Journal of the Anatomical Society of India

: 2022  |  Volume : 71  |  Issue : 3  |  Page : 178--185

Problem-based learning using online platforms: An interactive alternative to mandatory e-learning during the COVID-19 pandemic

Mamata Chimmalgi, S Rajesh, KV Anil Kumar, UV Asha, Jesin Elsa Jose, Komalavallyamma Chandrakumari 
 Department of Anatomy, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India

Correspondence Address:
Dr. Mamata Chimmalgi
Department of Anatomy, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum – 695 607, Kerala


Introduction: Problem-based learning (PBL) helps in contextual and experiential learning. PBL using online platforms (PBL-op) was introduced to counter the declining interest in the mandatory e-learning during the COVID-19 pandemic. The purpose of this study was to determine the effect of PBL-op on learning outcome; student perception of PBL-op; effect of communication and motivation on learning outcome; and performance in PBL-op. Material and Methods: Study participants were introduced PBL-op and the control group to PBL in classroom setting. Five-way assessment was done: learning outcome by pre-and postintervention tests; performance by project reports and presentations; communication skills; motivation; and student satisfaction through an anonymous survey. Data were analyzed using descriptive statistics, paired or independent t-tests to compare paired variables, Spearman's correlation to establish association, and theme-based analysis for qualitative inputs. Results: Students showed better learning outcome with PBL op than with e learning (t = 11.199; P < 0.001*), traditional teaching (t = 12.193; P < 0.001*) and PBL in classroom setting (t = −15.493; P < 0.001*; d = 1.83). Women outperformed men with PBL-op (t = −2.74; P = 0.0034*; d = 0.48). Performance in PBL was better when conducted using online platforms than in classroom setting (t = 8.5471; P < 0.001*; d = 1.01). However, learning outcome and performance in PBL-op did not show a significant association with motivation or communication skills. Students favored PBL-op as it offered them an opportunity for active participation. Discussion and Conclusion: PBL-op offers all the advantages of PBL and allows productive teamwork using familiar online platforms and freedom from restrictive class timings. It is, therefore, suggested that PBL-op may be used as a feasible and effective alternative to PBL even after the pandemic.

How to cite this article:
Chimmalgi M, Rajesh S, Anil Kumar K V, Asha U V, Jose JE, Chandrakumari K. Problem-based learning using online platforms: An interactive alternative to mandatory e-learning during the COVID-19 pandemic.J Anat Soc India 2022;71:178-185

How to cite this URL:
Chimmalgi M, Rajesh S, Anil Kumar K V, Asha U V, Jose JE, Chandrakumari K. Problem-based learning using online platforms: An interactive alternative to mandatory e-learning during the COVID-19 pandemic. J Anat Soc India [serial online] 2022 [cited 2023 Mar 29 ];71:178-185
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Full Text



Problem-based learning (PBL) provides context to learning by connecting the concepts in anatomy with clinical experiences.[1],[2],[3] By encouraging research, it inculcates the practice of scientific enquiry, critical thinking, and evidence-based decision-making.[4] By collaborative and self-directed learning, it trains the future physician to be a life-long learner.[5],[6],[7],[8] By enhancing motivation and underscoring communication skills, it paves the way for better clinical practice.[9],[10],[11]

Soft skills include social skills, communication skills, and professional and ethical attitudes. Good communication ensures greater compliance by the patients and greater job satisfaction for the clinicians.[12],[13],[14] Significance of communication skills in medical education is emphasized in international consensus statements[15] and standards for clinical practice.[16] This has led to development of various guidelines for teaching and assessing communication skills[13],[14],[17],[18],[19],[20] and integration soft skills in the curriculum by the medical schools.[12],[13],[14],[21]

Motivation determines how well the student engages in learning, which in turn defines his learning approach and academic performance. Different theories of motivation, e.g., Maslow's hierarchy of needs theory, Murray's need to achieve theory, Atkinson's expectancy value theory, Bandura's social cognitive theory, Pintrich's goal theory, and Deci and Ryan's self-determination theory, emphasize on different key factors or constructs.[22] Tools that measure strength of motivation rely on these motivational constructs. Motivation is broadly classified as intrinsic (behavior driven by what an individual perceives as valuable or enjoyable) and extrinsic (behavior driven by a promise of reward or a threat of punishment).[22],[23],[24],[25],[26],[27],[28],[29],[30] Some of the other constructs used to measure the strength of motivation include task value (how useful the task is), expectancy (belief that performance goals are achievable by one's efforts), interest (situational or individual), instrumentality (belief that one receives appropriate reward if performance meets the expectation), and cost value (negative aspects of choosing the task over alternatives).[31],[32],[33],[34],[35],[36]


Implementation of competency-based undergraduate curriculum in India from the academic year 2019–2020 initiated working with various teaching–learning methods that simultaneously addressed cognitive, psychomotor, affective, and/or communication domains. However, the concomitant onset of COVID-19 pandemic imposed a shift to obligatory e-learning. Although students welcomed e-learning with enthusiasm, initial excitement was soon replaced by disinterest, evidenced by declining attendance and learning outcome. Hence, a need was felt to change the passive instructive method to an interactive method that could work under the lockdown situation. This led to introducing “PBL using online platforms” (PBL-op) to the 1st-year medical students. Since the students were secluded in their homes under the duress of COVID pandemic, their motivation to participate in the activity was assessed. Since students were interacting using online platforms, their ability to communicate productively on the online platforms was assessed. The purpose of this study was to determine the (a) effect of PBL-op on learning outcome, (b) effect of different modes of interaction (online or offline) on the performance in PBL, (c) effect of communication and motivation on learning outcome and performance in PBL-op, (d) gender difference in learning outcome and motivation, and (d) if PBL-op was perceived favorably.

 Material and Methods

Design and sample

An experimental study was conducted during 2020–2021, for the duration of about 15 days each year in the department of anatomy following approval from the institutional ethics committee. Study participants were recruited within the cohort of 1st-year medical students of 2019–2020 batch (n = 150, 55 men, 95 women, age range 18y7m-23y, average±Std. Dev=20.01±0.89). At the time of the study, they were at home due to pandemic and were engaged in lecture series on neuroanatomy using asynchronous e-learning. The control group were recruited within the cohort of 1st-year medical students of 2020–2021 batch, who at the time of the study had completed lecture series on development of cardiovascular system using classroom teaching (n = 150, 49 men, 101 women, age range 18y2m-22y9m, average±Std. Dev=20.62±0.77). Participation in online or offline PBL was part of the training program. Participation in the questionnaire was voluntary following informed consent.


Study participants and controls were randomly divided into performance-matched, smaller subgroups. Study participants were divided into ten groups of 15 students each and controls were divided into six groups of 25 students each. Each subgroup was assigned a clinical scenario (anatomy of the brainstem and associated brainstem lesions for the study participants and development of cardiovascular system and associated congenital heart diseases for the control group). Members of each subgroup were instructed to collaborate, plan individual contributions, research information from various resources (textbooks, scientific articles, web pages, blogs, YouTube videos, etc.), discuss and analyze the data, and develop solutions and content over the next 10 days. Study participants were instructed to conduct all their discussions pertaining to planning, execution, and submission within the allocated WhatsApp group for each subgroup, whereas the controls discussed in the classroom setting with face-to-face interactions. Each subgroup was closely monitored by one of the investigators to assess communication and contribution by individual student. At the end of 10 days, all the subgroups were instructed to submit a project report (minimum thousand-worded document file) and a video (study group) or a live (controls) presentation.

Data collection

Learning outcome was assessed by average percentage scores in the pre- and posttests. Pre- and posttests were conducted using objective questions of multiple-choice questions type and single-word response type. Performance in PBL-op or PBL was assessed by the average percentage scores for the project reports and presentations. Project reports and the presentations were assessed independently by all the faculty members. Assessment was based on prior selected criteria (e.g. Content, clinical correlation, new or additional information, organisation/format, style of presentation, diagrams, references, and use of AV aids (for presentation)). Average percentage scores were awarded.

Communication among the study participants was assessed based on twenty statements from SEGUE framework and Kalamazoo consensus statement.[17],[18],[19],[20] Each statement was assigned ordinal value of one or zero for yes or no responses, respectively, and an average score (max. score of 20) was awarded.

Motivation of the study participants was assessed by a survey containing twenty-eight statements adapted from Motivation Strategies for Learning Questionnaire (MSLQ) and motivation section of phase 1 survey by McCord and Matusovich.[31],[35],[37] Statements belonged to one of the seven constructs: internal goal orientation (statements 1–3), external goal orientation (4–6), task value (7–11), expectancy (12–17), interest (18–20), cost (21–23), and instrumentality (24–28). As the statements were from valid and reliable instruments, only internal consistency reliability was evaluated. Cronbach's alpha coefficient for all the statements was 0.955, suggesting excellent internal consistency. Each statement required the students to respond on a five-point Likert scale with assigned ordinal values of 1–5. Average scores for overall motivation (all the 28 statements) and for different constructs were calculated.

Perception regarding PBL-op was assessed by an anonymous survey. It collected data regarding perception about ease of using online media and resources, and about the comparative merits of PBL-op, e-learning, and traditional teaching. It also collected responses to open-ended questions about what they liked or did not like about PBL-op.

Data analysis

Learning outcome was assessed by comparing the average percentage scores in pre- and posttests using paired t-test. Effect of mode of interaction during PBL (online or offline) on learning outcome was assessed by comparing the average scores of the two groups in posttests using independent t-test. The SPSS statistical package, version 16.0 (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Level of significance was set at 0.05. Performance in PBL by study participants (online) and controls (offline) was assessed by comparing the average percentage scores in the project reports and presentations using independent t-test. Effect of communication and motivation on learning outcome and on performance in PBL-op was determined using Spearman's correlation. Gender difference in learning outcome and motivation was assessed by comparing the average scores for the two genders using the independent t-test. Perception regarding PBL-op was inferred by the descriptive statistics for the categorical data and theme-based analysis of the narrative responses for the open-ended questions. Investigator triangulation was adopted for the latter to improve validity.


Learning outcome was found to be significantly better with PBL using online platforms than with classroom settings (average posttest scores for study group = 65.48 ± 15.09 and controls = 36 ± 17; t = −15.493; P < 0.001*; d = 1.83, suggesting large effect size). Students showed better academic performance with PBL-op than with asynchronous e-learning (average scores in pretest = 49.55 ± 12.79 and posttest = 65.48 ± 15.09; t = 11.199; P < 0.001*) or traditional teaching (average scores in pretest = 44.53 ± 13.27 and posttest = 65.48 ± 15.09; t = 12.193; P < 0.001*). However, PBL in classroom setting did not improve academic performance when compared to traditional teaching (average scores for control group for traditional teaching = 55.00 ± 16.00 and PBL = 36 ± 17; t = −9.6402; P < 0.001*).

Students showed better performance in the project reports and presentations when PBL was conducted using online interactions than in classroom settings (average percentage scores for the study group = 66.68 ± 6.14 and the controls = 61 ± 5; t = 8.5471; P < 0.001*; d = 1.01 suggesting large effect size).

Enhanced motivation was expected to improve communication, leading to better performance in PBL-op and ultimately improved academic performance. However, findings were mostly contrary to the expectations. Although overall motivation was high (3.81 ± 1.07), it did not show significant association with communication (rs = −0.357, P = 0.310). Similarly, performance in PBL-op did not show a significant association with motivation (rs = −0.40122, P = 0.2505) and showed a weak negative association with communication (rs = −0.3054, P = 0.00014*). Learning outcome also did not show a significant association with overall motivation (rs = −0.45732, P = 0.18389) or communication (rs = −0.06733, P = 0.41936) or performance in PBL-op (rs = 0.19453, P = 0.59021). When different constructs of motivation were considered, expectancy and instrumentality showed a strong positive association with communication (rs = 0.648, P = 0.043* and rs = 0.733, P = 0.016*, respectively). Cost value showed a significant negative association with performance in PBL-op (rs = −0.705, P = 0.023*). Expectancy showed a strong negative association with learning outcome (rs = −0.669, P = 0.035*).

Women showed better academic performance following PBL-op than men (average posttest scores of women = 68.04 ± 15.03, men = 60.94 ± 14.30; t = −2.74, P = 0.0034*, d = 0.48). However, there was no significant difference between the genders in overall motivation (women = 105.39 ± 19.39, men = 108.93 ± 18.61, t = 1.082, P = 0.281) or intrinsic goal orientation (women = 3.2 ± 0.7, men = 3.39 ± 1.32, t = −1.256, P = 0.112) or extrinsic goal orientation (women = 3.48 ± 0.62, men = 3.52 ± 1.56, t = −0.253, P = 0.401).

Total 147 students (54 males, 93 females) responded to the survey (98% response rate). Most students were using personal smart phones and perceived no difficulty in accessing the online resources (64.63%) or communicating with the peers using online platforms (84.27%) [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d and [Figure 2]. When didactic lectures, e-learning and PBL-op were compared, and majority observed that PBL-op would maximize attention to the task and help them become a better clinician, but didactic lectures helped them perform better in exams [Figure 3].{Figure 1}{Figure 2}{Figure 3}

Analysis of qualitative data revealed six major themes each for “what they liked” and “what they did not like” about PBL-op. Some of the narrative comments to the open-ended questions are listed in [Table 1]. What students liked about PBL-op was an opportunity for problem-solving, interaction with team members, and involvement of self in the process. What they liked least about PBL-op was that it was time-consuming.{Table 1}


Mandatory e-learning imposed by the COVID pandemic had a diametrically opposite effect on the progression of its two principal participants. With time, the instructors gained expertise by overcoming technophobia and infrastructure limitations. Students, on the contrary, showed steadily diminishing interest and learning outcome, and on occasions, the participation in the class was limited to only digital presence. PBL-op was, therefore, introduced as a remedial method, designed to trigger and maintain situational interest.[34] Participants enjoyed this interactive learning experience using familiar online discussion platform and found the method beneficial to learn tougher areas like structure of brainstem (“Working under a surveillance in a team seems more effective. Neuroanatomical structures are more clear when discussing among ourselves”). Majority opined that PBL-op provided an opportunity for critical thinking through its problem-solving approach (“It made us think and question, above all to find the solutions for all those problems”) and allowed them to search from various sources (“I could refer (to sources) other than books. whereas normal learning keep us within our (text) books itself…”). They perceived that PBL-op was more interesting than didactic teaching (“Each case gave us an opportunity to understand more about that topic… Routine classes sometimes seem boring as we are listening to lectures continuously”). Other advantages cited included opportunity for interaction, team work, involvement of self, better understanding, and clinical correlation. On the downside, they perceived that the method was time-consuming. A few had difficulty in navigating through intersource differences in information (“Different resources give different points about the topic. It is a little confusing”). However, almost a third of the students opined that they did not find any downsides about PBL-op (“Nothing at all. Literally that much I enjoyed finishing this project”).

Assessment in a problem-based approach focuses on evaluating application of the reasoning process rather than recall and requires use of several methods to evaluate different domains, as was done in the current study.[38] Learning outcome was assessed based on questions on application of reasoning (e.g., likely site of lesion or anatomical basis for clinical case scenarios). In addition to knowledge of anatomy, performance in PBL op also assessed the ability to conduct basic research, creativity, presentation skills, working as a team member and technological know how. As PBL-op was being conducted for the first time, students ability to communicate productively on online platforms and their motivation levels were also assessed.

Effect of PBL on learning outcome has been reported by different studies as both positive[38],[39],[40] and negative.[2],[5],[6],[41],[42] In the current study, academic performance of the study group with PBL-op agreed with the former observation, whereas academic performance of the control group following PBL in classroom setting agreed with the latter. Academic performance following PBL-op was not only superior to traditional teaching, but was also superior to e-learning and PBL in classroom setting. This was possibly because the students engaged more earnestly in PBL-op as they were relatively free from the robust academic training activities and perceived PBL-op as a relief from the monotony of passive e-learning. This prompts us to suggest that effect of PBL on the learning outcome is influenced by several factors outside the ambit of the merits of the method itself, e.g., situational interest, concomitant academic burden, mode of interaction, and perceived complexity of the topic.

Motivation is affected by situation, mood, goal and tool.[28] Educationists are interested in motivation, as it is purported to influence the performance in learning activities and learning outcome.[22] Although motivation and academic achievements are recognized as mutually inducing,[43],[44] different studies have reported the association between the two as not significant[45] or directly positive[25],[28] or indirectly positive through study strategy and study efforts[27] or as positive only for intrinsic motivation.[30] Our findings agree with those of Luqman, as overall motivation did not show a significant association with learning outcome (rs = −0.45732, P = 0.18389).[45] Moreover, “expectancy,” despite showing a strong positive association with communication, showed a strong negative association with learning outcome (rs[8] = −0.669, P = 0.035*). This means, the students who were motivated by the belief that performance goals were achievable by one's efforts contributed more to the discussions, but, they did not show corresponding improvement in academic performance. Similar findings have been reported by Kusurkar et al., where the study efforts did not show a significant association with academic performance.[27] In addition, in the present study, overall motivation did not show a significant association with performance in PBL-op (rs = −0.40122, P = 0.2505), although cost value showed a strong negative association with it (rs[8] = −0.705, P = 0.023*), suggesting that negative perception toward choosing PBL-op over other activities had a stronger influence on performance in learning activities. Thus, our findings implore re-examining the effects of motivation on the performance in the learning activities and on learning outcome.

Good communication skills play an important role in effective delivery of health care, making comprehensive training and assessment of communication skills a necessity in the medical curriculum.[12],[13],[14],[46] In the current study, communication skills showed a strong positive association with both expectancy (rs[8] = 0.648, P = 0.043*) and instrumentality (rs (8) =0.733, P = 0.016*), indicating that the students who believed that they could reach the performance goals through their efforts and receive appropriate rewards made an active effort to communicate better. However, better communication did not translate into better learning outcome (rs = −0.06733, P = 0.41936) or performance in PBL-op (rs = −0.3054, P = 0.00014). While the role of communication in clinical practice cannot be overemphasized, the results of the study suggest that the immediate outcomes of PBL for the 1st-year medical students, namely, cognitive learning, critical thinking, or content creation, are independent of their ability to communicate. Yet again, these findings demand a rethink about highlighting the significance of communication when selecting a newer teaching–learning method for the 1st-year medical students in the competency based undergraduate curriculum.

Gender is one of the important predictors for motivation. Studies comparing gender difference in motivation and academic performance have all reported better academic performance by the women, although observations on motivation are varied. Some studies have reported higher overall and intrinsic motivation in women and higher extrinsic motivation in men,[27],[44] whereas others have reported higher intrinsic motivation in men with no significant gender difference in extrinsic motivation.[30] Our findings are in concurrence with these studies in learning outcome as women showed significantly better academic performance (t = −2.74, P = 0.0034*, d = 0.48). However, our results differ regarding motivation, in that there was no significant gender difference in overall motivation, intrinsic motivation, or extrinsic motivation. This further supports our initial observation that motivation did not show a significant association with learning outcome.

Limitations of the study

The study with PBL-op was conducted as a single session in a single institution using a small sample size. Results may have been confounded by the novelty factor and the pandemic induced lockdown.


PBL-op offered a feasible and interactive alternative to the enforced e-learning during the COVID pandemic. Academic performance with PBL-op was significantly better than with asynchronous e-learning, traditional teaching, or PBL in classroom setting. Although PBL-op enhanced motivation, neither performance in PBL-op nor learning outcome was influenced by greater motivation. Similarly, better communication did not result in better performance in PBL-op or learning outcome. Women showed significantly better academic performance, although there was no gender difference in motivation. These findings suggest that communication or motivation need not be the defining factors in selecting the teaching–learning methods for the 1st -year medical students in competency-based undergraduate curriculum.

PBL-op offered all the benefits of PBL, e.g., opportunity for critical thinking and evidence-based decision-making, improved academic performance, enhanced motivation, clinical correlation, and sensitizing the students to the importance of research and communication skills. In addition, the method also offered the benefits of learning through familiar online platforms, freedom from restrictive class hours, and better academic performance. Hence, it is suggested that PBL-op may be used as an alternative to PBL even after the COVID-19 pandemic.


The authors wish to express their gratitude to Dr. P Chandramohan, Dean, for inputs on PBL, Dr. Manju L, Associate Professor (Statistics), for her contributions to statistical analysis, Dr. Regi Jose, Professor, Community Medicine, for valuable suggestions, and the first-year medical students (2019-20 and 2020-21 batches) for their enthusiastic participation.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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