Online or face-to-face instruction? A qualitative study on the electrocardiogram course at the University of Ulm to examine why students choose a particular format.

Background: Since the introduction of the e-learning electrocardiogram (ECG) course 'ECG Online' into the curriculum at the University of Ulm, a small but relatively constant number of students have decided not to participate in the online course but to attend the face-to-face course, although the content of both courses is identical. The present study examined why students prefer one format or the other.

Methods: In a qualitative research approach, ten medical students were questioned in a guided interview. At the time of the survey the interviewees were enrolled in the 7th to 10th semesters. Among the respondents, 2 had participated only in the face-to-face ECG course, 4 only in the online version and 4 in both the face-to-face and the online course.

Results: Interestingly, the very factors associated with e-learning - and always praised as advantages of it - are viewed critically by the students. Thus, although the 24-h access to learning content was consistently evaluated positively, the unlimited availability (lack of expiry date) was not seen as conducive to learning. The lack of fixed time constraints and the attendant lack of pressure were important reasons why some of the students had discontinued the online course prematurely. A similar distinction was seen in the flexibility of location for e-learning, because the very obligation to be physically present on a particular day at a fixed time led to a higher degree of commitment to courses and a willingness to actually attend the course until the end. In addition, if the content has a high degree of perceived professional relevance face-to-face courses are preferred because they offer the possibility of direct interaction.

Conclusions: Even though the small sample size limits the generalisability of the results, our findings indicate that when developing online courses students' needs could be better met if measures were included to strengthen extrinsic and intrinsic motivation and formats were favoured that enable students to have a minimum level of personal interaction with the lecturer.