Our first research question asked: In a cloud-based virtual classroom, how do medical students perceive the instructor role, and what is the predominant learning approach to using online learning technologies amongst medical students? Since the mean scores of all three dimensions of the instructor role were higher than 3.70, medical students were considered to endorse a certain amount of support and interactivity provided by their instructors, and instructors had a certain amount of innovations in a cloud-based virtual classroom. Meanwhile, most medical students agreed that they had adopted more deep approaches rather than surface approaches to learning in a cloud-based virtual classroom. Previous research indicated that providing effective instructional support and interactivity was particularly critical for the instructors in online learning environments [14, 16]. Therefore, in a cloud-based virtual classroom, medical students could perceive a satisfactory learning process supported by instructors who have made full use of various cloud-based technology, such as Tecent Docs, bullet subtitles for sending queries and recording video of a class in Rain Classroom, or We Chat by enhancing their behavioral and cognitive engagement in e-learning environment [17]. However, the results also indicated that students perceived a higher level of instructor-student interaction than that of instructor support and instructor innovation during the learning experience in a cloud-based virtual classroom. So, it is still a challenge for instructors and administrators how to improve effective and innovative teaching support by using cloud computing technology in cloud-based learning settings.
Results of the SOALT questionnaire showed that medical students adopted more deep rather than surface approaches to using online learning technologies in a cloud-based virtual classroom. This result is consistent with the results of previous research with medical students in blended learning environments [30]. The possible explanation could be due to the medical curricula reform made in China in response to the Ministry of Education’s requirements to cultivate more reflective and self-directed medical practitioners, which was accordant with the global trend towards encouraging deeper learning in medical education [31]. The main aim of medical curricula reform is to create a student-centered learning environment in which various teaching methods, unlike didactic pedagogies, are adopted to foster deep learning and understanding [32-34]. According to constructivist learning theory [34, 35], instructors may promote students’ deep approaches to learning by “ways of thinking about teaching and learning that emphasize student responsibility and activity in learning rather than content or what the teachers are doing” (Cannon and Newble, pp. 16–17) [35]. Given that students may develop their approaches to using online learning technologies as shown by their level of responses and activity, it could be possible for instructors to make students more engaged in learning and better encourage them to adopt deeper approaches to using online learning technologies, such as inquiry-based activities designed by the instructor via cloud-based education apps [36].
This study showed no significant difference in students’ perceptions of instructor role and approaches among those with different demographic characteristics such as gender and grade. The previous studies about the demographic characteristics are mixed and elusive [37-39]. Since students’ approaches to using online learning technologies are dependent on the learning environment and experience [3, 40], it is necessary to further investigate the impact of student demographics on the online learning process in a cloud-based classroom.
The second research question asked: How do instructors influence medical students’ choices of learning approaches to using online learning technologies in a cloud-based virtual classroom? This study revealed a significant positive relationship between instructor role and students’ deep approaches, and a significant negative contribution of instructor support to the students’ adoption of surface approaches in a cloud-based virtual classroom. The instructor innovation contributed more than instructor support or instructor-student interaction as a significant coefficient in the regression with deep approaches to using online learning technologies as the dependent variable.
The positive effect of instructor role on students’ adoption of deep approaches to use online learning technologies among medical students in a cloud-based virtual classroom, to our knowledge, is the first time to be reported. The results are similar to the findings of previous research into deep approaches to learning in blended learning environments [41]. To attain deeper learning in a cloud-based virtual classroom, it was more critical for instructors to offer proper guides on how to adopt deep approaches to using online learning technologies during learning process [3, 7, 14, 30]. The instructional guidance not only helps to deepen content understanding through the well-designed inquiry-based tasks etc. and promotes collective, cumulative and purposeful class interactions, but may also include the integration of content knowledge and online learning technologies in the online learning context, for example, how to develop and evaluate high-quality performance assessments via cloud-based education apps to have a deeper understanding of what kinds of tasks motivate thoughtful work, and how students think as they fulfilled the tasks. In this study, although students’ perception of instructor-student interaction was the highest level among the three, the contribution of it to enhancing students’ deep approaches to online learning technology was the smallest which may be due to the ineffective or low-quality class interactions. It is perhaps not surprising that the most positive correlations between instructor innovation and deep approaches to using online learning technologies, as instructors who keep pace with these new educational technologies could consider innovative and effective course design based on student needs, use various kinds of assessments and perform activities with personal characteristics supported by a good integration of content and cloud computing learning technologies [14, 42]. To stimulate students’ deep learning in online learning environments, the challenges of instructors’ innovation may include how to develop online adaptive expertise through inquiry-based tasks to find gaps and understand deviations in students’ knowledge and acquire new structures, explanations, and forms of interaction, and how to encourage them to express their own cognitive processes and analyze and self-evaluate their problem-solving. Furthermore, it is well known that assessment can be instructive [43]. Therefore, the other challenges of instructors’ innovation might include how to create an effective online assessments system that encourages the kinds of learning that are required to achieve the goals of career readiness.
The negative effect of instructional support on medical students’ adoption of surface approaches to using online learning technologies further supported the importance of instructional support to reduce student adoption of surface approaches. Compared with deep approaches, surface approaches to learning and to using online learning technologies are positively related to perceptions of unreasonable online course design and learning workload, and poor academic performance in blended learning settings [3, 44]. Therefore, instructor support could be the key to creating a high-quality online learning environment by providing proper instructional guidance mentioned above to boost deep approaches and reduce surface approaches to using online learning technologies.
Despite the low response rate of this study, the results are still encouraging and might be considered as representative because the demographic structure in terms of age and gender is consistent with current data on the broader medical undergraduate population in Chinese public universities. There are two possible reasons for the low response rate. The first one could be the general perception of lower student response rates of the online surveys compared to other survey methods such as paper-based surveys [45, 46]. The second one could be that medical students were less interested in the research topic of this survey because they thought the pure synchronous online teaching model was only a temporary emergency tool. Therefore, many students lacked the enthusiasm to respond to the questionnaires distributed by QR codes. This can be explained by the results of previous studies on the high correlation between survey response rates and participants' research interests [47].
This finding contributes to the body of literature by examining the relationship between the instructor role and students' approaches to using online learning technologies in cloud-based learning environments. Furthermore, it contributes to our understanding of why instructor support and innovation could be related to improving the quality of cloud-based online teaching and learning.