March 18, 2014

Distance Education in Healthcare Degree Programs

by Maureen Jones, M.S., Pharm.D., PGY-1 Pharmacy Practice Resident, Carroll Hospital Center

Distance Education has been defined as “the separation of educator and learner in time and space.”1  Among advanced healthcare degrees, nursing2, dental hygienist3, public health4 and Doctor of Pharmacy degrees5-6 can currently be completed through distance education programs. Many (perhaps most) traditional healthcare degree programs incorporate aspects of distance learning into their curricula as well.7-8  But what kind of evidence do we have evaluating the quality of distance education to traditional methods?  Should we celebrate distance education as an equal (or better!) alternative to traditional methods of instruction?  Or should we reject it?  The answer: we have data (but perhaps not enough) and it’s mostly positive.

Nursing programs have by far the most data on distance education.  One systematic review on the effectiveness of tele-education in nursing and medical education found that there was no significant difference in overall knowledge gain between face-to-face instruction and videoconferencing.9  Another study evaluating the effect of learning environment in a graduate nursing program found that there were no significant differences in final course grades or the student’s perceived learning between online versus traditional face-to-face classes.  The authors emphasized that it was the “quality of instruction [that was] more important than the medium by which the course content was delivered.”10

There has also been research on distance learning in the dental sciences. For example, traditional classroom versus e-learning in infection control education for first year dental hygienist students showed that both methods of teaching were comparable based on knowledge assessments and a competency based exam (CBE).  The researchers concluded either method could be used depending on school preference and resources.  It is true that the traditional face-to-face group performed significantly better on a multiple choice exam (mean score=86.8 vs. 82.8 p=0.011), however the difference was not deemed to be a “practical” difference as both group’s mean scores were passing.  Regarding the CBE, there was no significant difference in the pass rate in each pathway.11  Many Dental Schools offer distance education courses in their curriculum. The University of Missouri-Kansas City School of Dentistry conducted a pilot program whereby the school’s pharmacology course, which was previously taught by the University’s School of Pharmacy, was transitioned to an online course taught by dental school faculty.  The pilot study showed student grades in the online cohort were similar to grades in previous year’s.  Additionally, the dental school was able retain a highly qualified professor who would have otherwise sought employment elsewhere.7

Pharmacy Schools have researched distance education strategies as well.  Creighton University is the only school of pharmacy that has a distance learning pathway for some students in their entry-level Doctor of Pharmacy degree program.  Many schools now have hybrid pathways and satellite campuses. One particular school of pharmacy that has two satellite campuses evaluated student performance in a pharmacotherapeutics class taught synchronously between the campuses. Over the course of five years, there was no significant difference between the final grades of students attending each campus.12

While the academic aspects of online education are very positive, there are potential negatives associated with distance learning: namely students potentially feeling isolated, both from other students and professors, as well as technological frustrations.  In two separate studies, students in an online dental terminology class and students in an online Doctor of Nursing program both cited feelings of isolation and disconnectedness as drawbacks to distance learning.13-14 However, students overwhelmingly thought the benefits of distance education (convenience, access, good school-life balance) outweighed this drawback.14 Additionally, students and faculty can feel frustrations towards the technology needed for distance learning.  These may be from slow download speeds, dropped internet connections, or the lack of information technology (IT) support from the school.13 Practical ways that educators can overcome these shortcomings include utilizing synchronous online chat discussions or assigning group projects to help students feel more connected, promptly answering student emails and phone calls, preparing back-up plans for activities in the event of a technological failure, and making certain there is adequate IT support available during synchronous online events.  Practical ways that students can address potential negativities include utilizing social media outside of class time to become more connected to classmates and obtaining high-quality, reliable internet service.

While some individuals may still hold certain negative perceptions about distance education, the evidence shows that well-designed instruction delivered at a distance is equally effective as traditional teaching methods in educating our future healthcare providers.

  1. Du S, Liu Z, Liu S, Yin H, Xu G, Zhang H and Wang A Web-based distance learning for nurse education: a systematic review. Nurse Educ Perspect. 2011;32:406-10.
  2. US News. The Best On-line education programs in 2014. Accessed 2/25/2014.
  3. American Dental Hygienists Association. List of on-line Master’s of Dental Hygiene programs. Accessed 2/25/2014.
  4. Davis MV, Sollecito WA and Williamson W. Examining the Impact of a Distance Education MPH Program: A One-Year Follow-Up Survery of Graduates. J Public Health Management Practice. 2004;10:556-563.
  5. Lenz TL, Monaghan MS, Wilson AF, Tilleman JA, Jones RA and Hayes MM. Using Performance Based Assessments to Evaluate Parity Between Campus and Distance Education Pathway. Am J Pharm Educ 2006;70: Article 90.
  6. The Non-Traditional Doctor of Pharmacy Pathway. The Bernard J. Dunn School of Pharmacy at Shenandoah University. Accessed 3/4/2014.
  7. Gadbury-Amyot CC and Brockman WG. Transition of a Traditional Pharmacology Course for Dental Students to an Online Delivery Format: a pilot project. J of Dental Educ. 2011;75:633-45.
  8. Haney M, Silvestri S, Van Dillen C, Ralls G and Papa L. A Comparison of Tele-Education Versus Conventional Lectures in Wound Care Knowledge and Skill Acquisition. J Telemed Telecare. 2012;18:79-81.
  9. Chipps J, Brysiewicz P and Mars M. A Systematic Review of the Effectiveness of Videoconference-based Tele-education for Medicaland Nursing Education. Worldviews Evid. Based Nurs. 2012;9:78-87.
  10. Wells M and Dellinger AB. The Effect of Type of Learning Environment on Perceived Learning Among Graduate Nursing Students. Nurs. Educ. Perspect. 2011;32:406-10.
  11. Garland KV. E-learning vs. Classroom Instruction in Infection Control in a Dental Hygiene Program. J of Dent Educ. 2010;74:637-643
  12. Steinburg M. and Morin AK. Academic Performance in a Pharmacotherapeutics Course Sequence Taught Synchronously on Two Campuses Using Distance Education Technology. Am J Pharm Educ. 2011;75:Article 150.
  13. Grimes EB. Student Perceptions of an Online Dental Terminology Course. J of Dent Educ. 2002;66:100-107.
  14. Halter MJ, Kleiner C and Hess RF. The Experience of Nursing Students in an Online Doctoral Program in Nursing: A Phenomenological Study. Int. J of Nurs Studies. 2006;43:99-105.

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