By Ms Liu Ching Man, Dr Lee Shuh Shing and Dr Gominda Ponnamperuma,

Dean’s Office

The Yong Loo Lin School of Medicine has adopted blended learning as part of its instructional approach to the education and training of medical and nursing undergraduates. But what exactly does “blended learning” mean? And why is it important for educators to embark on “blending”? What are the resources needed and how does blended learning take place in a medical school?


What is blended learning

NUS has been actively promoting blended learning as a key strategy for effective teaching and learning. It is versatile, because it gives students control over when, where and how quickly learning takes place. This is possible because blended learning combines online and face-to-face (F2F) instruction, to create an integrated cohesive learning experience. It is one that is characterised by a reduced number of F2F meetings, with some lectures, assignments or group work done online.


Graham (2005) defined blended learning as a combination of F2F instruction with computer-mediated instruction, and highlighted the fact that with technological innovations, the two modes will progressively converge as technology advances.


Why blended learning

Blended learning can be justified using many learning theories. Since there could be different approaches to blended learning, often the theoretical basis may depend on the individual approaches adopted. However, in general, it is convenient to explain the theoretical basis using the two major, relatively recent educational theories: cognitivism and constructivism. Cognitive learning theory in general explains how information is processed in the brain, while learning is viewed as a process of making meaning in constructivist learning theory . The learner interacts with experience and environment in the construction of knowledge. The process is essentially learner-centered (Ashworth, Brennan, Egan, Hamilton, & Sáenz, 2004). Hence, the two theories are synergistic.


It is important for NUS Medicine to consider our current teaching and learning environment, clarify our aim in embarking on blended learning and better understand the benefits of F2F versus computer-mediated instruction. In so doing, teachers can strategise and blend the two instructional modalities effectively, thereby creating a flexible, responsive and spontaneous learning atmosphere for our students (Osguthorpe & Graham, 2003). Table 2 (page 4 below) provides a summary of why and how NUS Medicine adopts the blended learning effort.

Suggested approach for blended learning in NUS Medicine

Successful blended learning relies on the planning and execution of the learning experience. With the transfer of some control from teachers to students, the roles of the instructor and learner must be clearly communicated. For successful implementation of blended learning that goes beyond didactic learning, educators should follow the twelve principles of e-learning theory by Mayer, Sweller and Moreno. Educators who are keen to adopt a blended learning approach, but lack the know-how or experience should be assured that IT infrastructure and support are in place to help them get started. Those who are already constantly improving on their pedagogies should also be aware of the IT infrastructures available, and how they can make use of these resources to deliver their lessons and communicate expectations to students.


The three must-know IT tools, but not limited to, for blended learning that are available to all teachers and students are: Panopto, Entrada, and Poll Everywhere.


• Panopto is a Video platform to manage, live-stream, record and share video across NUS, supports webcasting, and the creation and sharing of e-lectures. Apart from providing webcasting services for all didactic lectures at NUS Medicine, educators can potentially use Panopto to record an e-lecture to enable students to learn at their own time and convenience.


• Entrada is NUS Medicine’s Event-based learning management system, with curriculum mapping and personalised events calendar. Educators can use the event scheduler to scaffold the entire learning experience for any teaching activity, from pre-event all the way to post-event. Students can then be guided through the required preparation before the lesson. They will be informed about what to expect during the lesson, as well as encouraged to participate in after-lesson activities to complete the learning cycle.


Poll Everywhere is a live, interactive PowerPoint- integrated classroom response system. Educators can set up and administer live quizzes to facilitate and elicit active student participation. It is especially useful when deployed during classes to transform the monotony of a didactic session into shorter, manageable large group lecture style segments, interspersed with interactive and interesting live polls which students can actively participate in.

1. Before Class
Online Content

Students view narrated presentation, learn the didactic contents or revisit earlier lectures online.

Tips for success:
It is highly advisable to segment the lecture by building in activities for students to apply what they have learnt. E-learning offers many facilities to build in such learning activities.

Online Quiz Identify weak spots, and check that preparation is done. Entrada Quiz
2. In-class Activities (i.e. interactive lecture/centralised teaching sessions)
Large /small group active learning • Review of online contents
• Address weak spots and explain complex theoretical concepts
• Check understanding using learners response system
(Examples of different approaches: Collaborative Learning Cases, tutorials/laboratory/practical sessions, self-directed training sessions, bed-side tutorial/ case discussions, projects etc.)
Poll Everywhere
3. After Class Review
Small group /Individual active learning

Active problem solving Peer learning

Entrada (Eg. Forum, quizzes, assignment etc.)

Table 1: A suggested approach to blended learning

  Pure F2F instruction Computer-mediated instruction
Our teaching
and learning environment
Desired outcome • Human connection
• Student participation limited
• Standardised
• Flow and pace is controlled
• Flexibility (time, locality)
• Student Participation maximised
• Individualised
• Flow and pace can be multi-directional
Our Teachers
• Strong and experienced basic medical science teachers
• Clinician educators
• Other healthcare specialists

Integration and collaboration between disciplines, to plan

and deliver a more coherent

and clinically relevant curriculum.

• Social presence in F2F environment to develop trust and overcome cultural barriers
• Allows for generation of rapid chains of associated ideas in a facilitated environment
• e.g. for Interprofessionalism, integrated medicine, multi-disciplinary teaching
• Remove constraints of time, locality for teachers
• e.g. deliver web-lectures instead of physically travel to lecture theatre at a fixed timing
• Cost effectiveness e.g.  rare or highrisk specimens can be quickly and safely replicated or simula
Our Students
• Large cohort size(>300)
• Diverse talent and background
• Digital natives (Tay, 2007
Every learner can minimally achieve the desired outcomes of the curriculum, and given space to grow to maximum potential, and where necessary given timely intervention.  • Time efficiency and standardised materials and quality for large cohort in a controlled pace for focused theme e.g. Centralised Teaching Sessions in place of numerous small group tutorials
in different hospitals
• Vital opportunity to apply and practice F2F social interaction, code of conduct and communication skills with teachers, future colleagues, healthcare team and patient.
• Increased range of personal choice for learners in terms of time, place, pace or path
• Personalised and on-demand
• Variety and richness of multimedia learning tools to cater to different learning styles or teaching needs.
• Assessment for learning that is instantaneous and targeted
e.g. learners response system
Our Curriculum
• Normal health, structure and function in first year
• Disease state and abnormal structure and function in second year
• Foundational exposure to clinical settings in third and fourth year
• Student Internship Programme in final year
Clinically relevant medical curriculum that is horizontally and vertically integrated, delivered as much as possible in a spiral, and just-in-time fashion. • Clarifying and explaining complex theoretical concepts to a large group efficiently through controlled and directed didactic sessions that directs the flow of thoughts
• Richness of environmental stimulus for acquiring complex skills needed for navigating real life situations e.g. exposure to clinical settings; social cues in soft skills training; nurturing the humanism

• Create space in timetable by transferring pure didactic, rote learning online where students can control the pace and repeat as many times as necessary
• Safe and cost effective environment for repeated experimentation for
high stake skills e.g. patient safety, procedural skills training,communication
• Cost effectiveness in developing, sharing and reusing quality learning materials
• Ease of revision, e.g. students can revisit e-learning materials from earlier years to strengthen connection

Table 2: Why and how to strategise blended learning effort




1. Graham, C. R. (2005). Blended Learning Systems: Definition, Current Trends and Future Directions. In C. J. Bonk, & C. R. Graham, Handbook of blended learning: Global Perspectives, local designs. San Francisco, CA: Pfeiffer Publishing. Retrieved December 2017, from


2. Osguthorpe, R. T., & Graham, C. R. (2003). Blended Learning Environments: Definitions and Directions. The Quarterly Review of Distance Education, 4(3), 227-233. Retrieved December 2017, from


3. Tay, R. (2007, November 21). Rethinking Pedagogies By Creating Possibilities Through Digital And Interactive Media. Retrieved December 2017, from Infocomm Media Development Authority: