Effectiveness of using blended learning strategies for teaching and learning human anatomy Jose �� A Pereira, Eulogio Pleguezuelos, Alex Mer��, �� Antoni Molina-Ros, M Carmen Molina-Tomas �� & Carlos Masdeu OBJECTIVES This study aimed to implement innovative teaching methods ) blended learning strategies ) that include the use of new information technologies in the teaching of human anatomy and to analyse both the impact of these strategies on academic performance, and the degree of user satisfaction. METHODS The study was carried out among students in Year 1 of the biology degree curriculum (human biology profile) at Pompeu Fabra University, Barcelona. Two groups of students were tested on knowledge of the anatomy of the locomotor system and results compared between groups. Blended learning strategies were employed in 1 group (BL group, n �� 69) the other (TT group n �� 65) received traditional teaching aided by complementary material that could be accessed on the Internet. Both groups were evaluated using the same types of examination. RESULTS The average marks presented statistically significant differences (BL 6.3 versus TT 5.0 P 0.0001). The percentage pass rate for the subject in the first call was higher in the BL group (87.9% versus 71.4% P �� 0.02), reflecting a lower incidence of students who failed to sit the examination (BL 4.3% versus TT 13.8% P �� 0.05). There were no differences regarding overall satisfaction with the teaching received. CONCLUSIONS Blended learning was more effective than traditional teaching for teaching human anatomy. KEYWORDS anatomy ��� *education teaching ��� *meth- ods education, medical, undergraduate ��� *methods computer-assisted instruction Spain clinical competence ��� standards. Medical Education: 2007 41: 189���195 doi:10.1111/j.1365-2929.2006.02672.x INTRODUCTION Times are changing and university teaching is not exempt from the repercussions on society that occur as a result of the development and utilisation of new technologies. In fact, the application of computer tools in teaching is among the prevailing themes in the current literature on medical education.1 Today, despite various efforts, there is still no clear proof that computer-assisted learning is better than the methods used in traditional teaching.2���7 Most of the changes introduced so far have concentrated on the development of computer tools as complements to traditional teaching methods, both for consultation purposes and as study material for students,8 as well as on their application by teachers as support materials for attendance-based teaching.9 In any case, the use of computing in teaching has been imposed on teaching practice, thanks to the ease with which teaching materials can be developed with modern computer programs, which have trans- formed the simple personal computer into a high- quality, multimedia creative instrument. Moreover, students have evolved in parallel with computers and are not only more demanding of the materials with which they are presented, but are usually highly capable in terms of searching for information and learning materials on the Internet.9���11 simulation and e-learning Department of Experimental Health Sciences, Pompeu Fabra University, Barcelona, Spain Correspondence: Jose �� A Pereira, Facultat de Cie `ncies de la Salut i de la Vida, Universitat Pompeu Fabra, C ��� Dr Aiguader, 80, 08003 Barcelona, Spain. Tel: 00 34 93 542 28 77 Fax: 00 34 93 542 28 02 E-mail: jose.pereira@upf.edu �� Blackwell Publishing Ltd 2007. MEDICAL EDUCATION 2007 41: 189���195 189

New computer technology applied to teaching has forced various changes on the methods classically used in the teaching of human anatomy.12���14 These changes have initially involved the incorporation of computerised materials presented in a variety of formats and used to complement the traditional delivery of the subject2,10,15,16 and as an aid with which the lecturer can improve classic teaching.17,18 In very few cases have computerised tools fully replaced traditional teaching19,20 and in practically none have they led to substantial changes, either to syllabi, or to the number of hours of attendance students must devote to a subject.10,21���23 The comparison between traditional teaching and computer-assisted learning, both in human anatomy and other areas of study, has generated discordant results2)6,10,21,24,25 and has highlighted the presence of a number of problems similar to those detected in the application of e-learning strategies in distance learning courses.26 These include difficulties in comprehension and orientation of materials, student doubts as to the most relevant points, and difficulties in ensuring that the teacher is able to control the development of the course and retain the attention of a student who is not physically present in the classroom.3,10,20 After all, the student is just a click away from dropping out of class. In order to avoid such problems, a strategy that may prove useful is semi-attendance-based learning, known as ��blended learning��.27 This teaching modality is based on the synergic combination of traditional teaching methods with tactics that are characteristic of non-attendance-based distance teaching or e-learning, with the aims of: ��� facilitating active learning ��� decreasing the number of hours of attendance- based classes ��� improving or maintaining academic performance and longterm knowledge, while ��� avoiding problems that may arise as a result of exclusively non-attendance-based teaching.28 The benefits that can be derived from the use of blended learning in the teaching of human anatomy are listed in Table 1. At Pompeu Fabra University, a variety of computer- based materials (summary of lessons with linked images in html format, instructions for and key points of practical lessons, examples of tests) have been used since 1998 in the teaching of human anatomy in the long degree in biology (human biology profile), integrated within the classic struc- ture of an attendance-based course on anatomy, which includes theoretical and practical lessons. The materials are diffused through a virtual campus (��Campus Global��) for use, fundamentally, as complementary study material and to follow up the lessons and practical activities involved in the course. In addition, specific components have been designed (PowerPoint presentations, videos and animations) to help lecturers deliver classes.29,30 However, over the years, there has been a lack of correlation between the effort put into designing the simulation and e-learning Overview What is already known on this subject No clear proof exists to demonstrate that computer-assisted learning is more effective than traditional teaching methods in the teaching of human anatomy. What this study adds The application of blended learning strategies achieves improved academic performance, an increase in the percentage of students who pass the examination and a decrease in the number of students who fail to sit the examination. Suggestions for further research Future research should evaluate the impact of blended learning as a replacement for the whole of a traditional course and assess its impact on long-term learning. Table 1 Potential benefits of blended learning in human anatomy ��� It makes use of the potential of the subject to render it more attractive ��� It modernises teaching methods that have traditionally been used in the teaching of human anatomy ��� It develops transversal competencies ��� It provides students with solid, reliable, continuously accessible and updateable materials ��� It helps to maintain a suitable level of knowledge for the profession ��� It improves academic performance ��� It increases lecturer?)pupil, pupil)?pupil and lecturer)?lec- turer communication flow ��� It facilitates adaptation to the Bologna Declaration directives (in the European framework) 190 �� Blackwell Publishing Ltd 2007. MEDICAL EDUCATION 2007 41: 189���195