Medical Teacher

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/imte20

Twelve tips to enhance student engagement in

synchronous online teaching and learning

Rehan Ahmed Khan, Komal Atta, Madiha Sajjad & Masood Jawaid

To cite this article: Rehan Ahmed Khan, Komal Atta, Madiha Sajjad & Masood Jawaid (2021):
Twelve tips to enhance student engagement in synchronous online teaching and learning, Medical
Teacher, DOI: 10.1080/0142159X.2021.1912310

To link to this article: https://doi.org/10.1080/0142159X.2021.1912310

Published online: 20 Apr 2021.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=imte20
MEDICAL TEACHER
https://doi.org/10.1080/0142159X.2021.1912310

TWELVE TIPS

Twelve tips to enhance student engagement in synchronous online teaching

and learning
Rehan Ahmed Khana , Komal Attab,c, Madiha Sajjada and Masood Jawaidc
a
Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan; bUniversity Medical and Dental College, The
University of Faisalabad, Faisalabad, Pakistan; cUniversity College of Medicine, University of Lahore, Lahore, Pakistan

ABSTRACT KEYWORDS
Synchronous learning is a component of online learning for engaging students in real-time. It is Student engagement;
the nearest we can get to a live feeling in the e-environment. These sessions must be designed in synchronous online
a way to keep students continuously involved. This paper aims to provide health professional edu- learning; learning
management system
cators with tips for increasing student engagement in the online synchronous environment. The
relevant literature regarding student engagement and synchronous online learning was reviewed
and collated with the authors’ own experiences, to formulate these tips. Health professional educa-
tors can use these tips to enhance student engagement in online synchronous classes.
Increased student engagement in online sessions, means better learning. These tips have been
tried and tested by the authors as being satisfactory for increasing student interest in synchronous
sessions and hence providing an optimal learning experience online.

Introduction student engagement,’ based on description of student

engagement by Chickering and Gamson (1989), Newmann
Student engagement is one of the important goals of med-
(1993), Coates (2007), and Schultz (2011):‘ Online Student
ical education. Sinatra terms it as ‘the holy grail’ owing to
engagement is the degree of interest, cognitive ability,
its importance for academic success and enhancement of
attention, interaction, time and effort that students can
cognition (Sinatra et al. 2015). There are many theoretical
show in a real-time online teaching and learning endeavor.’
frameworks of student engagement reported in the litera-
It is important to mention here that some of the tips
ture (Trowler 2010). However, there is a dearth of practical
are not exclusive for the synchronous method, but they
tips relating this process to online synchronous learning
can significantly enhance synchronous learning if used
(Lekwa et al. 2019). Technology Enhanced Learning (TEL) is
effectively.
slowly replacing the need for ‘human’ supervision with sub-
stantial automatic and artificial intelligence mechanisms.
Synchronous learning is the humanizing part of TEL, as it Tip 1
focuses on real-time interactions between teachers, stu-
Choose the appropriate online learning interface to
dents, and peers. This is most imperative to medical educa-
integrate synchronous activities
tion as medical teaching focuses on collaboration, student
interaction, situational learning, and promotion of student’s The key ingredients for enhancing a virtual space are aim-
presentation and decision-making skills (Finkelstein 2006). ing for student activity and interaction, and its manage-
COVID 19 pandemic has affected our lives in different ment. This can be achieved through a learning
ways. One of its main effects is the change in the educa- management system (LMS). From our experience, the
tional environment. Many countries around the world have authors strongly advocate the use of LMS for keeping a
witnessed a shift to online learning amidst the pandemic record of activity as well as streamlining the process of syn-
threat, with many interactive online platforms being used chronous learning, as many applications providing syn-
for online teaching. However, one of the main issues is stu- chronous engagement can integrate into an LMS. There are
dent engagement, which is difficult to achieve in an online many options to choose from among the learning manage-
synchronous learning environment (McBrien et al. 2009; ment systems (LMS) and the relevant applications. The best
Hampton and Pearce 2016). This article focuses on offering for you is the one your institution can easily integrate into
practical tips on the use of different modalities and strat- its systems, is more cost-effective, and more comfortable to
egies garnered by the literature and the collective experi- use by your faculty. For instance, MOODLE (www.moodle.
ences of the authors to engage students in synchronous org) is a freely available and adaptable LMS; however, it
online sessions effectively. Student engagement is a pro- requires some level of technical expertise to operate (Luo
cess by which learning may be embraced actively in aca- et al. 2017). It also offers more security when logging into
demic settings with both peers and staff (Coates 2007). For third party applications. Many face to face meeting applica-
this writing, we propose the following definition of ‘online tions that are used for online synchronous learning can be

CONTACT Rehan Ahmed Khan [email protected] Riphah International University, Al-Mizan IIMCT Complex, Old Supreme Court Building,
274 Peshawar Rd, Rawalpindi, Pakistan
ß 2021 Informa UK Limited, trading as Taylor & Francis Group
2 R. A. KHAN ET AL.

integrated into MOODLE. It also syncs the class attendance Social presence
with the academic record of the students. If LMS integra-
Social presence includes expression of emotion, interaction,
tion is not possible, due to scarcity of resources/technol-
and a sense of belonging (Pelz et al. 2004). Student intro-
ogy, many other options are available which may be used
ductions, open student and teacher webcams, and student
as standalone or in combination with other applications.
chats with peers and teachers can augment social pres-
These include Edmodo (www.edmodo.com), Microsoft
ence. It is also pertinent to know the background of your
Teams (www.microsoft.com/en-ww/microsoft-teams/group-
learners and the issues they face with interaction/connect-
chat-software), Google Classroom (www.classroom.google.
ivity/logistics etc. (Brown et al. 2016; Berry 2019).
com), etc. (Khan & Jawaid 2020). Keeping it clean, crisp, Finally, it is recommended that online instructors be
and simple is the way to go. flexible and adaptable to accommodate unanticipated
issues and have an alternative strategy in mind in case a
plan does not work out (Do 2018).
Tip 2
Use the principles of online instructional designing for
Tip 3
an effective synchronous learning experience
Keep the conversation going with real-time chats
The synchronous online learning environment is very differ-
ent from both on-campus learning and asynchronous for- Real-time chat boxes are chat windows open during webi-
mats. The challenge for online synchronous format nars or lectures where all participants can interact syn-
instruction design is integrating technology into teaching chronously via written messages. These serve as an
practices while juggling with various communication chan- excellent measure of engagement as students can clarify
nels and student engagement. This requires training and confusion in real-time with other students and mentors
practice (Do 2018). without disrupting the flow of the online session or webi-
Most of the literature referring to online instructional nar. We recommend that a co-moderator be designated to
designing caters to asynchronous or blended formats. monitor activity in the chat box so that the person moder-
However, the same principles can be adapted with modifi- ating the online teaching activity does not get distracted.
cations. The blended synchronous learning design frame- The student questions and opinions can be collected from
work (Bower et al. 2015) addresses pedagogical, the chat and discussed live later. In our experience, while
technological, and logistic requirements. Taking all three giving briefings or presentations to small groups, it has
into consideration in the designing and implementation helped massively to set ground rules with the audience to
phase of synchronous courses, can increase student keep asking questions in the chat box, which are periodic-
engagement and satisfaction. Garrison et al. (1999) have ally visited and answered by the instructor, addressing the
described their ‘community of inquiry’ model for learning individual who asked them. This enhances engagement as
in a computer-mediated communication environment, the student feels personally associated with the instructor.
This feature is available in many applications supporting
which has three pedagogical elements that need to be
face-to-face meetings.
taken into consideration for an effective synchronous
Real-time chats are also incredibly useful for small group
online educational experience: teaching presence, cognitive
discussions and with situations where insufficient connect-
presence, and social presence.
ivity is available for video conferencing. These may be uti-
lized in problem-based learning (PBL), case-based learning,
Teaching presence and patient discussions. Clinicopathological conferences
can be conducted online with a clinician monitoring the
Effective teaching presence involves instructional design- chat room, so valuable points are later discussed in syn-
ing, planned facilitation, and giving direct instruction chronous mode. The chat box is also invaluable for one on
(Garrison et al. 1999). Design for active learning, with the one mentoring and speed mentoring sessions (Britt et al.
aim to achieve specific learning outcomes, especially by 2017), as it gives a rapid synchronous mode for students
setting collaborative group tasks as they are better than and mentors to interact.
individual tasks in providing a sense of community (Teng Students using instant messaging and chat box apps
et al. 2012). Choose appropriate learning modalities, incor- report higher levels of engagement, ease of use, cost-
porating communication tools like chat boxes in online effectiveness, satisfaction, and less isolation within the
classes (Do 2018). Ensure clear two-way communication, community. Clinical students and trainees particularly
concerning your expectations from the students as well as found this modality to be of great help in discussing indi-
their apprehensions and problems (Benshoff and vidual cases and investigations with attendings (Hossain
Gibbons 2011). et al. 2015; Pimmer et al. 2018).

Tip 4
Cognitive presence
Use a virtual whiteboard to build collaborative
Cognitive presence is reinforced by including technological
thought process
tools or gamification in online sessions, which are also ela-
borated in other sections of this manuscript (Brown Synchronous learning faces the threat of monotony if used
et al. 2016). as a one-way route of dispelling information to the
 MEDICAL TEACHER 3

students. One of the most effective ways to enhance stu- students. A similar concept is used in some online applica-
dent interaction is through the use of virtual whiteboards. tions such as ‘Padlet’ (www.padlet.com). It provides stu-
A virtual whiteboard is an empty space that is shareable dents and teachers with options to paste notes on an
between multiple people, where they can interact, write, interactive wall in different ways. This activity can be done
share hyperlinks, images, or videos. It serves as an alterna- simultaneously by many students. They can share their
tive to the quintessential ‘blackboard.’ Its best features are notes on the padlet wall, on which the teacher can provide
that it is real-time or synchronous; simultaneous, wherein feedback, arrange the notes, and mark it. The final Portable
many people can work and even share documents, and the Document Format (PDF) can then be shared with students.
sessions may be saved for review later. Many online meet- The example shown in Figure 1 is of a Padlet created by
ing apps offer this facility. students of a medical education master’s course. The stu-
Whiteboards can be used as discussion conduits during dents were divided into groups in a synchronous session
peer learning and PBL tasks for small groups encouraging (via breakout rooms) and asked to provide their input on
scaffolding of concepts. They also serve as a channel to the concept and steps of ‘Delphi technique’ and ‘Nominal
‘humanize’ the e-learning experience. The instructor may group technique’ on a padlet left blank by the teacher.
choose to draw or elaborate points on the board akin to This activity was performed in real-time. The padlet wall
real classrooms. Students may be asked to draw/write their was then displayed, the comments rearranged in the
opinions, share feedback and bring out creative ways to proper order comparing Delphi and Nominal group techni-
enhance collaborative learning (Abdelrazek et al. 2010). ques, each comment was scrutinized and rated by the
Using the four-quadrant principle by Finkelstein (2006) the other groups, and hence a collaborative learning activity
whiteboard can be divided into four parts under different took place.
sub-headings of a topic, where students can annotate, and
teachers and peers can provide feedback and initiate
the discussion.
Tip 6
Utilization of whiteboards in clinical education is also
promising. They have been documented to be used in radi- Use ‘breakout rooms’ for small group
ology and imaging sciences with a high level of satisfaction collaborative learning
reported by the trainees (Lipton & Lipton 2010).
A large group of students can be distributed into breakout
Whiteboard has also been effectively used to make clinical
rooms where they can work as a smaller group by engag-
reasoning learning (CRL) more engaging by asking students
ing in discussion, sharing ideas, or making presentations.
to logically justify ordering and interpretation of clinical
Breakout rooms provide a platform for smaller group-based
tests and how they affected the diagnosis (Gouzi
tasks, especially in student-led online sessions (PBL, CBL,
et al. 2019).
Seminars). They let the students have a deeper interaction
or discourse with a smaller group of colleagues. This not
Tip 5 only allows students to strengthen the online learning
community but also increases their social and cognitive
Engage students with interactive pads
presence (Berry 2019).
Interactive pads or boards are different from whiteboards. Instructors can facilitate group activity by periodically
They are like ‘notice boards,’ that are routinely used in the monitoring each room individually, (we recommend 2 or
institutions to share information with the faculty and three moderators to be present and a total time of

Figure 1. Padlet used in master’s in medical education class for discussion on Delphi and Nominal group techniques.
4 R. A. KHAN ET AL.

20–30 minutes for each session) and then merge the come into play in real-time (Salem et al. 2020). These can
groups for feedback. be used as replacements to clinical tutorials in synchron-
ous mode, where the students may interact in groups/
individually in real-time to decide treatment course or
Tip 7 disease progression stages etc. To make engagement
Grab attention with online polls even more extensive, students can be asked to partici-
pate in the case design process and engage in decision-
Sun (2014) describes that online polling activities increase making skills (Berman et al. 2016). One such software is
engagement, facilitate learning, reduce anxiety, and ‘Body Interact’ (www.bodyinteract.com), that allows clini-
increase attention during live sessions. It is one of the best cians and students to manage patients interactively
ways to develop consensus and engage students in syn- online. Projects such as Med Biquitous also endorses inte-
chronous class activities. Starting the session with a poll to grating VPs into PBL sessions and creating custom-
gauge the expectations of the audience, and modifying the ized cases.
content accordingly is a great way to set the pace of the (Kononowicz et al. 2015). Other examples include
class. This is quite easily done with polling software, built using virtual patients for pharmaceutical interventions
into most online meeting programs or freely available (Smith et al. 2014) and distinguishing cardiac murmurs
online. Few examples of the software that can be used (Schwartzman and Zhong 2010).Virtual Patients are also
online are ‘Poll Everywhere’(www.polleverywhere.com), used in clinical/pre-clinical settings synchronously via
‘Mentimeter’ (www.mentimeter.com) and polling applica- linking them to the presentation software such as
tion embedded in ‘Zoom (www.zoom.us). PowerPoint (Cook and Triola 2009). The benefits include
Polls grab attention as they immediately engage all of cost-effectiveness, peer discussion, stimulation of critical
your audience in an activity, which makes them feel like thinking, enhanced student activity, and more cognitive
they are adding to the discussion. Also, being able to see engagement (Poulton and Balasubramaniam 2011).
the results in real-time generates a great deal of confi-
dence in bringing out the expectations and alignment of
the learning outcomes of the class. They can be used Tip 9
smartly to take opinions, or garner consensus statements
‘Improvise to energize’: use ‘medical improve
about treatment options or management plans (Hunt et al.
technique’ to develop professional skills
2018).Using polling in larger group synchronous activities
such as webinars is recommended to increase the partici- Another strategy that has been shown to increase engage-
pation and attention of the audience. Polling is also a ment is using ‘Improv Techniques’. Improvisation (Improv)
powerful tool to get feedback on the session in order to techniques refer to a form of theatrical performance in
make improvements. which a scenario is spontaneously generated by the actors
rather than having been previously scripted (Gao et al.
2019). This premise has now also been included in medical
Tip 8 education, as most of the patient-doctor interactions are
Use interactive videos and virtual patients for somewhat improvised and never scripted (Hoffmann-
clinical teaching Longtin et al. 2018).
Teaching the skills component through an online plat-
Interactive videos can be made a part of live sessions to form is difficult, but certain skill components like communi-
make small or large group teaching and learning sessions cation skills, leadership, teamwork, and ‘micro-skills’ may be
more engaging and interactive, with teachers providing taught using the ‘improv’ technique in a synchronous
feedback or initiating a discussion at each interaction. The online format (Gao et al. 2019). In the authors’ experience,
authors have used these videos in small group discussions this can be very effectively utilized online for clinical history
for clinical teaching. For example, to teach abdominal taking, communication skills, and professionalism contexts.
examination, a 2–3-minute interactive video demonstrating The instructor can pose as a simulated patient for history
palpation can be shown to the medical student with taking, with one student taking the history, and other stu-
embedded questions at different intervals of the video. The dents can give their feedback with a debriefing session at
students stay engaged owing to the quizzing element, the end. Similarly, students can be given a task to
where a query is raised about a certain aspect of the lesson ‘improvise’ a scenario related to communication (Roberts
and prompt feedback provided by the teacher, which is et al. 2013) or professionalism in a given context followed
not possible in asynchronous teaching. As compared to by self-reflection and feedback from other students.
asynchronously doing this task, the class as a whole will
more likely stay engaged collectively and benefit from the
added peer interaction. Tip 10
Virtual patients (VPs) are the online representatives of
Use interactive quizzes to stimulate active learning
cases presented to students (Bateman et al. 2013). The
simplest way to describe a virtual patient, is as a clinical Interactive quizzes are found to enhance students’ engage-
scenario which is made ‘interactive’ through a computer ment and intrinsic motivation in both face-to-face and vir-
program (Cook and Triola 2009). From an engagement tual environments (Raes et al. 2020). We recommend using
point of view, virtual patients are beneficial as they a quiz at various intervals during a synchronous learning
address complaints faced by real-life patients and require activity to stimulate students’ involvement and test know-
the decision-making/diagnostic skills of the students to ledge. Quizzes can be embedded in online lessons in an
 MEDICAL TEACHER 5

LMS such as MOODLE (Khan and Jawaid 2020). Other interests include curriculum development and innovation, assessment,
options include many online sites providing free and paid and online instructional designing. He has done master’s in medical
education from the University of Glasgow and is currently a PhD
access to develop and execute an online real-time quiz.
scholar in medical education at Maastricht University.
Examples include ‘Socrative’ (www.socrative.com), ‘Class
Marker’ (www.classmarker.com) etc. and built-in application Dr. Madiha Sajjad, MBBS, FCPS (histopathology), MHPE, is a Professor
of Pathology and member of Curriculum Committee at Riphah
to make a quiz in MOODLE and Microsoft Teams. Such
International University. She has also done master’s in medical educa-
activities enhance the interest of students and motivate tion from Riphah International University. Her interests in medical edu-
learning (Wormald et al. 2009). cation include assessment and professionalism.

Dr. Komal Atta, MBBS, MPhil Physiology, MME (Scholar), is Assistant

Tip 11 Director of Health Professionals Education, Senior Coordinator School
of Optometry, and Assistant Professor of Physiology at The University
Bring out the fun element of synchronous learning of Faisalabad. She is also a scholar of master’s in medical education at
with gamification the University of Lahore, Pakistan.

Dr. Masood Jawaid, MBBS, MCPS (surgery), MRCS, FCPS (surgery),

Gamification refers to the use of game design elements in
MHPE, is a General surgeon, medical educationist, technical advisor at
non-game contexts (Ahmed et al. 2015) . Games can be ‘CorTeach’ and visiting faculty in medical education, at the University
incorporated into all online synchronous activities to make of Lahore. His interests in medical education include e-learning and
students learn through entertainment. Much literature instructional designing.
exists on the utilization of Kahoot! (www.kahoot.it) for
game-based learning (Kuo and Chuang 2018; Felszeghy ORCID
et al. 2019). Pre readings and projects can be assigned to
students, and they may be tested in real-time via the Rehan Ahmed Khan http://orcid.org/0000-0002-8045-1471
Kahoot! application synchronously. This not only increases
attention but also gives a sense of achievement to the stu- References
dent. The leader board, up-levelling, awarding badges, and
incentives are some of the elements that increase student Abdelrazek S, El-Bakry HM, Mastorakis NE, Abd El-Razek SM, Abd El-
Wahed WF, Mastorakis N. 2010. Collaborative virtual environment
engagement through gamification (van Gaalen et al. 2020). model for medical e-learning. In: Proceedings of the 9th WSEAS
Games are used in diverse specialties, from radiology to International Conference on Applied Computer and Applied
internal medicine, surgery, and the basic sciences (Nevin Computational Science; April 11–13 2010; Hangzhaou, China. p.
et al. 2014; Sera and Wheeler 2017). For example, ‘Fold It’ 191–195.
Ahmed M, Sherwani Y, Al-Jibury O, Najim M, Rabee R, Ashraf M. 2015.
(www.fold.it) is a puzzle to learn protein folding, ‘Nuclear
Gamification in medical education. Med Educ Online. 20(1):19–21.
Event triage Challenge’ teaches triage for patients involved Bateman J, Allen M, Samani D, Kidd J, Davies D. 2013. Virtual patient
in nuclear accidents (Singhal et al. 2019). Customized game design: exploring what works and why. A grounded theory study.
designs related to cardiopulmonary resuscitation skills, Med Educ. 47(6):595–606.
safety protocols, and pathological processes have been Benshoff JM, Gibbons MM. 2011. Bringing life to e-learning:
Incorporating a synchronous approach to online teaching in coun-
designed and are in use (Sera and Wheeler 2017; Zhang
selor education. Prof Couns. 1(1):21–28.
et al. 2018). Berman NB, Durning SJ, Fischer MR, Huwendiek S, Triola MM. 2016.
The role for virtual patients in the future of medical education.
Acad Med. 91(9):1217–1222.
Tip 12 Berry S. 2019. Teaching to connect: community-building strategies for
the virtual classroom. Online Learn J. 23(1):164–183.
Keep energy levels up by taking breaks Bower M, Dalgarno B, Kennedy GE, Lee MJW, Kenney J. 2015. Design
and implementation factors in blended synchronous learning envi-
Online synchronous learning, particularly involving longer
ronments: outcomes from a cross-case analysis. Comput Educ. 86:
sessions, takes a toll on both energy as well as levels of 1–17.
engagement. To avoid such situations, it is best to plan Britt RC, Hildreth AN, Acker SN, Mouawad NJ, Mammen J, Moalem J.
some gaps (Pacheco 2020). These may be small five-minute 2017. Speed mentoring: an innovative method to meet the needs
rest breaks, a longer ‘coffee’ break, or you can get creative of the young surgeon. J Surg Educ. 74(6):1007–1011.
Brown B, Schroeder M, Eaton SE. 2016. Designing synchronous online
and introduce some sort of game (e.g. Bingo, truth or dare
interactions and discussions. Paper published in proceedings of the
etc.). It might even be helpful if mini-stretching or yoga IDEAS: Designing for Innovation; May 5–6, 2016; Calgary, Alberta,
sessions are suggested for the participants to relax Canada. p. 51–60.
(Wiederhold 2020). This will rejuvenate participants and Chickering AW, Gamson ZF. 1989. Seven principles for good practice
make them more alert for the session to follow. in undergraduate education. Biochem Educ. 17(3):140–141.
Coates H. 2007. A model of online and general campus-based student
engagement. Assess Eval High Educ. 32(2):121–141.
Cook DA, Triola MM. 2009. Virtual patients: a critical literature review
Disclosure statement and proposed next steps. Med Educ. 43(4):303–311.
The authors report no conflicts of interest. The authors alone are Do J. 2018. Understanding instructor’s synchronous online course
responsible for the content and writing of this article. design activity [dissertation]. Knoxville (TN): University of Tennessee.
Felszeghy S, Pasonen-Seppanen S, Koskela A, Nieminen P, Harkonen K,
Paldanius KMA, Gabbouj S, Ketola K, Hiltunen M, Lundin M, et al.
Notes on contributors 2019. Using online game-based platforms to improve student per-
formance and engagement in histology teaching. BMC Med Educ.
Dr. Rehan Ahmed Khan, MBBS, FCPS (surgery), FRCS, JM-HPE, MSc 19(1):273–211.
HPE, MHPE, PhD (Scholar), is an Assistant Dean Medical Education and Finkelstein J. 2006. Learning in real time: synchronous teaching and
Professor of Surgery at Riphah International University, Pakistan. His learning online (Vol. 5). Hoboken, New Jersey: John Wiley & Sons
6 R. A. KHAN ET AL.

Gao L, Peranson J, Nyhof-Young J, Kapoor E, Rezmovitz J. 2019. The Pimmer C, Br€ uhlmann F, Odetola TD, Dipeolu O, Gro €hbiel U, Ajuwon
role of “improv” in health professional learning: A scoping review. AJ. 2018. Instant messaging and nursing students’ clinical learning
Med Teach. 41(5):561–568. experience. Nurse Educ Today. 64:119–124.
Garrison R, Anderson T, Archer W. 1999. Critical inquiry in a text-based Poulton T, Balasubramaniam C. 2011. Virtual patients: A year of
environment: computer conferencing in higher education. Internet change. Med Teach. 33(11):933–937.
High Educ. 2(2–3):87–105. Raes A, Vanneste P, Pieters M, Windey I, Van Den Noortgate W,
Gouzi F, H
edon C, Blervaque L, Passerieux E, Kuster N, Pujol T, Mercier Depaepe F. 2020. Learning and instruction in the hybrid virtual
J, Hayot M. 2019. Interactive whiteboard use in clinical reasoning classroom: an investigation of students’ engagement and the effect
sessions to teach diagnostic test ordering and interpretation to of quizzes. Comput Educ. 143:103682.
undergraduate medical students. BMC Med Educ. 19(1):1–13. Roberts CM, Lopez-Campos JL, Pozo-Rodriguez F, Hartl S, European
Hampton D, Pearce PF. 2016. Student engagement in online nursing COPD Audit team. 2013. European hospital adherence to GOLD rec-
courses. Nurse Educ. 41(6):294–298. ommendations for chronic obstructive pulmonary disease (COPD)
Hoffmann-Longtin K, Rossing JP, Weinstein E. 2018. Twelve tips for exacerbation admissions. Thorax. 68(12):1169–1171.
using applied improvisation in medical education. Med Teach. Salem J, Fukuta J, Coombs A, Morgan J. 2020. Virtual patient journey:
40(4):351–356. a novel learning resource. Clin Teach. 17(3):315–319.
Hossain IT, Mughal U, Atalla B, Franka M, Siddiqui S, Muntasir M. 2015. Schultz SJ. 2011. Evidence-based strategies for teaching dysrhythmia
Instant messaging – one solution to doctor-student communica- monitoring practices to staff nurses. J Contin Educ Nurs. 42(7):
tion? Med Educ Online. 20:30593. 308–319.
Hunt G, Merzeder C, Bischofberger I. 2018. A tool for the consensual Schwartzman D, Zhong H. 2010. On the use of CartoSound for left
atrial navigation. J Cardiovasc Electrophysiol. 21(6):656–664.
analysis of decision-making scenarios. Nurs Ethics. 25(3):359–375.
Sera L, Wheeler E. 2017. Game on: the gamification of the pharmacy
Khan RA, Jawaid M. 2020. Technology enhanced assessment (TEA) in
classroom. Curr Pharm Teach Learn. 9(1):155–159.
COVID 19 pandemic. Pak J Med Sci. 36(COVID19-S4):108–110.
Sinatra GM, Heddy BC, Lombardi D. 2015. The challenges of defining
Kononowicz AA, Zary N, Edelbring S, Corral J, Hege I. 2015. Virtual
and measuring student engagement. Sci Educ Psychol. 50(1):1–18.
patients - What are we talking about? A framework to classify the
Singhal S, Hough J, Cripps D. 2019. Twelve tips for incorporating gami-
meanings of the term in healthcare education. BMC Med Educ.
fication into medical education. Med Ed Publish. 8(3):67.
15(1):11–18.
Smith MA, Mohammad RA, Benedict N. 2014. Use of virtual patients in
Kuo CL, Chuang YH. 2018. Kahoot: applications and effects in educa-
an advanced therapeutics pharmacy course to promote active,
tion. J Nurs. 65(6):13–19.
patient-centered learning. Am J Pharm Educ. 78(6):1–7.
Lekwa AJ, Reddy LA, Shernoff ES. 2019. Measuring teacher practices
Sun JCY. 2014. Influence of polling technologies on student engage-
and student academic engagement: A convergent validity study.
ment: an analysis of student motivation, academic performance,
Sch Psychol Q. 34(1):109–118. and brainwave data. Comput Educ. 72:80–89.
Lipton ML, Lipton LG. 2010. Enhancing the radiology learning experi- Teng DCE, Chen NS, Kinshuk LT. 2012. Exploring students’ learning
ence with electronic whiteboard technology. Am J Roentgenol. experience in an international online research seminar in the syn-
194(6):1547–1551. chronous cyber classroom. Comput Educ. 58(3):918–930.
Luo L, Cheng X, Wang S, Zhang J, Zhu W, Yang J, Liu P. 2017. Blended Trowler V. 2010. Student engagement literature review. High Educ.
learning with Moodle in medical statistics: an assessment of know- 11(1):1–15.
ledge, attitudes and practices relating to e-learning. BMC Med van Gaalen AEJ, Brouwer J, Scho €nrock-Adema J, Bouwkamp-Timmer T,
Educ. 17(1):170. Jaarsma ADC, Georgiadis JR. 2020. Gamification of health profes-
McBrien JL, Jones P, Cheng R. 2009. Virtual spaces: Employing a syn- sions education: a systematic review. Adv Health Sci Educ Theory
chronous online classroom to facilitate student engagement in Pract. DOI:10.1007/s10459-020-10000-3.
online learning. Int Rev Res Open Distance Learn. 10(3):1–17. Wiederhold BK. 2020. Connecting through technology during the cor-
Nevin CR, Westfall AO, Rodriguez JM, Dempsey DM, Cherrington A, onavirus disease 2019 pandemic: avoiding "ZOOM FATIGUE".
Roy B, Patel M, Willig JH. 2014. Gamification as a tool for enhancing Cyberpsychol Behav Soc Netw. 23(7):437–438.
graduate medical education. Postgrad Med J. 90(1070):685–693. Wormald BW, Schoeman S, Somasunderam A, Penn M. 2009.
Newmann FM (Ed.). 1993. Student engagement and achievement in Assessment drives learning: an unavoidable truth? Anat Sci Educ.
American secondary schools. Choice Rev Online. 30(7):30–39. 2(5):199–204.
Pacheco E. 2020. Twelve Tips for online live classes. Med Ed Publish. Zhang XC, Lee H, Rodriguez C, Rudner J, Chan TM, Papanagnou D.
9(1):250. 2018. Trapped as a group, escape as a team: applying gamification
Pelz B, Horton W, Upport S, Horton W, Jones A, Issroff K. 2004. Three to incorporate team-building skills through an ’Escape Room’
principles of effective online pedagogy. JALN. 8(3):33–46. experience. Cureus. 10(3):e2256.