Journal of Nature and Science of Medicine

: 2021  |  Volume : 4  |  Issue : 3  |  Page : 288--295

A nationwide online survey on comparative preference of face-to-face lecture, online synchronous, and asynchronous learning in indian undergraduate medical students

Himel Mondal1, Shaikat Mondal2, Sharada Mayee Swain3,  
1 Department of Physiology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
2 Department of Physiology, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India
3 Department of Physiology, Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India

Correspondence Address:
Himel Mondal
Department of Physiology, Nil Ratan Sircar Medical College and Hospital, Kolkata - 700 014, West Bengal


Background: During the coronavirus disease-2019 pandemic, learning activity via the digital medium has suddenly increased. Medical teachers quickly adapted with synchronous (i.e., online classes), and asynchronous (i.e., video-and other materials-based learning) method of delivering the content to the students. Aim: We aimed to explore the comparative preference of face-to-face lecture, synchronous, and asynchronous learning among Indian undergraduate medical students. Materials and Methods: We conducted a cross-sectional nation-wide online survey in July–August 2020 with a snowball sampling technique. We collected response from undergraduate medical students who had attended both online classes and video-and other materials-based learning. Preference on the three modes of learning (namely, face-to-face lecture, online synchronous, and asynchronous) was recorded in a 10 point Likert-type scale. Obtained responses were statistically compared by analysis of variance with a P < 0.05 to be statistically significant. Results: A total of 695 (female = 304 (43.74%), male = 391 (56.26%)) entries were analyzed. Overall, traditional face-to-face lecture class was the most preferred method (8.68 ± 1.49) followed by asynchronous (6.33 ± 2.22) learning and then online classes (5.22 ± 2.55, P < 0.0001). Perceived attention, interest, scope of learning, and possibility of interaction with the teachers were highest in face-to-face lecture. The scope of taking notes from all three modes was equal but the scope of formative assessment was highest with synchronous learning. The distraction was highest with asynchronous learning. Conclusion: Undergraduate medical students in India prefer to learn by face-to-face lecture while compared with distance delivery via the digital media. Postpandemic blended learning may be planned with the following sequence of importance: Face-to-face lecture >asynchronous >synchronous learning.

How to cite this article:
Mondal H, Mondal S, Swain SM. A nationwide online survey on comparative preference of face-to-face lecture, online synchronous, and asynchronous learning in indian undergraduate medical students.J Nat Sci Med 2021;4:288-295

How to cite this URL:
Mondal H, Mondal S, Swain SM. A nationwide online survey on comparative preference of face-to-face lecture, online synchronous, and asynchronous learning in indian undergraduate medical students. J Nat Sci Med [serial online] 2021 [cited 2023 Mar 21 ];4:288-295
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Full Text


During the coronavirus disease-2019 (COVID-19) pandemic, face-to-face classes in medical schools are forced to keep suspended all over the world. Face-to-face teaching and learning had literally come to a halt with an aim to prevent the spread of the virus.[1] Many of the institutions have started online classes where the students join on an online meeting started and moderated by the teachers. There are various applications available for the conduct of online classes. Some of those are free and some of those charge the institutions for the subscription.[2],[3] For the conduct of synchronous (online, real-time delivery) class, a high-speed internet connection is required from the teachers as well to the students to receive the live lecture. Many of the students may not have a high-speed internet connection at their home to participate in the online class or the connection may be lost in the midst of a class. This may be a potential reason why resource-limited settings may face difficulty in adapting the online classes.[4] In India, poor internet connectivity causing hindrance to online study.[5] A study by Desai et al. found that poor internet connection is one of the reasons why Indian undergraduate and postgraduate students are not attending online classes regularly.[6]

To overcome this barrier, teachers may record a video while teaching on a whiteboard or by PowerPoint and sharing the video with the students. The videos may be directly shared with the students via online messaging services (e.g., WhatsApp) or E-mail or it may be shared via video sharing platform (e.g., YouTube™). Some teachers are sharing their hand-written or typed notes with the students as a word file or a portable document format (PDF). In this method, the students can watch the video according to their choice of time. They can pause the videos or review the videos. If the internet connection is slow for a live streaming, they may first download the videos and then start watching.[7]

Board of Governors (BOG) in supersession of the Medical Council of India has not provided any clear guidelines on online teaching-learning activity. Furthermore, the BOG does not recognize the online learning by Indian students studying in foreign universities.[8] Whether distance learning would be given credit as face-to-face teaching remains obscure, practically it is inevitable in the current COVID-19 pandemic. In addition, in the postpandemic time, there would be a huge backlog of the syllabus to complete within a short time. If the National Medical Commission of India recognizes the online learning as a part of blended learning in the future, medical teachers may implement it according to the evolving guidelines.

In this context, our study aimed to explore the comparative preference of face-to-face lecture, synchronous, and asynchronous learning among Indian undergraduate medical students. The result of the nationwide survey would help the medical teachers to structure their strategy of digital teaching during and after the COVID-19 pandemic or in any similar future emergency situation.

 Materials and Methods

Study design

This cross-sectional observational study was conducted with a self-administered online survey questionnaire. The questionnaire collects information about the preference of face-to-face lecture, online synchronous and asynchronous learning methods.


After reviewing the process of the data collection and the method of taking informed consent, the Institutional Ethics Committee of Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India approved the study (HMCH/IEC/2021/103). For the survey, we used an online informed consent method. In this method, a user first reads and understands the consent and if she/he clicks on the “Agree” bullet and click “Next,” then only she/he would be taken to the survey proper. The detailed informed consent is available in Annexure 1. The questionnaire and the informed consent were in the English language. This method of obtaining informed consent is equivalent to the formal written consent. Furthermore, we declare that the study was conducted with full accordance with the World Medical Association's Declaration of Helsinki, updated in 2013.


The study was conducted by an online survey to collect data from undergraduate medical students from all parts of India. We started the online survey on July 1, 2020. The form was closed for any further responses on August 31, 2020.


After reviewing relevant literature,[9],[10],[11],[12] we designed the questionnaire for this study and tested its content validity with input from three experts who had experience in survey questionnaire design. The questionnaire was then pretested on 30 undergraduate students with a segment for open comments about the difficulty they faced in filling the questionnaire, their suggestions to modify the questions for better understanding. With the input from the students, we replaced three words with easily understandable ones. The questionnaire was again reviewed by the experts for the formation of the final questionnaire. The questionnaire can be found in Annexure 1.

The questionnaire had three parts. The first part is the informed consent. We kept the informed consent concise but informed all the relevant information. The next part of the questionnaire contains questions to collect demographics–age, sex, semester of study, states where the college is situated, used devices, and internet connectivity. The next part of the questionnaire contains the questions to collect comparative data on–preference of classes, level of attention, scope for learning, level of interest, chances of interaction with teachers, possibility of taking notes, provision of assessment, and level of distraction in face-to-face lectures, synchronous, and asynchronous learning. The statements in the questionnaire had a 10 point Likert-type response option where 1 indicates the lowest preference and 10 indicates the highest preference. The points in-between 1 and 10 were not defined. We preferred this 1–10 scale as this was an online survey with a large number of participants and this scale (1–10 point without text anchor) has diversity and it is relatively easy to code and analyze.[13]

The questionnaire was created on Google form and the link was generated for the form. Clicking on the web link would redirect the operator to a webpage in the default internet browser of the device she/he is using. As this is an online form, internet connection is a must. We prepared a paragraph of text for informing a recipient about the eligibility for the survey. This message was shared along with the survey link so that targeted students participate on the survey.

Study size

Total undergraduate students intake in Indian medical colleges is 79,855. Assuming all the students are studying across all semesters (a total of 5 batches of the students in each college), the number was multiplied by 5. So, total students are = 399275.[14] With this population and margin of error of 5%, confidence level 95%, sample proportion 50%, the calculated minimum sample size was 384.[15]

The underlying formula for calculating sample size n is:

n = N × X/(X + N – 1)

Where, X = Zα/22 × p × (1−p)/MOE2, and Zα/2 is the critical value of the normal distribution at α/2 (e.g., for a confidence level of 95%, α is 0.05 and the critical value is 1.96), MOE is the margin of error, p is the sample proportion, and N is the population size.

Although this was the minimum number of participants, we aimed to recruit more participants to increase the power of the study.

Participants and data collection

Any student currently studying undergraduate medical courses in India was the preliminary criteria to participate in the survey. Here, we presumed that all the participants attended face-to-face lecture before the participation as this is the common mode of teaching in Indian medical colleges in nonemergency time. The next criteria were those who had attended at least one synchronous and asynchronous learning session. There was no exclusion criterion. We shared a paragraph of text with eligibility criteria with the survey link. We shared the message via WhatsApp to personal contacts and requested them to share the link to the eligible contacts. This snowball type of sampling method was the only feasible method as we aimed to collect data from different zones of India with a large number of participants. Any user agreeing to participate on the survey voluntarily and submitting the response was deemed to be eligible for the study. Submitted data were collected from Google form and were analyzed.

Statistical analysis

Continuous variables were presented as mean and standard deviation and data between male and female was compared by unpaired t-test and preference among three types of learning was compared by analysis of variance. Categorical variables were presented as number and percentage and data between male and female was compared by binomial test. More than two sets of categorical variables were compared by the Chi-square test. For all the tests, a P < 0.05 was considered statistically significant. We used Microsoft Excel® 2010 and GraphPad Prism 6.01 for statistical analysis.


A total 695 (female = 304 [43.74%]; male = 391 [56.26%]) students participated in the survey. Zone wise distribution of students is shown in [Figure 1]. As all the questions were compulsory in the Google forms, all the entries were complete and were eligible for final analysis. We could not ascertain the survey response rate as the questionnaire was distributed to unknown numbers of participants. The distribution of students according to the year of study was similar. Majority of the students use smartphones for online learning. However, their internet connection was neither satisfactory nor dissatisfactory [Table 1].{Table 1}

Overall, traditional face-to-face lecture class was the most preferred method followed by asynchronous learning and then online classes [Table 2]. Their perceived level of attention, scope of learning, and level of interest on the topic of the class were also higher in face-to-face lecture class. The chances of interaction with the teachers are also highest in the face-to-face classes. However, the possibility of taking notes is equal in all three modes. Students think the provision of self-assessment of classroom learning is best with online synchronous learning. The level of distraction is highest in asynchronous learning.{Table 2}

There was a gender difference in some of the domains as shown in [Table 3]. The face-to-face lecture and asynchronous learning are more preferred by males and synchronous learning is more preferred by females. The attention and learning from synchronous classes is more in females. In contrast, perceived learning is higher from asynchronous classes in males. Female students think that the opportunity of interaction with the teachers is more in face-to-face lectures and male students think it is higher in online learning methods. In comparison to male, female students get more scope of taking notes from the face-to-face lectures and think that the scope of formative assessments is higher in face-to-face lecture and synchronous online classes. However, the distraction is more in online classes in females whereas distraction is more in face-to-face lecture in males.{Table 3}

[Table 4] shows the overall preference of class according to the satisfaction with the internet speed. The highest preference of face-to-face lectures was among the students who had neither satisfactory nor dissatisfactory internet connection followed by students with a satisfactory internet connection. The highest preference for electronic medium (both synchronous and asynchronous learning) was also among “neither satisfactory nor dissatisfactory” group; however, the lowest preference was among the students who had a dissatisfactory internet connection.{Table 4}


With the aim to find the comparative preference of face-to-face lecture, synchronous, and asynchronous learning among Indian undergraduate medical students, we found that the students prefer the face-to-face lecture over synchronous online and asynchronous learning. Kaur et al. also reported that traditional classroom learning is more preferred than online learning by Indian medical students.[12] In addition, if we compare between the online class and asynchronous learning, the students like asynchronous learning more than the online classes. Although Brockfeld et al. reported that live lectures and video-recorded lectures are equally effective for clinical examination, our students still prefer traditional lectures.[11] Furthermore, the finding of Moridani suggests that asynchronous video lectures are less preferred by students. The finding of our study does not support this finding.[9] The reason behind this discordant finding may be the difference in the sample (i.e., students), subject (e.g., pharmacology) of interest, study type, and geographical diversity. In addition, there may be underlying stress of the current COVID-19 pandemic that affected their opinion.[16] However, exploring it was beyond the scope of our study.

The underlining reason for this higher preference of face-to-face lectures may be multifactorial. Indian students are habituated to the classroom learning environment. In the current nationwide lockdown, the students have suddenly adapted to online learning where they sit at home and attend a class. This overall preference is further supported by the fact that students think the distraction is significantly higher in distant learning methods and their interest to attend the class is highest for the face-to-face lecture. Another reason may be the internet connection. The students who had dissatisfactory internet connection speed had the lowest preference for both synchronous and asynchronous learning methods.

Overall higher preference of asynchronous learning over the online classes may be due to the fixed-time conduct of online classes. Internet connection may be another factor as the students opined that their internet connection is neither satisfactory nor dissatisfactory. Hence, the students may have poor internet speed to receive the real-time classes. Hence, medical teachers, while designing balanced blended learning modules, may emphasize more to the asynchronous method.

Medical teachers can use their available resources to create videos. Those who are using PowerPoint™, can directly add narration on the slides and make a video by simply saving the files as “Windows Media Video.” Those who use overhead projector slides may take a photo of each slide by placing the slides on a white background. Then, can insert the figure in PowerPoint™ and make the video following the previous guide.

Gender wise preference showed that male students like a face-to-face lecture and asynchronous learning more than female.

The synchronous learning are more preferred by females. Female students' perceived attention and learning is also higher than male. A study by Khalil et al. found that in Saudi Arabia, female students residing away from the campus like the online synchronous learning, especially for preclinical subjects.[17] While the current study was conducted, majority of the students were at home. Hence, the finding of the study by Khalil et al. may be extended to our study finding.[17] Effective interaction with the teacher is a problem in online learning.[18] In the current study, we found that female students think they have higher chance of interaction in a face-to-face class, whereas males think online learning methods are best suited for interaction. Furthermore, female students get more scope of taking notes from the face-to-face lectures and distraction is more in online classes. In contrast, distraction is more in face-to-face lecture in males. These findings may be attributed to the difference in cognitive function in male and female university students.[19] A further study on this topic is the need of the hour to further explore these gender differences.

Although distraction is higher in distance learning, it is inevitable in an emergency situation like the current COVID-19 pandemic. Medical teachers may think of delivering the content by making it concise as the student may lose interest in prolonged online classes or may be less interested to watch online videos or read long PDF pages. Case-based learning can also be dispersed as asynchronous learning where teachers first distribute the case and later share the answer and answer key in a text message or as a PDF.[20]

Formative assessment is the continuous method of self-assessment of learning. The classroom learning can also be assessed by the students at the end of the class. The scope of online formative assessment is higher with the online learning methods. Hence, teachers may design self-assessment questions for the students according to the topic of the class. This not only gives students feedback but helps in improving their marks in summative assessment. The video projected practical examination can also be tried as a formative assessment either coupled with online class or video-based asynchronous learning.[21]

Novelty and limitation

This is the first study comparing the preference of face-to-face lecture, synchronous (online class), and asynchronous learning methods among Indian undergraduate medical students. We collected data from all parts of the India with a scalable sample. We used a 10 point Likert-type scale for a better quantification of the choices.

Although we received responses more than the minimum sample, participation of equal number of students from all the medical schools could not be ensured due to manpower limitation. Furthermore, the survey response rate was not feasible to calculate as we distributed the questionnaire via WhatsApp with snowball sampling technique; hence, could not estimate the total students to whom the questionnaire was reached. We did not collect the information about the type of institutions (government-run or private). Readers must consider these limitations while interpreting the results.


Indian undergraduate medical students prefer face-to-face lectures over online asynchronous and synchronous learning. The preference on the asynchronous teaching method was higher than real-time online classes. In the current pandemic, face-to-face classes are not yet possible. However, preference of asynchronous learning over synchronous learning may be considered by the medical teachers. After the pandemic or in any future emergency situation, blended learning can be designed keeping the students' preference in mind (i.e., face-to-face lecture > asynchronous > synchronous learning).


We thank the expert reviewers for their input during the questionnaire preparation. We also thank the students who participated in the pre-testing. We are thankful to all the students who participated in the survey. The contribution of valuable time of Sarika Mondal and Ahana Aarshi is acknowledged.

Financial support and sponsorship


Conflicts of interest

All the authors are medical teachers and they teach first-year undergraduate medical and paramedical students by face-to-face lecture, synchronous online, and asynchronous methods.

 Annexure 1

Text message

This is an online survey to know your opinion on learning from– face-to-face lectures, online classes, and by videos and other materials (e.g., text, portable document format). If you are an undergraduate medical student studying in any Indian medical college and attended both online classes and video-or other materials-based learning sessions, please provide your opinion. The survey is anonymous and participation is voluntary. To participate, please click on the following link. Please share the survey link with your known contacts of medical students. Thank you in advance. (Google form Link).

Form title

My opinion on different types of learning methods.

Description and informed consent

Please provide your opinion on– face-to-face lectures, synchronous learning (online class), and asynchronous learning (from videos and other materials). This is an anonymous survey. We only collect your age, sex, semester of study, the state in which your college is situated, the device you used for distant learning, and about your internet connection as your demographic data. We are not collecting your E-mail address. Participation in this study is completely voluntary. If you decide not to participate, you may leave the form here and exit the internet browser. Please be aware that if you decide to participate, you may stop participating at any time and exit the browser before submission of the form. We shall try our best to maintain the confidentiality of the research records or data, and all the data will be destroyed after complete analysis. Only anonymous data will be published in any journal in the future. By clicking on the “Agree” bullet, you are indicating that you have read the above text and participating on this survey voluntarily and without any coercion. Please click on the “Next” button to start the survey.

If you have any questions or would like a copy of this consent letter, please contact me at (email address).

Thank you in advance for your participation!

Survey questionnaire part 1


Survey questionnaire part 2

For response, you have a scale ranging from 1 to 10 where 1 indicates the lowest and 10 indicates the highest preference. There are 8 questions. Each question has 3 parts – (a) about face-to-face lecture classes (b) about online classes (c) Video- and other materials-based classes.



1Sahu P. Closure of universities due to coronavirus disease 2019 (COVID-19): Impact on education and mental health of students and academic staff. Cureus 2020;12:e7541.
2Singh K, Srivastav S, Bhardwaj A, Dixit A, Misra S. Medical education during the COVID-19 pandemic: A single institution experience. Indian Pediatr 2020;57:678-9.
3Petzold AM. Letter to the Editor: Resources and recommendations for a quick transition to online instruction in physiology. Adv Physiol Educ 2020;44:217-9.
4Frehywot S, Vovides Y, Talib Z, Mikhail N, Ross H, Wohltjen H, et al. E-learning in medical education in resource constrained low-and middle-income countries. Hum Resour Health 2013;11:4.
5Poor Internet Connectivity Hurting Online Study: Report. The Times of India. Available from: [Last accessed on 2021 Jan 10].
6Desai D, Sen S, Desai S, Desai R, Dash S. Assessment of online teaching as an adjunct to medical education in the backdrop of COVID-19 lockdown in a developing country – An online survey. Indian J Ophthalmol 2020;68:2399-403.
7Rasmussen K, Belisario JM, Wark PA, Molina JA, Loong SL, Cotic Z, et al. Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction. J Glob Health 2014;4:010405.
8Garima. Online Teaching in MBBS or Equivalent not allowed: MCI. Available from: [Last accessed on 2020 Nov 30].
9Moridani M. Asynchronous video streaming vs. synchronous videoconferencing for teaching a pharmacogenetic pharmacotherapy course. Am J Pharm Educ 2007;71:16.
10Alqahtani ND, Al-Jewair T, Al-Moammar K, Albarakati SF, ALkofide EA. Live demonstration versus procedural video: A comparison of two methods for teaching an orthodontic laboratory procedure. BMC Med Educ 2015;15:199.
11Brockfeld T, Müller B, de Laffolie J. Video versus live lecture courses: A comparative evaluation of lecture types and results. Med Educ Online 2018;23:1555434.
12Kaur N, Dwivedi D, Arora J, Gandhi A. Study of the effectiveness of E-learning to conventional teaching in medical undergraduates amid COVID-19 pandemic. Natl J Physiol Pharm Pharmacol 2020;10:563-7.
13Bernstein S. Stop Debating the Survey Question Scale: Why a 0-10 Scale is Your Best Option. Waypoint Research Group, LLC. Available from: [Last accessed on 2021 Jan 11].
14List of Colleges Teaching MBBS. India: National Medical Council. Available from: [Last accessed on 2020 Dec 03].
15Population Proportion – Sample Size. United Kingdom: Select Staistical Services. Available from: [Last accessed on 2020 Dec 03].
16Manjareeka M, Pathak M. COVID -19 lockdown anxieties: Is student a vulnerable group? J Indian Assoc Child Adolesc Ment Health 2021;1:72-80.
17Khalil R, Mansour AE, Fadda WA, Almisnid K, Aldamegh M, Al-Nafeesah A, et al. The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: A qualitative study exploring medical students' perspectives. BMC Med Educ 2020;20:285.
18Rajab MH, Gazal AM, Alkattan K. Challenges to online medical education during the COVID-19 pandemic. Cureus 2020;12:e8966.
19Alruwaili KH, Alruwaili IA, Naggar MA, Alshammery AS, Baseem SM, Alsaqabi QA. Association between oxygen saturation level, cognitive function, and the academic performance of medical students, Jouf University. Majmaah J Heal Sci 2020;8:4-14.
20Ciraj AM, Vinod P, Ramnarayan K. Enhancing active learning in microbiology through case based learning: Experiences from an Indian medical school. Indian J Pathol Microbiol 2010;53:729-33.
21Khan S, Hassan MJ, Husain M, Jetley S. Video projected practical examination as an introduction to formative assessment tool for undergraduate examination in pathology. Indian J Pathol Microbiol 2019;62:79-83.