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Competency-based education in health care requires rigor-
ous standards to ensure professional proficiency. Demon-
strating competency in hands-on laboratories calls for
effective preparation, knowledge, and experience, all of
which can be difficult to achieve using traditional teaching
methods. Virtual laboratories are an alternative, cost-effec-
tive approach to providing students with sufficient prepara-
tory information. Research on the use of virtual labs in
allied health education is limited. The current study investi-
gated the benefits, challenges, and perceived impact of a
virtual lab in an allied health program. The sample consisted
of 64 students (55 females, 9 males) enrolled in a university
medical laboratory science program. A convergent mixed-
methods approach (Likert survey, open-ended questions,
think-aloud protocol data) revealed that students had pos-
itive attitudes towards visual learning, authenticity, learner
control, organization, and scaffolding afforded by the vir-
tual lab. Challenges reported included navigational difficul-
ties, an absence of control over content selection, and lack
of understanding for certain concepts. Over 90% of stu-
dents agreed that the virtual lab helped them prepare for
hands-on laboratory sessions and that they would use this
format of instruction again. Overall, 84% of the students
agreed that the virtual lab helped them to achieve greater
success in learning. J Allied Health 2018; 47(1):45–50.
ONGOING ADVANCEMENTS in patient care have
prompted change in the delivery of health education
and led to a recent worldwide focus on a competency-
based model.1,2 A competency-based program develops
learning objectives based on a profession’s requirements
for entry into practice.3However, a competency-based
approach poses numerous challenges for educators and
students,2including excessive content coverage, cogni-
tive overload of students,1over-reliance on traditional
teaching methods,4inflexibility,5limited accessibility,
and financial sustainability.6Simulations and virtual
learning environments offer a cost-effective, accessible,
flexible, learner-centred option for facilitating a compe-
tency-based agenda in health care education.2,4,7
Benefits and Challenges of Using Virtual Labs
Students need theoretical and procedural preparation to
engage in meaningful hands-on laboratory activities.8,9
Poor preparation can lead to cognitive overload when
students attempt to learn novel hands-on skills and new
theoretical concepts simultaneously.8,9 Some research
suggests that students do not regularly participate in pre-
laboratory exercises.9,10–12 Virtual labs, available to stu-
dents anytime and anywhere, might help increase the
participation rate in pre-laboratory activities.
Benefits: Medical knowledge doubles every 6 to 8
years.13 This expanding knowledge base and the
increasing cost of running hands-on laboratory classes
are pushing healthcare programs to consider virtual lab
alternatives.14 Virtual labs support learning through
visual supports,8,9 opportunities for repetitive prac-
tice,9,15,16 learner control,13,17,18 and detailed scaffolding
for difficult concepts.9,19 Effective virtual labs offer a
realistic layout,20,21 are easy to use and navigate,18,21 and
provide timely, effective feedback.9,18,22
Challenges: Two main challenges associated with use
of virtual labs are authenticity23,24 and student motiva-
tion.9,20,25–28 Virtual labs can lack authenticity, because
they do not contain the element of uncertainty that
exists in a hands-on experience.23,24 In addition, virtual
labs must be designed with care to motivate students,29
or otherwise extrinsic motivation in the form of grades
or assessment may be required to ensure participa-
tion.20,25,27,28 Some researchers argue that participation
should be through intrinsic motivation created by well-
designed virtual labs.9,26
Impact: Virtual labs may help to overcome the inher-
ent difficulties of more traditional, passive learning
environments and encourage students to be responsible
for their learning.6Several studies reported that stu-
dents had positive attitudes toward using virtual labs
for knowledge acquisition.9,21,30 For example, Sancho et
al.30 noted that 90% of students (n=292) believed learn-
45
RESEARCH ARTICLE
Assessing the Impact of a Virtual Lab in an
Allied Health Program
Robin Kay, PhD
Helene Goulding, MA
Jia Li, PhD
Dr. Kay is Professor and Director of Graduate Studies, Ms. Goulding is
Senior Lecturer, and Dr. Li is Assistant Professor, University of Ontario
Institute of Technology, Oshawa, Canada.
The authors report no funding or conflicts of interest related to this
study.
RA1771—Received Sep 21, 2016; accepted Feb 2, 2017.
Address correspondence to: Dr. Robin Kay, Faculty of Education, Uni-
versity of Ontario Institute of Technology, 11 Simcoe Street North,PO
Box 385, Oshawa, ON L1H 7L7, Canada. Tel 905-721-8668.
robin.kay@uoit.ca.
© 2018 Association of Schools of Allied Health Professions, Wash., DC.
ing with a virtual laboratory allowed them to gain both
theoretical knowledge and practical expertise that they
would not have achieved through conventional meth-
ods alone. Also, student engagement in virtual prepara-
tory labs can increase confidence and performance in
hands-on laboratories.9,12,31
Research Gaps and Questions
To date, healthcare researchers have investigated the
use virtual learning environments in medicine, den-
tistry, and nursing. However, minimal literature is avail-
able in the domain of allied health.7Butina et al.7
reported that 85% of allied health programs that cur-
rently do not use virtual learning environments would
be interested in doing so. Baker and Verran14added that
allied health students need exposure to multiple and
varied scenarios to improve clinical diagnostic skills,
and virtual laboratories could support this process.
In the current study, three key research questions
examined students’ attitudes towards the impact of the
virtual lab to prepare them for a hands-on laboratory
session:
1. What are the perceived benefits of using the virtual lab to
prepare students for hands-on laboratory sessions?
2. What are the perceived challenges of using the virtual lab
to prepare students for hands-on laboratory sessions?
3. What is the perceived impact of the virtual lab on the
development of students’ skills?
Methods
Participants
The participants consisted of 64 students (55 females, 9
males) sampled from a total population of 97 under-
graduate students for a response rate of 66%. Partici-
pants were enrolled in the second (n=35), third (n=17), or
fourth year (n=12) of a medical laboratory science pro-
gram in small suburban Canadian university of 10,000
students. Of the participants, 67% (n=42) reported that
they were native-English speakers. Thirty-one percent
(n=23) were between 17–20 yrs old, 36% (n=23) were 21–
24 yrs old, 19% (n=22) were 25–29 yrs old, and 14% (n=9)
were over 29 yrs old. Four percent (n=4) of the students
(3 females, 1 male) submitted a think-aloud video
recording documenting their use of the virtual lab.
Research ethics approval was obtained through the
university and community colleges where the data were
collected. Consent was given by all participants before
they participated in the study.
Description of the Virtual Lab
The underlying motivation for developing the virtual lab
was to help students overcome the challenges of content-
heavy, competency-based courses using an interactive
online tool designed to improve hands-on laboratory
skills. The virtual lab, available at http://virtuallab.
apa.uoit.ca/intro.php, mimicked algorithmic bacterial
identification procedures performed in a clinical microbi-
ology laboratory and included several procedural videos
and images of expected reactions. The intent of using the
virtual lab was to allow students selected from three
courses to interact and learn from mistakes in a safe envi-
ronment before undertaking procedures in a hands-on
environment.
Research Design and Data Collection
A convergent mixed-methods design32 was chosen to
investigate the benefits and challenges of using a virtual
lab. Three sources of data were collected including a
Likert scale survey, open-ended questions, and think-
aloud video clips of students actually using the virtual
lab. Data from the Likert survey, opened-ended ques-
tions, and think-aloud video recordings were integrated
to reveal areas of potential convergence. Triangulation
of the data was performed to provide greater accuracy
and validity in reporting the results.32,33
The online survey consisted of 14, seven-point Likert
questions ranging from “strongly disagree” to “strongly
agree.” Three items focused on learning, 3 items referred
to design, and 8 items targeted the perceived impact of
the virtual lab. The internal reliability for the scale was
considered high based on Cronbach’s = 0.90.
Six open-ended, semi-structured questions were used
to assess benefits and challenges of using the virtual lab.
The open-ended responses were analysed thematically
by a data-driven organization approach,34 the research
questions, and theoretical framework.35 All comments
were assigned a main category (learning, design, or
engagement) and theme within the main category. Two
raters assigned categories and themes for all 159 com-
ments. The second rater assessed approximately one-
quarter of the total comments, resulting in 97% inter-
rater agreement.
Four students volunteered to think-aloud while
using the virtual lab. Each student talked out loud for 3
to 5 minutes while using the virtual lab. The process
was recorded using a screen casting software. The
think-aloud method is considered an effective approach
to exploring the use of computer simulation tools.38 The
recordings underwent a coding and analysis process
similar to the open-ended responses and produced 97
comments. Inter-rater agreement for the assigned cate-
gories and themes was 91%.
Procedures
Medical laboratory science students from three courses
were given access to the virtual lab as a course resource.
Students were advised that completing the pre-labora-
tory activities and using the virtual lab was voluntary
46 KAY ET AL., Impact of a Virtual Lab
and no extrinsic motivational factors, such as assess-
ments or grades, would be associated with their partici-
pation. After using the virtual lab, students were sent
an email inviting them to participate in the study.
Anonymous, online survey data were collected during
weeks 10 to 13 of the semester. After week 13, students
were sent a second email inviting them to create a
think-aloud screencast of them using the virtual lab.
Results
Benefits of Using the Virtual Lab
Mean scores from the Likert scale, ranging from 5.9 to
6.6 on a 7-point scale, suggested that most students
agreed that the virtual lab was easy to use, provided
images and videos that helped them learn, presented a
useful checklist that helped them prepare for hands-on
laboratory sessions, offered a helpful layout for bacterial
identification, and provided helpful feedback (Table 1).
Open-ended data produced 159 comments about
benefits of the virtual lab. Of the comments, 75%
(n=119) focused on learning, 18% (n=29) referred to the
design of the virtual lab, and 7% (n=11) targeted engage-
ment. With respect to learning, visual features (39%,
n=46) were the most the frequently mentioned benefi-
cial characteristic of the virtual lab. Another 27% (n=32)
of the comments referred to the virtual lab’s ability to
offer authentic learning with a genuine interactive
experience, and 14% (n=17) were about the benefits of
learner control, which allowed them to learn at their
own pace, no matter where they were, and at their own
convenience. Using the virtual lab helped some stu-
dents remember (n=11) and understand (n=12) the mate-
rial and concepts better. Table 2 provides sample com-
ments from students.
Regarding design, 55% (n=16) of the comments indi-
cated that the organization of the virtual lab was of the
greatest benefit in preparing for laboratory sessions. For
example, students noted that the virtual lab was organ-
ized exactly the same as bacterial identification per-
formed in hands-on laboratory. Seventeen percent of
the comments offered were about the quality of the
graphics and the ease of use of the virtual lab. Com-
ments about engagement (n=11) focused primarily on
virtual labs being more beneficial than traditional meth-
ods of learning, such as reading laboratory procedural
manuals or hands-on laboratory sessions or conducting
Internet searches. Table 3 provides sample student com-
ments regarding virtual lab design and engagement.
Journal of Allied Health, Spring 2018, Vol 47, No 1 47
TABLE 1. Student Ratings for Benefits of Using a Virtual Lab (n=64)
Item Mean*SD Disagree†Agree†
Images help me to learn 6.6 0.6 0% 97%
Videos help me to learn 6.4 0.9 0% 86%
Pre-laboratory checklist exercise helped me to prepare for labs 6.4 0.9 2% 81%
Easy to use 6.2 1.1 3% 86%
Helpful layout for bacterial identification 6.2 0.9 0% 80%
Helpful feedback 5.9 1.1 2% 75%
*Based on 7-point Likert scale (1=strongly disagree to 7=strongly agree).
† Disagree includes both disagree and strongly disagree. Agree includes both agree and strongly agree.
TABLE 2. Sample Student Comments about the Learning Benefits of the Virtual Lab (n=119)
Theme Sample Comments
Visual “We can see clearly how the tests [are] being done and what are the possible results.”
“[I] can see procedures beforehand.”
“Allowed for us to see the positive and negatives for the different reactions.”
“It’s fantastic to have a visual way of preparing for the labs.”
Authenticity “It was as if we were at the laboratory bench.”
“It gave you an idea of what to expect in the lab.”
“You had an idea when going into the lab what to look for.”
“It even took students through the steps they needed to do in lab without being in the lab itself.”
Learner control “It’s fantastic to be able to sit at home and view these videos.”
“It gave me the opportunity to go back and review what I missed.”
“It’s essentially a lab session but you can dictate the speed at which you perform the tests.”
Understanding “We’re able to understand the material easily.”
“By watching it before the lab, it helps me to grasp the new concept even better.”
Remembering “I was able to remember the procedure very easily.”
“Able to review tests you forgot.”
Reflective “If the option was incorrect, you have clicked an incorrect option and recommends to return to the previous step.”
Comments from the think-aloud data (n=97) focused
on the benefits of learning (70%, n=68), good design
(18%, n=17), and better engagement (11%, n=11). Most
learning-related comments referred to the extent to
which students could exercise control over their learn-
ing (30%, n=29), referring to place, time, pace, flow, inde-
pendence, and the ability to review. Nineteen percent of
the comments (n=18) related to the students’ ability to
better recall information and remember how to perform
a procedure while using the virtual lab.
Challenges of Using the Virtual Lab
Students offered 39 comments on the challenges of
using the virtual lab. Most challenges were related to
learning (56%, n=22) or design (36%, n=14). Within the
learning category, the lack of learner control (21%, n=8),
difficulties in understanding the material (15%, n=6),
and content issues (13%, n=5) were the most challenging
for students. Learner control issues were related to not
being able to skip forward to the end and the inability
of the program to save the students’ progress. Students
also remarked that not all tests and organisms were rep-
resented in the virtual lab. Regarding content, some stu-
dents noted a few discrepancies between procedures in
the virtual lab and the hands-on lab.
Lack of organization (23%, n=9) was the most com-
monly identified design issue. For example, some stu-
dents disliked not being able to retrieve information
quickly and being required to go through entire identi-
fication pathways. Other students found the pathways
confusing at times and had difficulty finding informa-
tion. Relatively few students noted limitations in graph-
ics (5%, n=2), difficulty of use (5%, n=2), and lack of inter-
activity (3%, n=1).
Only six comments about the challenges of using a
virtual lab were produced from the think-aloud proto-
cols. All referred to students wanting additional con-
tent added to the virtual lab (e.g., “I wish there would be a
motility video,” “Extra stuff would help,” “It would be cool to
have a quick summary,” and “[I] wish there was a written
summary [or] quick reference”).
Impact of the Virtual Lab
The mean scores for Likert questions addressing the
impact of the virtual lab, ranging from 6.7 to 6.1 (out of
7), indicated that students felt the lab was efficient and
helpful in preparing them for the hands-on laboratory.
Most students noted that they achieved greater success
due to the virtual lab and would enthusiastically use it
again for future preparation (Table 4).
Key beneficial characteristics of the virtual lab iden-
tified from open-ended comments (n=69) included the
visual graphics and supports (52%, n=36) and effective
organization and design (16%, n=11).
Discussion
This study examined the benefits, challenges, and per-
ceived impact of using a virtual lab to prepare allied
health students, enrolled in a medical labortory science
program, for a hands-on laboratory. Previous research
has examined the use of virtual labs in medicine, den-
tistry, and nursing, but not allied health. The benefits
that students rated highest included visual learning,
authenticity, learner control, effective design, and scaf-
folded learning.
Students often struggle to visualise laboratory expecta-
tions from written or verbal instructions.9Preference for
visualisation by students in this study is not surprising, as
the literature suggests that most students prefer visual
supports36 over traditional written laboratory manuals.8,9
48 KAY ET AL., Impact of a Virtual Lab
TABLE 3. Sample Student Comments about the
Design Benefits of the Virtual Lab (n=29)
Theme Sample Comments
Organization “I love how it was set up as a flow chart kind of
system.”
“It was like a nice flow chart that gave you an idea
of how to proceed with different reactions.”
Graphics “Good pictures of tests and media.”
“The length of each video was ideal.”
Ease of use “[It was] easy to understand.”
Interactivity “Each click brought to the next step down the flow
chart in organism identification.”
TABLE 4. Student Ratings of the Perceived Impact of the Virtual Lab
Item Mean*SD Disagree†Agree†
I would use the virtual lab again 6.7 0.7 0% 95%
Viewing procedures ahead of the hands-on lab was helpful 6.6 0.7 0% 97%
It helped me to prepare for labs 6.4 1.1 3% 91%
It played a role in completing the hands-on laboratory sessions 6.3 1.2 5% 88%
I completed the virtual lab pre-lab exercises 6.1 1.2 3% 88%
I achieved greater success in learning 6.1 1.0 2% 84%
Easier to learn new skills 6.1 1.0 0% 78%
Develop skills faster 6.1 1.1 2% 77%
*Based on 7-point Likert scale (1=strongly disagree to 7=strongly agree).
† Disagree includes both disagree and strongly disagree. Agree includes both agree and strongly agree.
Open-ended comments suggested that students
valued authenticity, specifically regarding the accurate
mimicking of bacterial identification and the ability to
make and learn from genuine mistakes. The result is
consistent with Lombardi’s37 claim that authentic learn-
ing can be achieved in virtual labs, but contradicts
Scheckler’s24and Lewis’23perspectives that virtual lab-
oratories cannot embody the reality of the hands-on
laboratory. The disparity may reflect the extent to
which a virtual design is successful in matching a real-
life laboratory experience.
Previous research supports the importance of stu-
dents being able to control the learning process in vir-
tual environments.1,17 Feedback from this study indi-
cated that students appreciated the ability to learn
independently at the pace, location, and time they pre-
ferred. This result aligns with previous studies5,17 identi-
fying learning control leading to a more personalised
learning experience.
Allied health students in the medical laboratory sci-
ence program commented on three key design issues:
ease of use, helpful feedback, and layout. Students rated
ease-of-use highly, a result that is consistent with previ-
ous studies.18,21 Students also valued helpful feedback, a
finding that corroborates Chittleborough et al.’s22 claim
that immediate feedback helped improve comprehen-
sion and reflection. Finally, students appreciated the
layout of the virtual lab, noting that online procedures
closely mirrored those of the hands-on laboratory.
Scaffolded learning empower students to individu-
alise their pre-laboratory preparation19 and exposes
them to the requirements and challenges of the hands-
on laboratory.20 Most students in this study found scaf-
folded learning in the virtual lab to be helpful in com-
pleting the hands-on laboratory exercises.
Though virtual labs may overcome many of the
constraints of physical laboratories,38 they come with
inherent limitations.23 In this study, students offered
very few comments about challenges, focusing on the
same features they deemed as benefits: ease of use, nav-
igation, and learning control. This result is consistent
with the findings of Flint and Stewart21 and is partially
related to student knowledge; less knowledgeable stu-
dents appear to need more learner control to review, or
they risk experiencing cognitive overload. On the
other hand, students who are more knowledgeable may
wish to navigate ahead, skipping information they
already knew.
The virtual lab enabled students to become familiar
with tasks before hands-on laboratory sessions, conse-
quently improving performance in the hands-on labora-
tory by decreasing cognitive load and allowing students
to acquire new skills faster and easier. These findings
align with several other studies in which virtual pre-lab
exercises provided students with a better understanding
of hands-on laboratory expectations.9,18,38
This study further reported that students readily
adopted the pre-laboratory exercises without assess-
ments or other extrinsic motivational factors. This
finding contradicts the belief that students engage in
preparation only if educators use extrinsic motivation
such as grades.27Motivational factors in this study,
such as the virtual lab being an aid for preparation and
greater success, indicate that a well-designed virtual lab
can intrinsically motivate students, a finding supported
by Limniou and Whitehead.18
Several educational implications emerged from this
study for medical laboratory science and other allied
health programs. First, virtual labs can be effective learn-
ing tools within the allied health education field. Second,
these labs should be carefully designed, focusing on effec-
tive visualisation, learner control, thoughtful scaffolding,
ease of use, navigation, layout, and feedback. Finally, this
study indicated that students would use a virtual lab
without extrinsic rewards if they felt it was user-friendly
and would help them achieve greater success.
Several limitations of this study will help guide
future research labs. First, the sample size needs to be
larger to generalise the results. Second, think-aloud
data, while useful, were gleaned from only four stu-
dents. Future research should consider longer video
recordings from more students to explore the use of vir-
tual labs in more detail. Third, the Likert scale items
need to be expanded to include both benefits and chal-
lenges. A fourth limitation was that only one allied-
health program, medical laboratory science, was exam-
ined. Finally, and perhaps most important, pre-and
post-tests need to be used with control and treatment
groups to determine the actual impact on virtual labs
on learning performance.
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