Available online at www.sciencedirect.

com

ScienceDirect
Health Professions Education 6 (2020) 325e333
www.elsevier.com/locate/hpe

Multimedia in Education: What do the Students Think?*

Tamara Vagg a,1, Joy Y. Balta b, Aaron Bolger c, Mutahira Lone b,*,1
a
Department of Computer Science, University College Cork, Cork, Ireland
b
Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
c
Department of Applied Psychology, University College Cork, Cork, Ireland
Received 26 September 2019; revised 25 February 2020; accepted 27 April 2020
Available online 13 June 2020

Abstract

Purpose: Multimedia is considered a cost effective and practical learning medium. This study aimed to investigate the attitudes of
medical and allied healthcare students towards the use of various multimedia learning aids and explored students’ attitudes towards
these learning aids.
Method: An online questionnaire was used to collect data. Students were invited to partake in the study via email and data was
collected over a six-month period.
Results: A total of 153 students responded to the survey. The data shows that students have had a positive experience using devices
like smartphones (88.88%, n ¼ 136) and laptops (89.19%, n ¼ 132). Students are confident searching for multimedia resources
(76.31%, n ¼ 116), and have some familiarity or exposure to multimedia as part of their learning experience. Students preferred
traditional teaching methods to learning with multimedia (58.59%, n ¼ 75), but regarded multimedia as an effective and efficient
tool for practical learning (73.02%, n ¼ 111). The participants reported using e-learning tools and 2D animations more frequently
than other multimedia tools and reported being least familiar with Augmented Reality and 3D websites. Finally, students expressed
an interest in the development of 3D animations (66.66%, n ¼ 80), interactive 3D teaching tools (65.45%, n ¼ 72), and simulators
(64.07%, n ¼ 66) to complement their future studies.
Conclusion: The results of the study show that participants acknowledged the important role of multimedia as a practical learning
tool that can greatly complement and enhance the traditional teaching methods but cannot replace them. Medical and healthcare
students expressed a particular interest in the development of interactive tools including simulators to supplement their studies and
enhance the learning process.
© 2020 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Attitudes; Medical and healthcare; Multimedia; Students; Survey

1. Introduction

Healthcare education is undergoing pioneering

*
Peer review under responsibility of AMEEMR: the Association
changes with traditional teaching complimented with
for Medical Education in the Eastern Mediterranean Region innovative technology enhanced learning tools and
* Corresponding author. multimedia resources such as computer assisted
E-mail address: m.lone@ucc.ie (M. Lone). learning (CAL) and mobile applications. Recent
1
These authors had equal contribution to this research.

https://doi.org/10.1016/j.hpe.2020.04.011
2452-3011/© 2020 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
326 T. Vagg et al. / Health Professions Education 6 (2020) 325e333

studies have demonstrated that the current generation education for learning and communication purposes
of students are routinely using these tools for educa- with web-based learning added to the existing teaching
tional purposes.1 curriculum.17
The term ‘Multimedia’ has been described as a The aim of this study is to identify the attitudes of
combination of sound, text, animation, video or art medical and healthcare students towards the use of
delivered by a computer or other digital platform2 and multimedia in education. For this research study,
encompasses simple teaching tools like videos or ani- multimedia most closely follows the definition as
mations to complex teaching tools like Virtual Reality described by computer science in that it is a combi-
(VR) and 3D Augmented Reality (AR).3 nation of sound, text, visuals on a digital platform and
Multimedia has been shown to be effective for encompasses an interactive element.
learning: animations effectively stimulate learner in-
terest and thus enhance the learning experience4 with 2. Materials and methods
augmented reality improving the students’ cognitive
skills by provided a platform to combine digital and 2.1. Study design
physical parameters.5 Gaming has been shown to
enhance medical education6 while improving the aca- This is a descriptive study which was designed to
demic writing skills of dental students7 and improving collect data pertaining to the attitudes of medical and
empathy in nursing8 and pharmacy students.9 Positive allied healthcare students for using multimedia
findings of these studies suggest that the use of learning aids to assist their educational learning. This
multimedia as a form of blended-learning technique study aimed to explore which technological aid stu-
cater to the multiple learning styles and have been dents used to support their learning and found most
found to provide better outcomes than traditional lec- useful.
ture delivery.10
Research conducted into the learning styles of the 2.2. Project timeline
students provided an explanation to why interactive
multimedia may prove beneficial to their learning The timeline for this project was the end of 2016.
experience. In most cases, research concerned with the An online questionnaire was developed and made
learning styles of medical students use the Visual, available online for the students from October 2016
Aural, Read or Write and Kinesthetic (VARK) learning and was closed in March 2017. The data was collected
styles questionnaire and guide.11 Lujan et al.12 and in this six month period.
Baykan et al.13 found from their research with 166 and
155 first year medical students respectively, that the 2.3. Setting
majority of students were kinesthetic learners. Overall
these studies demonstrate a tendency for medical stu- First and second year medical and healthcare stu-
dents to be kinesthetic learners who prefer multiple dents attending anatomy lab practicals were invited to
modes of presentation. participate in this online survey via email. Students
VR is becoming widely implemented and who would attend these practicals include medical
researched in the medical health sector.14 VR has (first year n ¼ 120), nursing (second year, n ¼ 180),
proven numerous benefits for education and medical and dentistry (second year, n ¼ 65) undergraduate
training. More recently, it has demonstrated an students. During one week of practicals, the re-
improvement in healthcare professional's knowledge searchers held an information session with the stu-
and skills in surgical training.15 Furthermore, it has dents, outlining the participant information leaflet.
also been found that VR can accommodate for varia- Participants were also made aware that the survey was
tions in learning styles.9 available for six months via the Virtual Learning
Nowadays, universities and colleges are relying Environment, Blackboard. Consent was obtained from
heavily on online resources to engage and connect with the students at the start of the study. The inclusion
students on day to day basis, providing platforms for criteria for this study were first and second year med-
communication between students and hold discussions ical and healthcare students attending anatomy lab
between the students and their teachers.16 Technology practicals. Exclusion criteria were applied to third,
is becoming an integral part of institutes of higher fourth, and fifth year medical and healthcare students.
 T. Vagg et al. / Health Professions Education 6 (2020) 325e333 327

2.4. Questionnaire design attend these practicals include medical, nursing, and
dentistry undergraduate students. A custom survey was
A questionnaire was designed by a multidisciplinary developed using web technologies such as HTML,
team of anatomists and multimedia specialists to JavaScript, PHP, and CSS and results were stored in a
gather data about the students’ use of multimedia Microsoft Excel Workbook. The website containing
technology. The questionnaire consisted of 19 ques- the survey also included an information sheet about the
tions some of which are multiple choice, 5-point Likert project, explaining that participation is voluntary, and
scale questions ranging from negative to positive scales details on how to retract their data. This survey was
(strongly disagree/disagree/least remember to strongly made available online from October 2016 and was
agree/agree/remember most) and open ended questions closed in March 2017.
(as seen Fig. 1.). Four senior medical demonstrators in
the Department of Anatomy and Neuroscience and five 2.6. Ethical Approval
computer science researchers at University College
Cork, Ireland were invited to participate in a pilot Ethical approval for the study was received by the
study for the validation of the questionnaire. This was Social Research Ethics Committee in University Col-
followed by a focus group session with the above- lege Cork, log number 2016e109. The study was
mentioned participants to discuss their feedback on conducted from October 2016 to March 2017. Partic-
the questionnaires. Questions were modified based on ipation in the study was voluntary and all data
the feedback session. The survey questions focused on collected was pseudo-anonymised. Participants had the
several topics which included collecting data on option to withdraw from the study at any stage.
background, Learning Preference Indicator, Device Participation and answering of the questions was
Usage, Interests in Technology, Multimedia Familiar- voluntary. The statistics below is calculated based on
ity, Attitudes towards Multimedia, Multimedia Usage, the number of respondents for each question.
and Perception of Multimedia Services in the
University. 2.7. Statistical analysis

2.5. Data collection Since this was a descriptive study and data was
collected which was pseudoanonymized only mean
First and second year medical and healthcare stu- values and percentages could be calculated for the
dents attending anatomy lab practicals were invited to data. Since paired data was not obtained non-
participate in this online survey. Students who would parametric tests could not be performed on the data.

Fig. 1. Screenshot of the consent form and first page of the online survey.
328 T. Vagg et al. / Health Professions Education 6 (2020) 325e333

Table 1
Participant Profile Summary. 153 medical and health student respondents, University College Cork, 2016.
Participant Profile Summary
Number of Participants 153
Age Range 18-50 (average 22)
Male 57
Female 96
Educational Background Medicine (n ¼ 79), Dentistry (n ¼ 47), Nursing (n ¼ 27)
Year of Education 1st year (n ¼ 78) and 2nd year (n ¼ 75)
Educational Institution & Country University College Cork, Ireland

Table 2
Learning preference indicator response percentage. 109 of the 153 medical and health student respondents, University College Cork, 2016.
Ranking (1e3) Watching video with audio Reading lecture notes and looking at images Reading notes while listening to a lecture
Remember Least (1) 18.34% (n ¼ 20) 20.18% (n ¼ 22) 52.29% (n ¼ 57)
Remember Some (2) 29.35% (n ¼ 32) 50.45% (n ¼ 55) 27.52% (n ¼ 30)
Remember Most (3) 52.29% (n ¼ 57) 29.35% (n ¼ 32) 20.18% (n ¼ 22)

3. Results state that the participants found that ‘things they read’
(53.1%, n ¼ 51) and ‘things they hear’ (35.4%, n ¼ 34)
3.1. Background to be least memorable. This was followed by another
question whereby students were asked to compara-
During the six month availability of the survey, the tively rank three scenarios involving multimodal
survey was completed by 153 students yielding a learning, in terms of how well they remember the
response of 42% (n ¼ 365). Of these 153 students, 79 content from 1 to 3 (1 being remembered the least and
were medical students, 47 were dental students, and 27 3 being remembered the most). Results show that
were nursing students. From the participating students, students remembered the least from reading notes
78 students were in their first year and 75 were in the while listening to a lecture and remembered the most
second year. The majority of participants were females from watching video with audio as demonstrated in
(n ¼ 96) with 57 male respondents. The youngest Table 2.
participant was 18 years old whereas the oldest was 50
years with an average age of 22 years. Of this cohort, 3.3. Device Usage
26 students had already acquired an undergraduate
degree and 12 students had achieved a postgraduate Students were first asked to select the devices they
degree. A summary of the participant profile can be currently own or have owned in the past. They were
seen in Table 1. The remaining results of this survey is then asked to rate their experience of these devices
outlined below in accordance to the survey structure from 1 to 5 (1 being an unpleasant experience and 5
previously outlined. being pleasant), the results of which can be seen in
Table 3 below. The first two rows represent the number
3.2. Learning Preference Indicators of students who selected each option. The percentage
values for user experience in the remaining three rows
Students were given five statements regarding their is calculated based on those who reported owning the
memory and learning preference. They were then device.
asked to rank the statements from 1 to 5 with 1 as
remember the least and 5 as remember the most. Stu- 3.4. Interest in technology
dents who answered this question, regarded things they
‘practice or do’ as the most memorable (71%, n ¼ 69). Students were asked to rate four statements about
This was followed by ‘things that they write after their interests in technology from 1 to 5 (1 being
reading’ (55.3%, n ¼ 53) and ‘things they see or strongly disagree and 5 being strongly agree). Results
watch’ (36.9%, n ¼ 46). The results of this question show that students have an interest in technology
 T. Vagg et al. / Health Professions Education 6 (2020) 325e333 329

Table 3
Number of students reported device usage and students experience of those devices. 153 medical and health student respondents, University College
Cork, 2016.
Smartphone Desktop Laptop Notebook Tablet/iPad Game Console
Students owning and using the below devices
Own 139 84 136 48 78 60
Use Frequently (daily/weekly) 137 35 131 37 38 14
Students' experience based on those who own the device
Unpleasant Experience (1,2) 2 11 3 7 8 7
Neutral Experience (3) 11 29 8 8 19 14
Pleasant Experience (4,5) 124 42 121 32 49 36

Table 4
A breakdown of medical student's familiarity, usage and need with multimedia. 153 medical and health student respondents, University College
Cork, 2016.
No. Of respondents who No. Of respondents who No. Of respondents who
are familiar with used during study want to see more of in education
3D animations 120 57 80
Mobile Apps 120 59 54
E-Learning 113 74 50
Interactive 3D 110 50 72
2D animations 106 78 34
Simulators 103 30 66
Virtual Reality 101 12 50
Game Based Learning 95 23 44
3D Websites 80 24 41
Augmented Reality 74 7 37

(58.16%, n ¼ 89) and do not find technology intimi- 3.5. Multimedia familiarity
dating (51.3%, n ¼ 78). However, the students had a
more varied response to whether technology was Several Likert questions regarding the students’
frustrating for them, with 41.83% (n ¼ 64) disagreeing confidence with multimedia were also asked, and
and 32.67% (n ¼ 50) agreeing. A similar distribution ranged from 1 to 5 (1 being the lowest and 5 being the
was seen in the final question of this section whereby highest). These questions found that the students are
users rated how up-to-date they attempt to stay with confident with:
advances in technology, 29.41% (n ¼ 45) of partici-
pants responded that they do not, 39.21% (n ¼ 60)  Using a computer to search for educational
attempt to keep up-to-date, and 31.37% (n ¼ 48) multimedia online (76.31%, n ¼ 116),
neither agree nor disagree that they keep up with  Manoeuvring/rotating 3D models on a smart-
technology. phone (60.92%, n ¼ 92),

Table 5
Reasons why students do not use multimedia response percentage. 124 of the 153 medical and health student respondents, University College Cork,
2016.
Option Frequency
I like traditional learning with textbooks, diagrams and lecture notes 58.59% (n ¼ 75)
Advances in technology intimidate me 5.46% (n ¼ 7)
I cannot understand 3D or VR 3.12% (n ¼ 4)
I don't have the time for using technology while studying 11.71% (n ¼ 15)
There is no multimedia resources available to benefit my learning 16.4% (n ¼ 21)
I had a bad experience with multimedia learning 1.56% (n ¼ 2)
330 T. Vagg et al. / Health Professions Education 6 (2020) 325e333

 Manoeuvring/rotating 3D models on a laptop or would search for additional visual content such as
personal computer (62%, n ¼ 93). videos, animations, images online or via a smartphone
when revising or studying. Furthermore, 98.03%
To gauge multimedia familiarity, students were (n ¼ 150) of students also confirmed that they have
provided with a table of common multimedia in- searched for an animation/video to explain a difficult
terventions and asked to select the multimedia they are topic encountered during their learning. With 98.68%
most familiar with, that they have used during any (n ¼ 150) students having watched an educational
point of their study, and what multimedia they want to video or animation, 52.02% (n ¼ 77) of students re-
see more of in health and medical education. The re- ported educational multimedia as being easy to locate.
sults are displayed in Table 4. The first column lists Similarly, 78% (n ¼ 117) of students agreed they
multimedia interventions, with the second representing would look for text-based content such as research
the number of users who reported being familiar with papers when studying or revising. Additionally,
the intervention. The final two columns represent the 71.24% (n ¼ 109) of students also reported using a 3D
percentage of familiarised students who reported using educational tool, such as a 3D website. It was also
this intervention and wanting more of this multimedia found that 54.9% (n ¼ 84) of students have used
to support their learning. educational games to support their learning and
54.05% (n ¼ 80) enjoy learning with games; however,
3.6. Attitudes towards multimedia only 13.72% (n ¼ 21) currently own an educational
game. In contrast, a high number of students (65.5%,
When asked if students find multimedia to be as n ¼ 99) have an educational app in-stalled on their
good as a class or lecture, 34.21% (n ¼ 52) of students phone. Virtual Reality (8%, n ¼ 12), Simulators (7.9%,
neither agreed nor disagreed, while 40.13% (n ¼ 61) n ¼ 12), and Augmented Reality (12%, n ¼ 18) were
agreed; however, 58.55% (n ¼ 89) reported that they found to be the least utilised multimedia interventions,
prefer lectures over multimedia content. A total of however all participants who reported using these in-
69.53% (n ¼ 105) students agreed they would like to terventions also considered the multimedia to be
utilise more multimedia interventions and content to beneficial to their learning.
support their learning, and 71.05% (n ¼ 108) students
agree that multimedia for education is engaging. 3.8. Perception of Multimedia Services in the
Likewise, 73.02% (n ¼ 111) agreed that interactive university
multimedia is a good resource for practical learning
and 74.17% (n ¼ 112) agree that it is important for Next, the students were asked to rate from 1 to 5 (1
educational multimedia to be interactive in-some way. being disagree and 5 agree) whether they believe their
Similarly, 72.36% (n ¼ 110) agree that multimedia can university has sufficient multimedia to support their
help them garner a better understanding of topics learning. Of the respondents, 36% (n ¼ 54) feel there
which were covered in a class or lecture. When asked was sufficient multimedia whereas 22.66% (n ¼ 34)
if the students preferred multimedia to textbooks, felt that the university did not and 41.33% (n ¼ 62)
47.36% (n ¼ 72) of students agreed that they did, while were unsure.
25% (n ¼ 38) were unsure. The students were then
asked if they prefer 2D or 3D multimedia; this question 4. Discussion
showed that 58.66% (n ¼ 88) of students prefer 3D
multimedia, and 28.66% (n ¼ 43) were unsure. It was A total of 153 healthcare students participated in the
also found that 52.02% (n ¼ 77) of students believe survey, whose perceptions about multimedia usage
that educational multimedia is expensive. Finally, the should reflect the current student cohort. There was a
students were presented with six statements and asked high amount of female respondents raising the possi-
to choose which option more accurately reflects why bility of gender bias. However, similar gender bias has
they do not use multimedia. The results of this can be been reported in other studies.1 The respondents in the
seen in Table 5. study were all first and second-year healthcare students
attending the anatomy practicals in the university.
3.7. Multimedia usage However, 38 students had already achieved a third
level qualification (undergraduate or postgraduate de-
During further questioning regarding their multi- gree). Looking at the age profile of the participants,
media usage, 84.66% (n ¼ 127) of students agreed they there was a variation between the age categories. The
 T. Vagg et al. / Health Professions Education 6 (2020) 325e333 331

average age of 22 years is more reflective of a student From the multimedia familiarity table it can be seen
in their final years of their degree (4th or 5th year). that these healthcare students are most familiar with
This could suggest that the student cohort are mature 3D animations and educational smartphone apps, a
learners.18 similar finding to other research in the area.28e30 They
The total student cohort included 127 new students appear to be the least familiar with Augmented Reality
(<24 years) and 26 mature students (25 years or older). (AR) and 3D websites, with very few studies about its
We were interested to see if there was any notable uses and efficiency.31 It was also found that students
difference between mature and new students as such use e-learning tools and 2D animations more
we extrapolated the mature student data across all the frequently than other multimedia during the course of
results and compared against the new student data. No their study. Interestingly, students also reported being
notable difference was found between the attitudes and the least interested in the development of more 2D
opinions of the two sub-cohorts. Therefore, the results animations to support learning, perhaps due to the high
stated and discussed are representative of both groups availability of this resource.30 Finally, students
as a single cohort. expressed the most interest in seeing 3D animations,
Overall, it can be seen that smartphone, laptop, and Interactive 3D teaching tools, and Simulators incor-
desktop are the students’ most frequently owned de- porated to support their studies in the future32 and
vices. In each case, students tend to rate their expe- found it significantly affecting their learning.33
riences positively with the majority of devices they Our findings of the survey are in line with those of
owned and have used. However, it can be clearly seen Prensky (2009), demonstrating that this generation of
that within all the devices the student owned, smart- healthcare students are considered to be ‘digitally
phones and laptops are the most preferred devices wise’,34 in that they have access to on-demand digital
among students.1 Advantages of smartphone and information via their smartphones and laptops. These
laptop have been listed as transportability thus digitally wise cohorts are considered to have enhanced
allowing students easier access to the internet for so- analytical abilities due to increased exposure to
cial media, education and communication multimedia resources (animations and simulations).34
purposes.1,19 Furthermore, they also have accelerated ability to
The results of this survey suggest that medical and extract information from these complex systems.34
healthcare students prefer traditional teaching methods Moreover, the participants indicated having a
to educational multimedia,20 and believe that multi- pleasant experience of learning with multimedia re-
media cannot replace these traditional teaching sources and regarded it as enhancing their learning.
methods. However, this study found that the students This is also reflective in learning preferences of stu-
prefer interactive multimedia as a feasible resource for dents where multimedia resources can engage the
practical learning.21 Multimedia resources were found various learning approaches through a single multi-
to be both favourable and effective by the students media platform. It is acknowledged that learning
which is reflective of their indicated learning prefer- preferences can change over time and for various
ences21,22 The participants of this study also regard topics and hence multimedia can accommodate for
multimedia as complimentary to their traditional these changes easily.35
learning.23 and often seek multimedia to support or Furthermore, with the advent of Virtual Learning
further explain difficult concepts encountered during Environments (Moodle, Blackboard, and Canvas) and
their study.24 Using multimedia resources improves not their advanced capabilities, multimedia is becoming
only the teaching to the students25 but also the learning ever more accessible and tangible as a teaching
by the students.26 resource. In addition, this survey also proves that stu-
In addition to this, it can be seen that this particular dents, themselves, would like to see more multimedia
student population do not appear to be intimidated by included in their curriculum. Hence, this study and its
technology and use smartphones and laptops regularly data can inform the development and use of multi-
which is also reported in literature.27 These students media for students learning and educational
also report being confident at sourcing and interacting purposes.36
with multimedia with about 40% (n ¼ 60) of students
attempting to stay up to date with technological ad- 5. Limitations
vancements and developments. This data indicated
healthcare students’ keen interest in digital learning Firstly, the manner in which the students were
and technology. recruited can cause potential bias, i.e., online learners
332 T. Vagg et al. / Health Professions Education 6 (2020) 325e333

may be more inclined to answer the survey. However, Declaration of competing interests
as the survey was made available via Blackboard,
which every current student must access in order to There are no conflicts of interest.
obtain course materials, it provided equal opportunity
for every student to participate. Furthermore, the sur- References
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