3.1 Literature extraction
A total of 1643 potentially relevant titles and abstracts were screened. 24 articles met the eligibility criteria and were included for full text screening. Of the included articles, 15 reported on DLT in general and nine articles reported on DLT during the Pandemic. Three of the included papers were systematic reviews which offered an overview of enablers and barriers to DLT in health education [5, 14, 46, 47].
3.2 Synthesis of DLT literature published before the pandemic
The thematic analysis of the literature resulted in four overall themes, requirements, obstacles, facilitators and advantages. (Table 1: Summary results from the literature published before the pandemic.). Then, results were used to source the development of the interview questions.
3.3 Synthesis of the DLT literature addressing the situation during the early pandemic-phase
The second part of the literature review was used to add to and support the analysis of the interviews.
The same primary themes were identified (Table 2: Summary results from the literature reporting pandemic related experiences).
3.4 Synthesis of the Interviews
Curriculum managers shared their perspectives during interviews that institutions were relatively munprepared for the quick transition from onsite to online at the onset of the pandemic. Table 3: Summary results from the interviews presents the deductive themes aligned to the question route. Given that interviewees consisted of curriculum managers only, the presented themes of teachers’ and student’s are presented from the perspective of curriculum managers and from their own experiences as teachers.
3.5 Comparative analysis between literature and interviews: Common aspects
Figure 1: Common (dark) and different elements (orange) between literature and interview findings addressing DLT experience. illustrates the results from the integrated thematic analysis. The themes highlighted in dark are common to both the literature, reporting pandemic experiences, and the interviews. Themes highlighted in orange show unique information to each source.
Requirements:
Lack of standards regarding the quality of the online teaching are apparent. Interviewees suggested that it is not necessary to focus on the quality of teaching in times of crisis, although a need for bestpractice guidelines for DLT was stated. ‘Structure’ was selected a relevant theme particularly for students as it can reduce stress and anxiety and structure is needed for them to manage assigned tasks.
L: “Providing structure was a key element of effective support for managing stress and anxiety.
(p 292 [56])”
I: “…that was for students maybe the hardest point, that a structure was crushed” …. The teaching strategy was called into question, exposing that the reluctance towards transition to online teaching my not be the relevant issue, instead there is a need that educators rethink teaching and clarify the purpose of teaching.
L: “Given the limited time available for transition to remote/online delivery, the authors experiences demonstrated an almost consistent strategy of repurposing existing material (page 294 [56])”.
I: “…we should think about the teaching strategy in general and not only the online teaching strategy”
The need for teacher training is a recurring issue. Due to the immediate transition from onsite to online training, no support could be offered to the teachers at the rate required. From our findings, we present a unique means of training support.
L: “When tasks are beyond their training, additional training must be provided…(page 13 [57])”
I: “Teachers had personal coaching, they were able to make a date with us to come to our house and get supported to record and upload their lecturers online.”
Figure 1: Common (dark) and different elements (orange) between literature and interview findings addressing DLT experience.
Obstacles:
One of the most frequent obstacles was a lack of technical knowledge, particularly for the teachers. A direct consequence of the reluctance to adapt, combined with minimal institutional support and lacking institutional structures.
L: “A common challenge reflected on was that of information technology (IT) skills, and the lack of prior training or knowledge for effective online education delivery practices. (p 289 [56]).
I: “We had to choose the right tool for keeping up the pedagogical concepts as much as we could.”
Facilitators:
Both the literature and interviewees stress that a positive attitude towards implementing and using DLT possibilities is prerequisite for success (See Fig. 1). Collaboration was one of the most mentioned elements to assure a higher acceptance of DLT. In the interviews, the importance of communication was stressed between teachers and between universities.
L: “Collaboration or interaction between learners and facilitators would influence an attitude of sharing knowledge, which is one of the crucial elements of e-learning’s shared enterprise.” ( p 8 [14] I: “I also experience that there is a good sense of teamwork with the whole faculty in an extreme situation.”
Advantages:
DLT offers flexibility of temporal teaching-delivery, as clearly indicated in Figure 1: Common (dark) and different elements (orange) between literature and interview findings addressing DLT experience. Another advantage and effect of the pandemic was gained DLT experience, which indeed can facilitate DLT implementation. When users overcome resistance due to unknown or unfamiliar territory, new experiences on a learning platform could then new experiences could be further encouraged.
L: “The experience respondents have had during the first few weeks of COVID-19 has increased their confidence in the effectiveness of online medical education. (page 9 [27])”
I: “So, the students could take this class and then that class in the order they wanted, and in the rhythm wanted, or could stop and look for more material.”
3.6 Comparative analysis between literature and interviews: Deviating aspects
Most differences between the literature review and interviews were found related to ‘Requirements’ of stakeholders (students and teachers) only, and no deviating insights between the literature and interviews on requirements at the institutions level were noted. Also, we found relevant differences between the literature and interviews under characteristics of ‘Obstacles’.
Requirements of Teachers and students
Requirements for training within the literature relate to experiences on implementation of DLT including student guidance, time and training. The interviews, however, offered a richer picture of requirements. In the process of course delivery and digital uploads, participants reported a positive experience of interacting with the system. At some institutions, however, this process required more time than planned, due to a lack of prior experience with DLT. Delivery of online examinations were challenge due to the possibility of cheating online.
I: “I would say that it was good to see that in this modern crisis, our system was able to adapt very quickly and very effectively.”
I: “So here it took maybe double that time <as planned>.”
I: “There was no strategic plan for online teaching before.”
I: “We reduced the time of the exam to minimize the possibilities for collaboration.”
I: “It's a wonderful opportunity to increase the part of blended learning in our curriculum.”
Obstacles
In published research, inequality and access to resources continues to be reported. This subtheme did not emerge from the interviews, likely to be an effect of high socioeconomic standards in the Swiss educational system among all stakeholders. However, the interviewees mentioned a variety of other Swiss obstacles influencing students’ learning and teachers’ coping. More specifically, students were overwhelmed with the amount of available information. A lack of interaction between teachers and the students was reported in the interviews in many different ways.
I: “The students prefer to have as few different sources as possible.”
I: “Students would have preferred to stay in presence at the university.”
I: “There was less discussion between the students and less interaction with teachers and students.”
I: “Of course, interactivity was an issue. And so, we learned to use the chat room for asking questions, and to break the zoom call into smaller groups for student presentations.”
Facilitators
As shown in Figure 1: Common (dark) and different elements (orange) between literature and interview findings addressing DLT experience. for the theme ‘facilitators’, the insights gained from the interviews were richer than the literature. The subtheme cost-effectiveness was only mentioned in the literature.
L: “…the studies included addressed the cost-effectiveness of eLearning versus traditional learning.
(page 11 [33])”
In the interviews, ‘competence’ emerged as a new theme. The presence of highly skilled persons at the university facilitated the DLT transition.
I: “What I learned is that we have wonderful people around us and they have competence that sometimes they don't need to use that much. And all of a sudden, because of the crisis, you see how competent they are in some fields, how willing and involved they are to help and make things happen.”
Advantages
In the literature the theme ‘Increased confidence’ in new technologies due to the pandemic was unique (28). In the interview a similar but not identical subtheme came up: ‘discovery of new tools’ meaning that the forced online teaching brought the teachers a chance place to try out new tools.
L: “…COVID-19 has boosted their <teachers> confidence in the effectiveness of online education…(page 1 [27])”.
I: “So personally, I found it was a very big opportunity to discover some of those tools.”