Students’ perspectives of E-learning utilization in medical students: A qualitative study at the University of Medicine and Pharmacy at Ho Chi Minh City

Abstract

Introduction: The global landscape of medical education has been profoundly transformed by the COVID-19 pandemic. E-learning plays a significant role in promoting students’ self-directed learning. However, end-of-course surveys have indicated that students do not perceive e-learning to be as beneficial as anticipated. The current study explores e-learning utilization and the challenges impeding its effectiveness, highlighting the difficulties encountered by students during their initial experiences. Methods: A qualitative study was conducted in the academic year–2022-2023 at the Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City (UMP). Sixteen students from years 3 to 5 participated in the interviews. Results: The findings revealed three themes: (1) the inadequacy of e-learning functions to support learning activities, (2) barriers preventing students from increasing e-learning usage for learning activities, and (3) recommendations for maximizing the utilization of e-learning platforms. Discussion and conclusions: To fully harness the e-learning potential, it is crucial to address the challenges faced by students and continuously improve the platform based on their feedback. This could involve expanding access to digital resources and developing new features tailored to different educational stages and disciplines. Addressing these issues can render e-learning a robust and effective tool for enhancing educational outcomes.

Introduction

Medical education is imperative for the cultivation of proficient healthcare professionals and advancement of medical knowledge 1 , 2 . E-learning has evolved significantly over the last two decades and has emerged as a revolutionary method that enhances accessibility, cost efficiency, and interactive teaching practices in medical education 3 , 4 , 5 . As a subset of digital education, e-learning encompasses the acquisition of knowledge through information technology and has progressively permeated the realm of medical education. E-learning, which is primarily integrated into fundamental medical science courses rather than clinical training, has been combined with traditional teaching approaches, resulting in blended learning formats 6 , 7 . Effective implementation of e-learning in medical education requires a diverse array of resources ranging from the availability of electronic devices and Internet connectivity to suitable pedagogical strategies and proficient technological support 4 , 8 , 9 . Moreover, the presence of on-campus and off-campus infrastructures is pivotal for the successful deployment of e-learning initiatives. Online learning management systems, exemplified by platforms such as Moodle, have been customized to serve as conduits for course delivery, thereby enriching overall teaching and learning encounters 10 , 11 .

The landscape of medical education on a global scale has been profoundly reshaped by the advent of the COVID-19 pandemic, compelling emergency medical institutions to transition swiftly to online pedagogical approaches. Noteworthy challenges in implementing e-learning include issues such as substandard network quality, inadequate internet connectivity, deficient digital competencies among IT personnel, and students’ limited experience 12 , 13 . Despite the aforementioned obstacles, e-learning significantly contributes to fostering active and self-directed learning among students, while assisting faculty members in managing and monitoring students’ academic progress 14 , 15 , 16 , 17 . This mode of learning also facilitates the dissemination of and accessibility to educational resources.

Since 2016, UMP has used e-learning along with basic medical education programs to support teaching and learning. However, end-of-course surveys revealed that students did not find e-learning as useful as expected. This study explored e-learning usage and the challenges preventing its effectiveness, highlighting the difficulties faced by students during their initial online learning experiences.

Methods

Research design

This study employed a qualitative research approach to deeply explore students' experiences with e-learning and gather their recommendations for enhancing its effectiveness in supporting academic learning at the University of Medical Practice (UMP). Specifically, an exploratory phenomenological study design was chosen, as it allows for an in-depth investigation of lived experiences and the meaning participants attribute to those experiences. This approach was particularly suitable for understanding the nuanced ways in which e-learning platforms facilitate or hinder students' educational journeys. The study was conducted over the 2022-2023 academic year within the Faculty of Medicine at UMP.

To recruit participants, a broad and inclusive outreach strategy was implemented. An online introduction to the study was prepared, detailing the research objectives, the nature of participation, and the ethical safeguards in place, including confidentiality and voluntary participation. This invitation was disseminated to all students across the Faculty of Medicine through the university’s official communication channels, including email and the student portal. Students who expressed interest were invited to engage in semi-structured interviews with members of the research team.

Data collection

In-depth semi-structured interviews and focus group discussions were conducted to collect data from participants. Online consent forms were provided before participating in interviews and discussions. The guiding questions for the interviews were based on previous studies and feedback from students at UMP. The questions explored participants’ current practices with e-learning platforms, their drivers and barriers, and their recommendations to improve users’ experiences when using e-learning for learning activities. All interviews were conducted at the UMP, with durations varying from 20 to 45 minutes.

Permission for audio recordings was obtained before each interview. There was no attempt to convince the participants to give their permission to record in order to avoid suspicion of how the results of the interview might be used. The interview notes were taken, transcribed, and analyzed via content analysis. Direct quotes from the participants ensured reliability.

Sampling methods

In the context of this study, the sampling strategy was designed to include students from a variety of academic disciplines and different years of training. The objective was to capture diverse experiences and perspectives regarding the use of the e-learning platform, as students at different stages in their academic journey may have distinct interactions with and expectations from the system. Despite these efforts, the final sample included only students from Years 3 to 5, as they were the only volunteers who agreed to participate in the study.

The determination of an appropriate sample size is a critical consideration in qualitative research, as the goal is not to achieve statistical generalizability to a broader population but rather to uncover specific insights and emerging themes relevant to the study context. One widely accepted principle in qualitative research is that of "data saturation." This concept refers to the point at which additional data collection yields no new or significant insights, indicating that the sample is sufficiently comprehensive to address the research questions.

In this study, the principle of data saturation guided the determination of the final sample size. During the data collection process, it became evident that the responses from participants were increasingly repetitive, with no novel information emerging from additional interviews. This observation aligned with the principle of sampling adequacy, which ensures that the data collected is sufficient to capture the breadth and depth of the phenomena under investigation. As a result, the final sample comprised 16 participants, which was deemed appropriate to meet the study’s objectives and to achieve a nuanced understanding of the themes under exploration.

By adhering to the principle of data saturation and systematically evaluating the adequacy of the sample, this study ensured the robustness of its qualitative findings. This methodological rigor enhances the credibility and transferability of the insights generated, providing a solid foundation for interpreting the complexities of e-learning platform usage among the student population.

Data analysis

The qualitative data collected from the 16 recorded interviews were systematically analyzed using a thematic analysis framework. This approach was selected due to its suitability for identifying, analyzing, and interpreting patterns of meaning (themes) within qualitative datasets. The analysis aimed to provide a structured and comprehensive understanding of the participants’ experiences and perspectives related to e-learning.

The first step in the data analysis process involved transcription verification to ensure the accuracy and completeness of the interview transcripts. Each audio recording was meticulously transcribed, and the transcripts were cross-checked against the original recordings to eliminate potential errors or omissions. This step was crucial for preserving the integrity of the data and establishing a reliable foundation for subsequent analysis.

Following transcription verification, inductive and comparative analyses were employed. The inductive approach allowed themes to emerge directly from the data, without being constrained by preconceived notions or theoretical frameworks. Comparative analysis involved examining the transcripts for similarities and differences across participants' responses, facilitating the identification of recurring patterns.

The coding process was carried out in two stages: open coding and focused coding. During open coding, the transcripts were examined line by line to identify and label meaningful segments of data. These codes represented discrete concepts or ideas shared by the participants. In the subsequent stage of focused coding, related codes were grouped into broader categories based on conceptual similarities. This iterative process of grouping and refining codes was instrumental in generating initial subthemes and themes.

To ensure the robustness of the thematic analysis, the researchers employed a dynamic, iterative approach, moving back and forth between the transcripts, codes, and emerging themes. This reflexive process allowed for the constant refinement and validation of the categories and themes, ensuring that all relevant data were accurately represented. Themes and subthemes were further consolidated and defined by establishing conceptual linkages and hierarchies, providing a coherent framework for interpretation.

The analysis was deemed complete when the themes and subthemes comprehensively captured the key aspects of the participants’ narratives and no new themes emerged. This "saturation" ensured that the analysis was both exhaustive and reflective of the full breadth of the data. The final set of themes and subthemes were presented in a structured manner, accompanied by representative quotations from the participants to provide contextual depth and enhance the validity of the findings.

Ethical considerations

This study was approved by the IRB of the University of Medicine and Pharmacy under Decision No. 552/HĐĐĐ-ĐHYD on February 06 ^th , 2022, and applicable guidelines for research with human subjects were followed.

Results

Characteristics of participants

A total of sixteen students from years 3 to 5 participated in this study, engaging in both individual interviews and group discussions. The participants were strategically organized into three discussion groups, each consisting of two to four students. This group arrangement was designed to encourage open dialogue and diverse perspectives while maintaining an intimate setting conducive to meaningful discussion.

At the time of their participation, the students were enrolled in various modules across their curriculum, including Family Medicine, General Surgery, Tropical Diseases, Oncology, and Pediatrics. These modules represent a range of medical disciplines and provide a broad context for their academic and clinical experiences with the e-learning platform.

Additionally, all participants were actively involved in clinical training during the study period. Their clinical placements spanned multiple settings, including hospitals and community health centers, providing them with firsthand exposure to the practical application of their academic learning. This dual engagement in academic modules and clinical training enriched the data by reflecting the diverse and multifaceted ways in which e-learning was integrated into their educational journey.

Results from interviews

During the interviews, the participants were asked about their experience of using e-learning in the learning process. Their responses provided insights into how e-learning platforms are currently being used by students. The participants were then asked to discuss the benefits and challenges of using e-learning, which helped identify various issues that hinder the effective use of e-learning platforms. Finally, the participants were invited to offer recommendations for optimizing the use of e-learning. The analysis revealed three main themes that are presented in the following section, accompanied by quotations from participants. We labeled S- for students’ excerpts.

Results from interviews

During the interviews, the participants were asked about their experience of using e-learning in the learning process. Their responses provided insights into how e-learning platforms are currently being used by students. The participants were then asked to discuss the benefits and challenges of using e-learning, which helped identify various issues that hinder the effective use of e-learning platforms. Finally, the participants were invited to offer recommendations for optimizing the use of e-learning. The analysis revealed three main themes that are presented in the following section, accompanied by quotations from participants. We labeled S- for students’ excerpts.

Results from interviews

During the interviews, the participants were asked about their experience of using e-learning in the learning process. Their responses provided insights into how e-learning platforms are currently being used by students. The participants were then asked to discuss the benefits and challenges of using e-learning, which helped identify various issues that hinder the effective use of e-learning platforms. Finally, the participants were invited to offer recommendations for optimizing the use of e-learning. The analysis revealed three main themes that are presented in the following section, accompanied by quotations from participants. We labeled S- for students’ excerpts.

Results from interviews

During the interviews, the participants were asked about their experience of using e-learning in the learning process. Their responses provided insights into how e-learning platforms are currently being used by students. The participants were then asked to discuss the benefits and challenges of using e-learning, which helped identify various issues that hinder the effective use of e-learning platforms. Finally, the participants were invited to offer recommendations for optimizing the use of e-learning. The analysis revealed three main themes that are presented in the following section, accompanied by quotations from participants. We labeled S- for students’ excerpts.

Discussion

Our findings showed that most students agreed that e-learning supports learning in medical education, which aligns with other studies 17 , 18 . E-learning’s role as an official forum for student‒faculty exchanges is underutilized because students find it less effective than email or social media. Students often prefer direct messaging for queries because of the lack of anonymity in the forum. They value e-learning most as an "online library" for downloading materials. The forum is crucial for fostering academic connections, especially during lockdowns when direct contact is minimized 19 .

A major barrier is the lack of essential features such as user monitoring for self-study, tools for practical assessments, and the complexity of uploading exams. E-learning has not facilitated student–faculty exchanges, as expected, leading to frustration. Similar to previous findings, system instability, including frequent crashes and slow response times, hinders high-stakes assessments, further limiting the utility of e-learning 20 , 21 20 , 21 . Our study did not assess student autonomy in self-directed learning. Although students are tech-savvy, their use of e-learning for self-directed learning is not widespread, possibly because of a lack of training and encouragement. In a study by Alioon et al., students stated that online learning platforms are helpful for active and self-directed learning 22 . The absence of a unified policy to guide and manage e-learning exacerbates these issues 21 . Modules requiring practical hands-on learning, such as clinical evaluations, are particularly disadvantaged as current e-learning features primarily support preclinical stages with lectures and theoretical assessments. However, the blended learning approach has been shown to be beneficial in improving medical students’ clinical practice and enhancing their active learning 23 .

To enhance e-learning, comprehensive regulations, policies, and mandatory requirements should be implemented to increase its adoption during the learning process. Additional features should address specific needs, especially for formal student‒faculty communication channels, as active interactions between students and faculty encourage users to access the platform. Stabilizing the school's server and Internet systems is crucial for a seamless e-learning experience. Regular maintenance and upgrades are essential to meet the increasing demand. Tracking module time, logins, and task completion along with regular learning-based assessments can encourage active participation and self-directed learning. Our findings align with those of other studies that emphasize comprehensive approaches to enhance e-learning effectiveness, including adequate training, robust support, and tailored features. Addressing these factors can create a robust e-learning environment, leading to improved educational outcomes 24 , 25 , 26 .

These three themes reveal that, while e-learning has the potential to revolutionize education, several barriers must be addressed to maximize its effectiveness. The students expressed dissatisfaction in various aspects. To fully harness this potential, it is crucial to address these challenges and continuously improve the platform based on feedback. This could involve expanding access to digital resources and developing new features tailored to various educational stages and disciplines. Addressing these issues can make e-learning a robust and effective tool to enhance educational outcomes.

Limitations

This study, which was conducted at a medical university in Vietnam, used a convenience sample, limiting its generalizability. Although practical, this method may not accurately represent a broader population, leading to a potential bias. Future research should employ more rigorous sampling methods to enhance validity and reliability. Future work could explore the integration of e-learning into training and assessment in medical education by blending it with traditional methods to create a hybrid environment. Additionally, studies should investigate the long-term impacts of e-learning on student performance, engagement, and satisfaction to better leverage e-learning to improve educational outcomes.

Conclusions

Medical educators should continue to explore innovative approaches for training medical students through e-learning. Ensuring the quality of online education is crucial, especially during crises when reliance on digital platforms increases. This involves all aspects of the online learning environment and stakeholders. This study offers comprehensive recommendations for educators, institutions, and evaluators, addressing key areas such as network infrastructure capacity, technological proficiency, and effective teaching and learning activities. Educators and institutions can implement successful online learning initiatives by considering these factors.

ACKNOWLEDGEMENTS

We would like to thank our students for their willingness to participate in the interviews.

This research was funded by the University of Medicine and Pharmacy at Ho Chi Minh City under contract number 19/2022/HĐ-ĐHYD, dated 18/04/2022.

Competing Interests

The authors declare that they have no competing interests.

Authors' Contributions

• Conceptualization: Tan Thi Minh Nguyen, Tuan Huu Ly, Quynh Thi Vu Huynh

• Data curation: Tan Thi Minh Nguyen, Linh Mai Thuy Le, Tu Thanh Duong

• Formal analysis: Tan Thi Minh Nguyen, Tam Khanh Tran

• Methodology: Tan Thi Minh Nguyen, Tam Khanh Tran, Tuan Huu Ly, Quynh Thi Vu Huynh

• Software: Tan Thi Minh Nguyen

• Validation: Tuan Huu Ly, Thanh Van Tran, Quynh Thi Vu Huynh

• Investigation: Tan Thi Minh Nguyen, Linh Mai Thuy Le, Tam Khanh Tran, Tu Thanh Duong

• Writing - original draft: Tan Thi Minh Nguyen, Tuan Huu Ly, Thanh Van Tran

• Writing - review & editing: Tan Thi Minh Nguyen, Tam Khanh Tran, Linh Mai Thuy Le, Tu Thanh Duong, Tuan Huu Ly, Thanh Van Tran, Quynh Thi Vu Huynh