Research questions for this study were (1) Do students in a completely online anatomy laboratory acquire content knowledge as well as students in a traditional face-to-face laboratory? and (2) Are there particular topics in which one mode of instruction is superior to the other?

The use of hands-on laboratory instruction has and will likely always be, integral to student learning in science. Several trends within higher education are driving some or all of that instruction into a virtual or online environment. Enrollments across higher education in the United States are growing, particularly in public institutions, which are receiving increasingly lower state funding, and a virtual laboratory experience is easier to scale. Additionally, offering a laboratory online frees funding that would normally go to equipment, specimens, reagents, and other high-cost essentials in delivering a face-to-face (F2F) laboratory. The central question in this trend of moving laboratory instruction into a virtual platform is: Is it as effective in producing the kinds of learning that takes place in a F2F laboratory class?

To date, the literature on the effectiveness of online or virtual laboratory instruction is quite mixed. One of the first large-scale reviews of online laboratory efficacy found that the results were mixed across the literature due largely to investigators valuing and therefore measuring different outcomes and objectives (Ma & Nickerson, 2006; Cancilla & Albon, 2008). If one’s primary objectives in laboratory education are social or affective then F2F would have an obvious advantage, whereas if the objectives are primarily knowledge acquisition or conceptual understanding, then perhaps a virtual environment with its theoretically infinite opportunities for repetition and practice would have the advantage. Brinson (2017) confirmed that indeed there is no real consensus across the literature in science, technology, engineering, and math (STEM). He did however, add that other confounders such as demography, the bias toward undergraduate education instead of K–12, and the siloed nature of STEM educational publishing (i.e., few cross-disciplinary journals), also contribute to the variety of results in measuring the efficacy of online laboratory instruction (Brinson, 2017). Faulconer & Gruss (2018) state that objectives (cognitive and affective) should absolutely be considered when attempting to measure the effectiveness of an online laboratory experience. However, they further argue that if student opinions or content knowledge assessments are one’s primary measures, then a well-designed nontraditional format can be effective, but that the needs and goals of the learner and the institution must be considered (Faulconer & Gruss, 2018).

Indeed, throughout the STEM fields, results do appear to be mixed when comparing the efficacy of an online/virtual laboratory experience to a traditional F2F one. Several studies in multiple STEM fields found no statistical difference between students who completed a virtual laboratory versus the traditional one (Bloodgood, 2012; Faulconer et al., 2018; Miller et al., 2018). One such study looked not only at performance, but also student attitudes and preferences and found no statistical difference between the online and F2F environment (Miller et al., 2018). However, some researchers found that one or the other format was indeed better. Gilman (2006), in looking at a single biology lab, found that the nontraditional (online) format was actually superior in developing students’ content knowledge. In contrast, Van Nuland and Rogers (2017) found that it was the F2F environment that produced vastly superior outcomes in student content knowledge.

Like many other disciplines within STEM, it makes sense that virtual options should be explored in the Anatomy and Physiology lab, especially in light of the cost of anatomical models, cadavers, and specimens for dissection. The nature of the anatomy laboratory in particular, is quite different from others in that the types of activities that take place are especially intense in spatial reasoning and benefit from opportunities for kinesthetic learning. The human body is a three-dimensional structure and the anatomy laboratory is largely an exploration of that structure and the relationships between the various sub-components therein. As in the rest of the STEM fields, the literature on the efficacy of virtual anatomy instruction is mixed and confounded by other variables. For example, in a study that compared a traditional lab to a virtual experience called Anatomy TV, the students in the F2F hands-on experience outperformed the virtual section in content knowledge acquisition (Mathiowetz et al., 2016). When the authors investigated other variables, they found that the students in the F2F experience had significantly more time on task than those in the virtual experience, so the mode of offering could not be definitively put forward as the primary reason for the differences they observed (Mathiowetz et al., 2016). Other investigators found no significant difference in student gains of laboratory content knowledge and that, once again, factors such as incoming grade point average (GPA) or level of student engagement were more predictive of student success than mode of instruction (Davidson, 2017; Attardi et al., 2018; White et al., 2019). Despite the availability of some very well-developed commercial resources, the F2F seems to have an edge, especially for the types of spatial and kinesthetic learning that needs to take place in the anatomy laboratory. In fact, the virtual experience actually disproportionately affects students who enter the course with low spatial reasoning ability (Van Nuland & Rogers, 2017).

In this study, we look closely at a particular STEM course (Anatomy and Physiology) in which we are able to eliminate most of the confounding variables that made a direct comparison between instructional methods more difficult in some prior studies. The implications of our data, however, go beyond our own discipline. The variance in performance between the two modes of instruction have implications for laboratory instruction in general.

Methods

We conducted a retrospective analysis on student academic performance in the first semester of a two-semester lecture plus lab traditional introductory Anatomy and Physiology course (typically taken by preallied health majors—nursing, dental hygiene, radiography, physical therapy, etc.). Students self-enrolled in an asynchronous online Anatomy and Physiology lecture course and elected to enroll in an F2F or asynchronous online laboratory. The lecture and laboratory components of the course were all taught by the same instructor, with over seven years of teaching the course F2F and online.

All analysis was approved from by our Institutional Review Board East Tennessee State University institutional review board (c0819.17e-ETSU).

Course design

Course delivery, student assessment of learning, and student engagement were managed through the university’s course management software Brightspace (D2L) Virtual Learning’s online learning environment. The course textbook was the open source Anatomy and Physiology by Openstax (Openstax College, 2013). Students were not proctored for quizzes and were encouraged to use their notes. Exams were proctored in a certified testing facility and notes were not allowed.

The lecture component of the course was administered asynchronously online for all students and was divided into three main components, each ending with an exam: The first component included an overview of the anatomical systems, cellular anatomy, and histology; the second included the integumentary system, the skeletal system, and the muscular system; and the third component included the nervous and endocrine systems. Each component of the course was subdivided into a series of prerecorded lectures (5–15 minutes, 39 videos in total), nongraded review questions (for each video), content area review quizzes (12 quizzes total), and an interactive discussion activity (12 total). Lecture content was assessed by approximately 80% knowledge based, 15% comprehension based, and 5% application-based, multiple-choice questions.

Both the F2F and online laboratory course were divided into 13 separate modules, as indicated in Table 1, with the first four modules corresponding to the content assigned within the first lecture exam, five modules for the second lecture exam, and three modules for the third lecture exam. Each module included a brief introductory video, a list of terms to identify, and a series of images of anatomical diagrams, anatomical models, and pro-dissected cadavers from multiple angles in which students were tasked with identifying the corresponding anatomical features. Each lab module also had a corresponding ungraded review activity where students were asked to identify the indicated anatomical features from a random set of anatomical images. Lastly, each lab module had a corresponding multiple-choice quiz. Laboratory material was 99%+ knowledge-based, multiple-choice questions primarily identifying the labeled component of an image or diagram using the same images that were provided to students to study.

The F2F laboratory session included the same study materials and online modules as the online laboratory, but additionally included access to anatomical models and a pro-dissected cadaver in a traditional F2F format. Additional nonsupervised time with the anatomical models and cadaver was available to all students (F2F or online) throughout the semester; however, almost no students online were observed to participate.

Student demographic data

Student demographic data were obtained in aggregate from university records.

Student assessment

Specific assessments included three lecture examinations, two laboratory examinations, and 12 specific content quizzes for lecture and laboratory respectively (24 quizzes total). All quizzes and examinations were administered through the course management software. The examinations were proctored, whereas students were not proctored for quizzes and were encouraged to use their textbooks and notes.

Student engagement

All students were enrolled in a single online lecture section. Additionally, the F2F lab students had access to all of the online material available to the online lab students. Student engagement was assessed for both the lecture and laboratory sections of the course based on the total time spent actively logged into the course website, number of independent course log-ins, and average quiz grades. While there might be some very slight differences between the F2F and online lab sections, all activities were completed online through the course website, so the F2F lab students were doing the same online activities as the online labs, only in a room with access to three-dimensional models, bones, and other artifacts.

Statistical analysis

Sex distribution and course completion frequency between the F2F and online courses were compared by the Kolmogorov-Smirnov Test. Correlations were determined by calculating the Spearman’s Rank Correlation Coefficient. All remaining data were checked for normality with the D’Agostino and Pearson omnibus normality test. Comparisons between data that passed the normality test were analyzed by an unpaired t-test, whereas skewed data were analyzed by a Mann-Whitney U test.

Results

Students demographics

One hundred and one students total enrolled in the course, 44 students enrolled in the F2F lab, and 57 enrolled in the online lab. Aggregate student demographic data are reported in Table 2. Data from students who did not complete the course or missed a regularly scheduled exam were not included in the analysis. In total, 83 students completed the course as scheduled, 38 F2F and 45 online, respectively. Although not quantified, reasons for students not completing the course included: changing schedule, medical withdrawals, or excused absence requiring a make-up exam. Students who completed a make-up exam were not included in the analysis, as make-up exams were different from the regularly scheduled exams. There was no difference in the number of students who did not complete the course between the F2F and online sections. All demographic data were collected in aggregate from university records office and were not able to be matched to individual students.

Overall performance

Overall, there was no significant difference between the course engagement (as measured by time spent logged into the online activities in the course website) between the online lab students and the F2F lab students in either the lecture or laboratory material (Figure 1A-D). Further, there was no difference between the two groups in the average lecture quiz grades (Figure 1E). However, there was a 22% decrease in the laboratory quiz grades in the online laboratory students compared with the F2F laboratory students (90.8 ± 12.4% versus 68.8 ± 14.9%; p = 0001; Figure 1f).

Students who enrolled in the F2F laboratory instruction had significantly higher average lecture examination percentage scores than students in the online lab (78.6 ± 15.0% versus 69.6 ± 16.1%; Figure 2a). In both groups there was a significant strong positive correlation between the student performances on the lecture exams and laboratory exams (Figure 2b). However, the online laboratory students fared worse on each of the two laboratory exams, and this reduction was still present for each laboratory exam even after normalizing the laboratory exam to the average lecture exam grade (Figure 2c–f).

Lecture modules

The three lecture exams each corresponded to a specific area of the course. Interestingly, there was no difference between the two groups in the first lecture exam (regional anatomy, cellular anatomy, and histology). However, the online laboratory students scored on average 11% lower on the second lecture exam (musculoskeletal system; 81±15% vs 70±19%) and 13% lower on the third lecture exam (nervous system; 75±19 versus 62±19%) than students in the F2F laboratory version of the course (Figure 3).

Patrick Brown (brownpj@etsu.edu) and Jonathan Peterson are associate professors in the Department of Health Sciences at East Tennessee State University in Johnson City, Tennessee.