Initial Experience with Pediatrics Online Learning for Nonclinical Medical Students During the COVID-19 Pandemic&nbsp;
Authors: Min Yang , Jinrong Li , Xiaolin Gao , Weiran Li , Lina Qiao 
Published: February 2021

Abstract
Background: To minimize the risk of infection during the COVID-19 pandemic, the learning mode of universities in China has been adjusted, and the online learning of clinical medicine is facing great challenges. This study preliminarily discusses the experience of express team-based learning (eTBL) combined with a flipped classroom (FC) and case-based learning (CBL) online for nonclinical medical students and addresses the distribution of online learning resources used in pediatrics. This study helps to document additional experience in online learning during the global trend of digital learning. Methods: When online learning was fully launched at Sichuan University in the spring of 2020, 236 penultimate-year students of nonclinical medicine majors were selected as the research objects. The penultimate-year students of the same majors in the spring of 2019 were taken as the reference objects. The research objects successively used the methods of eTBL combined with FC and CBL methods to conduct online learning in pediatrics, and students were encouraged to search and share online learning resources. The reference objects used the method of eTBL combined with CBL for offline face-to-face learning, and the test results of the two learning environments were compared. At the end of the pediatrics course in the spring of 2020, the research objects were invited to participate anonymously in an online questionnaire survey involving 12 items on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) to evaluate the participation, satisfaction, and distribution of online learning resources used in pediatrics. Results: 1. Student participation and test scores: i. A total of 75.8% (179/236) of the respondents completed the questionnaire effectively, and 7 items on the Likert scale indicated that online learning with eTBL + FC had higher student participation than eTBL + CBL (4.64 vs 4.27, P < 0.001). ii. In the spring of 2019 and 2020, the average scores of the last four subjects were higher than those of the first four subjects (P < 0.001). The average scores of online learning courses in the spring of 2020 were higher than those of offline learning in the spring of 2019 (P < 0.001). 2. Online learning resources: i. The main motivations for students to use online learning resources were pre-class preparation (4.83), class discussion (4.28) and pre-class testing (3.79). ii. A total of 72.9% (129/179) of the students “most or all of the time” searched online learning resources in the pre-class preparation stage. iii. Students' online learning resources mainly included Chinese academic databases, search engines, teaching platforms and foreign databases. iv. The information retrieval ability of students was improved after the above online learning methods (after versus before, Mdn 5 VS 4, U = 591.0, P = 0.007). 3. More students thought that the online learning method of eTBL + CBL was more beneficial for understanding than that of eTBL + FC (P = 0.044), while the online learning method of eTBL + FC was more conducive for online learning resource retrieval than that of eTBL + CBL (P = 0.034), and the workload was greater (P = 0.001). Both of the online learning methods were conducive to online learning resource sharing (P = 0.298). 4. The results of five items on the Likert scale in the questionnaire showed that students' satisfaction with the online learning mode was high (4.16). Conclusion: i. During the COVID-19 pandemic, online eTBL shortened the learning time of typical TBL. After online learning with eTBL, in combination with FC, CBL and the use of online learning resources, students had high rates of participation and satisfaction. ii. Online learning test results were as good as offline test results. iii. The main motivation for students to use online learning resources came from learning tasks. Chinese academic databases and search engines were the main learning resources for nonclinical medical students. iv. Both online combined learning methods were helpful for students to share online learning resources. eTBL + FC was more helpful in retrieving online learning resources, and the workload was also larger, while eTBL + CBL was more helpful for students to understand course content.