, HIM, health studies, nursing, public health, radiologic sciences, and respiratory care.	Not stated	ʽTeamwork throughout the courseʼ: ʽdiscussions, and meetings, agreeing on a team norms document, and creating patient education materials.ʼ	Throughout the course	Not stated
Shimizu, I [65]. (2022) Japan	ʽTo compare the degree of social interdependence in OCL with face-to-face environments and clarify aspects that affect social interdependence in OCL.ʼ	Mixed methods RCT (crossover); Questionnaire (Likert scale), and Focus group interviews	Medical	Synchronous	Group discussions as a team as part of TBL. Tasks regarding problem solving of medical cases	TBL process 6 weeks online, 6 weeks face-to-face	7–9
Siah, C.-J. R [66]. (2022) Singapore	ʽTo examine the impact of online-tutorials in place of face-to-face tutorials on knowledge level and understand the perspectives of learners who experience online-tutorials.ʼ	Mixed methods experiential design; Assignment and exam results, and Individual interviews	Nursing, Psychology for Nurses module	Synchronous	Group written assignment, discussions	2-hour sessions from week 1–13	Smaller groups of 5 implied in results
Trobec, I [67]. (2015) Slovenia	ʽA pedagogical experiment conducted to identify the readiness and responsiveness of current organisation of nursing higher education in Slovenia through It compared the successfulness of active learning methods online (experimental group) and in the traditional classroom (control group) and their impact on the ethical competences of nursing students. ʼ	Non-randomized interventional study; Questionnaire (Likert scale and open-ended)	Nursing, Philosophy and Professional Ethics in Nursing course	Synchronous and asynchronous	Discussions in tutorials	Not stated tutorials were part of the course (The study was performed in the academic year 2010/2011)	5–6
Vogt, M. A [68]. (2016) US	ʽTo evaluate various technology enhanced methods on the learning acquisition and satisfaction of graduate nursing students in an advanced pharmacology class using an unfolding case study.ʼ	Mixed methods; Group grades and survey (Likert scale and open-ended)	Nursing, Advanced pharmacology course	Synchronous or asynchronous	Evolving case	3 weeks	Five groups of 8 and one group of 6
Wolcott, M. D [69]. (2022) US	ʽTo describe the implementation and impact of an introductory session on psychological safety for incoming first-year Doctor of Dental Surgery (DDS) learners.ʼ	Intervention, Mixed Methods; Surveys (Different scales and open-ended), Students’ work, and Focus group interviews	Dental	Synchronous	Small group conversations	2 hours session	8–10
Yamashita, T [70]. (2021) Japan	ʽTo evaluate the utility of online group work in interprofessional education.ʼ	Quantitative study; Test scores	Medical and nursing	Synchronous	Discussion activities ‘NASA Exercise: Survival on the Moon’	1 session	4–5

Table 3. Facilitators and barriers to online group work in health science education categorized according to the community of inquiry framework.

		Facilitators	Barriers
Social presence	Affective expression	Getting to know the other group members [66] Establishing and improving interpersonal relationships [43,67] Working in the same group over time [47,48,63]	Lack of personal interaction in group work [64]
	Open communication	Feeling included and safe in the group [48] Trusting the others in the group [48] Reciprocity [54] Establishing quality communication early in the group process [52,53]
	Group cohesion	Joint accountability, responsibility and shared commitment [45,47,48,52,54,63]. Equal distribution of workload [37,62] Establishing group norms [53] Intensive interactions early in the collaboration [52] Encouraging interaction and inclusion of all members of the group [67] Continuous socio-emotional interaction [48,52] Endorsing and valuing teamwork [41]	Lack of shared commitment [54] Working on tasks regardless of other group members [47] Unequal distribution of workload [42,44,48,62,64,68] Unequal distribution of responsibility [62] Limited interaction with the other group members [52].
Cognitive presence	Triggering events	Guidance prompts or questions [40,59] Micromovies/videos [51,69]
	Exploration and integration	Joint responsibility, joint discussion and mutual revision [47,54] Assignments that promote sharing experiences and exploring one’s own and others’ opinions or perspectives could be seen as potential facilitators of exploration [68].	Dividing tasks between group members working individually [47,54]
Teaching presence	Design and organization	Smaller groups [36,62,64] 3–4 students per group [38,47,59] Choosing their team [63] Being in the same group over time [47,48] Groups with diversity in health professional fields [46,70] Problem-, or case-based assignments [47,48] Access to relevant learning resources before and throughout group work was found to be beneficial [32,51] Activities or requirements that supported group organization and regulation [56,58] Peer-to-peer feedback [33] or expectations of peer assessment [37],	Lack of time management for groups could be a potential barrier [45].
	Facilitating discourse	Discussion prompts seemed to enhance achievement [40,59].	Unclear instructions and explanations were suggested as a potential barrier in several studies [32,44,46].
Outside CoI		Agreeing on digital tools or social media between students to use for communication and collaboration [61] Using well-known digital tools or social media [39,49,50,60,61]	Technical challenges [50,57,60] Internet connection [34,49,59,63] Lag time [55] Insufficient instruction or competence in using technology as a potential barrier [60,65,68] Scheduling group meetings as a barrier [34,43,44,50,61,62,64,68] Find time to work individually on group assignments [35]

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Data availability statement

Data charting schemes can be made available on request