Due to COVID-19, the education method needs to change to conventional face-to-face (FF) methods to prevent the infection and outbreak of COVID-19. The healthy policy suggested that people avoid contacting others and adopt distance communication tools for daily communication in workspaces, education institutes, hospitals, etc. (Qian & Jiang, 2022). Because of the limitations of FF activity, the teaching system has started building up the online distance learning (DL) tooling to upload the classes' movies or teaching in real-time.
In the beginning, “distance learning" means separating teacher and learner in space and time (David Sewart, 1988). In 2002, Ulric Björck first reported information about asynchronous distance learning in social economy PBL class (Bjorck, 2002). Most communication was conducted in texts and can still delivered the information to class members. Brenda Ortiz at Columbia University also discussed distance learning in the PBL class (Ortiz, 2004). They clarified that readiness, interaction, and group development should be considered. However, at that time, asynchronous media were not affordable for everyone, and usually, the institute purchased them for the students. But now, distance learning is not about asynchronous but emphasizes synchronous learning. Synchronous learning means both voice and image can be delivered in time, just like teachers and students have face-to-face interaction on the internet.
Due to the help of global commercial cooperation and the development of the internet (4G and 5G), several distance online media have been released. Internet communication technologies and services present a feasible alternative solution for distance learning, especially when offered free of charge; this provides more choices compared with the hardware systems still offered at an immoderate price (Kotevski & Milenkoski, 2018)
Most classes were lectures that can go well if the participants are familiar with the online operation and have a stable network environment. Nevertheless, some classes rely on plenty of discussions. For instance, this research will focus on problem-based learning (PBL), a student-centered approach, and learning via peer discussion. PBL was initially coined and systematically developed by the Faculty of Health Sciences of McMaster University in the late 1960s in Canada. The University of New Mexico was the first to adopt a medical PBL curriculum in the United States. PBL is wildly promoted in medical courses globally, and this learning is more like self-learning, letting medical students train the ability to find answers via group discussion or knowledge searching and filtering. Several medical courses used PBL in their course design; A global investigation indicated that PBL classes are still conducted during COVID-19 for several medical education (Chang et al., 2021). Several countries need to switch classes online; however, whether learning effectiveness would be reduced or not still needs more investment.
Our research was surveyed during COVID-19, and all workers were conducted at National Cheng-Kung University (NCKU). National Cheng-Kung University started to teach PBL classes in the medicine department and implement the PBL learning style in the course “Introduction to Pathophysiology”. Pathophysiology means abnormal physiological symptoms and usually present in multiple syndromes. With the help of PBL, students can find possible physiological information via group discussion.
The PBL course design encourages students to interact more with the teacher and their class members to make the course close to the students. There are three systems different from the conventional lecture class in NCKU MED, including PBL, case-based learning (CBL), and team-based learning (TBL). The PBL class follows the block course and has corresponding cases. For each semester, in 18 classes, there will be 3 cases for the PBL learning, and each case schedule includes two discussions, a one-time group presentation, and a one-time group mini wrap-up. There will be two tutor meetings for the consensus conference and one reflection meeting in each semester (Fig. 1). It is still the only PBL class continually conducted in the department of medicine at NCKU.
COVID-19 appeared in 2019 winter, but it started to outbreak in Taiwan in March 2021; that is to say, we have approximately one and half-year for preparation. Such a PBL class relies on plenty of discussions requiring some course modification. During the early stage of the global COVID-19 outbreak, schools in Taiwan had delayed opening for two weeks, after which there was no large-scale school closure. To protect students from COVID-19 infection, the Ministry of Education has announced rules for suspending classes prepared and allocating medical supplies to the schools. In addition, schools are required to monitor students’ health conditions, maintain environmental disinfection, and follow up on the activities in which teachers and students have participated (CDC, 2020). The most severe epidemic appeared in May 2021; the Taiwan government announced a “Level 3 Alert” stary, which started from 19 May to 26 July 2021. During this period, all the classes should be proceeded via the internet and avoid face-to-face classes (Fig. 2).