Tag: Study

Depressive symptoms and physical activity among community-dwelling perimenopausal women: a prospective longitudinal study | BMC Psychiatry

Study layout and configurations

A multi-centre possible longitudinal observational study was performed from March 2019 to December 2019. Individuals from 4 group wellness centers were being chosen by ease sampling. The four neighborhood well being facilities are positioned in Chengdu, Ya’an, Leshan, and Deyang cities in Sichuan province, China, respectively. Information were being gathered in the local community overall health facilities, the baseline assessment was carried out in March 2019, and follow-up assessments were being done at a 3-thirty day period interval. In this paper, Time (March 2019), Time 1 (June 2019), Time 2 (September 2019), and Time 3 (December 2019) represented the baseline evaluation, the initial, the 2nd, and the 3rd adhere to-up, respectively.

Prior scientific tests noted that the indicate age of menopause in Chinese women of all ages is concerning 48.94 and 53.6 years [17, 18]. In accordance to the Seventh Nationwide Census in Sichuan and Sichuan Studies yearbook in 2019 [19], the typical every month cash flow of the Sichuan population was RMB 2100, 13.2{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of them had a university training stage or above, even though 31.3{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} has a primary training amount or below.

Individuals

Women ended up suitable if they achieved the inclusion conditions as follows: (1) the Chinese Han nationality, (2) aged 45 ~ 60 years, (3) lived in the taking part communities, (4) with variability to the menstrual cycle for at the very least 12 months, (5) the most up-to-date menstruation was in just 12 months, (6) with intact uterus, (7) existence of at minimum 1 intact ovary, and (9) supplied educated consent. The exclusion requirements incorporated: (1) currently being addressed with antipsychotics, and (2) obtaining hormone alternative remedy. At just about every adhere to-up, we reassessed irrespective of whether women’s most current menstruation was inside of 12 months. If it arrived at 12 months and previously mentioned, the participant would be excluded from this examine. In addition, if girls did not complete the four-wave stick to-up for the reason that of hospitalization for gynecological issues or acquiring treatment for perimenopausal signs or symptoms, they would also be excluded from facts analysis.

Measurement tools

Essential facts of members

We utilized a self-created type to accumulate the basic data, like age, educational qualifications (primary and under, junior, senior, and college and previously mentioned), monthly earnings (≤1000 Yuan, 1001 to 3000 Yuan, and ≥ 3001 Yuan), marital position (married, divorced, widowed, and solitary), continual diseases (of course or no), and damaging daily life events in the previous 6 months (sure or no). Long-term health conditions ended up outlined as conditions that lasted for at the very least 1 year and necessary ongoing clinical interventions and/or minimal actions of daily residing [20]. Everyday living gatherings involved the pursuing that had happened in the earlier 6 months: dying and/or serious ailment of a substantial other, significant ailment of your possess, adverse occasions in a marriage, and other experiences of decline.

Depressive indications

Depressive signs were assessed at baseline and at each adhere to-up. The 9-product Chinese version of the Client Wellness Questionnaire (PHQ-9) was utilized to evaluate the depressive indicators of individuals. PHQ-9 has been utilized extensively in main treatment institutes to screen depressive symptoms and other psychological issues [21,22,23]. Individuals ended up asked to fee every merchandise on a scale of to 3 centered on how considerably a symptom bothered them in the earlier 2 weeks (0 = not at all, 1 = several times, 2 = more than fifty percent of the times, 3 = almost each individual working day) [23]. The overall score of PHQ-9 ranges from to 27, with 0–4 implies minimum/subclinical depression, 5–9 suggests delicate melancholy, 10–14 implies reasonable melancholy, 15–19 implies moderately serious depression, and 20–27 indicates critical despair. Wang et al. evaluated the reliability and validity of the Chinese version of the PHQ-9 in the normal inhabitants and noted a Cronbach’s alpha coefficient of .86 and a test-retest dependability coefficient of .86 [24].

Bodily exercise

Bodily activity was assessed at baseline and each individual stick to-up. Given that no released devoted software was located to evaluate actual physical action in perimenopausal gals, the Chinese version of the Physical Activity Scale for the Aged (PASE) was adopted. Staying produced by Washburn RA et al. in 1993, PASE is a short, effortless-to-score, reputable, and valid software for assessing bodily activity in group-dwelling older people [25]. It is comprised of 12 self-described occupational, domestic, and leisure action merchandise in the prior 7 times. The whole scores ranged from to 793, with increased scores reflecting higher levels of bodily activity. PASE is not only relevant to the aged, it has also been greatly used to assess physical exercise among grown ups aged underneath 60 years [26,27,28]. Shirley P.C. et al. reported that the Chinese edition of PASE demonstrated good examination-retest reliability with an intraclass correlation coefficient of 0.81 [29].

Info selection

Data were collected by registered nurses in the community health and fitness facilities who ended up educated by the principal researchers of this analyze. Just after evaluating the eligibility of the participants, the standard details kind was done by info collectors by face-to-encounter interviews. The questionnaires for depressive signs and bodily action have been self-claimed by members at baseline and each individual abide by-up. For individuals who had been tough in reading and/or producing, information collectors would examine the merchandise verbatim and history the solutions on their behalf. Moral acceptance was acquired from the Institutional Overview Board.

Statistical procedures

Only all those members with entire knowledge for four waves were being provided in the data assessment. IBM SPSS version 25. and Mplus 8 were being used to carry out knowledge investigation. Categorize info was represented with the quantity (n) and share ({af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}). Ongoing information had been explained as imply and regular deviation (SD). Multivariable linear regressions by generalized estimating equations (GEE) were executed to determine factors affiliated with depressive signs or symptoms and physical action among perimenopausal women. Pearson correlations were done to examine the cross-sectional and longitudinal interactions between depressive indicators and bodily exercise at baseline and every single stick to-up. Four-wave autoregressive and cross-lagged panel model in a structural equation modeling framework was conducted to investigate the bidirectional associations amongst depressive signs and symptoms and actual physical activity over time right after controlling for age, instructional history, month-to-month earnings, marital position, continual ailment and negative daily life activities of individuals. We utilized the requirements formulated by Hu and Bentler to examine the healthy of the cross-lagged panel product [30]: Root Mean Square Mistake of Approximation (RMSEA) under .08, Standardized Root Imply Sq. Residual (SRMR) below .08, CFI earlier mentioned .95, TLI over .9. A two-tailed p-price of less than .05 was deemed statistically important.

Children lost about 35{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of a normal school year’s worth of learning during the pandemic, study suggests



CNN
 — 

A new paper adds to the mounting proof that faculty-age children throughout the world experienced significant setbacks in their discovering development in the course of the Covid-19 pandemic.

Learners “lost out on about 35{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of a ordinary college year’s value of learning” when in-person understanding stopped all through the public well being disaster, according to a paper released Monday in the journal Nature Human Conduct. The faculty closures have been meant to sluggish the distribute of the coronavirus, but the new paper suggests that understanding deficits emerged and persisted in excess of time. The paper included knowledge from 15 diverse nations around the world.

“Schoolchildren’s discovering development slowed down significantly during the pandemic. So on normal, kids misplaced out on about a single-3rd of what they would have normally uncovered in a usual university calendar year, and these discovering deficits arose really early in the pandemic,” reported Bastian Betthäuser, an writer of the paper and researcher at the Sciences Po Centre for Analysis on Social Inequalities in France and the College of Oxford in the United Kingdom.

“Children however have not recovered the studying that they dropped out on at the commence of the pandemic,” he claimed. Also, “education inequality between little ones from unique socioeconomic backgrounds increased during the pandemic. So the learning crisis is an equality disaster. Little ones from deprived backgrounds were disproportionately afflicted by faculty closures.”

The scientists reviewed and analyzed data from 42 scientific studies on understanding progress during the pandemic throughout 15 international locations: Australia, Belgium, Brazil, Colombia, Denmark, Germany, Italy, Mexico, Netherlands, South Africa, Spain, Sweden, Switzerland, the Uk and the United States. The scientific tests have been revealed among March 2020 and August 2022. The researchers executed an original search for the research in April 2021 and supplemental queries in February and August 2022.

“We systematically reviewed all of the present exploration on faculty children’s mastering development in the course of the Covid-19 pandemic,” Betthäuser explained. “And it is significant to note that most of the present investigate comes from superior- and middle-profits international locations, whereas there’s a couple of experiments from very low-profits countries.”

The knowledge showed that understanding deficits in the course of school closures and lockdowns in the early times of the Covid-19 pandemic were probable to have been “particularly pronounced” for youngsters from lower socioeconomic backgrounds, and finding out progress slowed far more for arithmetic than for reading abilities.

Data specifically from the United States and the United Kingdom was “pretty equivalent,” Betthäuser said, and translated to a little bit additional than a third of a faculty calendar year value of discovering progress missing, on common.

The paper reveals that the intercontinental proof of discovering reduction throughout the early days of the pandemic mirrors the US knowledge, Thomas Kane, faculty director of the Centre for Instruction Plan Study at Harvard College, said in an e mail.

“One vital variation is that remote schooling had a disproportionately adverse result on high-poverty learners in the U.S. It was not just the pandemic. Gaps widened a lot less in school districts that returned to in-individual studying extra rapidly,” wrote Kane, who was not included in the new investigation. “If we do not act decisively now, discovering loss will be the longest-long lasting and most inequitable consequence of the pandemic.”

Kane suggested that university districts take methods these as incorporating tutoring and studying time through expanded summer time applications or lengthier college a long time.

Whilst this knowledge on discovering decline during the pandemic is not itself new, the new paper shows how the conclusions have been regular, Susanna Loeb, professor at Stanford University’s Graduate Faculty of Education, said in an electronic mail.

“Students, on typical, are much guiding exactly where they would have been without the need of the pandemic and this minimized learning is considerably higher for groups of students who were already extra most likely to be battling in school,” wrote Loeb, who also was not included with the paper.

In October, effects from the 2022 US Nationwide Evaluation of Academic Development tests, typically named the “Nation’s Report Card,” showed that fourth- and eighth-graders fell powering in looking through and had the greatest ever drop in math in the United States. It was the initially national evaluation of scholar achievement in three yrs given that Covid-19 emerged, and uncovered the devastating effect of the pandemic on studying.

Benefits from a Pew Investigate Centre survey, revealed in Oct, counsel that about 61{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of parents of K-12 college students say the very first yr of the pandemic had a destructive outcome on their children’s education 7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} say it experienced a favourable impact, and 28{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} say it experienced neither a beneficial nor unfavorable impact.

Amongst people who say the pandemic experienced a negative impact on their children’s instruction, 44{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} claimed that was however the situation, whilst 56{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} mentioned the impression was only momentary. The survey involved 3,251 moms and dads.

“I do believe that that dad and mom ought to be concerned about their children’s skipped finding out as a end result of the pandemic,” Loeb reported. “We have tons of evidence that what students discover in university contributes markedly to their later on accomplishment – substantial university graduation, school heading, even labor market options and their lengthy-expression effectively-becoming. Moms and dads can support by encouraging their little ones to reengage with classmates and lecturers and with beneficial understanding routines.”

study abroad: Study abroad trends to watch out for in 2023

The study overseas sector picked up the tempo at the commencing of 2022 right after two yrs of pandemic inflicted slowdown. Tendencies level to continual expansion in analyze overseas programs with a report from Crimson Seer estimating that 2 million Indian college students will be in foreign universities by 2024.

International universities and increased training institutions way too have undergone transformation pushed by the require to digitalize studying in document time, offering rise to blended programmes. The New Training Plan (NEP), getting implemented in India this 12 months, far too has promoted the notion of dual levels and twinning programmes, in addition to making India itself a research abroad destination. Evidently, the research overseas area is much more vivid than at any time prior to and learners will probable encounter some of the beneath traits in 2023.
Emergence of new programmes
Worldwide choice for educational classes is beginning to change absent from personal computer science and engineering. Pupils are increasingly getting drawn to programmes in liberal arts, enhancement studies, culinary arts, urban planning, and architecture, to name a handful of as these are akin to skilling and provide early work avenues. Pursuing the pandemic and the increased demand from the health care sector, quite a few college students are anticipated to pursue programs in biotechnology, pharmacy, health care informatics, and hospital administration.

Because of to the improved demand for proficient specialists in parts like AI, cybersecurity, electronic advertising, and cloud computing, a lot more learners in new years have picked out to review these topics at global campuses.

Increase in programs from tier 2 and 3 cities
The year 2023 is almost certainly heading to be a huge a single for the worldwide instruction field. Pupils who enrolled in courses on the net or all those who waited to return to classroom training are envisioned to journey to their preferred destinations this 12 months.

The quantity of students implementing to U.K. universities has elevated drastically since the U.K. opened its new graduate route, that makes it possible for international learners to keep back or function for 2 many years relying on the nature of their degree. In addition, the U.K. has demonstrated overall flexibility by offering learners the decision to begin on the internet and travel later.

Now that Australia, which has also been one of the prime choices of Indian pupils for overseas education and learning, has reopened its borders after a extended period of closure, candidates from India and other countries are expected to grab the opportunity before the admissions window for this year closes. Considerably, tier 2 cities are sending extra students than previously, matching to their metro and mini metro counterparts on analyze abroad purposes. An instance of this trend can be viewed in cities these types of as Vijaywada, Guntur and Khammam which rank in the prime 10 of GRE exam takers.

Hybrid Mastering
While on the net studying was the only option through the pandemic – quite a few learners and institutions have now found a harmony involving on-line and classroom instructing. A number of pre lessons and induction programmes are now on the web only, and students travel to campuses for core topics. Also, with NEP’s internationalization agenda scaling up, many international universities are envisioned to collaborate with their Indian counterparts for partial mastering in India and stability at the overseas campus.

Evidently, there will be a whole lot of possibilities for study abroad aspirants in the instances to occur.

Residence Screening as an possibility for examine abroad tests
At-property screening commenced in the course of the pandemic, and it is right here to stay. ETS was the 1st corporation to introduce this solution to check takers when the pandemic commenced. TOEFL, for example, delivers check takers an possibility to get the test from property or a test centre, as nicely as on personal computer and via paper. In the two occasions, the scores are accepted by countless numbers of universities throughout the globe.

For the GRE as well, which is the world’s most commonly taken admissions take a look at for graduate and qualified experiments, such as business enterprise and regulation plans, the developments demonstrate that just about an equal variety of candidates are opting for at-dwelling tests. The assessment’s written content and scoring remain unchanged, enabling exam takers to check from the ease and comfort of their individual homes.

Diversity in Classrooms
The opportunity to learn from and be influenced by some of the best teachers and issue issue specialists in the planet is by considerably the largest profit of finding out abroad. In international universities, given that the understanding is imparted in English, which is unquestionably a enterprise language close to the world, it opens doorways to a myriad of prospects for the younger Indian learners to turn into a global citizen. This is reflected in the soaring range of examine overseas programs that are predicted to surpass former benchmarks.

Also, the continued rollout of vaccinations and varying unlock policies about the globe have encouraged pupils to prepare their vacation, ensuing in increased cultural variety in the classroom. As a make a difference of simple fact, on the web learning as well has permitted learners from various geographies and backgrounds staying ready to consider up courses that are provided either in on line or blended modes, all over again leading to equity and cross-cultural practical experience for the learner.

Analyze overseas aspirants need to continue to be abreast of these trends offered the huge need and rush for overseas education and learning. Establishments will examination for aptitude and for that reason becoming knowledgeable and getting ready in advance will be key to for a longer time term accomplishment.

NRI-QR-labelET Online

Humans can understand apes’ sign language, study finds

Indication up for CNN’s Surprise Theory science newsletter. Examine the universe with information on intriguing discoveries, scientific improvements and a lot more.



CNN
 — 

From pointing to animated arm actions and nodding, people on a regular basis hire gestures to accompany and build language.

Now, it’s been instructed that humans can also understand indication language applied by apes, which means people may retain an knowledge of ape interaction from their ancestors.

Fantastic apes deploy additional than 80 indicators to connect every day targets, in accordance to a examine published Tuesday in the journal PLOS Biology.

These gestures involve the “big loud scratch,” which signifies “groom me” — apes do this to clear away bugs or dust from each individual other’s hair. “Object shake” can mean “let’s have sexual intercourse,” “groom me” or “move absent.” The “directed push” means “climb on my back” for bonobos or “move to a new position” for chimpanzees.

Chimpanzees and bonobos, which share much more than 90{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of their gestures, are humans’ closest residing relations, the review reported. Their gestures have been suggested to be an essential framework in the evolution of human language, in accordance to examine authors Kirsty E. Graham, a exploration fellow at the University of St. Andrews’ Faculty of Psychology and Neuroscience in Scotland, and primatologist Catherine Hobaiter, a principal investigator at the university’s Wild Minds Lab.

Infants ages 1 to 2 have been identified to use much more than 50 gestures from the ape repertoire, scientists claimed. It was therefore imagined that humans may perhaps have retained their comprehension of core capabilities of ape gestures.

Scientists utilized information from 5,656 individuals who viewed 20 on the web video clips that have been clipped to present a gesture manufactured by a bonobo or chimpanzee but without the need of the reaction it brought on. The contributors have been demanded to choose the accurate which means of the gesture from four achievable choices.

The scientists selected 10 of the most popular gesture varieties that had been formerly located to confer meaning for both chimpanzees and bonobos to include in the films. They ended up every single accompanied by a simple illustration of the gesture to aid inexperienced viewers in determining the action in the clips.

Each and every participant was randomly allotted both a “video only” match or movies with a person line of context that described what the apes have been undertaking prior to their gesture.

This type of comprehension research has been used to take a look at nonhuman species on comprehension of human language, but the design was flipped this time.

Graham explained to CNN through email on Thursday that the individuals ended up identified to be in a position to productively interpret the chimpanzee and bonobo gestures with just about 50{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} accuracy — double what is expected by likelihood. There was up to 80{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} good results for some particular gestures, such as the “mouth stroke” (that means “give me that food”) and “big loud scratch.”

This means was still current in pinpointing the meaning of more ambiguous gestures that experienced alternate meanings, with the “object shake” becoming the only gesture to which members failed to assign possibly the primary or alternate meanings.

“That our members were being capable to interpret primate signals enhances latest findings that propose human beings may possibly be able to perceive affective cues in primate vocalisations,” the examine authors concluded.

“These gestures are shared by all other excellent ape species,” Graham advised CNN, “and if individuals comprehend them, then it appears to be like a excellent ape gesture potential that would have been used by our previous popular ancestors.”

Even so, the underlying mechanism that permits individuals to comprehend apes stays unresolved, the researchers additional.

Some possible explanations for this puzzle incorporate people biologically inheriting the wonderful ape repertoire, apes and humans sharing basic intelligence to interpret signals as perfectly as shared body plans and social plans, or the resemblance of gestures to the actions they goal to evoke.

“We will need to take a look at how participants comprehended the gestures — do human beings inherit a vocabulary or a ability or are we reasoning our way by it? It’s a major problem that will demand a assortment of approaches to deal with,” Graham mentioned.

“But this experiment is an significant proof of notion and from below we can perform around with the information and facts that contributors acquire and request participants extra about how they are interpreting the gestures. We are also finding out various communities of terrific apes in the wild to get a fuller image of their gestures.”

The researchers mentioned that gorilla and orangutan gestures could also be interpreted by individuals, despite the fact that the meanings for gestures in these ape species are not yet founded.

“Dogs are appealing far too, because we are not that closely related but we have domesticated and co-progressed with them more than tens of hundreds of yrs,” Graham added, “so how we communicate with them can be extremely instructive for researchers far too.”

Physical education requirements continue to decline at colleges and universities, OSU study finds

CORVALLIS, Ore. — A new review from Oregon Point out University located that about 32{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of faculties and universities in the U.S. have to have some sort of bodily instruction class to graduate, down from 39{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} as observed in an OSU research from 2010.

The continuing decline in needed PE programs arrives at a time when little ones and youth in the U.S. are also participating in a lot less and significantly less bodily action, according to the Bodily Action Alliance’s 2022 Report Card, which bases its rubric on U.S. Section of Wellbeing and Human Products and services tips.

“There’s an enormous volume of scientific evidence supporting the value of actual physical activity. It’s fantastic for the human overall body, very good for college students — it allows them be greater learners, greater organized it will increase cognitive operating and allows with anxiety administration,” claimed research co-creator Brad Cardinal, a professor in OSU’s Higher education of Community Health and Human Sciences.

However, he mentioned, there is no universal normal for what need to be required in conditions of bodily education courses in colleges and universities.

“Longitudinal studies have proven that when somebody attends an establishment with a bodily action education graduation prerequisite, they tend to be much healthier prolonged-term,” Cardinal mentioned, citing research from his lab and other investigation from the 1980s to the 2000s.

Far more lately, he claimed, scientists at George Washington College, the Nationwide Most cancers Institute and the American College Overall health Affiliation identified that university and university learners attending institutions with PE graduation specifications ended up more very likely to satisfy the national actual physical exercise guidelines.

“Removing the need is these types of a counterintuitive plan,” Cardinal stated. “It definitely does not characterize an evidence-based finest observe.”

Without having prerequisites in position, Cardinal reported, his study has discovered that on-campus PE offerings are a lot more very likely to engage students who are by now bodily energetic or cozy in gyms and activity-associated configurations. This leaves out learners who may well gain from finding out how to use these spaces and turn into snug in them for the to start with time during early adulthood, he claimed.

The analyze seemed at a agent sample of 331 schools and universities from all around the country and documented no matter if they thoroughly or partially needed completion of a PE training course to graduate. Partial prerequisites provided schools wherever only selected degree plans had a PE need, or in which pupils could decide on from a menu of solutions that involved physical instruction among the other overall health-linked classes this sort of as fiscal literacy or sexual overall health.

Researchers outlined PE as “any action or academic system pertaining to wellness, wellness, sporting activities or physical activity,” and included “conceptual” PE programs that emphasize instructing overall health conduct approaches to preserve lifelong bodily action life.

They discovered that 56.2{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of establishments did not require PE 31.7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} completely necessary all undergraduates to full a PE system to graduate and 12.1{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} experienced a partial requirement.

The most typical necessities mandated learners full both an exercise-dependent and a conceptual-dependent study course or a conceptual-only course. Private establishments were about two times as possible as general public institutions to thoroughly need PE classes, and establishments in the south were most possible to completely have to have PE out of any geographic region

The research did not exclusively look at incapacity accessibility or lodging for PE necessities.

Cardinal said quite a few aspects are very likely motivating faculties to shift absent from PE necessities: Students have a lot of other programs they’re required to choose for graduation, and there is a prevailing assumption that most master fundamental bodily education and learning in their K-12 decades, building it less needed at the university level.

But the recent quantities from K-12 universities present that isn’t the case, he claimed. In accordance to the 2022 Report Card, the U.S. receives a D- grade with only 21{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of U.S. young children and youth ages 6-17 meeting the actual physical exercise tips of 60 minutes of bodily exercise each individual working day.

That drops noticeably in just the older age bracket: 42{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of 6-11-year-olds strike the focus on, but only 15{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of 12-17-yr-olds are receiving their day-to-day hour.

“The argument that bodily education is something they’ve been taught, that they already know this in advance of college — it is just not occurring,” Cardinal claimed. “The lifestyle has shifted to where bodily exercise continues to be stripped out of day by day everyday living.”

Guide writer on the examine was Alexandra Szarabajko, a new doctoral graduate from OSU who is now the section chair of work out science at Columbia University in South Carolina.

Physician Assistant Students’ Perception of Online Didactic Education: A Cross-Sectional Study

Purpose: This study describes physician assistant students’ perception toward online didactic education and highlights relationships between student characteristics and their preference for online learning.

Methods: A previously validated survey questionnaire was administered online to physician assistant students enrolled in traditional, in-person training programs across the United States. The survey consisted of five Likert-scale statements measuring perceptions of online learning and was rated on a seven-point Likert scale. Students also reported their age, gender, history of taking an online course, and preferred learning style. Mean scores were reported for agreement with each Likert-scale statement; Pearson correlation coefficients, one-way ANOVA with post hoc Tukey tests, and independent samples t-tests were used to determine relationships between student characteristics and their preference for online learning.

Results: A total of 391 completed surveys met the inclusion criteria for the study and were used in data analysis. The average age of respondents was 25.98 years, 81.1{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 317) were female, 96.2{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}, (n = 376) reported taking an online course previously, and preferred learning styles were reported as 36.1{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 141) visual, 7.7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 30) auditory, 15.6{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 61) reading/writing, and 40.7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 159) kinesthetic. Nearly a quarter of respondents indicated they preferred online courses, particularly students with a preferred learning style of reading/writing. No relationships were observed between age, gender, or history of taking an online course and preference for online education.

Conclusion: Most physician assistant students prefer in-person learning. However, a substantial number prefer online learning, and a significant number of these students reported a preferred learning style of reading/writing. More research is necessary to give educational institutions the ability to make data-driven, student-centered program development decisions. However, data in this study indicate a need for continued development of online/hybrid physician assistant programs to better align with current student preferences. 

Introduction

Since the inception of the profession in 1965, physician assistants (PAs) have learned to practice medicine through a combination of in-person didactic instruction followed by the completion of supervised clinical practice experiences at affiliated hospitals and clinics. Although this is an effective curriculum delivery method, pioneers in the field have also recently demonstrated the feasibility of hybrid PA education [1]. In the hybrid model, students complete the didactic year predominantly online, followed by traditional, in-person clinical training. Anderson summarized some of the benefits of online medical education [2]. These include fostering the development of self-directed learners [3], enhancing student engagement in the classroom [4], expanding opportunities for interprofessional education experiences [5,6], promoting digital literacy with medical technology [7], widening the instructor pool [7,8], removing barriers to attending PA school [9], repurposing time spent commuting [4], allowing students to live in and learn about the communities where they may one day practice, and helping to close the gap of clinician shortages in underserved areas [10]. The ability to teach didactic content online may also prove beneficial considering recent changes to the educational landscape following the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2)/coronavirus disease 2019 (COVID-19) pandemic. During this time, remote learning in the didactic year across PA programs increased from 6.4{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} before the pandemic to 96.8{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} during the pandemic [11]. During this time, there has also been increasing program director support for online didactic education in PA programs [12]. Now that online didactic PA education is possible, innovative PA educators should seek to determine what method of curriculum delivery students prefer, and analyze these preferences to help guide future program development decisions.

A review of the current literature indicates an overall preference for traditional in-person education over online learning among health professions students, both within and outside of the PA profession; however, research specific to the PA community is limited. In a 2006 seminal study, Day et al. concluded that PA students preferred in-person over online curriculum delivery [13], and in 2009, York et al. observed that 78{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of PA students enrolled in a web-based evidence-based medicine course stated they would have preferred in-person lectures instead of, or in addition to, online learning [14]. A review of the literature outside of the PA profession yields similar findings [15-17]. Although video-recorded lectures were found to be of equal or more educational value when compared to in-person instruction, Harvard Medical School students continued to attend traditional lectures if given the choice [15]. Hamilton et al. reported that third-year pharmacy students favored a blended educational approach as opposed to an exclusively online course [16]. A study by Bramer et al. also found that United Kingdom nursing students preferred a balanced mixture of online and face-to-face learning and did not feel that online learning should replace traditional teaching [17].

Further research is needed to explore the current preferences of didactic PA students regarding in-person versus online education to ensure PA program development decisions are student-centered, evidence-based, and data-driven. This is especially important considering the number of new PA programs in development and the number of existing programs that are adapting their curricula to combat current and evolving barriers to medical education. The current study sought to narrow this information gap by determining the curriculum delivery preferences of currently enrolled didactic PA students. Participants were also asked to report their age, gender, history of taking an online course, and preferred learning styles to determine if an association existed between any of these factors and their preference for online education.

Materials & Methods

Study description 

This was a cross-sectional survey study. Risks were minimal and consisted of time lost by students to complete the survey and the potential loss of confidentiality among participants. To mitigate these risks, the survey was designed to be completed in fewer than five minutes, participation was a one-time endeavor with no follow-up, and no personally identifiable information was collected. The primary benefit of the study was insight into the preferences of didactic PA students regarding their preferred curriculum delivery method. This could help current and future programs plan the instructional design of their curriculum. The study proposal was reviewed and approved by the institutional review board (IRB) of A.T. Still University, Mesa, Arizona, United States (approval number: 2021-174), and secondary approval was given by Franklin Pierce University, Rindge, New Hampshire, United States (protocol number: 08252021) for exempt status prior to data collection. 

Study sample

The Physician Assistant Education Association (PAEA) Program Report 35 reported that the maximum capacity enrollment of didactic students in PA programs across the United States was 11,299 [18]. According to a sample size estimator by Qualtrics (Seattle, Washington, and Provo, Utah, United States), 372 individuals from this population needed to be sampled to adequately represent the target population [19]. Inclusion criteria for participation were as follows: students had to be at least 18 years old, be enrolled in a currently accredited PA Program in the United States, and be in their didactic phase of study. Students at the Yale PA online program were excluded from participation as the principal investigator felt they may reasonably have a favorable bias toward online education. The principal investigator currently works for Franklin Pierce University and has previously been employed by the University of South Alabama; therefore, students from these institutions were also excluded to limit participation bias. 

Survey design and distribution

A previously validated survey instrument from O’Malley et al. [20] regarding perceptions of online education was adapted for use in the study, with the author’s permission. The adapted survey consisted of two questions to identify eligibility criteria, five Likert-scale questions regarding student perception of online education, and four student characteristic/demographic questions: (i) age, (ii) gender, (iii) history of taking an online course previously, and (iv) preferred VARK (visual, auditory, reading/writing, kinesthetic) learning style [21]. An alphabetical list of currently accredited PA programs by state from the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) website was used to determine which programs to target for student recruitment [22]. The program director for the first accredited program listed for each state was sent a recruitment email asking whether they would offer participation to their didactic students. Those who agreed were asked to forward a standardized student-specific recruitment email to their currently enrolled didactic students that described the study’s purpose, risks, and benefits, and informed students that participation was voluntary, and completion of the survey was considered their consent to participate. The email also provided a link to the survey should they wish to complete it. If no response was received from a program director after one week, the recruitment email was sent for a second and final time. At the end of every two-week period, the next accredited program listed on the ARC-PA website for each state was contacted. This process continued, every two weeks, until the needed sample size of 372 qualified surveys was completed. 

Data collection, storage, and analysis

Data were collected from September through December 2021. Both ordinal and nominal (categorical) data were collected and stored on the SurveyMonkey platform (Momentive Inc., Waterford, New York). Following data collection, descriptive (frequencies, percentages, means, standard deviations, and confidence intervals) and comparative statistics were conducted using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021, Armonk, New York). To determine if a correlation existed between age and preference for online education, a Pearson correlation coefficient was calculated for each Likert-scale statement; p-values less than .05 were used to determine statistical significance. A one-way ANOVA test was used to compare means among Likert-scale statements according to the four different preferred learning styles of participants; p-values less than .05 were used to determine statistical significance. Post hoc Tukey tests were then conducted to determine pairwise differences between the preferred learning styles for each Likert-scale statement; p-values less than .05 were used to determine statistical significance. Independent samples t-tests were used to determine if there was a significant difference in mean Likert-scale scores between genders or between those who had taken an online course previously versus those who had not; because multiple t-tests were conducted, the criterion for statistical significance was adjusted downward to a p-value less than 0.1 to control for alpha inflation in accordance with the Bonferroni correction.

Results

PA program participation and student characteristics 

The researchers did not directly access the study sample (didactic PA students), which instead had to be recruited to the study by PA program directors of invited programs. Therefore, the total number of student participants who received the survey was unknown and an accurate response rate could not be calculated. Approximately 35{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (50/141) of PA programs invited to the study responded to the email request, and 32{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (45/141) opted to participate. These programs represented didactic PA students across 31 states. At the conclusion of data collection, 472 surveys were received, of which 391 were complete, met inclusion criteria for the study, and were subsequently used for data analysis. The average age of the study sample was 25.98 years (range = 21-51 years). Gender was reported as 18.4{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 72) male, 81.1{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 317) female, 0.3{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 1) gender non-binary, and 0.3{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 1) preferred not to answer. Most participants (96.2{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}, n = 376) reported taking an online course previously. The distribution of preferred learning styles of the sample was 36.1{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 141) visual, 7.7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 30) auditory, 15.6{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 61) reading/writing, and 40.7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 159) kinesthetic (hands-on). 

Participant preferences for online education

Table 1 reports the study participants’ agreement and disagreement with statements pertaining to their perception of online education. Most students disagreed to some degree (strongly disagreed, disagreed, or somewhat disagreed) with four out of the five Likert-scale statements studied; 76.5{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 299) disagreed with the statement “Most people believe that online learning is more effective than traditional methodologies”, 72.4{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 283) disagreed with the statement “In a course with both traditional and online methodologies, I learn better through the online portion”, 69.4{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 271) disagreed with the statement “I prefer online courses to traditional courses”, and 59{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 231) disagreed with the statement “I believe that I can learn the same amount in an online course as in a traditional course.” In contrast, most students (56.5{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}, n = 221) agreed to some degree (strongly agreed, agreed, or somewhat agreed) with the statement “I believe that I can make the same grade in an online course as in a traditional course.”

Likert-scale Statement Strongly Disagree, n ({af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) Disagree, n ({af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) Somewhat Disagree, n ({af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) Neither Agree nor Disagree, n ({af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) Somewhat Agree, n ({af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) Agree, n ({af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) Strongly Agree, n ({af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
Most people believe that online learning is more effective than traditional methodologies. 96 (24.6) 125 (32.0) 78 (19.9) 29 (7.4) 39 (10.0) 14 (3.6) 10 (2.6)
In a course with both traditional and online methodologies, I learn better through the online portion. 104 (26.6) 117 (29.9) 62 (15.9) 35 (9.0) 29 (7.4) 27 (6.9) 17 (4.3)
I prefer online courses to traditional courses. 116 (29.7) 96 (24.6) 59 (15.1) 27 (6.9) 41 (10.5) 25 (6.4) 27 (6.9)
I believe that I can learn the same amount in an online course as in a traditional course. 74 (18.9) 83 (21.2) 74 (18.9) 22 (5.6) 55 (14.1) 48 (12.3) 35 (9.0)
I believe that I can make the same grade in an online course as in a traditional course. 41 (10.5) 48 (12.3) 42 (10.7) 39 (10.0) 67 (17.1) 101 (25.8) 53 (13.6)
Table
1: Levels of Agreement with Likert-scale Statements Regarding Perception of Online Education

n, number of participants

Relationships between participant characteristics and their preferences for online education 

Age

One survey respondent was omitted from analysis due to an erroneous input of their age (“2t”) which could not be validated. As reported in Table 2, no significant correlation was observed between age and preference for online education. 

Likert-scale Statement What is your current age?
n Pearson Correlation p-value
Most people believe that online learning is more effective than traditional methodologies. 390 0.02 0.66
In a course with both traditional and online methodologies, I learn better through the online format. 390 0.09 0.07
I prefer online courses to traditional courses. 390 0.06 0.23
I believe that I can learn the same amount in an online course as in a traditional course. 390 0.03 0.56
I believe that I can make the same grade in an online course as in a traditional course. 390 0.01 0.79
Table
2: Correlation of Likert-scale Statements with Age

n, number of participants

Gender

Only male and female genders were used in the analysis as these categories made up 99.49{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of the sample. As reported in Table 3, no significant relationship existed between gender and preference for online education. 

Statement Gender n Mean Standard Deviation t df Two-sided p-value Mean Difference 95{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} Confidence Interval of the Difference
Lower Bound Upper Bound  
Most people believe that online learning is more effective than traditional methodologies. Male 72 2.64 1.50 -0.16 387 0.87 -0.03 -0.43   0.37    
Female 317 2.67 1.56  
In a course with both traditional and online methodologies, I learn better through the online format. Male 72 2.72 1.68 -0.31 387 0.76 -0.07 0.23 -0.52  
Female 317 2.79 1.75  
I prefer online courses to traditional courses. Male 72 2.89 1.84 -0.09 387 0.93 -0.02 -0.51 0.47  
Female 317 2.91 1.92  
I believe that I can learn the same amount in an online course as in a traditional course. Male 72 3.58 2.07 0.59 387 0.56 0.15 -0.36 0.66  
Female 317 3.43 1.95  
I believe that I can make the same grade in an online course as in a traditional course. Male 72 4.33 2.06 -0.44 387 0.66 -0.11 -0.61 0.39  
Female 317 4.44 1.93  
Table
3: T-test Comparison of Likert-scale Scales by Gender

n, number of participants; t, independent sample t-test; df, degrees of freedom.

History of Taking an Online Course Previously

As reported in Table 4, no significant relationship existed between taking an online course previously and preference for online education. 

Statement Online Course Previously n Mean Standard Deviation t df Two-sided p-value Mean Difference 95{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} Confidence Interval of the Difference
Lower Bound Upper Bound  
Most people believe that online learning is more effective than traditional methodologies. Yes 376 2.66 1.53 -0.74 14.58 0.47 -0.41 -1.59   0.77  
No 15 3.07 2.12  
In a course with both traditional and online methodologies, I learn better through the online format. Yes 376 2.77 1.71 -0.79 14.56 0.45 -0.50 -1.85 0.86  
No 15 3.27 2.43  
I prefer online courses to traditional courses. Yes 376 2.90 1.88 -0.61 389 0.54 -0.30 -1.29 0.68  
No 15 3.20 2.31  
I believe that I can learn the same amount in an online course as in a traditional course. Yes 376 3.44 1.96 -1.86 389 0.06 -0.96 -1.98 0.06  
No 15 4.40 2.20  
I believe that I can make the same grade in an online course as in a traditional course. Yes 376 4.38 1.94 -2.74 15.53 0.02 -1.22 -2.17 -0.27  
No 15 5.60 1.68  
Table
4: T-test Comparison of Likert-scale Statements by History of Taking an Online Course Previously

n, number of participants; t, independent sample t-test; df, degrees of freedom.

Preferred Learning Style

As reported in Table 5, the highest mean score (most agreement) for each Likert-scale statement was observed with those who selected reading/writing as their preferred learning style; four out of the five differences in means reached statistical significance. There were also statistically significant findings on the pairwise analysis of the different learning styles (Table 6). 

Likert-scale Statement Visual n Mean Standard Deviation 95{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} confidence interval for mean p-value
Lower Bound Upper Bound
Most people believe that online learning is more effective than traditional methodologies. Visual 141 2.75 1.49 2.50 3.00 0.04
Auditory 30 2.70 1.70 2.06 3.34
Reading/Writing 61 3.08 1.80 2.62 3.54
Kinesthetic 159 2.44 1.44 2.21 2.67
In a course with both traditional and online methodologies, I learn better through the online format. Visual 141 2.84 1.71 2.56 3.13 0.02
Auditory 30 2.77 1.87 2.07 3.46
Reading/Writing 61 3.33 2.07 2.80 3.86
Kinesthetic 159 2.53 1.56 2.29 2.78
I prefer online courses to traditional courses. Visual 141 3.01 1.83 2.71 3.32 0.01
Auditory 30 2.73 1.91 2.02 3.45
Reading/Writing 61 3.56 2.25 2.98 4.13
Kinesthetic 159 2.60 1.75 2.32 2.87
I believe that I can learn the same amount in an online course as in a traditional course. Visual 141 3.57 1.99 3.24 3.90 0.55
Auditory 30 3.57 1.96 2.83 4.30
Reading/Writing 61 3.66 2.06 3.13 4.18
Kinesthetic 159 3.30 1.94 3.00 3.61
I believe that I can make the same grade in an online course as in a traditional course. Visual 141 4.43 1.97 4.10 4.75 0.04
Auditory 30 4.47 2.13 3.67 5.26
Reading/Writing 61 5.03 1.75 4.58 5.48
Kinesthetic 159 4.19 1.93 3.89 4.49
Table
5: One-way ANOVA of Likert-scale Statements with Preferred Learning Styles

n, number of participants

Likert-scale Statement Preferred Learning Style (a) Preferred Learning Style (b) Mean difference
(a-b) 		95{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} confidence interval for mean p-value
Lower Bound Upper Bound
Most people believe that online learning is more effective than traditional methodologies. Visual Auditory 0.05 -0.75 0.85 1.00
Reading/Writing -0.33 -0.94 0.28 0.50
Kinesthetic 0.31 -0.15 0.77 0.30
Auditory Visual -0.05 -0.85 0.75 1.00
Reading/Writing -0.38 -1.27 0.50 0.68
Kinesthetic 0.26 -0.53 1.05 0.83
Reading/Writing Visual 0.33 -0.28 0.94 0.50
Auditory 0.38 -0.50 1.27 0.68
Kinesthetic 0.64 0.04 1.24 0.03
Kinesthetic Visual -0.31 -0.77 0.15 0.30
Auditory -0.26 -1.05 0.53 0.83
Reading/Writing -0.64 -1.24 -0.04 0.03
In a course with both traditional and online methodologies, I learn better through the online format. Visual Auditory 0.08 -0.82 0.97 1.00
Reading/Writing -0.48 -1.17 0.20 0.26
Kinesthetic 0.31 -0.21 0.82 0.41
Auditory Visual -0.08 -0.97 0.82 1.00
Reading/Writing -0.56 -1.55 0.43 0.46
Kinesthetic 0.23 -0.65 1.12 0.91
Reading/Writing Visual 0.48 -0.20 1.17 0.26
Auditory 0.56 -0.43 1.55 0.46
Kinesthetic 0.79 0.12 1.46 0.01
Kinesthetic Visual -0.31 -0.82 0.21 0.41
Auditory -0.23 -1.12 0.65 0.91
Reading/Writing -0.79 -1.46 -0.12 0.01
I prefer online courses to traditional courses. Visual Auditory 0.28 -0.69 1.25 0.88
Reading/Writing -0.54 -1.28 0.20 0.23
Kinesthetic 0.42 -0.14 0.98 0.22
Auditory Visual -0.28 -1.25 0.69 0.88
Reading/Writing -0.82 -1.90 0.26 0.20
Kinesthetic 0.16 -0.83 1.10 0.98
Reading/Writing Visual 0.54 -0.20 1.28 0.23
Auditory 0.82 -0.26 1.90 0.20
Kinesthetic 0.96 0.23 1.69 0.00
Kinesthetic Visual -0.42 -0.98 0.14 0.22
Auditory -0.14 -1.10 0.83 0.98
Reading/Writing -0.96 -1.69 -0.23 0.00
I believe that I can learn the same amount in an online course as in a traditional course. Visual Auditory 0.00 -1.03 1.03 1.00
Reading/Writing -0.09 -0.87 0.69 0.99
Kinesthetic 0.27 -0.33 0.86 0.65
Auditory Visual -0.00 -1.03 1.03 1.00
Reading/Writing -0.09 -1.23 1.05 1.00
Kinesthetic 0.26 -0.75 1.28 0.91
Reading/Writing Visual 0.09 -0.69 0.87 0.99
Auditory 0.09 -1.05 1.23 1.00
Kinesthetic 0.35 -0.42 1.12 0.64
Kinesthetic Visual -0.27 -0.86 0.33 0.65
Auditory -0.26 -1.28 0.75 0.91
Reading/Writing -0.35 -1.12 0.42 0.64
I believe that I can make the same grade in an online course as in a traditional course. Visual Auditory -0.04 -1.04 0.96 1.00
Reading/Writing -0.61 -1.37 0.16 0.17
Kinesthetic 0.24 -0.34 0.81 0.72
Auditory Visual 0.04 -0.96 1.04 1.00
Reading/Writing -0.57 -1.68 0.55 0.56
Kinesthetic 0.28 -0.72 1.27 0.89
Reading/Writing Visual 0.61 -0.16 1.37 0.17
Auditory 0.57 -0.55 1.68 0.56
Kinesthetic 0.84 0.09 1.60 0.02
 Kinesthetic Visual -0.24 -0.81 0.34 0.72
Auditory -0.28 -1.27 0.72 0.89
Reading/Writing -0.84 -1.60 -0.09 0.02
Table
6: Tukey Post Hoc Pairwise Analysis of Preferred Learning Styles

Discussion

Purpose and major findings

The PA educational community has endured many challenges and evolved significantly over the last few years. Due to the unfortunate COVID-19 global pandemic, almost every PA program across the country quickly discovered its ability to implement didactic curriculum online and continue the education of PA students at a time when clinicians were crucially needed [23]. Academic administrators, faculty, students, and other stakeholders must now decide what role hybrid PA programs have in the future of PA education. Perceptions of PA students toward online learning should be considered in this discussion; determining these perceptions was the purpose of this study. 

Most pre-COVID-19 studies show that health professions students generally prefer in-person over online education [13-17], and the results of the current study align with those findings. However, the current study also reveals a significant number of PA students who do prefer learning in an online environment. Despite the majority of participants (69.31{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}, n = 271) preferring traditional courses, the survey nevertheless identified 23.79{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 93) who preferred online learning. Furthermore, as the sample population did not include students from programs that currently use online programming as a major component of their curriculum [2], the preference for online education of the entire PA student population may be slightly higher than reported here. The current study also provides insight into the type of student who may prefer learning online. Interestingly, data analysis showed no correlation between age and students’ preference for online education. Similarly, there were no significant relationships between gender or having previously taken an online course and preference for online education. However, a statistically significant relationship did exist between self-reported preferred learning styles and preference for online learning. Although only 15.6{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (n = 61) of the sample reported their preferred learning style as reading/writing, this group had the most agreement with all Likert-scale statements favoring online education; four out of five of these results were statistically significant. 

Relevance of findings 

A substantial interest among PA students in online didactic education is not surprising considering other recent studies of medical students in a post-COVID-19 educational environment. Stoehr et al. collected cross-sectional data from 3,286 medical students across 12 countries [24]. In their study, 91{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of participants agreed that lecture-style education was a suitable teaching concept for online learning, 97{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} indicated they had the devices required for online learning, 80{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} felt comfortable using the software required for online learning, 76{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} felt well prepared for online learning, and 62{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} reported being happy with the quality of online courses [24]. Another post-COVID-19 study of 64 medical students at a United States-based allopathic medical school that moved the entire pre-clinical curriculum to a virtual format during the pandemic demonstrated that 70.3{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of students reported an unchanged or improved overall medical education in a virtual course module compared to a previous module that was taught in a traditional face-to-face setting [25]. Furthermore, a recent systematic review of 24 studies measuring medical student satisfaction with e-learning during the pandemic indicated that 51.8{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of the 15,473 medical students studied were satisfied [26]. 

Study limitations

A potential limitation to this study is that it was conducted during the COVID-19 pandemic and perceptions of online education may have been influenced by either positive or negative experiences encountered during this turbulent time in medical education. Furthermore, the study was not experimental in nature and, therefore, could not control for other variables that may have influenced student perception of online PA education, such as the quality of instructional design and the types of resources made available to students at different institutions. Another limitation was that students were asked to self-report their VARK [21] learning style instead of completing the VARK questionnaire, and students were limited in their selection to only a single preferred learning style. Other limitations to this study are those inherent to survey-based research, including an inability to clarify study questions if needed and not allowing respondents to further explain their answers beyond predetermined survey selections. 

Conclusions

Most didactic PA students (69.31{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) prefer traditional in-person education over online learning. However, the number of didactic PA students that do prefer online learning (23.79{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) is also substantial. If we generalize these findings to the 11,299 maximum enrollment slots available per the last PAEA Program Report, there are potentially 2,689 students who may benefit from online/hybrid PA education. Despite these findings, only three out of the 282 currently accredited PA programs are designed to offer a significant portion of their curriculum in an online/hybrid format. Although more research is needed regarding hybrid PA education, based on the findings of this study, the researchers recommend more institutions consider exploring and/or piloting this type of program delivery. Future studies may consider determining the characteristics and preferred learning styles of students who decide to apply to online/hybrid PA programs and how a student’s preferred learning style relates to their satisfaction with, and success in, an online PA educational environment.