A comparative analysis of online learning versus face-to-face learning approach in problem based learning in dentistry

Abstract

BACKGROUND:

Problem-based learning (PBL), a student-centered approach which has been implemented in many educational institutes worldwide.

OBJECTIVES:

This study aimed to evaluate and compare the proficiency of students in 5 key areas of PBL process and assess perceptions of students towards PBL learning using a self-explanatory questionnaire.

METHOD:

This cross-sectional study was conducted from March 2020 to September 2022 and evaluated perceptions of 1^st year dental students of Batch 2021 (having Face-to-face PBL sessions) and batch 2020 (having online PBL sessions) using a questionnaire. Three similar PBL cases were used, which assessed PBL parameters that included attendance, group dynamics, knowledge, communication skills and preparation. Statistical analysis was performed for all the categorical and continuous variables.

RESULTS:

Majority of Distance Learning (DL) group (66.7%) concurred that PBL helped improve their communication skills, decision making power (66.7%), self-directed learning (80%) and promoted interaction with peers (66.7) and teachers (68.9%). The Face –to- Face (FF) group demonstrated better scores (7.7±2.42 & 7.55±2.55) with respect to their attendance and group dynamics (7.44±2.17 & 8.02±2.40) in PBL 1 & 3 as compared to DL group. Overall, better performance in all the 5 key areas of PBL was observed for the FF group versus the DL group.

CONCLUSION:

The Distance learning (DL) group displayed a positive attitude and perception towards PBL as a learning strategy whereas Face-to-face (FF) group showed greater performance and proficiency in the key PBL parameters scores.

Keywords

Problem-based-learning conventional teaching distance learning coronavirus disease 2019

1 Introduction

The emergence of COVID-19 instigated the transition of educational system from traditional to virtual mode. This changeover faced certain limitations such as practical applicability and acceptability among population in the developing as well as developed countries [1 –3]. Presence of known barriers such as lack of availability of internet facilities, smart phone devices and laptops and deficient technical/technological qualification and skillfulness at some teachers and students end, hindered the learning process for a short period of time. Studies were consequently warrantied to assess the comparable effectiveness of online learning to traditional face-to-face learning methodology [4 –9]. Keeping in view the constraints experienced by our students, it was hypothesized that proficiency of students in 5 key areas of PBL processes (attendance, group dynamics, knowledge, communication skills and preparation) would not be similar for both distance learning and traditional learning groups.

Active learning and teaching modalities are the new norms in the world of education. Students are taught to critically approach medical scenarios and engage in productive discussions with their peers to find viable explanations for their problems and find a solution, using the readily available learning resources [10].

Back in 2020, when the world was afflicted due to COVID-19 which halted the regular day to day affairs of people globally, all the educational institutes worldwide transitioned towards E- learning to keep students engaged with education amid the pandemic [11]. Like other modes of education, Problem based learning was also conducted online.

Problem based learning (PBL) is an advanced, student-centered, and self-directed teaching strategy that allows students to learn about clinical problems by building their conceptual understanding and applying general principles [12]. In addition to strengthening the students’ capacity for problem-solving by identifying potential answers to the given tasks, problem-based learning aids in the development of contemplative skills, which are crucial for examining a topic thus helping them acquire life- long learning experiences [12]. Additionally, it enables the students to work independently, boosts their self-esteem, and develops their critical thinking skills. Apart from the cognitive benefits, it promotes the student’s ability to perform in a team/group as an active team-player, which teaches them to adhere to principles of group dynamics and boosts their communication skills by active participation in peer-group discussions [12, 13]. All these characteristics are pivotal for the students’ professional development, especially those related to health sciences as it is a mandatory requirement for health care professionals to provide quality care to patients [14]. Hence, succinctly, PBL is a pedagogical technique which inspires students to construct ideas based on prior knowledge and assumptions to facilitate active, self-directed, and team-based learning [15].

Online PBL refers to execution of PBL process by using various electronic and software facilities such as zoom and Microsoft Team in situations where physical presence was hindered due to unavoidable circumstances [16]. It also provided the students with the ease and flexibility to study anywhere and participate in discussions as compared to traditional face to face PBL [17]. However, in developing countries, the population residing in rural areas faced electricity shortage, Wi-Fi and internet connectivity issues, and lack of smart phone devices/laptops. Execution of education through online mode especially PBLs required participation of the whole group of students at the same time was a challenge [6 –9].

Research by Ibrahim et al demonstrated effectiveness of PBL learning strategy as a useful tool in acquiring evidence –based knowledge and soft skills (compared to conventional teaching methods) amongst the preclinical medical students [18]. Similarly, prior research conducted in Pakistan, identified PBL as a constructive approach when compared with the traditional teaching strategies which accelerated not only the students’ learning but also enhanced their communication skills [19]. Moreover, another study conducted on dental undergraduates also preferred PBL as an efficient mode for learning which enhanced their cognitive and social interaction skills and positively impacted their professional development [12].

According to a pilot study by Manwa et al. carried out in Hong Kong, students enjoyed online PBL sessions due to its convenience, and online PBL was identified to be equally effective as traditional PBL strategies. Moreover, there was no discernible difference in the evaluation grades of the students [20]. Another study by Jiang et al reported that online teaching was preferred by Chinese dental students, but they favored lecture-based and case-based learning more as compared to PBL due to limited online resources available [21]. Conversely, Ahmed Elzainy observed that during online sessions, students’ mean PBL grades improved significantly. [22]. In contrast, course learning outcomes (CLO) and student learning outcomes (SLO) were significantly lower in online sessions compared to face-to-face sessions conducted during the pre-COVID-19 lockdown era. Hans and Linda reported that no significant difference was found between the online and traditional PBL performance of students. This could be attributed to psychological and health-related stresses imposed by COVID-19 [23]. According to research undertaken during COVID-19 by Chi-Choong et al, students in the Distance Learning group performed below par, compared to the face-to-face group in each key component of PBL [24].

Despite understanding the value of PBL as a teaching methodology, in expanding the students’ horizons for critical thinking and problem-solving techniques through evidence-based research, scarce studies comparing the key characteristic areas of PBL such as (i) Attendance (availability in all 3 sessions of PBL process) (ii) Group dynamics (raising hand to participate, listening attentively to each other’s comments, and non –offensive behavior) (iii) Knowledge (the information contributed by the student through prior knowledge and literature search) (iv) Communication skills (talking to each member of the group, and involving them in discussion) and (v) Preparation (literature search and presentation of answer in flow chart forms) for PBL using various learning resources, exist, especially in developing country like Pakistan. This study was conducted during pre- and post-COVID era. Similarly, comparison of students learning outcome via PBL process which had been conducted online and face-to-face learning also needed to be evaluated and explored through assessment grades in Pakistan as it has been done alike in developed countries [24]. Therefore, this study aimed to evaluate and compare the proficiency of students in 5 key areas of PBL processes (attendance, group dynamics, knowledge, communication skills and preparation) which had been conducted online (during COVID-19 pandemic) as well as face to face (after COVID-19 pandemic). The study also assessed the perceptions of students towards PBL learning strategy using a self-explanatory questionnaire. The findings of the study would help bring improvement in the existing teaching and learning practices such as provision of laptops to students via government reward policies and providing internet connections and software to improve students’ learning based on students’ own preferences.

2 Methods

2.1 Study design

The research was an exploratory cross-sectional study conducted amongst the Bachelor of Dental Surgery (BDS) students at Dental College in Pakistan, from March 2020 to September 2022.

2.2 Sampling technique

Two complete batches of 1^st professional year Bachelor of Dental Surgery (BDS) students (52 in Batch 2021 and 38 in Batch 2020) were selected as samples for comparison groups (DL and FF). The sampling technique hence employed was non-probability purposive sampling technique.

2.3 Sample size

The sample size was calculated from the online software openepi.com. The statistical considerations were taken as 95% confidence interval and 5% margin of error and hypothesized prevalence was considered as 50% to get a large sample from total population of 116. The derived sample size was 90. Two batches of Bachelor of Dental Surgery (BDS) students (52 in Batch 2021 and 38 in Batch 2020) were considered.

2.4 Study participants

First year undergraduate students, enrolled in Bachelor of Dental Surgery (BDS) program during year 2020 and year 2021 respectively at Dental College were selected for the study purpose.

2.4.1 Student groups

The students of batch 2020 were designated as Distance Learning (DL) group due to the emergence of COVID-19 pandemic in 2020, which caused on-campus teaching to be shifted to online mode and studies were managed using Microsoft Teams and Zoom software. PBL sessions for this group were also held online.

Whilst during the year 2021, conditions succeeding COVID-19 improved considerably, and colleges/universities shifted back to on-campus teaching; therefore, PBLs conducted during this duration were held on-campus. Therefore, Batch 2021 students were allocated into the Face-to-face group (FF) in the present study.

2.5 Ethical approval

The ethical approval for research was obtained from the Institutional ethical committee (144/2020) which was conducted according to the declaration of Helsinki. The study participants were initially informed regarding the research study design, after which all the participants voluntarily provided written informed consent. All the data was coded to ensure the anonymity of received responses.

2.6 Inclusion & exclusion criteria

All the students enrolled in 1^st year BDS during the years 2020 and 2021 were selected for data collection. Students absent or missing any one of the three sessions of the PBL process were excluded from the study.

2.7 Construction of Problem Based Learning (PBL)

2.7.1 Preamble for students

First-year BDS students are delivered an orientation each year that includes acquainting them with the format and teaching/assessment methodology of the PBL process (3 in number). The subject specialist prepares clinical scenarios for PBLs, which are then integrated with all first year BDS curriculum subjects i.e anatomy, biochemistry, physiology, oral biology and tooth morphology.

2.7.2 Construction process

The PBL is constructed following the guidelines laid down by the university according to international criteria. After the PBL scenario has been constructed, it is reviewed by the subject experts who are usually the heads of respective departments of the academic year (due to subjects’ integration). Further revision of the PBL process is undertaken in accordance to suggestions and comments of the subject specialists. Final PBL scenario is then presented to the panel of university experts via a presentation, and all the necessary changes are implemented.

The PBLs scenarios employed in this study were based on topics of salivary glands, oral mucosa, Temporomandibular Joint (TMJ), tooth morphology, Gastrointestinal Tract (GIT), mandible, and bone.

2.8 Process of Problem Based Learning (PBL) for face-to-face sessions

A PBL consists of three sessions. Students completed seven steps during the first session, which included evaluation of the scenario, identifying the difficult terms, providing explanation for each term and phenomena using their prior knowledge. The students also suggested a title for the case and summarized the scenario. Learning objectives were also derived in the last step, which were forwarded to second session: a self-study session. During the self-study session, students prepared answers of the derived learning objectives either on their own or with their peers, using different learning resources like textbooks and research articles. Whilst in the third session, students shared and discussed their findings and provided references, which were assessed by facilitators. The students were simultaneously marked on their individual and group performance in each session on a proforma provided to the facilitator. Each session comprised of 2 hours making a total of 6 hours for one PBL, and 18 hours for 3 PBL conducted in one academic year.

2.9 Process of Problem Based Learning (PBL) for online sessions

The conduction of PBL for online session was similar to that conducted during face-to-face sessions. The students and facilitators were all visible to each other via cameras on the laptops or mobile phones and interacted with each other as they would during the traditional face to face method. Similar steps and assessment modes applied for akin to traditional face to face PBL sessions.

2.10 Groups for problem based learning

The whole batch of each academic year was divided into five groups. Each group consisted of approximately 7-10 students. The students had been randomly allocated to each group by the year coordinator using a bowl and chit method. Each student was called to pick a chit that had the number of PBL group written on it where he/she were to be place ensuring total randomization. These groups remain the same during all the sessions of PBLs for that academic year. However, the number of students in each year and group varied and were not uniform due to college dropouts and failed/repeaters students.

2.11 Role of facilitator during problem based learning

The facilitator/tutors for each group were also randomly selected using the same chit and bowl method to ensure randomization. First year facilitators were not chosen for this study, instead, facilitators who interacted with third and final year students and had no previous experience with first year students were enrolled in this study.

Facilitators were dental professionals who had been trained regarding the steps of PBL process. The facilitators only observed and marked the students during session 1, and demonstrated minimal involvement unless required, whereas in session 3 the facilitator evaluated and assessed the information which students brought along in session 3. Each facilitator was provided with standardized evaluation forms for session 1 and session 3, which marked student’s performance in terms of attendance, participation, group dynamics, critical thinking, and preparation.

All these key PBL parameters were scored from 1- 10 for every student. The scoring criteria included (i) Attendance: student coming on time for PBL = 10 marks, student comes within 5 min=5 marks, and comes 10 minutes after the start of session = 0 marks. For (ii) Group dynamics the criteria was: raising hand to participate = 4, listening attentively to other’s comments = 4, non –offensive behavior = 2, Does not participate at all = 0, (iii) Knowledge was assessed as follows: provides relevant explanation of the topic = 5, and explains with relevant examples = 5, (iv) Communication skills criteria were: speaks to each member of the group = 5, does not attack on others opinion nor defend their own = 5, and (v) Preparation of students was assessed using the following criteria = literature search provided with references = 5, and presentation of answers in flow chart forms = 5. Score 1 being the lowest, whereas 10 being the highest score for each key characteristic of PBL process. The cumulative score for each PBL was thus a maximum score of 50.

2.12 Study tool

Perception of students regarding PBL was assessed using a questionnaire which was formulated after slight modification from research by Jaganathan et al [25]. Demographic information of the student comprised of age, gender and year of study followed by 11 questions which perceived the role of PBL in improving students’ communication skills, student’s interaction, knowledge on topic, building confidence, improving self-directed learning, enabling use of various resources material and role of facilitator in motivating students. Student’s responses were evaluated using a five-point Likert scale, in which 1 = Agree, 2 = Disagree, 3 = Neutral, 4 = Strongly Agree, 5 = Strongly disagree.

2.13 Reliability

The reliability of the tool was assessed using Cronbach’s alpha test. The value of Cronbach’s alpha was found to be 0.94, which was considered to be excellent. Whilst the inter-examiner reliability evaluated using Cohen’s Kappa test, was found to be 0.74, which demonstrated substantially good agreement.

2.14 Process of data collection

For both years (2020 and 2021) similar PBLs were employed for research purposes to ensure uniformity and avoid any possible confounding. The content, session duration, facilitators and assessment methods were also kept uniform.

Data was collected in two stages. During year 2020, PBLs were conducted online due to COVID-19 lockdown using Microsoft team and zoom according to feasibility of the facilitators, therefore the data was collected retrospectively from dental education department that had the details of all the 3 PBLs that were conducted online. Data from batch 2021 students were concurrently collected after each PBL had been executed. In December 2021, once all PBL were executed and submitted to dental education department. The data was obtained and evaluated.

To ensure anonymity of data, each response was coded. The list of students who were enrolled in the study, were approached during their free periods to obtain their response about perception of PBL via a questionnaire.

2.15 Statistical analysis

The collected data was entered and analyzed using Statistical Package for Social Sciences (IBM- SPSS Statistics) version 23. Shapiro Wilk test measured the normality of data. Categorical data was computed using the Chi-Square test, and was displayed as frequency and percentages, while continuous variables were expressed as mean and standard deviation (SD). Performance in PBL using the five key PBL performance indicators were compared between the distance learning and face to face group by Mann Whitney U test and Spearman’s correlation coefficient correlated the 3 PBLs with each other. P-Value of < 0.05 was taken as significant.

3 Results

A total of 90 students (52 in Batch 2021 and 38 in Batch 2020) participated in the study. The male to female ratio of batch 2020 {M: 11 (28.9%), F: 27 (71.1%)} and Batch 2021 {M: 15 (28.8%), F: 37 (71.2%)} was similar in both years with mean age of 20.2 years.

Perceptions regarding PBL in both distance learning group (Batch 2020) and face-to-face learning group (Batch 2021) are depicted in Table 1. Statistically significant differences were observed between the two groups regarding influence of PBL in improving students’ communication skills, confidence in decision making, stirring their quest for knowledge of topics by exploring different resource materials, self-directed learning and promoting interaction with peers and teachers. Both the groups denied the influence of facilitators in motivation them towards learning. DL group showed encouraging results towards PBL as seen by their higher mean scores in comparison to Face-to-face group’s score suggesting that PBL was successfully executed and was able to serve the learning process during online teaching.

Table 1
Attitude and perception of DL and FF group regarding PBL

Questions Agree Disagree Neutral Strongly agree Strongly disagree Mean scores P value

DL FF DL FF DL FF DL FF DL FF DL FF

n(%) n(%) n(%) n(%) n(%) n(%) n(%) n(%) n(%) n(%) Mean Mean

1. PBL improved my communication skills 30 (66.7) 17 (37.8) 2(4.4) 1 (2.2) 9 (20) 23 (51.1) 4 (8.9) 4 (8.9) 0 0 2.20 2.46 0.018*

2. PBL helped to promote student–student interaction 30 (66.7) 19(42.2) 0 0 8 (17.8) 24 (53.3) 7 (15.6) 2 (4.4) 0 0 2.02 2.48 0.001*

3. PBL improves teacher and student interaction 31 (68.9) 24 (53.3) 0 0 7 (15.6) 18(40.0) 7 (15.6) 2 (4.4) 0 1 (2.2) 2.0 2.42 0.023*

4. PBL improved my confidence in decision-making 30 (66.7) 19 (42.2) 1 (2.2) 0 8 (17.8) 24 (53.3) 6 (13.3) 2 (4.4) 0 0 2.08 2.48 0.004*

5. PBL provides better knowledge of the topic 31 (68.9) 21 (46.7) 0 0 8 (17.8) 19 (42.2) 6 (13.3) 4 (8.9) 0 1 (2.2) 2.04 2.40 0.05*

6. PBL improves my self-directed learning on the topic 36(80) 22 (48.9) 0 0 5 (11.1) 20 (44.4) 4 (8.9) 3 (6.7) 0 0 2.02 2.37 0.002*

7. PBL promotes to explore different resource materials 32 (71.1) 17 (37.8) 0 1 (2.2) 7 (15.6) 22 (48.9) 6(13.3) 4 (8.9) 0 1 (2.2) 2.02 2.51 0.005*

8. Dental teacher/ faculty member stimulated and motivated us to learn by ourselves 24 (53.3) 17 (37.8) 0 1 (2.2) 13 (28.9) 20 (44.4) 8 (17.8) 6(13.3) 0 1 (2.2) 2.11 2.42 0.291

9. PBL should be combined with traditional curriculum 28 (62.2) 21 (46.7) 1 (2.2) 0 9 (20.0) 22 (48.9) 7 (15.6) 2 (4.4) 0 0 2.08 2.44 0.017*

10. More sessions of PBL should be included each year 30(66.7) 8 (40.0) 0 0 8(17.8) 19(42.2) 7 (15.6) 8(17.8) 0 0 2.02 2.24 0.023*

11. Faculty members are well prepared for the PBL sessions 31 (68.9) 17 (37.8) 0 1 (2.2) 9(20) 18 (40.0) 5 (11.1) 5 (11.1) 0 4 (8.9) 2.08 2.60 0.017*

	Questions	Agree	Disagree	Neutral	Strongly agree	Strongly disagree	Mean scores	P value
1.	PBL improved my communication skills	30 (66.7)	17 (37.8)	2(4.4)	1 (2.2)	9 (20)	23 (51.1)	4 (8.9)	4 (8.9)	0	2.20	2.46	0.018*
2.	PBL helped to promote student–student interaction	30 (66.7)	19(42.2)	0	0	8 (17.8)	24 (53.3)	7 (15.6)	2 (4.4)	0	2.02	2.48	0.001*
3.	PBL improves teacher and student interaction	31 (68.9)	24 (53.3)	0	0	7 (15.6)	18(40.0)	7 (15.6)	2 (4.4)	1 (2.2)	2.0	2.42	0.023*
4.	PBL improved my confidence in decision-making	30 (66.7)	19 (42.2)	1 (2.2)	0	8 (17.8)	24 (53.3)	6 (13.3)	2 (4.4)	0	2.08	2.48	0.004*
5.	PBL provides better knowledge of the topic	31 (68.9)	21 (46.7)	0	0	8 (17.8)	19 (42.2)	6 (13.3)	4 (8.9)	1 (2.2)	2.04	2.40	0.05*
6.	PBL improves my self-directed learning on the topic	36(80)	22 (48.9)	0	0	5 (11.1)	20 (44.4)	4 (8.9)	3 (6.7)	0	2.02	2.37	0.002*
7.	PBL promotes to explore different resource materials	32 (71.1)	17 (37.8)	0	1 (2.2)	7 (15.6)	22 (48.9)	6(13.3)	4 (8.9)	1 (2.2)	2.02	2.51	0.005*
8.	Dental teacher/ faculty member stimulated and motivated us to learn by ourselves	24 (53.3)	17 (37.8)	0	1 (2.2)	13 (28.9)	20 (44.4)	8 (17.8)	6(13.3)	1 (2.2)	2.11	2.42	0.291
9.	PBL should be combined with traditional curriculum	28 (62.2)	21 (46.7)	1 (2.2)	0	9 (20.0)	22 (48.9)	7 (15.6)	2 (4.4)	0	2.08	2.44	0.017*
10.	More sessions of PBL should be included each year	30(66.7)	8 (40.0)	0	0	8(17.8)	19(42.2)	7 (15.6)	8(17.8)	0	2.02	2.24	0.023*
11.	Faculty members are well prepared for the PBL sessions	31 (68.9)	17 (37.8)	0	1 (2.2)	9(20)	18 (40.0)	5 (11.1)	5 (11.1)	4 (8.9)	2.08	2.60	0.017*

Descriptive statistics, Chi Square test, significant p-value < 0.05, DL = Distance Learning group, FF = face to face learning group.

PBL performance with respect to five key parameters has been displayed as mean scores in Table 2. Significant differences in terms of attendance, group dynamics and preparation were observed between the 2 groups in the PBL1 where the face-to-face group demonstrated higher mean scores and performed better. Likewise, a significant improvement in performance by FF group was observed in attendance and group dynamics conducted in PBL 3. DL group showed improvement in group dynamics in comparison to FF group during the PBL 2 which was also statistically significant. Hence FF group demonstrated an overall better performance in all the 5 key areas of PBL versed the DL group. (Table 2).

Table 2

Comparison of PBL performance between the DL and FF groups

PBL performance indicators	Batch 2020 (DL)	Batch 2021 (FF)	P-value
	Mean±SD	Mean±SD
PBL 1
Attendance	6.55±2.84	7.7±2.42	0.05*
Group dynamics	6.07±3.01	7.44±2.17	0.041*
Knowledge	7.97±2.04	7.92±2.42	0.803
Communication skills	7.84±2.44	8.44±2.19	0.097
Preparation	7.44±3.31	9.19±2.77	0.020*
PBL 2
Attendance	7.63±2.49	6.80±2.54	0.089
Group dynamics	8.00±2.24	6.71±2.47	0.010*
Knowledge	6.73±2.72	6.07±2.62	0.261
Communication skills	5.97±2.69	7.00±2.72	0.064
Preparation	6.26±2.87	5.94±3.06	0.637
PBL 3
Attendance	6.65±2.48	7.55±2.55	0.035*
Group dynamics	7.15±2.34	8.02±2.40	0.05*
Knowledge	6.81±2.74	7.42±2.30	0.332
Communication	6.36±2.99	7.06±2.99	0.337
Preparation	5.94±3.38	7.15±3.01	0.082

Mann Whitney U Test. Significant p-value < 0.05. SD = Standard deviation. DL = Distance Learning group, FF = face to face learning group.

Table 3 showed correlation between the 3 PBL conducted among the 2 groups. Statistical difference was observed between PBL 1 & 2 and 2 & 3 with the DL group showing a slightly positive correlation in all the 3 PBL whereas there was a negligible association of FF group with 1 & 2 and 3 and 1 PBLs. (Table 3).

Table 3

Correlation of PBL performance between the DL and FF group

Tutorial	Cases		2020 (DL)	2021 (FF)
A	A and B	Correlation coefficient (r)	0.317	–0.084
		p-value	0.052*	0.552
B	B and C	Correlation coefficient (r)	0.372	0.326
		p-value	0.021*	0.092
C	C and A	Correlation coefficient (r)	0.218	0.105
		p-value	0.188	0.457

Spearman correlation, Significant p-value < 0.05, DL = Distance Learning group, FF = face to face learning group.

4 Discussion

PBL is an educational methodology which not only enhances the learning capability of the students but also makes them work together in groups and seek solutions for the problem at hand [26]. The current study aimed at evaluating the perception of students regarding the PBL strategy and to compare the scores of PBLs conducted during period of online teaching due to COVID-19 Pandemic in 2020 against PBL conducted during face-to-face learning in 2021.

In the current study, the DL group displayed a positive attitude towards PBL while the FF group showed better performance and proficiency in the key parameters of the PBL. The majority of the students agreed that PBL helped enhance not only their communication skills but also improved their coordination with each other. Similar findings have been reported by a Nigerian study where students perceived PBL, as an effective means which augmented their communication skills [27]. This could be attributed to the fact that during online and face-to-face learning, students demonstrated high satisfaction with PBL, which is a student-directed learning strategy, which helps in the development of professional attributes such as critical thinking and decision making. The better performance of FF group was proposed to be due to the conducive learning environment where students interacted face to face with each other and were able to interact more efficiently, voice their opinions and explained their thoughts about the problem at hand. During the PBL process, the C-shaped setting arrangement of the students’ groups boosted their visualization, enabling them to better communicate with one other and eliminated hesitant and antisocial behaviors.

During Pandemic, owing to strict lockdown everyone was forced to stay indoors, online teaching served as a means for students to communicate with one another. Hence the higher level of satisfaction of students for DL could be attributed to studying online during pandemic. Students used technology to interact feasibly regardless of time, place, or space to learn and develop their skills.

During PBL sessions, students were expected to act professionally when handling the concerns of patients in the scenarios. They are provided with limited information, and they were encouraged to utilize their prior knowledge to propose solutions. In our study, the majority of students concurred that PBL helped them understand topics thoroughly and with greater confidence. These results are in line with a study conducted in Saudi Arabia, where PBL demonstrated a beneficial impact on students’ learning [28]. This could be because group learning encourages collaboration and enhances non-cognitive skills and creative thinking. Additionally, DL group demonstrated greater satisfaction with PBL in providing better knowledge and helped students in understanding a topic, as compared to FF group. This can be because DL group was introduced to online teaching for the first time, and students had the opportunity to study a new teaching modality at the comfort of their home.

The role of the instructor has also changed as a result of PBL. Instead of instructing students how to solve problems, the facilitator stimulates class debate and increases students’ awareness of the learning process [29]. The findings from the current study also reported positive feedback of students regarding PBL in improving knowledge of the subjects. Similar findings were also reported by Jaganathan et al where students stated positive influence of PBL on their learning process [25] (Table 1). The promising results demonstrated that PBL had a beneficial impact on knowledge acquisition, opening the doors for adoption of more student-centered learning strategies like case presentations and Case Based Learnings, in which students themselves gather information from various learning resources and educational platforms in order to comprehend and gain knowledge. It also motivates the students and broadens their horizon of obtaining knowledge. The role of facilitator/educator has also shifted from being the primary source of education provider to a specialized entity, whom students will approach to have their knowledge verified and seek help to clarify their concepts. Moreover, DL group demonstrated higher satisfaction as compared to FF group. FF group had PBL sessions on campus and could have got distracted for sessions which can be accounted for the differences observed between the two groups. DL group during online mode of teaching had reduced anxiety levels and performed comparatively better.

Self-directed learning is a process during which participants take the initiative to identify their learning objectives, use appropriate resources, select applicable learning strategies, and assess their learning outcomes [30, 31]. Moreover, PBL promoted critical thinking in students by presenting them complex case scenarios, for which they accessed various learning resources. These findings are in line with study by Al-Drees et al, where students used different resources namely textbooks, journal, google scholar etc. for collecting information [28]. Similarly in our study, students used textbooks, research journals, and various online sources to extract important information which improves knowledge and cognitive processes.

When the scores obtained from three PBL sessions were analyzed, it was identified that students from FF group performed better as compared to the DL group (Table 2). These findings are in analogous with the report by Foo CC et al, where students from DL group performed comparatively less as compared to FF group [24]. One possible reason could be that during COVID-19, due to sudden closure of institutes, students and facilitators had to abruptly shift towards online mode of teaching, which could have made this difference. Also, disruption in internet connectivity experienced by the students during the online sessions could have affected their performances and thus their grades. Similar problems were also endorsed in a study by Wilcha et al [32]. Moreover, study by Ullah et al conducted on Pakistani students also identified that students during COVID-19 pandemic had faced various electricity issues during online sessions which badly affected their studies [33]. Despite this, no issues with the students’ attendance or preparation were identified in our study. Hence the disparity in scores between the two groups might be due to the time taken for the DL group to get adjusted and acclimatized with the technology.

Findings from the correlation conducted between the three PBLs showed that DL group demonstrated significant difference in scores between PBL 1 & 2 and 2 & 3 showing a slightly positive correlation in all the 3 PBLs while a negligible association of FF group with 1 & 2 and 3 and 1 PBLs was seen. Similar results were observed in study by Foo et al, where PBL 1 and 2 demonstrated statistically significant difference between the two groups [24].

4.1 Implications

These findings could serve as a platform for future studies to prove that distant learning is a practical approach and serves as an excellent alternative to traditional approach in case of crisis. Student’s missing educational institutes due to unforeseen reasons which include prolonged illness; travels, migration to distant area or any other reasons could benefit from online learning approach and stay at par in academic with their fellow students. Hence universities should develop a mechanism to ensure that students are added to online platforms and gets familiarized with the platform. Furthermore, faculty training sessions must also be conducted to train faculty on conducting sessions online. An adequate number of devices must be provided to faculty who are unable to work from home.

4.2 Strengths

Certain strengths of the study could be identified which included that it was carried out in single institute using the same PBL scenarios and facilitated by same tutors so that differences in PBL cases or scoring by facilitators may not affect students’ performance and strengthen the finding of the study. It also enabled evaluation protocols to be similar for each year’s groups. The comparison of 2 different modes of teaching (DL and FF) for a similar learning strategy (PBL) also reinforced that online teaching served as an effective alternative and could be applicable in future situations of nature calamities or disasters.

4.3 Limitations

The main limitation of our study was a small sample size as the study was conducted in a single private sector institute. Secondly, current study did not include students ‘perception from other private and/or public sector universities which could limit generalization of results on larger scale. The questionnaire data collected from students of year 2020 may present recall biasness. Furthermore, this study also assessed only the scores and perceptions of students towards PBL and did not consider the factors contributing to the scores. Influence of gender on the objectives of the study was also not considered. Although pre-PBL meetings were held prior to execution of PBL to make sure that all facilitators are at uniform level in marking and evaluating the process of PBL, subjective biasness may be a limitation.

4.3.1 Future recommendations

Further, multi-centric studies on similar objectives must be executed involving a large sample size. Further comparison of the response of students between private and public sector universities could also be done. Students studying in medical and dental specialties as well as other disciplines can be compared. More studies which discern the underlying cause and issues should also be undertaken. PBL teaching modality could be compared with other teaching methodologies such as lectures. The introduction of systematic scoring assessment forms provided to each facilitator will enable them to reach uniformity with their peers regarding scoring of PBL performance of each student.

5 Conclusion

Attitude and perception regarding Problem-based Learning strategy was perceived good by the students of Distance learning group and differed for those of Face-to-face group. However, the Face-to-face group showed better performance and proficiency in the PBL parameters scores. Therefore, it can be concluded the students were able to produce better scores in all the Problem-based-Learning (PBL) proficiency parameters when they were interacting face to face with peers and facilitators.

Ethical approval

The ethical approval for research was obtained from the Institutional ethical committee (144/2020) which was conducted according to the declaration of Helsinki.

Consent for publication

Not applicable.

Conflict of interest

The authors have no conflicts of interest.

Footnotes

Acknowledgments

We are grateful to the dental students for helping with data collection.

Funding

Not applicable.

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