A comparison of attitudes toward remote learning during the COVID-19 pandemic between students attending a Chinese and an Australian campus.

The COVID-19 pandemic has been a strong driver for moving more teaching and learning activities online. Border restrictions have had a severe impact on international students either hoping to enroll in courses offered in Australia or continue with such courses if they are already enrolled. The online learning experience is likely different between students onshore and offshore. This study took a unique opportunity to investigate any such differences in students' attitudes toward remote learning, necessitated by the pandemic, by comparing two cohorts of students, Australia versus China based. An anonymous survey using the Likert Scale and open-ended questions was available for student feedback on subject delivery. The students based in Australia expressed a preference for remote learning due to the convenience of attendance and availability of the video recordings. However, students in China had a strong preference for face-to-face sessions, with the lack of prior experience in an English-speaking learning environment and hesitance to speak with the lecturers and engage in the learning activities possible reasons for this. In quizzes, students in Australia performed better than those in China regardless of local or international student status. This difference may be due to the Australian-based students' prior experience of English-speaking environments and open-book quizzes. In conclusion, remote learning in a familiar language and learning environment is accepted by students, whereas if the teaching is delivered in a second language using unfamiliar teaching methods, remote learning will require additional scaffolding to enhance their learning experience.

INTRODUCTION

Online learning is heralded as providing flexibility, increasing access, and reducing time lost commuting to and from campus (1–3). However, some experts have raised significant pedagogical concerns regarding the effectiveness of content delivery, the quality of teacher-student interactions, and the capacity for collaborative learning (4–8). Additionally, it is well established in the literature that online learning requires strong self-regulation skills for students to succeed (9, 10), and it is strongly linked to student motivation (11, 12). Before COVID-19, the provision of exclusively online delivery was available through massive open online courses and virtual campuses such as Open University, allowing students to undertake a degree without any on-campus learning experiences. Online learning has been considered a strategy for higher education institutions to save costs and generate more income by increasing enrollment beyond geographical proximity. However, there are additional costs in relying on online delivery, which need to be considered as well (13–19). The main idea behind online learning is to allow educators to have a student-centered approach, a mixture of educational strategies, learning experiences, instructional methods, and a support plan designed to address students distinct learning needs, interests, aspirations, and cultural backgrounds (20). This approach is harder to achieve purely with face-to-face teaching.

With the COVID-19 pandemic, and the requisite lockdowns, educational institutions have relied on fully online delivery. When there has been the relaxation of travel and assembly restrictions, some measures remain, e.g., reductions in the maximum number of people within the lecture theaters and practical laboratories to enable physical distancing. Thus there has been the implementation of a blend of on-campus and online activities where the choice of mode of delivery for any teaching event would ideally align with best practices and linked learning objectives (21–25). Online platforms like Zoom and Microsoft Teams support interactions between lecturers and students. Any live sessions can be recorded automatically and shared with students inside the Learning Management System (LMS) for students who missed the class and for revision purposes (20). Lecture recordings have been a feature of higher education for over a decade but generally required special audiovisual equipment installed in every lecture theater (26). Using webinar software has simplified this process. Despite recorded lectures remaining a concern for educators as to their impact on student attendance, permanent replacement of on-campus delivery of particular teacher-led activities with delivery online is now being considered (27–31).

Learning is a social interaction. There is strong evidence of the capacity of nonvisual or nonverbal cues that characterize face-to-face events to facilitate such interaction (32–36). Furthermore, when it comes to face-to-face classes, there are still national differences in the requirements, teaching methods, and how these relate to students’ perceptions of and engagement with this type of class. In most Australian campuses, attendance has not been compulsory for lectures, regardless of the availability of the recordings (37–39). However, attendance is commonly recorded in Chinese universities, even in the online delivery setting during the pandemic, and counts toward the final grade. Also, face-to-face delivery remains heavily favored by Chinese university students (40–43). Students in Australia are believed to be more likely to ask questions or challenge the concept with the lecturers during the class, whereas those in China are considered more likely to receive the information without any questioning passively. The difference in approach to learning may be partly due to national differences in the acknowledgment of the authority of the teachers. Notably, one of the Hofstede Model of Cultural Differences dimensions is “Power Distance.” This dimension allows for comparisons between societies as to how hierarchal they are. When making the comparison between China and Australia (https://www.hofstede-insights.com/product/compare-countries/), the Power Distance Indices are 80 versus 38, respectively (44). Different teaching methods may also contribute to such differences. To encourage critical thinking interaction between the students and teachers and lifelong learning skill development, campuses in Australia have been promoting online self-directed learning and flipped learning methods for several years before COVID. Campuses in China commonly still employ the traditional didactic style, which may be why attending students are still positioning themselves as knowledge receivers (12, 45–49). The contrast between face-to-face classes with the everyday experiences of online delivery remains stark. In online lecturing, the teacher remaining seated in front of their camera, students opting out (albeit in some cases for legitimate reasons) of using their camera, and current setups restricting the number of participants visible at any moment are all likely to have an impact on the quality of interaction. However, some features of webinar software, such as creating breakout rooms, can promote student interaction and collaboration when the learning design is well executed (50–52).

COVID-19-related border restrictions have had a severe impact on international students coming to Australia. While vaccination is becoming more widespread, any sort of return to prepandemic international student numbers will likely be some time away. Online delivery to offshore students is also something that preceded the pandemic but appears to be gaining more traction now (52–55). Notably, offshore online delivery can be part of a student equity strategy in offering an alternative to overseas students for whom the social and financial costs of studying overseas remain an obstacle. This approach must be underpinned by understanding differences between different national cohorts and remote learning.

At a large metropolitan Australian university in Sydney, Human Pathophysiology is delivered as a core unit (referred to as a “subject” at the Australian campus) to the medical science students in their second year and as an elective to students with any other majors who have completed the prerequisite unit on human anatomy and physiology. In 2020 Human Pathophysiology was delivered entirely online for the first time. The university has a 4-yr undergraduate pathway program with a campus in the People’s Republic of China (PRC). The fourth year provides students with the opportunity to study abroad. In this program, lecturers from the Australian campus deliver several units to the China-based students enrolled in the third year of this pathway program. Due to border closures, the Australian campus replaced the planned face-to-face delivery with online delivery via Zoom. In combination, these changes gave the investigators a unique opportunity to compare remote learning attitudes between students enrolled at the Australian campus and those attending the campus in the PRC. The main challenges may include language barriers (e.g., English as an Additional Language and the absence of an English-speaking living environment) and differences in prior learning experience between the two cohorts. In Australia, universities aspire to follow a student-centered approach characterized by practice-oriented, collaborative learning focusing on critical thinking and engagement in authentic learning (47, 48, 56). In contrast, science education in China is more traditional, commonly utilizing didactic methods, with only gradual employment of student-centered approaches (40–43).

This research paper investigates student attitudes toward remote learning during the pandemic by comparing two cohorts of students, Australia versus China based. The investigators formulated two research questions: 1) what is the overall student attitude toward remote learning during the pandemic; and 2) are there any differences between the two cohorts in their respective attitudes toward remote learning?

RESEARCH METHODS

This study was approved by the University’s Human Ethics Research Committee (No. ETH20-5469). One cohort under study was students, from a mixture of majors (including Medical Science, Biomedical Science, Biotechnology, Biomedical Physics, Nursing, Traditional Chinese Medicine, Engineering), enrolled in the unit Human Pathophysiology, taught at the Faculty of Science at a metropolitan university in Sydney, Australia. The other cohort was students enrolled in the pathway program mentioned above (Biotechnology major) at a public university in a Northern province of the PRC. Both cohorts studied the same unit during the same time [during Spring Session (August to November) 2020] delivered by the same group of teaching staff. Given the time of the year when the unit ran, all students had previously experienced at least one online teaching session. Students at the Australian university were a mix of domestic and international students generally halfway through their respective courses at the Australian campus. The details of any international students’ specific nationalities were not available. The researchers used a mixed-method approach (57), which combines qualitative and quantitative data to answer the research questions. They used methodological triangulation of data to increase the credibility of findings (58). Data collection included demographics, a survey using the Likert Scale (Table 1) and open-ended questions, final marks for the unit, and student feedback on its delivery.

Table 1.

Survey items

Item
1) I prefer to watch a pre-recorded lecture and attend a live zoom Q&A session.
2) I prefer to attend a live zoom lecture.
3) I prefer to watch a recording of the live zoom lecture.
4) I prefer to attend a live workshop/tutorial.
5) I prefer to watch a recording of the live workshop/tutorial.
6) I prefer to attend a live face-to-face workshop/tutorial.
7) I prefer face-to-face meetings for group presentations.
8) I prefer meeting online for group presentations.
9) I prefer a mixture of face-to-face and online meetings for group presentations.
10) I believe this subject provided the right amount of theoretical and practical experience (e.g., case studies, evaluation of laboratory test results).
11) I believe the subject has been well organized.
12) Overall, I feel satisfied with the quality of this subject.
13) I enjoy learning remotely.
14) Overall, I am satisfied with my marks in the exams.

In the survey, “exams” refers to online quizzes. Q&A, question and answer.

Unit Structure

Zoom is the webinar platform used at the Australian campus for online teaching. The 2-h-long lectures were delivered weekly either as a live Zoom session, or a prerecording, with the latter supported by a live question and answer (Q&A) Zoom session during the designated live lecture time slot. The Q&A sessions were recorded. Due to the exclusively online learning delivery for both cohorts, all the laboratory-based practical sessions were replaced by online Zoom tutorials (but timetabled as “workshops” and running for 2 h/wk). These tutorials incorporated videos demonstrating relevant skills performed by the teaching staff and case studies that allowed students to apply their theoretical knowledge in a clinical context. The case studies required the students to identify characteristic symptoms in a patient, form an initial diagnosis, order the relevant laboratory examinations (e.g., total blood counts, computed tomography scans), and choose the most appropriate treatment. Some case studies included short videos demonstrating patient consultation procedures filmed in a simulation facility that incorporated a hospital ward and consultation rooms (59). The students were required to analyze the case in Zoom breakout rooms and form their own answers, facilitated by the tutor. All Zoom sessions and tutorial recordings were made available to all students immediately after the class on the LMS. While students onshore followed a timetable organized by the student administration unit of the Australian university, the Chinese students were assigned session times that were not part of the formal timetable of their campus.

The assessments were open-book quizzes (60% of the final mark) and a group-created assignment (40% of the final mark). The quizzes used higher order multiple-choice questions that examined the ability of the students to apply their knowledge to authentic scenarios. Only the top three quiz results contributed to the determination of the final grade. As these were open book exams, there was no restriction on materials that could be brought into the exam. The only difference between the cohorts was that due to access issues for the China campus students, while the Australian cohort undertook the quizzes online, the Chinese students used hard copies. The group assignment required each group to prepare a presentation to introduce or promote a health concept (not restricted to teaching content) to audiences with no scientific background. Students were required to research information not covered by the unit teaching content.

Study Design

Although delivering teaching using Zoom is not a new technology, there is a lack of validated surveys to gauge student attitudes toward the webinar style of teaching. Conceivably, this is due to the limited use of the platform in higher education before the COVID-19 pandemic. Instead, the investigators designed a survey. Completing the anonymous survey was voluntary, and no demographic details were collected (Table 1). Students were not surveyed regarding nationality or study major to avoid any concerns from the participants of potential cross-referencing of their identity.

The intention was to validate the survey using Exploratory and Confirmatory Factor Analysis, although the sample size did not allow the researchers to run the statistical validation.

The students were asked to rank each statement on a four-point Likert scale (Strongly Disagree, Disagree, Agree, and Strongly Agree). The items addressed whether students prefer participating in a live activity or watching the recording of activity and whether the online format provided sufficient learning material and a balanced learning experience in terms of theory and its application. The survey included open-ended questions (“1. What would you like to be changed or modified in this subject if you were to be a tutor for this course? 2. Any suggestions for improvement in the near future?”) that allowed students to give feedback on their interactions among their peers during tutorials and group assignments, any need for face-to-face learning activities, and suggestions for future refining of the delivery of the learning resources. The answers to the open-ended questions were subjected to thematic analysis.

The survey for the Australia cohort was delivered using the learning platform Canvas and available from the last week of the session for 2 wk. Due to the technical limitations of their university’s LMS, the same survey was provided as a hard copy to the students at the Chinese campus during the last of the weekly meetings of the session. Each question had the text translated into Chinese script directly below to avoid misinterpretation. Of 371 students enrolled at the Australian campus, 62 students completed the online survey (17% participation). All students enrolled at the Chinese campus completed the survey. A lower response rate for the Australian students using an online platform was expected (60). That 17% of the total Australian campus students responded was in line with the historical data on responses provided by the same administrative unit. The much higher response for Chinese students using a hard copy is consistent with a previous hard-copy survey that we have administered with students at the Australian campus (59, 61).

The University’s Student Administration Unit provided the demographic information of the Australian cohort.

Data Analysis

Each survey response was tallied to determine the extent to which the surveyed students agreed or disagreed with each statement. This number was converted into a percentage of the total number of students who submitted the survey. The final mark distributions for domestic and international students were obtained from the University’s Student Administration Unit. The same unit also indicated which students disclosed whether English was their first language when enrolled on the Australian campus. The same lecturers marked the assessments submitted by both cohorts.

RESULTS

Demographics

For the Australian campus, 368 students were enrolled in the 2020 Spring Session, of which 13.5% were international students. As stated previously, neither chosen major, demographic information, nor enrollment status was collected. Most international students identified English as an Additional Language (EAL) (58%). Most of the students were older than 20 yr old (83%), and 65% of the whole class were female. The Chinese campus cohort (n = 40) were all in their early twenties, 36 were female, and all were native Chinese speakers. Twenty-five of them had English language competency equivalent to or above International English Language Testing System (https://www.ielts.org) score of 6.5 (62.5%), the minimum entry requirement for Australian universities. The rest of the students did not attend the Academic English unit offered by the Faculty of Science of the Australian campus but attended a 500-h-long college-level English course provided by the Chinese campus for the 2 yr before enrolment in Human Pathophysiology. Although there was no available evaluation of their English competence, all the Chinese students undertook and passed four units delivered partially in English in previous semesters by the teaching staff of their host university. The Chinese teaching staff previously received teaching training at the Australian University where the investigators conducted this study.

Attitude toward the Remote Learning Format

Regarding lectures, over half of the Australian and Chinese cohorts agreed or strongly agreed to the statement, “I prefer to watch a prerecorded lecture and attend a live zoom Q&A session” (Fig. 1, and ). Over 75% of students at the Australia campus also agreed or strongly agreed with the statement, “I prefer to watch a recording of the live zoom lecture” (Fig. 1). However, nearly 60% of the students at the Chinese campus disagreed or strongly disagreed with the same statement (Fig. 1). Several students at the Chinese campus commented that there was little time to view the recordings when such activity was not timetabled.

Figure 1.

Students’ responses to the questions on the format of lectures. The results are expressed as the percentage of total answers (the Chinese campus: n = 40; the Australian campus: n = 62). SD, strongly disagree; D, disagree; A, agree; SA, strongly agree; AUS, Australian university; PRC, Chinese university. A: prefer prerecorded lecture. B: prefer live Zoom lecture. C: prefer a recording of live Zoom lecture.

More than half of the students at the Australian campus agreed or strongly agreed with the statements, “I prefer to attend a live workshop/tutorial” and “I prefer to watch a recording of the live workshop/tutorial” (Fig. 2, and ). They enjoyed the interactions with the tutors during the live tutorial (which the students referred to as “workshops” as per their timetable) and used the recording for revision purposes or when they missed a session. Some commented, “I thoroughly enjoyed the workshops”; “workshops recorded. I was unable to attend one of the workshops and would love to be able to re-watch some to write more notes on the content covered”; and “lectures and workshops recorded so that we are able to replay and re-watch content at our own convenience.” In contrast, more than half of the same cohort did not want to attend a face-to-face tutorial class (Fig. 2). However, in the open-ended questions, several students still wanted the face-to-face class to perform the practical activities (e.g., taking blood pressure, measuring lung function, performing urinalysis), in addition to watching the videos demonstrating these skills. In addition, in the open-ended questions, students also raised concerns over fewer interactions among their peers online when compared with face-to-face sessions. One stated that “I do prefer face-to-face learning as online workshops for two hours can be a bit disengaging.” While another student wrote that “12 people in there [i.e., the breakout room] only 2 would actually talk.” One student suggested, “make cameras be turned on to encourage and ‘force’ interaction.”

Figure 2.

Students’ responses to the questions on the format of case study-based tutorials. The results are expressed as the percentage of total answers (the Chinese campus: n = 40; the Australian campus: n = 62). SD, strongly disagree; D, disagree; A, agree; SA, strongly agree; AUS, Australian university; PRC, Chinese university. A: prefer live Zoom tutorials. B: prefer a recording of live Zoom tutorials. C: prefer face-to-face tutorial.

In contrast, although the students at the Chinese campus also showed preferences for both a live Zoom tutorial (Fig. 2) and the availability of the recordings (Fig. 2), more than 80% of them also agreed or strongly agreed with the statement, “I prefer to attend a live face-to-face workshop/tutorial” (Fig. 2). These students did mention issues with internet quality that affected their learning quality, notably that the Chinese campus does not provide broadband access to the students. Surprisingly, they were willing to watch the tutorial recordings rather than the lectures. This willingness may be due to the greater amount of content delivered in the latter.

When it came to collaborative learning for a group assignment, there were no clear preferences for either face-to-face or online meetings for the students at the Australian campus (Fig. 3). While those at the Chinese campus most strongly preferred face-to-face or a mix of both (Fig. 3). In the open-ended questions, students at the Australian campus suggested using various methods to communicate with their peers, including Zoom, Microsoft Teams, WhatsApp, and Facebook. However, some students noted that there could be delays in receiving information from group members and missing chat posts. Subject information was also delivered to the China campus-based students via the popular Chinese social media app WeChat, which they considered efficient (61.5% agree; 30.8% strongly agree). Therefore, while both student cohorts preferred a mixture of online and face-to-face meetings to prepare their group assignments, there was a clear preference for face-to-face among the Chinese campus students.

Figure 3.

Students’ responses to the questions on the format of case study-based tutorials. The results are expressed as the percentage of total answers (Chinese campus: n = 40; Australian campus, n = 62). SD, strongly disagree; D, disagree; A, agree; SA, strongly agree; AUS, Australian university; PRC, Chinese university. A: prefer face-to-face meeting for group assignment. B: prefer online meeting for group assignment. C: prefer a mixture of the above for group assignment.

Student Feedback on the Unit Delivery

Albeit delivered purely online, the majority of students at both universities agreed that there was a good balance between the theoretical and practical teaching (i.e., lectures vs. case studies and skill demonstrations) (Fig. 4), and more than 80% of the students considered the unit (the students understand these to be “subjects”) well organized (Fig. 4). Answers to open-ended questions reinforced this: “This semester adopted the online teaching, but I still gained a lot of knowledge of human pathophysiology”; “I liked how everything in the subject was related (lec[ture], tutorial, assessment), allowing for effective learning”; “This subject has adapted quickly and effectively to the change to online learning, and it has proven successful”; “The presentation is a good idea as it allowed students to use teamwork and creative skills and apply that to an assignment which was very enjoyable”; and “It was a [sic] unique assessment that made online learning great.” Interestingly, 87% of students at the Australian campus were satisfied with the remote learning, while only half of the Chinese campus students felt the same way (Fig. 5). In the open-ended question, two Chinese students expressed the need for the lecturers to slow down in their speech. Six Chinese students asked for a reduction in the teaching content, as there was too much to memorize. Nine Chinese students asked for more videos, images, and additional materials to help them understand the content, and one specifically asked for equivalent Chinese materials.

Figure 4.

Students’ responses to the subject content (A) and organization (B). The results are expressed as the percentage of total answers (Chinese campus: n = 40; Australian campus: n = 62). SD, strongly disagree; D, disagree; A, agree; SA, strongly agree; AUS, Australian university; PRC, Chinese university.

Figure 5.

Students’ responses to their overall satisfaction on the remote learning (A) and quiz marks (B) (Chinese campus: n = 40; Australian campus: n = 62; SD, strongly disagree; D, disagree; A, agree; SA, strongly agree), and the final mark distribution (C) [fail (F): <50/100; pass (P): 50–64/100; credit (C): 65–74/100; distinction (D): 75–84/100; and high distinction (HD): 85–100/100] among Australian campus and the Chinese campus students. The results are expressed as the percentage of total answers. AUS, Australian university; PRC, Chinese university.

Quiz Marks

Eighty-five percent of students from the Australian cohort were satisfied with their quiz marks, which were known at the time of the survey (Fig. 5). According to the data analyzed, there was a difference in the grade distribution between domestic and international students. For the enrolled domestic students, the grades were skewed toward Distinction and High Distinctions (Fig. 5), while the grades were more evenly distributed among Credits, Distinction, and High Distinctions for the international students at the Australian campus (Fig. 5). The failure rate was low among both cohorts (1.3% for Australian campus-enrolled domestic students, 2% for international students in the Australian cohort, and 5% for the Chinese campus-based cohort). Notably, among the Australian cohort, those who identified themselves as EAL speakers were less represented among the High Distinction students than those self-identified as native English speakers. However, both groups at the Australian campus still outperformed their Chinese campus-based colleagues (Fig. 5).

While receiving similar percentages of Distinctions or High Distinctions as the Australian campus cohort, only about a third of the China-based students were happy with their marks (Fig. 5). Most of these students’ grades were in the range of Pass and Credit (Fig. 5). Six students at the Chinese campus expressed the need to increase the quiz time by 25% as they experienced difficulties completing all questions during the allocated time. Reading speed and the need to check words in the dictionary were the reasons for difficulty with completion. The time allocated to complete the quiz did not arise as an issue for the students enrolled at the Australian campus.

DISCUSSION

The COVID-19 epidemic has been catastrophic, claiming many lives and affecting the economy of all nations and the well-being of individuals, including students. Among all the changes wrought by the pandemic, remote working has become commonplace. Notably, a significant number of people are indicating a preference for it, although this has not been without issues such as extended work hours and the challenges of working in a domestic environment (62–64). Students enrolled at the Australian campus echoed a similar preference toward remote learning. One of the advantages of using Zoom meetings to deliver lectures or tutorials is that they can be recorded easily and, potentially, with a high degree of fidelity. This advantage may explain why most students in both countries agreed or strongly agreed with both attending live streaming sessions and having the video recordings available. However, there was a substantially higher rate of favorable responses to face-to-face delivery sessions among students enrolled at the Chinese campus.

There are some similarities in the attitudes toward remote learning in tutorials among students at the two universities. Most students at both campuses showed preferences for remote live delivery of tutorials. The quality of any Zoom presentation can be influenced by the quality of an individual’s internet connection, the degree of student participation, and the individual’s proficiency in the language of instruction. For example, if not all the students participate in a breakout room (whether due to technical or personal reasons), then discussion and consideration of ideas will be suboptimal. In a face-to-face session, participation can be encouraged by eye contact, facial expression, and body language. This level of interaction is difficult online when a student does not always turn on the video due to shyness, privacy, or bandwidth issues. Also, remote learning is commonly in isolation, an environment likely to have more distractions than an on-campus classroom requiring students to harness strong self-regulation skills such as environment structuring to avoid these distractions.

Where the cohorts did differ was in the preference for face-to-face classes. Less than half of the students in the Australian cohort felt they needed these, whereas most students at the Chinese campus would also want a face-to-face session in addition to an online collaborative session. This difference was not a surprising response since the practice of face-to-face teaching remains the norm at Chinese campuses (42). In addition, differences in accent can also add a layer of difficulties when staff from the Australian university are themselves from an EAL background (65–67).

Most students in the Australian cohort were satisfied with remote learning. This response could be attributed to the nature of student-centered approaches in Australian universities and that students do not need to commute to the campus. Additionally, the recording of lectures and tutorials provides the flexibility of when and where to study (68). Routine recording of lectures was not always available before COVID-19 due to differences in audiovisual support and infrastructure between faculties and campuses. Previously at the Australian campus, if students missed a lecture or tutorial, they often could only rely on printed and printable resources, perhaps supplementing these with notes from their peers. At the Chinese campus, all the units delivered by their own staff were face-to-face in a classroom, and attendance remained compulsory in the absence of any legitimate reasons, e.g., illness. These same students may have anticipated the same for units delivered by the Australian campus staff rather than attending a Zoom session at a location of their choice. This failure to match expectations may explain why less than half of Chinese students were satisfied with remote learning, whereas 87% of students in the Australian cohort were satisfied with learning remotely.

The students of the 2020 cohort were examined remotely via open book online quizzes. Interestingly overall, the students achieved higher marks when compared with a cohort that studied the unit exclusively on campus with a supervised closed-book summative exam (61). One reason may be less stress in the former, given that previous studies have demonstrated that stress undermines learning and cognitive processes (69, 70). Students preparing for open-book exams or quizzes may be required to utilize learning strategies based on higher order thinking rather than being structured around student recall of content (71, 72). Therefore, the learning experience is more active and helps students understand and apply what they have learned (73).

The better performance of international students in the Australian cohort than those at the Chinese campus could have been due to several reasons. The international students of the Australian cohort had studied in an English-speaking environment for at least a year at the time of enrolment in Human Pathophysiology. Albeit the grade distribution of students at the Australian campus who self-identified as EAL suggests that English proficiency can still have an impact on their performance, their familiarity with academic English could still give these students an academic advantage compared with students at the Chinese campus. Notably, most students at the Chinese campus could not complete all questions within standard quiz time and suggested they needed more time to complete them. Another consideration is the type of assessment. Open-book exams or quizzes ideally focus more on applying knowledge than recalling information. The students at the Australian campus undertook supervised open-book exams and quizzes before Spring 2020. However, tests for in-house units at the Chinese campus are still closed book, which was likely to have an impact on how these students prepared for any quiz in Human Pathophysiology. Notably, seven students from the Chinese campus asked for more practice questions for the quizzes or to be told what contents to examine from each lecture. These requests align with a common approach adopted by students in China at all levels by practicing how to answer exam questions instead of learning how to apply the knowledge (74–76). The students in China likely prepared for closed-book assessments without realizing the quizzes for Human Pathophysiology were evaluating their application, rather than recall, of content. This was despite the intention of the Human Pathophysiology tutorials to encourage the application of knowledge, seeing the students “skilled up” to utilize the same approach for the open-book quizzes. There has been a discussion in the literature on transitioning from closed-book to open-book exams and quizzes (77, 78). Students need time and scaffolding for this transition. Strategies include the educator providing exemplars of questions to prepare the students. The Australian campus students have had these resources since 2018, as well as a video on how to prepare for open-book tests. These resources were embedded into the LMS and had more than 2,000 views in previous years.

This study has several limitations. For instance, it has a gender imbalance, specifically for the Chinese campus cohort where 90% were female (cf. 65% in the Australian cohort). This imbalance could have had an impact on the comparisons made in this study as the literature has reported gender-related differences in the attitude toward using Information and Communication Technology according to gender (79–81). The experience of studying Human Pathophysiology also differed between the two cohorts. Teaching was delivered exclusively online for those attending the Australian campus, with the assumption that streaming to a primarily urbanized and domestic cohort would be of good quality, whereas, at the Chinese campus, the quality of the online delivery appeared to be suboptimal due to internet quality of the local providers (Wang Y, Liu G, Zhang Z, personal communication). Only 17% of the students in the Australian cohort filled in the survey, so the responses may not reflect the attitude of the whole class. However, this response rate was considered representative for this cohort. In the absence of collecting demographic information from the participants, we were unable to segment the responses of the Australian cohort based on their citizenship status. Such information could be incorporated in future survey designs. Also, the study did not incorporate follow-up interviews and focus groups that would have allowed the investigators to investigate better the responses to the open-ended questions (57). Finally, the study collected data in one session only. A longitudinal study could provide a more accurate view of Chinese student attitudes toward remote learning, particularly after additional experiences of student-centered approaches.

As a recommendation, using the Hofstede Model of Cultural Differences to frame future research in the field will be ideal as it could identify cohort’s characteristics and develop strategies to achieve a culturally sensitive learning design and empower students to become self-directed learners (44). This adoption could include utilizing a scaffolding strategy for offshore Chinese students to support their remote learning. This strategy will support the transition to open-book exams and applying knowledge rather than just recalling it. Discussions via online conferencing on strategies for preparing for open-book quizzes could be helpful for Chinese students. Additionally, a welcome video to the unit in which teaching staff highlight the expectations and point the students to support resources will be beneficial. Such a video can be linked to a quiz about the teaching strategies in the unit to optimize students “buy-in.”

Conclusions

Students welcome remote learning in a familiar language and learning environment that is student centered. However, if the teaching is delivered in a second language using unfamiliar teaching methods, remote learning will require scaffolding to enhance their learning experience. This preliminary study opens the window to future research aiming to standardize the delivery of the unit across different nationalities.

DISCLOSURES

No conflicts of interest, financial or otherwise, are declared by the authors.

AUTHOR CONTRIBUTIONS

H.C., D.v.R., and J.R. conceived and designed research; H.C. and B.G.O. performed experiments; J.R. analyzed data; H.C. and J.R. interpreted results of experiments; H.C. prepared figures; H.C. and D.v.R. drafted manuscript; D.v.R. and J.R. edited and revised manuscript; H.C., D.v.R., J.R., and B.G.O. approved final version of manuscript.