AN ANALYSIS OF THE EFFECTIVENESS AND QUALITY OF E-LEARNING IN MEDICAL EDUCATION

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AN ANALYSIS OF THE EFFECTIVENESS AND QUALITY OF E-LEARNING IN MEDICAL EDUCATION

Wiesław Półjanowicz

¹

, Magdalena Roszak

²

, Barbara Kołodziejczak

²

, Andrzej Bręborowicz

³

1

Department of Didactics and Modern Technologies in Education University of Bialystok

ul. Sosnowa 64, 15-887 Białystok, wpoljan@uwb.edu.pl

2

Department of Computer Science and Statistics Poznan University of Medical Sciences

ul. Dąbrowskiego 79, 60-529 Poznań, mmr@ump.edu.pl

3

Department of Pathophysiology Poznan University of Medical Sciences

ul. Rokietnicka 8, 60-806 Poznań

Abstract: Technology advancement has a major impact on the prevailing education methods and ways to present knowledge. More and more frequently, blended learning or even e-learning methods are implemented along with traditional education. On the other hand, rapid changes in medical sciences involve the need to continuously extend and update the teaching contents. All this contributes to seeking an optimized and efficient method of imparting knowledge in medical education on academic level, to maximize the learning results without imposing excessive load on the teaching staff. Comparison of learning effects and student satisfaction is the primary method of checking whether the implemented changes in learning methods and context bring positive results.This article presents an evaluation of methods of measuring learning efficiency and quality on the basis of classes held in selected medical subjects at the Faculty of Health Sciences of the Medical University of Bialystok and the results of the implementation of an electronic examination at the Faculty of Medicine, Department of Pathophysiology, The Poznan University of Medical Sciences. Efficiency of traditional education was compared to that of distance learning, involving the use of an e-learning portal implemented for research purposes. The results of research on e-examination may constitute the basis for a discussion concerning electronic knowledge evaluation in medical education and an example implementation for those medical schools that are now commencing e-testing.

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Keywords: e-learning , distance education, effectiveness of e-learning, quality of e- learning, e-examination, e-test, Standard QTI

INTRODUCTION

Academic education, in its adaptation to technological and social advancements, takes up more and newer forms and methods. The learning contents delivered to students are further enriched with multimedia elements, such as interactive presentations, videos, audio recordings, animations and computer games (Roszak, Kołodziejczak, Ren-Kurc, Kowalewski, 2013: 350-358; Roszak, Kołodziejczak, Ren-Kurc, Kowalewski, Bręborowicz, 2013: 42-45). The traditional class organization method is often replaced or supplemented with distance learning involving the use of the Internet.

Continuous development of multimedia communication techniques, data exchange systems, intelligent learning systems, free e-learning portals (LMS/LCMS) and tools for creating e-learning courses lead to perception of on-line education as the factor encouraging students' interest in this form of education.

The university education system, offering studies at medical faculties (medicine, dentistry), faculties of pharmacy, medical analytics, biotechnology and health sciences (fields of study: nursing, obstetrics, physiotherapy, medical emergency services, dietetics, radiology) requires learners to master information regarding issues from multiple medicine-related areas. With this wealth of knowledge, its acquisition becomes more efficient when it is communicated using modern communication methods, across a broad time interval. A traditional lecture or seminar does not offer such options, while an LMS/LCMS-class e-learning portal meets these requirements.

A professional e-learning course with the right choice of interactive elements and parts for testing knowledge of the teaching content (Rosza k , K oł od zi ej czak, K owal ews ki , Ren -K urc , 2013a), will accelerate and improve the efficiency of the learning process. Characteristics of medical faculties require students to master a lot of practical skills that cannot be replaced with the e-learning format of class (e.g.

therapeutic massage, childbirth, blood collection, injections, resuscitation, etc.);

however, theoretical background in the field can be successfully conveyed during a distance class (Półj anowi cz, Lat osi ewi c z, Ni ewi ńs ki , Mi l ews ki 2009;

Półjanowicz, Latosiewicz, Kulesza –Brończyk, Piekut, Kalisz, Pi echoc ka, T erl i ko ws ki 2010; Pół j anowi cz, Ci t ko 2008).

1. EDUCATION EFFICIENCY AND QUALITY

Efficiency is an important aspect of assessing the quality of education. Education quality consists of the professional and methodological contents of learning materials as well as the consistency of learning goals with the adopted learning

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model: traditional, or e-learning. For the on-line model, the technical aspect of the IT solutions is important (reliability, functionality, user friendliness of the e-learning system). Learning efficiency means the degree of achievement of the anticipated learning goals. Learning efficiency can also be presented as improvement of operating effects with regard to the given issue. Learning effects consist of the following elements:

− knowledge acquisition - this is the volume of knowledge acquired per unit of time compared to the entire volume of acquired knowledge;

− proficiency in new contents - measured across an entire spectrum of various tests, checks, forum posts and educational games (Braml e y 2011).

A traditional process of teaching medical students consists of several essential components: theory presentation (lectures, seminars), practical classes, specialization classes (clinical), internships. Some components of this education process can be easily replaced with the e-learning formula and as a result, a transparent and comprehensible e-learning course should facilitate the traditional teaching process.

1.1 E-learning quality

The prevailing model in university students' e-learning research is the e-course model (Mi schke, St ani sł aws ka 2006), which offers selected subjects in an electronic version available in the form of learning materials. Research on e-course quality should consist of the following parts:

− measurements of learning materials (in terms of subject-matter contents, logical structure, understanding);

− e-students' needs arising from lack of direct contact with the teacher (discussion forums, chat rooms, videoconferencing);

− needs for synchronous learning process implementation;

− studies in terms of methodology applied to the learning goals set (learning through acquisition - lecture, working with a book, learning through discovery - case method, marketplace of ideas, learning games, learning through experience (video, demonstration, art), learning through action (case method, simulations, activities);

− studying e-course organization methods;

− research of students' own activity (students' logging activity in the e-learning portal, time dedicated to knowledge acquisition, students' activities in the specific modules; the latter can be used to determine course complexity;

− research of learning process evaluation, including the system of hints, recommendations on the adequacy of proposed solutions, mentoring (Mi schke, St ani sł a ws ka 2006).

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1.2 Effectiveness of e-learning

Verification of e-learning efficiency in the Kirkpatrick model should include:

− assessment of students' satisfaction through a system of evaluation surveys - this is the reaction level of the model;

− assessment of knowledge acquisition ratio among students through a system of verification tests - learning level of the model;

− assessment of students' attitudes and behaviors, evaluation of efficiency improvements through observation and analysis of deliverables - behavior level of the model;

− assessment of financial outcomes of the project (return on investment in education) - results level of the model (K i r kpat ri ck 2001; Dąbr ows ki 2008).

Summing up, the issues of evaluating quality and efficiency of e-learning can be presented in two interdependent aspects: evaluation of the quality of e-class preparation, and comparison of traditional learning with e-learning.

2. E-LEARNING SURVEY BASED ON THE EXAMPLE OF SELECTED MEDICAL SUBJECTS

The survey was conducted among the students of the Bialystok Medical University, at the Faculty of Health Sciences, first- and second-cycle full-time studies. The publication presents an analysis of learning results in full-time first-cycle studies in subjects ending with an exam.

With two subjects prepared according to the e-course formula, the students were divided into two groups for each of these subjects. The first group of 237 members (53%) followed the course syllabus according to the traditional learning model (control group). The second group of 209 members (47%) completed e-courses in an e-learning portal (study group). The survey covered a total of 446 students in the 3rd year of their first-cycle (bachelor), full-time studies (Table 1).

Objectivity, comparability, as well as regularity (one-semester intervals) and interdisciplinary research quality were the indispensable elements of the measurements. The data analysis process covered results from various fields of knowledge, such as: obstetrics, gynecology, gynecological and obstetric nursing and therapeutic massage. The Bioethical Committee of the Bialystok Medical University approved of the research project (Resolution no. R-I-002/338/2009).

After the end of each e-course, a survey was conducted with evaluation questionnaires, covering elements of e-learning quality and efficiency evaluation referred to in chapters 1.1 and 1.2. The questionnaire consisted of three parts:

sociodemographic data, students' opinions about the completed classes, and students'

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opinion about learning effectiveness. Final exams in the particular subjects were conducted in both groups using the traditional method, i.e. single-choice tests.

Table 1.

Number of first-cycle full-time students during the particular academic years covered by the research project during 2009-2012

Program

Course

Method

Number of students in each group in the

subsequent years of teaching Sums of rows 2009/2010 2010/2011 2011/2012

Physiotherapy

Therapeutic massage

e-learning 17 33 44 94

traditional 59 31 43 133

Nursery I st.

Obstetrics, gynecology and gynecological and obstetric nursing

e–learning 43 25 47 115

traditional 40 23 41 104

TOTAL: 159 112 175 446

Source: O wn work

The exam results in the study group and the control group were compared, including the grades received by students in final exams and the degree of their satisfaction with the classes. The s

urvey results were statistically analyzed using relevant two-tailed tests: Chi-square test, exact Fisher test and Mann-Whitney test.

Calculations were carried out at statistical significance α=0.05 in STATISTICA v. 10.0 (StatSoft. Inc.).

3. RESULTS AND DISCUSSION

When pursuing the above specified e-learning efficiency measurement strategy, similar final exam results were achieved in both the studied groups, with slightly

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higher average grades in the e-learning groups. The differences between the studied averages were not statistically significant (p > 0.05). A summary of results is presented in Table 2.

The results may indicate that professionally developed and adequate learning materials published in an e-learning portal, together with their continuous accessibility, allowed students from the study group to acquire and consolidate knowledge a bit more effectively than students taking part in traditional classes.

Table 2

. Average exam grades in the particular academic years 2009–2012

Academic year

Parametr

Group

n Mean SD Min Q1 Me Q3 Max Mode p value

2009/2010 Study 60 3.54 0.54 2 3 3.5 4 4.5 4

0.174 Control 99 3.63 0.59 2 3.5 4 4 4.5 4

2010/2011 Study 58 4.29 0.62 3 3.86 4.5 5 5 5

0.30 Control 54 4.08 0.60 3 3.5 4 4.5 5 4

2011/2012 Study 91 3.75 0.59 3 3 4 4 5 4

0.168

Control 84 3.65 0.60 2 3 4 4 4.5 4

Source: O wn work

Figure 1 presents the distribution of grades (in academic scale: 2 – 5) received from final exams in the study group and the control group during academic years 2009–

2012. Statistical analysis did not show any statistically significant differences in the distribution of grades between the compared groups (p > 0.05).

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F i gure 1 . Distribution of grades (as a percentage) received from final exams by students taking part in the research project during the academic years

2009–2012 Source: O wn work

In order to evaluate satisfaction with the classes, students' answers to questions in the survey concerning their opinion about the classes were reviewed in each of the studied groups (e-learning and traditional).

The answer to the question: "Were the classes well organized?" was "Definitely yes"

or "I think so" for the majority of the students (86.1%), while only 6.5% of them answered "Not really" or "Definitely not". The answer "Don't know" ("Neither") was given by 7.4% of respondents. These percentages illustrate the results obtained jointly in both the student groups during the academic years 2009-2012, which were covered by the research project. The distribution of answers given by students, divided by subject and group during the particular academic years is presented in Table 3.

Tabl e 3.

Evaluation of class organization for subjects ending with an exam during the particular academic years

Academic year

Course

Parametr

Group n

Definitely not (1) Not really (2) Don’t know (Neither) (3) I think so (4) Definitely yes (5)

p value

2009/2010

Thera- peutic massage

Study 17 0 1

5.9% 0 13

76.5%

3

17.6% 0.306

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

EL_2009/2010 TR_2009/2010 EL_2010/2011 TR_2010/2011 EL_2011/2012 TR_2011/2012

2 3 3,5 4 4,5 5

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Control 59 0 1 1.7%

4 6.8%

35 59.3%

19 32.2%

Obstet- rics, gynecology and gynecological and obstetric nursing

Study 43 0 2

4.7%

2 4.7%

25 58.1%

14 32.6%

0.335 Control 40 1

2.5% 0 5

12.5%

21 52.5%

13 32.5%

2010/2011

Study 33 0 0 1

3%

18 54.5%

14 42.4%

0.085 Control 31 2

6.5%

4 12.9%

2 6.5%

15 48.4%

8 25.8%

Study 25 0 2

8%

2 8%

16 64%

5 20%

0.314

Control 23 0 3

13%

6 26.1%

11 47.8%

3 13%

2011/2012

Study 44 1

2.3%

5 11.4%

3 6.8%

24 54.5%

11 25%

0.776 Control 43 1

2.3%

2 4.7%

3 7%

28 65.1%

9 20.9%

Study 47 0 0 1

2.1%

31 66%

15 31.9%

0.636

Control 41 0 1

2.4%

2 4.9%

26 63.4%

12 29.3%

Source: O wn work

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A significant majority (88.9%) students answered "Definitely yes" or "I think so" to the following question in the survey: "Were the learning contents well prepared for the class, available and helpful?", while only 5.3% of the students answered "Not really" or "Definitely not". The answer "Don't know" ("Neither") was given by 5.8%

of the respondents. Like in the previous question, these percentages illustrate the results obtained jointly in both groups during the academic years 2009-2012, which were covered by the research project. The distribution of answers given by students, divided by subject and group during the particular academic years is presented in Table 4.

Tabl e 4.

Quality of preparation, availability and helpfulness of learning contents according to students,

in subjects ending with an exam during the particular academic years

Academicyear

Course

Parametr

Group n

Definitely not (1) Not really (2) Don’t know (Neither) (3) I think so (4) Definitely yes (5) p

value

2009/2010

Study 17 0 0 1

5.9%

9 52.9%

7 41.2%

0.844 Control 59 2

3.4%

2 3.4%

5 8.5%

28 47.5%

22 37.3%

Study 43 0 1

2.3% 0 24

55.8%

18 41.9%

0.480

Control 40 0 1

2.5%

2 5%

19 47.5%

18 45%

2010/2011

Study 33 0 0 2

6.1%

15 45.5%

16 48.5%

0.473

Control 31 0 2

6.5%

2 6.5%

15 48.4%

12 38.7%

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Study 25 0 0 0 20

80%

5 20%

0.015

Control 23 0 3

13%

5 21.7%

12 52.2%

3 13%

2011/2012

Study 44 0 5

11.4%

1 2.3%

14 31.8%

24 54.5%

0.002

Control 43 0 5

11.6%

3 7%

28 65.1%

7 16.3%

Study 47 0 0 1

2.1%

26 55.3%

20 42.6%

0.105

Control 41 0 4

9.8%

2 4.9%

23 56.1%

12 29.3%

Source: O wn work

The answers to the question: "Has the syllabus covered during the course enriched your knowledge and skills?" were positive ("Definitely yes" or "I think so") for the majority of the students (90.5%), while only 3.7% of them answered "Not really" or

"Definitely not". The answer "Don't know" ("Neither") was given by 5.8% of respondents. Table 5 presents the distribution of answers given by students, divided by subject and group during the particular academic years.

Tabl e 5.

Students' opinions regarding expansion of their individual knowledge and skills

Academic year

Course

Parametr

Group n

Definitely not (1) Not really (2) Don’t know (Neither) (3) I think so (4) Definitely yes (5)

p value

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2009/2010

Study 17 0 0 1

5.9%

7 41.2%

9 52.9%

0.683

Control 59 0 1

1.7%

2 3.4%

17 28.8%

39 66.1%

Obstet- rics, gynecology and gynecological and obstetric nursing

Study 43 0 0

1 2.3%

24 55.8%

18 41.9%

0.470

Control 40 0 1

2.5%

2 5%

17 42.5%

20 50%

2010/2011

Study 33 0 0 0 17

51.5%

16 48.5%

0.039

Control 31 0 3

9.7%

4 12.9%

12 38.7%

Study 25 0

1 4%

13 52%

10 40%

0.062 Control 23 0

4 17.4

%

4 17.4%

12 52.2%

3 13%

2011/2012

Study 44

1 2.3

% 2 4.5%

3 6.8%

16 36.4%

22 50%

0.659

Control 43 0 1

2.3%

2 4.7%

21 48.8%

19 44.2%

Study 47 0 0

1 2.1

22 46.8%

24 51.1%

0.170

Control 41 0 0 2

4.9%

26 63.4%

13 31.7%

Source: O wn work

The students' positive opinions about the classes indicate high professional quality of the courses. High popularity of e-courses may have its roots in the diversity of forms of knowledge presentation (classes, SCORM activity) and activities available in the course (quiz, assignment, forum). Each student may review the contents they should master multiple times, thus acquiring them more effectively. In addition, they can use quizzes to see for themselves how proficient they are in the given field (Pół j anowi cz, Lat osi e wi cz, Ni ewi ńs ki , Mi l ews ki 2009; Półj anowicz,

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Lat osi ewi c z, K ul es za –Brońc zyk, Piekut, Kalisz, Piechocka , T er l i kows ki 2010).

The results obtained lead to the conclusion that distance learning may offer a highly successful addition to traditional classes. It would be justified to continue the research and to analyze e-learning efficiency and quality at universities, particularly in the context of expanding the educational offer at medical faculties, increasing the number of students, and high workload imposed on teaching staff.

4. E-EXAMS IN PATHOPHYSIOLOGY AT THE POZNAN UNIVERSITY OF MEDICAL SCIENCES

Electronic knowledge evaluation via an e-learning portal was first implemented at The Poznan University of Medical Sciences in 2009. It was a part of pilot implementation of an OLAT e-learning portal at the Department of Pathophysiology. It was the outcome of work of an inter-institutional team of experts in the field of distance learning from Poznan universities. Implementation of the electronic examination system was possible due to a research grant (Grant No.

504-07-02232378-34205-08956 of Poznań City and Inter Grant No. 501-03- 02232378-08956, the website of the grant: http://old.amp.edu.pl/_nowa/pol/

index.php?department=38).

The exam in the portal was taken by 45 Polish-language students of the second year of Medicine. A similar exam in pathophysiology was taken by 40 English-speaking students of the second year Doctor of Medicine Program in 2010. A database of 200 test questions was created. The exams consisted of 30 randomly picked questions for each student, which had to be answered in a limited time. The exams took place in the University's computer rooms. The tests consisted of multiple-choice questions and gap questions (calculating a given value on the basis of problem analysis) in 4 topical areas. After the end of the test, every student received information about their results: score, and whether or not the test was passed. After the exam, the students were to fill in a questionnaire in the portal regarding the exam organization and form.

All students had access to the portal before the exam. The contents published in the portal included trial tests with single and multiple-choice questions with multimedia elements (static images, videos), true/false questions, and completion tasks. This allowed students to find out the electronic examination capabilities offered by QTI (Question and Test Interoperability) and exam parameterization dimensioning in terms of time, number of test launches, different formats of presentation of results and ways to present questions and answers (Rosza k M., K oł od zi ej cza k B., K owal ews ki W., Ren - K ur c A., 2013a).

Discussion forums were also created in the portal for each group of students separately. They were used to exchange remarks about the tests and the exam procedure. After the exams, the students' general remarks gathered during individual

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interviews or larger group discussions were published in the portal. An archive of the exam procedure was attached as well, i.e. videos captured and photos taken during the exam. The materials were available only to an authorized group of students.

The authors present the results of electronic examination research at the Department of Pathophysiology of The Poznan University of Medical Sciences for Polish- and English-speaking students (Figure 2).

F i gure 2. E xampl e of pathophysiology test in OLAT Source: ow n work

4. 1 Results and discussion

4.1.1 The following answers were given by students (Polish- and English-speaking, n=85) to the question concerning the pathophysiology exam: "I liked the test in electronic format because...":

− I know my results immediately 76%

− I see a clear list of questions 43%

− system can show the correct answer 38%

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− time of the test measured individually 32%

− the same time for everyone 31%

− a random set of questions – proof of the student’s independence 21%

− system drawing questions – a more objective test 20%

− I can see which questions I have already answered (padlock symbol) 18%

The students participating in electronic knowledge evaluation would point to 3 items on average from the 8 available options (multiple-choice question) - reasons they liked the electronic exam. Information about the result after the test has been submitted was the most frequently chosen option (76%), an important aspect for students in an electronic exam. The students also appreciated the test interface in the portal - a transparent list of questions with information about the number of answers already given (43%). Moreover, the students liked the fact that they received feedback after answering each question about whether their answer was right or wrong, and about their score at any time during the test (38%). With electronic examination, the exam duration can be controlled individually (32%) and is the same for every participant. Research shows that this aspect is important for students (31%). Comparative analysis of answers given to that question between the groups of Polish- and English-speaking students did not reveal any significant differences.

4.1.2 The following answers were given by students to the question: "The electronic pathophysiology exam was difficult for me because..." (Figure 3):

F i gure 3. Answers to the question: "The electronic pathophysiology exam was difficult for me because..."

Source: ow n work

The students would point to 2 items on average from the 5 available options (multiple-choice question) - reasons that rendered the exam difficult. Only in the case of the answer ”the computer measures time relentlessly” would the covered

36%

7% 24% 36%

60%

34% 25%

16% 13%

47%

0%

10%

20%

30%

40%

50%

60%

70%

online test done for the

first time

unclear way of doing

I don’t like computers

the computer measures time

relentlessly

other causes of negative

attitude

PL ANG

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groups of students (42 Polish and 32 English-language students) differ significantly (p=0.023, p<0.05); for the remaining options, no significant differences were observed between the groups. Still, it should be added that in a comparison for the category of "unclear way of doing", p value received was on the border of significance (p=0.07, p>0.05). The results obtained indicate that Polish students are more stressed by seeing exam time counted automatically (36%) than their foreign counterparts (13%). From the answers given to "online test done for the first time", we may infer that electronic examination format is not very popular in Poland or abroad, as the results were not significantly different. Pilot survey did not reveal any anticipated differences in this respect. In the case of the students who chose the final option, namely "other causes of negative attitude", their reasons could not be clearly determined. The authors suppose that within the group of Polish students, this option could have been chosen for the late time of exam and being tired after the whole day of studying.

4.1.3 The next question was the following "I found the online tests I have done before to be...". The distribution of answers is presented on the figure 4.

F i gure 4. Answers to the question: "I found the online tests I have done before to be..."

Source: ow n work

Significant differences (p=0.046, p<0.05) were discovered within the answers to that question when the results from the studied groups were compared (Figure 5). The options chosen by Polish students (Median=5="difficult") differed from those selected by their foreign counterparts (Median=3="does not matter"). According to the authors, the reason behind this difference is the different level of ICT competences.

4.1.4 The students were also asked "what they considered to be negative about tests in electronic format". The following distribution of answers was obtained (Figure 6).

32% 27%

17% 15%

11% 10%

25% 28%

19% 17%

0%

5%

10%

15%

20%

25%

30%

35%

difficult sometimes difficult

no problems the form of the test does not

matter

I like online testing

PL ANG

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Median 25%-75% Min-Maks

Polish English

Students -1

0 1 2 3 4 5 6

Points

F i gure 5. Comparison of answers to 4.1.3 question Source: ow n work

F i gure 6 . Answers to the question: "What they considered to be negative about tests in electronic format"

Source: ow n work

The answers to questions 4.1.3 and 4.1.4 may corroborate the statement that an automatic exam is not an easy task. It requires a consistent methodology and

30% 48% 64%

24% 41%

0%

10%

20%

30%

40%

50%

60%

70%

unclear way of doing the test

it is difficult to read the text on

the screen

the computer distracts my

attention

I don’t like being assessed by a computer

you have to be more skilled in doing online

tests

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adequate exam parametrization, according to the field of study and exam conditions.

The methods of creating exam questions and accuracy of the questions database also play an important role here. After every edition of exams, the results obtained by students should be analyzed, including detailed analysis of exam questions in order to eliminate those which are found erroneous, too difficult, or too easy. Research in the field may help minimize the level of error in terms of technical, methodological and professional aspects, while properly prepared electronic knowledge evaluation would be useful for years.

4.1.5

The exam participants were asked for their opinion about: "I will be happy to answer online questions in the field of..."

(Figure 7).

F i gure 7 . Answers to the question: "I will be happy to answer online questions in the field of..."

Source: ow n work

The distribution of answers to that question confirms the observation that electronic evaluation and distance learning are much more expected by students at courses such as essential morphological or eseential functional than clinical courses.

4.1.6 Exam grades. Because this was a pilot implementation of electronic knowledge evaluation, the students took the exam twice. After they passed the on-line exam, they took it again in traditional paper format. The results achieved by the students in both exams did not vary significantly. Therefore, it may be inferred that the exam organization form does not affect the results.

Actions taken to implement automatic examination in medical education are reasonable and needed but they require proper preparation, considering the unique characteristics of these studies (Ren -K ur c , Ros za k, 2011).

51% 48%

38%

54%

0%

10%

20%

30%

40%

50%

60%

essential morphological

essential functional

clinical others

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The presented results of the pilot implementation are used during exams at the Department of Pathophysiology and may be helpful for other medical education institutions.

CONCLUSION

It may be inferred from the results obtained that the e-learning method is no worse in any aspect than the traditional method of teaching professional subjects in the field of nursing and physiotherapy. The e-learning method is perceived by students as more convenient and easier in terms of acquiring knowledge, due to continuous availability of interactive learning materials. Learning materials prepared on a high level of advancement in terms of content and methodology, available non-stop in an e-learning portal, facilitates good preparation to the final exam by students and helps them acquire and master their knowledge in the given field.

Research results show that average exam results for the subjects of therapeutic massage and obstetrics, gynecology and gynecological and obstetric nursing during 2009-2012 were similar, with slightly higher grades recorded in the e-learning groups. The above results indicate that both forms of education are equally effective.

Distance education requires a lot of effort during the initial stages of implementation (Rosza k, K oł od zi ej czak, K owal ews ki , Re n -K ur c, 2013). E-learning providers (academic teachers responsible for the subject matter) must cooperate with a competent team of IT experts specializing in distance learning. The authors are convinced that with the support of university bodies, involvement of teaching staff, and valuable suggestions from students, distance learning can be gradually implemented in all the fields of study at medical universities. Apart from IT facilities (computer labs, e-learning portals, and a team of IT specialists), certain changes are also needed in the regulations/statutes laying down the operating rules of universities.

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