Advantages and challenges of fostering cognitive integration through virtual collaborative learning: a qualitative study

The drastic shift from physical lectures and tutorials to online or virtual learning during the start of the COVID-19 pandemic in the first quarter of 2020 has enabled educators to utilise existing platforms that ensure continuity of learning for students. This was to address the need to find innovative ways of delivering the same quality of content to learners despite the limitations of not having face-to-face classes. Such a move was particularly vital for health professions students who needed to continue acquiring knowledge in preparation for their clinical postings despite the challenges of the pandemic.

In many countries, COVID-19-related restrictions have prompted the shift from traditional physical classes to remote or online learning. Various modes of online instruction delivery have been implemented, each with its own merits and drawbacks. However, the common perception that face-to-face instruction is superior to virtual or online teaching still permeated most of the educational milieu [1]. Although the online or virtual platform did offer the flexibility of having more efficient time management [2], some still argued that the platform did not motivate some students to engage in meaningful discussions that create rich learning experiences [3]. In addition, most educators were caught unprepared as some were not well versed with technology, while others resisted the integration of technological innovations into their pedagogy [4]. It is thus not surprising that the quality of these “emergency” initial virtual learning experiences might have been subpar in standard compared to traditional face-to-face modes [5].

The use of existing strategies for teaching and learning to augment the perceived inadequacies of virtual learning became important. One such strategy is the collaborative learning method. Collaborative learning is an educational approach to teaching and learning that promotes group engagement. This strategy has the potential to develop critical thinking and facilitate cognitive integration among learners [6]. Its innate characteristic of being student-centred, allowing learners to actively work with each other; finding meaning and understanding of concepts needed to create new knowledge, assists in promoting deep learning [7]. Although the use of a collaborative learning strategy through virtual platforms is not entirely new, the advancements in technology made way for the use of collaboration as a part of virtual learning activities for learners to achieve a collective understanding of shared knowledge, resulting in a shared mental model [8‐10]. Currently, virtual collaborative learning is becoming a cogent substitute for face-to-face learning, particularly in the field of language learning where this approach has been more readily used [11]. The virtual mode of collaborative learning has also been utilised in nursing education, albeit non-extensively, using different forms of virtual learning activities [12‐14]. Similar to face-to-face collaborative learning sessions, these virtual activities aim to promote a robust sharing of ideas and the assimilation of knowledge from different perspectives and sources that lead to deep learning and the generation of new knowledge that is coherent for all participants. According to Redmond and Lock’s [15] Collaborative Online Learning (COL) framework, which was based on a social constructivist approach, knowledge in action is an amalgamation of active processes that involve active participation and sharing of knowledge by the learners within a digital environment; hence personal meanings are discovered, and new knowledge is created. Careful planning and design of the learning activity are thus imperative. Technology to support virtual collaborative learning needs to also be carefully considered such that the objectives of the learning experience are met, and the learning outcomes are supported [16].

Utilisation of face-to-face collaborative learning sessions at the end of the semester has been one of the educational approaches for an integrated module comprising of pathophysiology, pharmacology, and nursing practice. This module is taught to undergraduate nursing students with the objective of helping them make sense of these three disciplines and integrate concepts learned from pathophysiology and pharmacology to achieve an informed nursing practice knowledge solidly founded on basic science concepts. The development of learners’ cognitive integration is the central pillar that underpins this teaching approach. Cognitive integration is particularly of vital importance in health professions education, such as in nursing education, as it is closely linked to clinical reasoning skills [6]. The competence to apply clinical reasoning in practice, on the other hand, is essential to achieving positive patient outcomes [17]. With the urgent need to shift physical collaborative learning classes virtually due to the pandemic, considerations as to the viability of collaboration in a virtual platform was explored and evaluated. The objective of delivering an engaging learning session that effectively integrates concepts and information from pathophysiology, pharmacology, and nursing practice with the authenticity of a face-to-face interaction via a virtual platform was of utmost importance. Traditional face-to-face collaborative learning involved a case discussion for individual practice, a class discussion of the case study, small group work to analyse components of the case study, and another class discussion to share the small groups’ findings and consolidate the information with the facilitators.

Drawing, therefore, from the concepts of the COL framework, which uses six components contributing to learning in action, this study aimed to describe and evaluate a virtual collaborative learning activity implemented for first-year undergraduate nursing students to facilitate cognitive integration. Focus group discussions were conducted to elicit students’ and faculty’s perceptions of the virtual collaborative learning pedagogy utilised during the initial period of the COVID-19 pandemic.

Separate focus group discussion sessions were conducted for first-year undergraduate nursing students and nursing practice faculty. Three themes were generated from the thematic analysis of the students’ focus group scripts. These were: (1) achieving engagement and interaction, (2) supporting the collaborative process, and (3) considering practical nuances. The three themes were further subdivided into subthemes to highlight noteworthy elements captured during the focus group discussions. Three themes emerged from the focus group discussion scripts of faculty participants: (1) learning to effectively manage, (2) facing engagement constraints, and (3) achieving integration. These themes were further sectioned into salient subthemes. Table 1 shows the themes and subthemes from the student focus group discussions. Table 2, meanwhile, highlights the themes and subthemes from the focus group discussion involving the faculty.

Based on the findings from the focus group discussions of both student and faculty participants, the virtual collaborative activity may have a potential effect on learning and can be at par with face-to-face collaboration in terms of meeting learning objectives, as already noted by some studies [11, 22]. However, much has to be done to enhance its ability to truly engage students with their facilitators, with each other, and with the content as face-to-face sessions could not be merely transferred virtually lock, stock, and barrel [9].

The educational success of any learning endeavour is reliant on multiple factors. A student-centred approach wherein students actively participate in their own learning fosters engagement. Engagement, meanwhile, aids in critical thinking needed for cognitive integration and deep learning to take place [6]. Collaborative learning is a strategy that relies on teamwork to reach a common goal. Thus, achieving engagement and interaction is important. The student focus group discussion findings highlighted that the participants understood the need to engage during the collaborative learning session to benefit from it. Most students considered the richness of face-to-face interactions as more beneficial to their learning as compared to a virtual mode of collaboration; visual elements of face-to-face interactions, such as facial expressions and gestures, contribute positively to learning [23]. However, in a study by Ku et al., [24], it was noted that students preferred to work online collaboratively as compared to face-to-face. This was in line with evidence showing that online is as valid as a face-to-face collaboration in supporting learning [25]. As face-to-face learning could not just be converted wholesale to virtual learning for it to be effective in engaging students, the learners should first be motivated to engage [3]. This is so because effective virtual collaboration requires an active interaction among all those involved [26]. In addition, the participants of this study appropriately underscored that elements such as learners’ personality and cultural differences contribute to the success of any virtual learning activity. These factors were, in fact, also identified in literature as variables that influence virtual learning [27, 28]. Furthermore, the participants’ acknowledgement that discipline and control (e.g., engaging even when they don’t feel like talking) are needed during virtual collaboration to avoid zoning in and out of the session, validates the importance of emotion regulation. Emotion regulation is “a sequence of transactional emotion episodes within a social event or scene, where the unit of analysis is not a lone person but a person in the context of other people who are mutually influencing one another within the bounds of a social episode” ([29] p.13). Hence, the effect of each learner to self-regulate his or her emotions during the session is intrinsic to its success. Indeed, the socio-emotional aspects of working collaboratively pose challenges that may undermine the effectiveness of collaborative learning. As such, these aspects, emotion regulation in particular, should be recognised and addressed for learning to occur [30, 31].

In supporting the collaborative process, the students highlighted that knowing their peers matter as group dynamics is vital to be able to achieve the goals of collaboration. Some students noted that this was lacking in the virtual collaborative session. This was because the students were only in the second semester of their first year in the nursing programme when face-to-face was converted to virtual teaching because of the pandemic. Furthermore, the collaborative learning session comprised two combined tutorial groups of first-year students hence it was logical to expect that students only knew those who belonged to their own group since the first semester. A study by Janssen et al. [32], reported that positive perceptions of online communication and collaboration result from participants’ better familiarity with each other. Higher familiarity with the group would result in better teamwork and the ability to reach mutual agreements because of more favourable team satisfaction [24].

Students also mentioned that having a holistic view of the different disciplines included in the virtual collaboration would be helpful. When learners have the proper view of the pathophysiology and pharmacology, and nursing practice components, that is, that these disciplines are linked, then it is easier for them to collaborate thereby facilitating cognitive integration [6]. Cognitive integration is one goal of collaborative learning, and the ability to formulate links in knowledge has clinical implications as it is associated with clinical reasoning.

The virtual collaborative learning experience also posed some issues that highlight the importance of considering practical nuances related to the implementation of the pedagogy. These practical concerns impact on the students’ experience of the virtual collaboration and affect their overall benefit from the activity. Some students were quite comfortable with technology, yet technical problems resulted when connectivity disconnects, that is, when their internet connectivity was disrupted, either by a slow internet speed or by a faulty hardware. In fact, a recent study noted that stability of the internet connection is one challenge that threatened the effectiveness of an online learning strategy [33]. In addition, to effectively engage in any virtual learning, students need to first interact with technology. This could be a daunting exercise for those who are not so technically-savvy and could result in limiting the benefits of a virtual learning collaboration [26]. Meanwhile, having an online collaborative class was favourable to some students as they valued being comfortable while engaging in the session. This means that students perceived that their learning was not compromised in any way because the virtual platform afforded them with efficiency, time management and comfort that facilitated their learning [2, 34]. Hence, it could not be denied that practical considerations also need to be initially studied when planning for a virtual collaborative learning activity as these could adversely negate the positive outcomes educators intend to achieve.

Some ideas from the faculty interviews did overlap and were well-aligned with those of the students’. Learning to effectively manage is one of the themes that was generated. Faculty served as facilitators; hence they were expected to be initiators of the virtual collaboration. Faculty involved in this virtual collaborative learning highlighted that an advantage of a virtual platform was that they appreciated gaining more control of the session thus allowing them to manage the session more effectively. In a typical face-to-face collaborative learning, faculty faced the difficulty of organising the class more efficiently for example, in terms of attendance-taking and preparing the audio-visual set-up in the classroom. These challenges were overcome by greater control provided by the virtual platform to the faculty in facilitating collaborative learning. This resonates with the findings of Glava and Glava [35] which stressed the importance of time management in one online learning platform.

Leading and facilitating the virtual collaborative learning also required the faculty to be proactive and engaging. This was particularly challenging when the students were unwilling to engage because of being naturally shy or quiet. Providing a means to participate in the virtual collaboration was definitely something that the faculty needed to address. Thus, the chat function of the virtual platform proved to be helpful, and faculty encouraged shy students to type in their questions. However, this chat function also served as a distraction as faculty were sometimes overwhelmed by multiple chat questions and comments from students within a short time span. Prior online or virtual teaching experience by educators is thus needed to use the online platform more effectively in teaching [36]. Faculty involved in the virtual collaboration were experienced educators. However, they were new to virtual collaborative learning. Hence, it has been suggested that aside from experience, continuous training is needed to ensure the success of educators engaging in virtual pedagogy [37].

Another theme that was generated during the faculty focus group discussion was facing engagement constraints. The purpose of virtual collaboration was to facilitate engagement that brings about critical thinking and cognitive integration [6]. However, there were inherent constraints to virtual collaboration. This finding was also highlighted during the student focus group interviews. For instance, the faculty noted that opinions of those who tend to be shyer were not verbalised and heard. This restricted the robustness of the interchange of ideas thus achieving true discussion is limited, restricting the learning experience.

While some student participants underscored the fact that they did not know their peers, the faculty also highlighted that it is also imperative that faculty know the students. Having a relationship matters and, in this case, this is akin to knowing the students involved in the collaboration. This is in line with the findings of Smith and Crowe [38], which noted that social connection with students and teaching presence are vital to educators in virtual teaching and learning.

The ultimate goal of the virtual collaborative learning session was to help students integrate concepts and knowledge gained from pathophysiology, pharmacology, and nursing practice. The session was designed to apply information from these disciplines to a case study as the students worked in small groups using the breakout rooms. Achieving integration was found by some faculty to pose challenges. Although both pathophysiology and pharmacology, and nursing practice facilitators were present during the session, having them facilitate the session one after the other did not mirror true collaboration. In fact, one faculty interviewed noted that because of having this clear delineation, integrated teaching or co-facilitation did not necessarily happen as the session was more of a “two-in-one” session. Literature has indeed mentioned that students mimic how educators collaborate to become collaborators themselves [39]. Hence, when facilitation becomes segmented, collaboration between the facilitators become non-existent and integration may be difficult to realise. Clarifying principles of integration is vital for faculty prior to engaging in a virtual collaborative activity. In addition, the design of the questions used during the virtual collaborative learning is also an important element in achieving cognitive integration. An effective questioning technique promotes critical thinking [40] and is a significant element that aids students synthesise knowledge. Guide questions used in collaboration should thus be better crafted to meet this goal as effective question structure is key.

The COVID-19 pandemic has dictated a major shift in various processes globally. Higher education was not exempt. The need to convert face-to-face classes to virtual learning activities prompted educators to think of new ways and approaches to deliver content to students remotely without compromising the quality of their learning.

Collaborative learning is a strategy that has proven to be effective in developing critical thinking and aiding students in cognitive integration [6]. In many instances, synthesis of knowledge from a combination of disciplines has been effectively achieved through collaboration as this approach has been shown to stimulate student learning [45]. However, the use of a virtual collaborative learning pedagogy to facilitate integration and synthesis of knowledge is a relatively new approach to learning. It is vital that the intrinsic characteristics of the collaborative learning experience, such as the sharing and creation of knowledge through teamwork, not be compromised when this pedagogy is used virtually instead of face-to-face; doing so will help achieve knowledge integration and effective learning.

This study evaluated the use of a virtual collaborative learning session for first-year undergraduate nursing students enrolled in an integrated pathophysiology, pharmacology, and nursing practice module during the initial stages of the COVID-19 pandemic. Key findings from the focus group interviews, both from the faculty who facilitated the session and the student participants, highlighted the valuableness of the pedagogy. However, enriching this pedagogy by addressing variables that impact the learners and the educators need to be prioritised prior to its implementation. Student involvement during the collaborative process should be ensured. The educators’ comfort and adaptability to the new modes of delivering content and facilitating knowledge acquisition by the students should also be given appropriate focus. With better planning directed at addressing the learners’ needs and the faculty’s capabilities and readiness for online learning pedagogies, and with a strong institutional support to help mitigate the identified constraints of virtual collaborative learning, students and faculty will definitely benefit.