Digital Redesign of Problem-Based Learning (PBL) from Face-to-Face to Synchronous Online in Biomedical Sciences MSc Courses and the Student Perspective

Abstract

PBL is a widely used teaching approach that is increasingly incorporating digital components. Although, by its nature, a face-to-face approach is the preferred mode of delivery, its digital counterpart is gaining ground. The current paper discusses the digital redesign of PBL in an MSc in Biomedical Sciences. Face-to-face and online PBL followed the seven steps of the PBL process, and each case was completed in three sessions. For the delivery of online PBL, collaborative tools were utilized, including CiscoWebex, the online platform for synchronous meetings, and OneDrive, shareable PPT, and Moodle for synchronous and asynchronous self-directed learning. Three cohorts were followed, and students had both face-to-face and online PBL experiences. Student feedback was obtained using focus groups, and data analysis utilized a deductive and inductive approach. Our data indicate that CiscoWebex is a suitable and user-friendly platform for synchronous online PBL. The students enjoyed both formats and stated that online PBL is an effective teaching approach for promoting student learning. In regards to student interaction, the face-to-face mode was preferred, while online PBL was perceived as more organized. The redesign allowed for effective student learning and could pave the way forward for a fully online MSc program in Biomedical Sciences.

1. Introduction

Problem-based learning is an educational approach commonly used in tertiary health education programs. This is because it promotes the development of skills that are key to health professions, including critical thinking, collaboration, problem-solving, and self-directed learning [1]. Traditionally, PBL utilizes a real-case scenario, small-group work, and student-centered learning. By its nature, a face-to-face approach is the preferred mode of delivery. Currently, there is a trend to incorporate digital technology into PBL either fully or in part [2].

This is not surprising as synchronous e-learning provides a flexible environment for learning. This can be attributed to several factors, including the availability of a plethora of resources such as virtual classrooms and shareable whiteboards (WB) and documents [3,4]. The fact that it may be synchronous still allows for teacher–student and student–student interactions using electronic tools (such as the ‘raise hand’ feature) rather than reading body language. Still, this may limit the ability of the student to read non-verbal cues and decrease effective communication. Cost efficiency is another key advantage of e-learning, and the savings are transferred to both the education institution (e.g., infrastructure, staffing) as well as the learner (e.g., travel, time) [5,6].

The COVID-19 pandemic contributed to the push toward online education, providing the opportunity for creative online teaching. [7]. As previously suggested, PBL is well-suited for online teaching. To illustrate, PBL works best with a small number of participants (8–12), and this does not overload the network. This allows for simultaneous work that facilitates effective synchronous communication. In addition, the online environment may allow for the participation of individuals that are shy and do not participate in face-to-face PBL [8]. It is also possible that shy students may hide behind technology, decreasing participation. Furthermore, PBL relies on both synchronous and asynchronous teaching. The latter is particularly important for self-directed learning, which is one of the key characteristics of PBL. Students may continue interacting and sharing information through platforms such as Moodle or Blackboard. By engaging with the digital world, students become part of a learning community and may embrace life-long learning in the future [8].

Even if it is becoming more common to provide PBL components digitally, studies that have already been conducted, albeit with a small sample size, have shown encouraging results. There is no discernible performance difference between traditional and online PBL formats, according to the research, despite ongoing difficulties with student involvement and technological adaption [8,9]. Therefore, additional in-depth research is required to fully comprehend the efficiency of PBL presented online.

Student communication is one of the key skills gained in PBL, and it is not yet clear whether this skill is comparably achieved in online PBL. This may relate to student perception as well as actual information shared. A study by Lajoie et al. (2014) indicated that discussion was just as rich in the online setting, while the students noted that the flow was disrupted as they had to use the ‘raise hand’ tool [6,10]. Notably, Leavy et al. (2022), that transitioned from traditional to online PBL in an undergraduate health sciences unit in an Australian university highlighted that as the process was refined, both students and tutors became more comfortable with the technology, and collaboration improved [11].

The framework for this research is grounded on the constructivist theory upon which PBL is built. The constructivist approach is based on the premise that knowledge is constructed by the learners rather than passively taken in [12]. As such, in constructivist teaching, students are actively involved and utilize existing knowledge to tackle real-life problems. Online education runs the risk of a low-level learning experience. This may occur when traditional teaching material is transferred directly to an online setting without taking into consideration the online learning environment. As such, when moving from the traditional face-to-face setting to the online mode, this basic premise of the PBL teaching approach needs to be addressed. As such, the current study was also grounded on the computer-supported collaborative learning (CSCL) pedagogical approach. The constructivist approach discussed above is the basis for the CSCL environment, and it ‘provides a framework to bring individual learners together to achieve a shared learning goal by managing their learning processes’ [13].

The current study had two research questions:

• Can a face-to-face traditional PBL curriculum be delivered digitally, and what are the best tools?
• How do students perceive PBL in the two delivery settings (face-to-face vs. online)?

2. Materials and Methods

2.1. Setting and Participants

The study was conducted from 2019 to 2023, and three cohorts of students participated (2019–2021; n = 7, 2020–2022; n = 10 and 2021–2023; n = 13). All students enrolled in the MSc in Biomedical Sciences (Immunology concentration) at the University of Nicosia in Cyprus were invited to participate in the study following completion of the MSc and on a voluntary basis to avoid bias. Informed consent was obtained from all participants. The MSc requires three Semesters for completion. Students attended a course that incorporated PBL each semester and attended PBL either face-to-face or online. In all courses of the MSc in Biomedical Sciences, the case studies took the format of long-case PBL. Each case took three sessions to be completed. The long cases follow the seven-step Maastricht model. All classes were hybrid, including both PBL and lectures. The lecture component comprised basic immunology information to bring students to the same level prior to PBL. In Semester 1, students were given a lecture with an overview of PBL, and the course had two case studies interspersed with lectures to introduce the teaching method. In the subsequent semesters, PBL was the predominant mode of teaching. The three cohorts were exposed to different combinations of face-to-face and online PBL delivery. Details are provided in

Table 1. Courses and mode of teaching in three cohorts.

	Number of PBL Cases (n = # of Weeks of the Course)	Cohort 1 2019–2021 (n = 7)	Cohort 2 2020–2022 (n = 10)	Cohort 3 2021–2023 (n = 13)
Semester 1: Cellular and Molecular Immunology	2 (6)	Face-to-face	Online	Face-to-face
Semester 2: Autoimmunity and Inflammatory Disorders	4 (12)	Online	Online	Online
Semester 3: Immunodeficiency Disorders and Control	4 (12)	Online	Face-to-face	Face-to-face

. All students received training on how to use the online tools through the Distance Learning unit of the University of Nicosia. Students also attended an ‘Introduction to PBL’ session by the tutor the week prior to PBL delivery in Semester 1.

2.2. Face-to-Face and Online PBL Delivery

One course from each semester was designed for both face-to-face and online delivery. Tools were chosen to ensure close adherence to the PBL delivery. Face-to-face delivery was the normal mode of delivery and included the use of a physical classroom that included a round table and a whiteboard (WB). In this case, all case material was handed out and printed sequentially.

Face-to-face PBL was redesigned for online delivery following a careful selection of online tools. The selection relied on (a) ability of the tool to promote PBL principles and (b) availability of the tools (either free or through university licenses). CiscoWebex was used as the online platform for synchronous teaching. This platform incorporates several features that support effective synchronous communication, including real-time visual/audio communication, screen-sharing, live chat, ‘raise hand’ and ‘emotion icons’, as well as recording and archiving of sessions. Some of the features are shown in Figure 1. To encourage student participation, the following steps were taken: (a) students were instructed to leave their cameras ON at all times and microphones OFF if they did not speak, (b) the ‘raise hand’ tool was used to ensure everyone had a voice, and importantly, (c) the facilitators were experienced PBL tutors.

2.3. Focus Groups

To obtain the student opinion on PBL and answer our research question, all students from the three cohorts who trained using both face-to-face and online PBL were invited to participate. The participation rate was 73% (

Table 2. Student enrolment number and focus group participation.

	Cohort 1 2019–2021	Cohort 2 2020–2022	Cohort 3 2021–2023	Total
Number of Students #	7	10	13	30
Focus Group	7	7	8	22
% participation	100%	70%	62%	73%

). Prior to the focus group, we constructed a semi-structured guide and organized questions around two areas (a) PBL in general and (b) different modes of teaching PBL (face-to-face vs. online). Open-ended questions designed to stimulate discussion included, among others, prompting to discuss PBL in general, comparison of different modes of delivery, the virtual environment and tools, and adherence to PBL principles. The focus groups were conducted online using the CiscoWebex platform by two researchers that acted as a moderator or note-taker in each focus group. One of the researchers taught one of the three courses, whilst the other was not involved. Focus groups lasted for about one hour and were recorded and transcribed verbatim.

2.4. Qualitative Data Analysis

A thematic analysis of the three focus groups was conducted by the two researchers who had experience with PBL and thematic analysis. Specifically, the two researchers performed the following steps independently: familiarized themselves with the data and then summarized the data to identify meaning units, condensed meaning units, and codes that were subsequently refined into categories and themes. The coding relied both on a deductive (pre-determined areas of inquiry) and an inductive approach (generated codes directly from the data). Once these steps were completed, the two researchers discussed and agreed on a final list of categories and themes [14].

3. Results

3.1. Redesigning Long Case PBL from Face-to-Face to Online

As with most traditional PBL programs, the one discussed here followed the seven steps of PBL and was delivered face-to-face (Figure 2).

During the redesign process, all steps of the PBL process were defined in detail, and online tools that could facilitate each step were identified (

Table 3. Face-to-face and Online PBL process tools used.

	Face-to-Face PBL	Online PBL
PBL 1	Printed handout Whiteboard (WB) and markers Take a photo/copy of the information on the WB	Webex meetings (Share screen) OneDrive—share the PowerPoint (PPT)
Self-Directed Learning	Personal notes on paper/computer/any other mode	Upload LOBs on Moodle
PBL 2	Student notes or photos of the WB	Moodle and shareable PPT
	WB and markers	Shareable PPT
Self-Directed Learning	Personal notes on paper/computer/any other mode	Upload LOBs on Moodle
PBL 3	Student notes or photos of the WB	Moodle and shareable PPT
	WB and markers	Shareable PPT

WB: Whiteboard; PPT: PowerPoint.

). Specifically, for synchronous collaboration, the classroom was substituted with the CiscoWebex platform; the WB and markers were substituted with a shareable PowerPoint (PPT) (shared through Microsoft OneDrive). Knowledge was shared through the open-source learning management system, Moodle, to facilitate asynchronous collaboration. The structure of the three sessions is shown in detail in Supplementary Table S1.

3.2. Student Perceptions

Initially, cohort-specific analysis was performed to identify themes, categories, and codes. Our analysis did not show any major differences between the three cohorts, and as such, the data were pooled together. The two themes and most categories were identical for all three cohorts. Some differences in codes were observed, but all codes were seen in at least two of the three cohorts. The thematic analysis of the data generated two broad themes that included 5–6 categories and 21–22 codes per theme. The first theme identified was ‘PBL as a teaching approach’, which included ideas that students expressed about PBL as a teaching method in general. The second theme was ‘Online PBL’, containing opinions about their experience from the online setting. These are described below by Theme and corresponding categories and are summarized in

Table 4. Summary of qualitative analysis of focus groups.

Theme	Category	Code
PBL as a teaching approach	Core Characteristics	Student-centered/Interactive
		Small Group/Collaboration
		Authentic problem
		Self-directed learning
		Concentration
	Tutor	Group dynamics
		Facilitates learning
	Knowledge/Learning	Knowledge retention
		Learning Objectives
		Pre-existing knowledge
		Holistic approach
		Material covered/learn how to learn
		Confidence In knowledge gained
		Learning Curve
	Skills	Communication skills
		Organization
		Teamwork
		Critical evaluation of the literature
		Time management
	Experience	Fun/interesting
		Energy in class
	PBL and other modes of teaching	Lectures
Online PBL	Core characteristics	Student-Centered
		Small Group/Collaboration
		Self-directed learning
		Report-back
	Knowledge/Learning	Knowledge retention
	Skills	Communication skills
		Teamwork/Collaboration
		Contribution
	Experience	Adjustment/transition
		Comparable
		Prefer face-to-face
		Prefer online
		Convenient
	Technology	Cameras
		Organization
		Technical issues
		Computer
		Shareable PPT
		Recording
		Platform

.

3.3. Theme 1: PBL as a Teaching Approach

3.3.1. Category 1: Core Characteristics

One important aspect of this project was to ensure that the main characteristics of PBL were identifiable in both delivery modes. This was to make sure that the redesigned online mode did not take away from the PBL process. All three cohorts identified the key characteristics of PBL, including that it is student-centered, that it relies on small groups and collaboration, that it is case-based and realistic, that it is facilitated by a tutor, and that learning is also driven outside of the session using self-directed learning. Specifically, students stated that the process is interactive and that it develops around the learner, recognizing the difference between one-way teachings. A student said:

‘…it’s not just learning stuff through the tutor, but we say our opinions’

In regards to collaboration, students noted they could cooperate and share their opinions within the group. A student mentioned:

‘…and also it was interesting to see the different opinions between the students and how each perceived the case study.’

Students also appreciated that PBL is case-based, exposing the learner to authentic problems, making this more applicable and realistic. A student said:

‘…because we would see it step by step how an actual scientist, an actual doctor would come to a conclusion about a diagnosis, it was actually a lot more representative of how laboratory work goes on and it was a lot more representative of real life.’

In addition, being part of the process and contributing to learning in practice engaged learners to be more attentive and concentrated.

‘…it was easier for me to be focused during PBL…

Students also commented on self-directed learning, one of the most important elements of PBL. By definition, here, students have to perform private research on their learning outcomes using valid scientific sources and report back. Students commented on the importance of self-directed learning and added that although time-consuming, it allowed them to increase their database literacy. A student explained:

‘…time-wise, we didn’t have a lot of time to go through all the diseases in a PBL case but besides that, we did get some directions (through self-directed learning) on how to approach every disease and research it… and learn about it and actually not have to memorize everything by heart, but actually going in depth about it and learn a lot more as we would in the PBL on our own.’

3.3.2. Category 2: Tutor

According to the students, the tutor plays a crucial role in PBL, as this is the person that organizes and plans the sessions. Further, the students noted that the tutor handles group dynamics, ensuring everyone participates. As one student said:

‘I think because (the tutor) wanted us all to participate… (he/she) asked us questions directly and we answered.’

Another role identified by the students was that tutors guided and prompted students to use and share their knowledge so they came up with a conclusion as a team. The tutor did not provide answers but instead put learners in a place where they could find the solution. A student explained:

‘…when we were at a dead end…, not giving us the answer and by (asking the) right question it helped figure out (the answer) and sometimes the question made us think more and more deeply.’

3.3.3. Category 3: Knowledge and Learning

Students discussed the concept of knowledge from four different perspectives: (a) pre-existing knowledge, (b) acquired knowledge through learning outcomes generated and report-back, (c) learning curve, and (d) knowledge retention. On pre-existing knowledge, a student noted:

‘…(we had to) put in force all our knowledge in order to solve an issue…’

On learning outcomes and report-back, students appreciated the contribution of the group. For example, a student mentioned:

‘You have an assignment that you have to think about when you come back (to PBL)… everybody says what they think, so we may come to a general conclusion…’

One area where student opinions varied was confidence in the knowledge gained. The majority felt confident about the answers and commented that they had prepared them for exams. As one student said:

‘I never felt that the level was low because my classmates prepared and it was supervised, so we got the correct points at the end and we improved our answers at the level the tutor wanted. I believe they were appropriate for the exam.’

On the other hand, a minority revealed that they felt insecure about their answers and the information provided by other students. A student stated:

‘it would be nice if we had pointers on which information is important and should be included in the answer.’

Students strongly declared that in terms of knowledge retention, PBL is an effective way for learners to understand and remember things better. Specifically, they mentioned that they felt more prepared for their assessment/exams. A student stated:

‘…when it’s time for the exams we are more prepared (with) PBL…’

While another one explained:

‘With PBL, it was more effective remembering the information about a specific topic because it gives you the motive to contribute to problem- solving in contrast to a traditional class.’

For almost all students, the PBL method was something they had never experienced before, and the learning curve between cohorts varied. The predominant view was that their confidence increased with each PBL. A student noted:

‘…the first time, the first session it was stressful, but later it worked…’

Finally, students felt that through PBL, they obtained holistic knowledge. As one student said:

‘…We had a more holistic approach to a disease or a disorder and because we didn’t focus only on the immunological mechanism, but also in symptoms and treatment, it was very helpful.’

3.3.4. Category 4: Skills

Students highlighted the numerous skills gained during PBL. They mentioned communication skills in the context of presenting and explaining to peers. Students realized that they had to make every effort to find, rephrase, and present information to their peers. As a student described:

‘I had to do my research and write it down in my own words in a way that I could understand and present to my colleagues in a way that they would understand.’

Another skill students reported was the critical evaluation of the literature. They admitted that during the initial sessions, they reported back any information found on a topic, irrespective of whether it was relevant or irrelevant. After a few meetings, they were able to report back exactly what they needed to. For instance, a student noted:

‘…it helped me a lot to be very direct of what we have to say…’

All groups identified teamwork and working towards a common goal as important skills gained in PBL. Through the PBL sessions, they learned to coexist and cooperate with different personalities and people coming from different fields. As students expressed:

‘we come from different backgrounds, so we worked as a team better because we got to know each other so we used our strengths separately and as a group.’

Students were also able to critically evaluate the literature while working with time constraints. Especially for those who have a job and are performing it in parallel, a student said:

‘…you learn how to manage your time’

while another student stated:

‘it was extremely helpful for me because you obviously study before you attend a PBL session’

3.3.5. Category 5: Experience

Students found the PBL sessions enjoyable, interesting, and a fun break from lectures. They also obtained positive energy from class, which left them with a nice impression. A student said:

‘…I do feel like PBL was a lot more fun and a lot more interesting.’

While another said:

‘…it was a friendly team…’

3.3.6. Category 6: PBL and Other Modes of Teaching

Students also compared their PBL experience with lectures. Specifically, they believed that lectures support PBL because they lay the groundwork for the PBL sessions. For instance, a student said:

‘I think they complete each other because when you do the lectures you get information and when we did the PBL, we use that information and through the cases we understood it better.’

Overall, students were very positive about PBL as a teaching approach.

3.4. Theme 2: Online PBL

In the second theme, students explored their experience with online PBL. Here, they shared their opinions on PBL sessions in the online setting and reported differences and similarities identified between online and traditional face-to-face delivery. Some of the categories identified were similar to Theme 1, but the codes varied. The student perceptions are discussed below.

3.4.1. Category 1: Core Characteristics

Once again, students highlighted the core characteristics of PBL and acknowledged their presence in the online setting, albeit with some variations. According to students, online PBL remains student-centered, but they felt that it was more ‘guided’ as compared to face-to-face PBL. In this context, ‘guided’ did not mean tutor-led; instead, it referred to the flow of the information and how the discussion was orchestrated. A student explained:

‘…we had to raise our hands and wait and sometimes (the tutor) had to directly ask one of us to answer the question, it was a lot more guided…’

As a result, students contributed to the process one by one. This actually worked well for some students as it gave them time to think about their answers, so they were able to make significant contributions. As one student said:

‘…online we had to think about our answer more. We had to wait for everyone else to finish and raise hands. We had to form the answer in our head better than face-to-face…’

In regards to self-directed learning and report-back, they were comparable in face-to-face and online environments. One student said:

‘Searching information for the questions and reporting them back was identical face-to-face and online.’

3.4.2. Category 2: Knowledge and Learning

The matters of knowledge retention or assessment preparation were perceived by students to be similar in both modes of delivery. This was due to the fact that they felt that the online setting did not affect knowledge acquisition in any way. As two students said:

‘It was the same actually, I didn’t expect this (but) it was the same like you are in the class.’

‘I didn’t prepare more in one method or the other. It was pretty much the same’

3.4.3. Category 3: Skills

One area that students focused on was skill acquisition. Those included communication skills, teamwork/collaboration, and contribution. Some students expressed the view that the learning environment was conducive to learning and that they communicated effectively. One student noted:

‘Even if we didn’t meet at all it worked very well. It was as if we knew each other. We were feeling comfortable I believe.’

Still, other students felt that their collaboration and student interaction were hindered by the online delivery. Specifically, they noted a lack of ‘teamwork spirit’. For example, one student said:

‘…face to- face was more of a group work than online because we were all together… we could have a conversation without interrupting… mute, unmute etc.…’

On the other hand, for some students, the ‘guided conversations’ they had online were perceived as an advantage as their participation increased in the online setting. As one student mentioned:

‘…we all participate in [the] online setting, everyone can say even a word, even a small opinion.’

3.4.4. Category 4: Experience

This was another area that generated a lot of discussion among the students as their experiences varied. In one form or another, they all (a) experienced PBL for the first time (this was discussed above) and (b) transitioned from face-to-face to online or vice versa. The discussion focused mainly on the transition from face-to-face to online. The vast majority of the students found the transition manageable with no problems. One student said:

‘It wasn’t a big deal…the transition wasn’t bad for me.’

Still, for a few students, an adaptation period was necessary before they settled into the online mode. As one student said:

‘The first time was terrible but now I’m used to it and you should turn all courses into online.’

In regards to their overall impression of both settings, they found the experience comparable but still expressed a preference for one over the other. Specifically, students were split into those who prefer the face-to-face and those who prefer the online setting. To illustrate, students that preferred the face-to-face mode of delivery mentioned that they enjoyed the interaction with their classmates, the university setting, and their ability to have a face-to-face conversation. One student said:

‘…I like the fun of going to the University, in class, we see each other we get together face-to-face. I prefer face-to-face, I don’t prefer online but I didn’t find any difficulties with online…’

While students that preferred online PBL said:

‘Personally, I prefer the online because I was in my place, in my environment, it was much easier.’

In addition, for some students who live far away, the preference was also linked to convenience as it saved them the travel and time. As a student explained:

‘Online was more convenient as students stayed at home’.

3.4.5. Category 5: Technology

This category is specific to this theme since it concerns tools used in this mode of delivery. Students highlighted several tools that they found useful or even better than their face-to-face counterparts. They all agreed that the use of computers and cameras was useful for synchronous collaboration. Beyond that, they found the PPT file was an effective tool to collate and organize information. As one student stated:

‘PPT was easier to collect information because it was more organized vs. the white board’

The second reason is that it was shareable. That is, while one person was occupied serving as the scribe, all others focused on the case study, and at the end of the day, they all had the same information in one file. As one student described:

‘…with the online, because we didn’t have to copy the WB and because we have everything on the PPT, we didn’t have to worry about that, and we were just worried about answering the questions and participating in the conversation.’

In addition, students found the university platform very accessible and user-friendly. They did not face any difficulties in the transition from paper to digital documents and submissions. A student comment:

‘I’m not very familiar with technology… but as for the online PBL, with the shared PPT and Moodle that we could upload our answers et cetera, it was very accessible and easy to use with a common computer and some basic knowledge.’

Despite the conveniences offered by the online tools, some students faced some technical issues during online PBL meetings. Specifically, they had connection issues that prevented them from listening to what was said. As one student explained:

‘…(I had) trouble hearing that question, so I couldn’t answer it or I had to listen to what everyone else was saying to understand’

For most students, this was easily fixed as they could watch/listen to the recordings later on. This gave them a chance to catch up even if they had some gaps or missed a session. A student noted:

‘Unfortunately, I had technical issues. However, it’s good that in this way (online) we have the recordings and this is very useful because we can listen again to things that we didn’t have the opportunity (to listen to) when we were in class.’

Overall, as noted by the students, online PBL delivery was inherently different from face-to-face delivery in regard to the tools used. However, as far as learning, understanding, and preparation for the exams were concerned, the students noted that they were comparable.

3.5. Student Recommendations

Upon conclusion of the focus groups, students were asked to describe their ideal PBL session and provide recommendations. The most common recommendation was to promote blended learning in the sense that some sessions would be online while others would be face-to-face. In all cases, they suggested that synchronous PBL was best. Others indicated that online PBL might allow people from different locations to participate. They also suggested the implementation of some online tools into the face-to-face delivery setting. That included the replacement of the WB with the interactive PPT in an attempt to increase organization and clarity, as they found some writing illegible. Also, they suggested that all sessions be recorded to allow for a review of the material.

4. Discussion

The current study discusses the digital transformation of three MSc immunology PBL courses from face-to-face to online delivery. Online tools were carefully selected, and student perceptions were investigated using focus groups. Our findings suggest that most students are familiar with technology and did not have major problems transitioning from the face-to-face to the online environment. Further, they stated that learning in both environments was the same and that the PBL core characteristics were maintained. Still, although students believed that their participation was the same or even increased, the quality and quantity of the comments varied. Specifically, in the online environment, they commented less, but their comments were more substantial as they were unable to just add a word here and there.

4.1. Student Interaction

Digital PBL allows for student interaction, collaboration, exploration, and knowledge construction [2]. Our students indicated that although they felt able to participate, the flow of the discussion in the online environment was disruptive as they had to ‘ask for permission’ before they were able to comment. This happened because when they were online, they had to follow a process where they raised their hands (digitally), unmuted, talked, muted again, and then the next student followed. The tutor supervised this process. As a result, students felt that they could only contribute information if it was perceived as ‘significant’ while minor contributions were bypassed. Others have also noted that online delivery limits the ability of the student to read nonverbal communication and make a decision when it is a good time to add to the discussion [6,15,16]. This is especially important when no cameras are used in an attempt to decrease connectivity issues [15]. The literature suggests that other students found this disruptive as well, while others viewed these features as a way to increase organization as well as maintain student engagement [6,17]. Interestingly, Lajoie et al. (2014) also found that technology slowed down the interaction; however, the discussions were just as rich [10].

Interestingly, the majority of the students felt more confident about participating in the online environment as they were less inhibited, while students believed that their contribution was equal in both settings. This is not surprising as the use of a computer may benefit shy individuals and actively decrease anxiety [8,15].

Student interactions are often facilitated and monitored by the tutor. In the online setting, in addition to these roles, the tutors also needed to manage other cognitive demands imposed by online platforms as well as different collaboration strategies that are used [11,15]. As such, tutors would benefit from training on how to deliver PBL online. According to some of the students in this study, the online session was more dependent on the tutor in the sense that they had to control the flow through the raise hand tool, and so it felt ‘guided’. This was not observed in other studies where the tutors noted a decrease in their intervention in the online environment, and the tutors stated that the sessions ran more efficiently [8,10]. Interestingly, our students did not identify any significant disruptors in face-to-face PBL, probably because they were focusing on the online mode of delivery.

4.2. Learning and Assessment

Regarding learning and assessment, our students and others reported that they were equally satisfied with the knowledge gained [8,15]. Still, other students indicated that their learning was disrupted by online delivery [6]. In studies where knowledge was evaluated, and with the exception of one study that showed lower performance of online PBL on learning outcomes [14], they either found no difference in the performance of students in online PBL or a moderate improvement [2,5,8,18,19]. In regards to skills, in a study by Foo et al. (2021), tutors assessed student PBL performance (participation, communication, preparation, critical thinking, and group skills) and found that the distance learning group performed statistically lower, although the difference was small (by 0.21–0.42 points on a scale from 0–10) [20]. The differences observed in these studies may be attributed to the use of different online tools and variations in fields of study and culture. Notably, these data are important to consider when designing or revising courses, and as such more research is warranted in the field.

4.3. Technology

The 21st century has seen unprecedented growth in technology. Current students are familiar with digital tools in general and are able to adapt to new tools provided. As such, it was not surprising that the students in the current study were either familiar with or were able to use the online tools and adapt to the online version of PBL in a short amount of time. A number of effective online tools have been incorporated into digital PBL in a variety of online courses, including Blackboard Collaborate, AdobeConnect, and Zoom. The current study used CiscoWebex [6,10,15,16]. The current study used an interactive PPT, which seemed to be very effective, while other studies incorporated a virtual WB [6]. The students noted that it helped them organize their learning and suggested including it in traditional PBL as well. Technology allows students to perform several tasks simultaneously, for example, using the chat box, writing on the WB, and searching the internet. This may be helpful as interaction may continue regardless of whether a student is speaking [6,15]. However, care should be taken as these can also act as distractors and may prevent PBL from being delivered effectively.

The use of new technologies may present additional challenges, including confidence in the process and the technology, and additional support may be needed to promote key PBL skills such as teamwork and digital literacy [11]. Technical issues are expected in online education, and thus, the selection of tools and the ability to use them from any computer and most internet capabilities is very important. Students may become distracted, frustrated and perceive online education negatively if they face technical issues frequently [6,15]. Indeed, some students indicated that they faced technical issues, but with the use of recordings and asynchronous learning, they were able to learn effectively.

4.4. Preferred Approach

While in the present study, there was a split decision regarding their preferred mode of delivery, others have reported that the majority of students showed increased satisfaction online [2,8,18]. Some students indicated that one of the reasons for preferring online PBL is that it saves travel time and cuts down on cost. This was reported in other studies as well [5,6]. Students also indicated that a combination of traditional PBL and online tools or blended learning would also be effective.

4.5. Study Limitations and Future Research

The current study had some limitations. The first one is that it was conducted with students in an MSc curriculum at one university. As such, the results may not be generalizable to students of other disciplines. Still, most of our findings are supported by other researchers. Further, our students were diverse in regard to age, educational background, and country of origin, which may contribute to transferability as well. Another limitation of the study was that one of the researchers was involved in teaching some of the courses, and this may result in bias. Notably, measures were taken to limit student bias. Those included (a) focus groups were run at the end of the MSc and after all grades had been submitted, (b) participation of the students was voluntary, and (c) no incentive for their contribution was given. As such, we believe that student bias was limited and effectively managed.

Digital PBL is gaining ground, and the literature is promising as to its effectiveness. Future studies may focus on other factors that may affect the PBL process. This includes the PBL tutors and how their role changes as well as longitudinal studies to investigate student outcomes (learning and skills). The student experience is also important, and the current paper contributes to this as well.

5. Conclusions

The current study suggested a method for the digital redesign of traditional PBL in Biomedical Science courses. The students adapted to the new setting successfully and noted that their learning was comparable to the face-to-face format. Students also commented that although the online environment delayed collaboration, it still allowed for participation and discussion. The students also noted that the redesign allowed for skill development such as communication skills, teamwork, collaboration, digital literacy, self-directed learning, and effective student learning. Based on our data and taking into consideration the growth in distance learning education, we propose that synchronous online PBL is an effective alternative to face-to-face PBL.