The origins of education delivered by distance learning trace back to the 18th century, when on 20 March 1728, the Boston Gazette, advertised teaching and tutoring on the subject of shorthand, which Professor Caleb Phillips delivered by correspondence [1]. Numerous authors have described the history of distance learning in depth [1, 2] but it is of interest to note that, within the United Kingdom, during the 1840s, Sir Isaac Pitman established the first correspondence teaching school. Pitman delivered not only shorthand teaching, but also assessment and feedback using distance learning as he sent postcards to students on to which they would transcribe passages from the Bible and return, by post, for correction [2, 3]. Globally, correspondence education expanded, during the 19th century, with a significant event occurring in 1858, when the University of London pioneered the delivery of global degree level education by correspondence distance learning education [4]. The most subsequent notable development over 100 years later in relation distance learning occurred on the 23 April 1969, when the Open University (OU) was established by the Royal Charter [4]. According to Royal Charter “The objects of the University shall be the advancement and dissemination of learning and knowledge by teaching and research by a diversity of means such as broadcasting and technological devices appropriate to higher education, by correspondence tuition, residential courses and seminars and in other relevant ways, and shall be to provide education of University and professional standards for its students and to promote the educational wellbeing of the community generally” [5]. The OU became the world’s first university solely devoted to distance learning and in its first year, 1971, enrolled approximately 24,000 students, offering courses to students with all abilities and disabilities which were primarily delivered by correspondence and television [1].

As technology advanced so did the mode of delivery, the number of education providers globally and the range of educational programmes offered remotely (see Figure 1 for historical milestones in distance and e-learning) [6–10]. The most significant impact was associated with the development of digital computing technologies including the internet and the World Wide Web, which led to online distance learning (e-learning) delivery [1] which has now significantly replaced the previous media of delivery, namely, correspondence, phonograph, radio, telephone and television, particularly in countries with good communication and digital infrastructure [6]. Online platforms and e-learning management systems have transformed the current approach that education providers have taken with the majority offering both blended learning and fully online distance or e-learning education.

Distance learning addresses all 17 UN sustainable development goals (SDGs) (Figure 2), by creating innovative solutions through education, to each of these goals by varying degrees [11], but particularly three of these goals, namely, 1 (No Poverty), 4 (Quality Education) and 5 (Gender Equality) (Figure 2). Access to education has been described as an avenue out of poverty [12]. Distance learning may help alleviate educational costs by staying at home, thus avoiding travel costs to educational institutions, accommodation costs, as well as remaining at home to undertake employment around asynchronous learning platforms. However, poverty can itself impede learning by contributing through a vicious cycle of poor digital access and connectivity within the domestic setting. If digital access can be secured and maintained, e-learners may avail of multiple free web-based resources, but which may not award academic credentials on successful completion. Socio-political factors are important considerations for the introduction and development of distance learning. Komba (2009) concluded that education is an important tool for socio-economic development and a key factor in strengthening human capabilities and reducing poverty in an increasingly globalized world [13]. Distance learning plays a significant contribution to SDG4 (Quality Education). A study from Thailand concluded that for SDG4 to be met, then distance learning requires a quality digital infrastructure of connectivity to allow for sustainable learning [14]. Distance learning may also play a crucial role in helping reduce gender inequality. A study from Tanzania showed that Open and Distance Learning had a crucial role in promoting gender equality and women through empowerment by widening access of education for both women and men and hence improving their socioeconomic and political status [15]. The study showed that the majority of women enrolling did so as it was the only means that they could learn, sustain their career and simultaneously care for their family [15]. A further study from the Philippines made an important point that web-based applications are gender-neutral, which may support the uptake of distance learning [16]. Likewise, Margolis and Fisher 2002 suggested that online education methods are non-sexist and more gender-inclusive [17].

Distance learning programmes are chosen by students for a variety of reasons however it must be acknowledged there are several challenges associated with the delivery of such programmes both for the course team and the student, which need to be addressed (see Table 1). In recent times, the COVID-19 pandemic has forced a root and branch re-examination of provision and capabilities of digital infrastructure and an opportunity to horizon scan to anticipate current and future needs within universities and colleges, as well as within junior, middle and senior schools. It created a watershed relating to the hegemony of physical teaching over distance learning. The barriers and challenges of such “emergency delivery” of educational programmes have been extensively reported [18], particularly in relation to the training and final year research project assessments of students enrolled in biomedical science degree programmes [19, 20].

For many individuals, however, online distance learning education has been and still is a personal choice both pre- and post-pandemic, particularly in relation to postgraduate programmes. Within Ulster University, prior to the pandemic, between 2008 and 2019, 4,000 students graduated with an on-line degree/short course qualification from 109 available e-learning courses, supported by 100 part-time e-tutors. More than 70% of these students were enrolled within the Faculty of Life and Health Sciences, indicating the value and interest in distance learning programmes within this discipline area.

Successful completion of the Institute of Biomedical Science (IBMS) accredited MSc degree programmes both on campus and via distance learning, provide eligible IBMS members an opportunity to be recognised as Chartered Scientists [21] and offer a valuable opportunity to promote career progression. As of March 2021, seven universities offer 28 IBMS accredited postgraduate distance learning educational programmes [21]. In relation to the biomedical science postgraduate distance learning courses at Ulster University, enrolment generally comprises of mature allied healthcare professionals who are working fulltime and have various life commitments. As such, distance learning courses offer the required flexibility to enable individuals to balance such commitments whilst furthering their education [22].

It is essential that students enrolled on e-learning programmes are delivered a quality and valuable teaching experience which helps equip them with the knowledge and relevant skills to enable them to be valuable contributors within the workplace and society. The “Know-Do-Be Theory” of education which resulted from UNESCO Commission, “Education for the Twenty-first Century,” is the cornerstone when designing the curriculum and specific learning outcomes and as such direct the key aspects of what needs to be assessed [23].

In the module in this study “Advances in Clinical Microbiology,” it is essential that students, who are generally currently allied healthcare professionals in this discipline specific modality, gain a knowledge of the rapid evolving issues such as antimicrobial resistance, vaccinology and emerging pathogens of global concern, which contribute to “making the material alive to students” [24], as well as the development of automated, digital and molecular diagnostic platforms which are transforming the clinical microbiology service. The fourth pillar of “Know-Do-Be Theory” i.e., learning to live together is particularly important in terms of distance learning where students from diverse geographical locations and backgrounds must learn to live and study together and treat others with value and respect [23]. Also, of particular relevance in the twenty-first century holistic model of education is the opportunity to develop competencies and employability skills [25] which is of particular importance in relation to the Integrated Design Framework [26]. Such Biomedical Science online educational programmes at Master’s level also provide students from the biomedical science sector the opportunity to expand and develop competencies aligning with the 2023 updated Health and Care Professions Council (HCPC) standards of proficiency (SOPs), particularly in relation to digital skills and new technologies, leadership, and equality, diversity and inclusion [27]. In addition, the World Economic Forum has detailed the most critical 16 “21st-century skills” required by students to support them as they seek and further their careers in a “technology-mediated world” [28].

A primary disadvantage of e-learning is the minimal opportunities for face-to-face interaction which in turn can impact on students in terms of course satisfaction, engagement, communication, psychology and a lack of sense of community [29]. Distance learning students can often feel isolated due to the temporal separation from both their tutor and peers [22], hence it is important to foster the establishment of online learning communities. The curriculum of the “Advances in Medical Microbiology” module embraces global issues and developments within clinical microbiology and this module provides healthcare professionals with life-long learning opportunities to professionally develop their knowledge of the various emerging issues and developments in clinical microbiology and infectious diseases [30]. This curriculum coupled with an international enrolment, provides a valuable environment for global engagement which should be harnessed so that students can appreciate by learning from each other the real-life impact of the curriculum content from different perspectives across the globe. Interaction of students has been reported as a key element in designing any e-learning activity in general. Various approaches have been used to embed online community interaction and engagement with the e-learning course content, such as collaborative projects, discussion forms and peer evaluation [24]. Although discussion forms are embedded in many online platforms such as Blackboard, learning experiences are more enhanced when a variety of media, i.e., written, visual and verbal, are used to communicate in an online student group [24].

The aims of the development and execution the virtual group assessments described in this paper were to establish an authentic, valid and competency-based group assessment which aligned with the learning outcomes of the module (see Supplementary File S1). This group activity was designed to establish learning communities culminating in the creation of a digital output which would permit the assessment of all six levels of Bloom’s Taxonomy [31]. The development of the creative outputs and their subsequent sharing and evaluation by peers coupled with the consequential validity of the assessment on student learning, would provide students the opportunity to expand microbiology discipline specific knowledge. Additionally, this would promote the development of transferable digital, reflective and social competencies, such as communication, collaboration leadership and respect of others [32].

Online group assessment, requires extensive planning, assignment design and access to student support to ensure effective strategies are in place to counteract any challenges faced by academic staff or students when undertaking such activities [36]. This form of assessment was considered in this current study, as it ultimately fosters student negotiations in relation to co-construction and constructive conflict, leading to a mutual cognition resulting in the development of deeper learning and interpersonal skills, all of which are relevant within professional practice [37]. Furthermore, a group-based activity helps to establish an on-line learning community promoting “team engagement” and “collaborative creativity” [38], which encourages an “interaction-knowledge network” and a sociocognitive approach to learning by aligning to real-life collaborative scenarios.

In the case of the current group assignments, students acknowledged the opportunity to execute their creative skills (Figure 6B) and the group activities fostered good teamwork, building a collegiality which resulted in successful attainment of the assessment learning objectives and the construction of a final product which students felt proud of (Table 3). The pinnacle of Bloom’s modified taxonomy is creativity, which these group activities promoted, however, it has been reported that students of biomedical science may not realise creative opportunities [39]. Educators, therefore, have a responsibility to define creativity and innovation; particularly where this applies to the learning outcomes through assessment, enabling students to recognise and harness their creative abilities and appreciate the value of these skills in terms of employability [39]. Educators must also be mindful when designing group activities, that dominant members do not negatively impact on the activity of their peers [38]. From the student reflection in relation to these assessments, this did not however appear to be an issue, in contrast students reflected they were encouraged and supported by their peers and felt great pride for their co-produced digital output (Table 3).

The challenges which have presented in the integration of online groupwork need to be acknowledged and have been discussed in a recent systematic review by Donelan and Kear [36]. Several of these challenges were identified during the two group assignment activities, namely, i) initially prior to the commencement of the group activities, students were concerned that not all group members would participate equally, however such fears were rapidly dispelled once the members of the group made initial contact; ii) scheduling and time issues impacted on the ability to hold virtual meetings in real time and iii) anxiety was reported in relation to having to work with strangers in a remote situation (Table 3). Students overwhelmingly however, valued the group assessments and many reported that these activities promoted them to take on leadership roles, both within the assessment and subsequent translation within the workplace.

Donelan and Kear [36], concluded that although the literature identifies numerous challenges, for which strategies have been developed to address, there are two fundamental areas which are a priority for consideration, namely, i) that initially all aspects of the group activity are carefully designed supplying students with detailed guidance and preparation and ii) the groups’ relationships are supported throughout the duration of the activity [36]. It was therefore essential, academics robustly developed an assignment plan (Figure 8) and that early in the module clarity was provided to students in relation to i) which aspects of the group activity were being assessed, i.e., individual/group contribution, ii) details regarding the process and tools used to prepare the final product and that e-tutor support was available throughout the process to offer guidance. Such clarity helped to alleviate any concerns students may have had relating to the assignment task. This approach is also transferable to online group debates in other healthcare and non-healthcare educational programmes.

To guide developments relating to assessment, it is important to critically appraise evidence-based practice approaches and assessment guidelines in conjunction with the students’ voice, gathered by means of local student feedback and reflections to help mould the final product into an engaging, challenging, criterion-referenced assessment. Such assessment embeds the translation of relevant pedagogical theories; particularly those of Anderson and Krathwohl’s modification of Bloom’s Taxonomy [40] and Biggs’ constructive alignment [41], into educational practice, to help students become effective learners. Following the assessment of the first group activity in which student cohorts prepared a slide deck on topical issues in clinical microbiology, it was considered by the course team that although the students enjoyed the activities and their knowledge of the subject area was enhanced, a more critical appraisal of the topics could have been promoted. Additionally, in relation to the group 1 assessment activity, two groups were proud of their achievements and although not compulsory, wished to orally deliver their slide deck via a live Blackboard Ultra session. As such, the group assignment was reconstructed to include a recorded oral presentation in a debate style format to ensure a positive student experience focusing on higher order thinking processes and competencies, as well as summative and formative learning approaches to help prepare students for the workplace environment [25, 32].

Debate incorporates constructivist pedagogies and offers a platform for students to express and consider diverse thoughts and ideas [42]. This activity has been used effectively in face-to-face teaching to develop and assess higher-order cognitive and communication skills, stimulating interest and confidence and acquire knowledge in microbiology [42–44]. On-line debate encourages group interaction in an innovative and a more engaging manner using digital communication and presentation rather than the use of traditional discussion forums [45]. Indeed, students reflected that they found the use of discussion forms frustrating as these forums did not allow communication in real-time (Table 3). If conducted asynchronously, on-line debate could permit a more critical evaluation of the scientific evidence before constructing a response, thereby providing a pedagogical strategy promoting reflexivity [46]. On-line debates have not been used extensively as an assessment model which may be due to the fact that their coordination and evaluation requires significant input particularly if delivered via Blackboard Discussion Forums [47], as such it was decided that the delivery of these online debates would be by means of an audio-visual format, namely, voice over PowerPoint. Careful consideration was required in relation to the logistics and digital tools required within the online setting. With provision of the appropriate digital platforms and tools and e-tutor guidance, students successfully delivered their voice over debates, which resulted in an improvement in utilising critical thinking skills in comparison with the preparation slide deck in the first group activity (Figure 6A).

The challenge associated with developing assessment is to ensure it is effective and fair to all students and staff, as recently considered within JISC’s report [48], “The future of assessment: five principles, five targets for 2025.” This report examined how new technologies, namely, digital tools and platforms, can improve and ensure assessment is authentic, accessible, automated, continuous and secure, resulting in students having a fulfilling learning experience, as they develop skills and character during their education and for future employment. Online group activities offer an ideal environment for students to develop their leadership, time-management, collaborative and organisational skills but most importantly digital communication and digital creation skills all of which are central to the success of online group activities as well as a skill set transferable to the workplace [36].

While this study has focused on the evaluation of the development of microbiological knowledge and transferable skill development, when embedding a new form of assessment, it is of utmost importance to provide students with feedback. Feedback and more effectively feedforward coupled with clear instruction is an important aspect of assessment and the meta-cognitive experience [49, 50] contributing to students becoming effective learners by correction and development. The initial submission of a group strategy, enabled students to receive feedback which they could then subsequently feedforward into the development of their final output.

Such feedback guides students to understand requirements in terms of their understanding and demonstration of knowledge and promotes development through reflection, thinking, reading and writing [51]. In the case of distance learning students, feedback is a source of intrinsic motivation [52]. Consideration is required when delivering feedback in relation to a group activity to ensure all students fully appreciate and value the feedback in terms of both their own performance and in relation to group performance. Feedback in the form of peer assessment provides an opportunity to challenge students cognitively and highlight areas which deviate from the standards required [53] and should be considered in group-based assessment. A number of feedback modalities both written and verbal may be used to support students’ varied needs and preferences [49]. Students report a preference for written feedback [54], although verbal and face-to-face feedback are considered more personal and thorough [55]. In the case of these assignments, the e-tutor delivered personal written feedback and general audio-visual feedback to the complete cohort of students. Overall, whether feedback is written or verbal, it is important to ensure the tone and language used is not derogatory but offers valid, balanced, personal and motivational advice linked to learning outcomes which students can respond to in order to promote improvement [56].

Reflection is of fundamental importance to all allied healthcare professionals and is central to their continual professional development. Many education providers of biomedical science programmes have embedded reflection into their assessments [57, 58]. Reflection can take many forms, visual, written, audio, etc. and valuable resources are available for healthcare professionals and academics to promote to their students [59–61]. Within these assessment tasks, two modalities of reflection were incorporated, namely, written and a reflective video. The reflective video was prepared using the free Microsoft app FlipGrid (now known as Flip), a social learning community app, which educators globally have used to create safe online groups for students to communicate and convey their thoughts and ideas using short video messages [33]. FlipGrid has been used in all levels of education to promote student engagement and discussion [62]. In relation to higher education, FlipGrid has been used to promote scientific communication and enhance oral skills [63]. It has been used both by students and academics and has the potential to help build online educational communities [63]. FlipGrid has also been used to facilitate and improve critical reflection by collaborative online interactions in a undergraduate Sports Coaching degree programme [64].

Students in this study who used the FlipGrid to reflect reported that this digital tool was easy to use and that they enjoyed being able to see that they were part of a larger group of individuals who had the same successes, challenges and reflective thoughts as their peers, with only two students (2/41) indicating that they found the recording of a reflective video challenging and stressful. It should be noted however, that FlipGrid also provides the opportunity to make audio posts and students can use a still image or avatar image if they do not wish to reveal their face [65]. Further studies are required to fully examine the potential of utilising FlipGrid to promote e-learning communities and asynchronous interactive discussions in the discipline of biomedical science.

In addition to the knowledge acquisition gained during the completion of these two group activities, it was evident that the skills which students developed were of particular value in relation to digital platforms, digital tools and digital communication. These are important skills to develop, particularly in relation to the updated HCPC Standards of Proficiency (SOPs), effective from 1 September 2023, which have emphasised the need to be able to keep up to date with digital skills and new technologies, namely, 7.7, which addresses effective communication “Registrants must use information, communication and digital technologies appropriate to their practice” [27]. Both of these group-based activities were conducted prior to the updating of the SOPs and it is interesting to note that prior to the assessment tasks students attributed a lower importance to the development of digital skills than skills development with respect to communication, teamwork, accuracy confidentiality, respect for others and health and safety. This highlights the importance of embedding and highlighting where such digital skills are useful within the healthcare setting and the biomedical science sector [66]. Within this study, students reflected and acknowledged areas where they had already used or would potentially use such digital skills in their workplace (Figure 7). It must also be acknowledged that the majority of students enrolled in this distance e-learning postgraduate programme did not actively participate in using a range of digital platforms and digital tools in their undergraduate programmes (Figure 5) with many unfamiliar with the full potential of PowerPoint and some students had never used this tool. Educators should, therefore, actively seek opportunities to embed digital skills and digital communication skills in both undergraduate [57] and postgraduate biomedical science degree programmes which are IBMS accredited and/or HCPC approved. Additionally, the use of digital tools in e-learning programmes, enhances engagement with the discipline specific content, provides motivation in relation to learning and assessment activities, and promotes communication between students and their peers as well as tutors [30]. Furthermore, from this study, the group-based activities fostered students’ confidence in taking on leadership roles and instilled an appreciation of the importance of inclusivity of other’s viewpoints and abilities, which aligns with the updated HCPC Standards of Proficiency in relation to equality, diversity and inclusion, namely, 5: “recognise the impact of culture, equality and diversity on practice and practise in a non-discriminatory and inclusive manner” [27].

In conclusion, online distance learning group activities are possible to implement if aligned with learning outcomes and clear instruction and support are provided. Although students and staff may find embedding such group assessments into the curriculum difficult, the benefit in terms of student experience is valuable. Students have an opportunity to build learning communities and have peer support, as well as develop specialist knowledge and key transferable skills, namely, digital competencies. Online debate formats improve students’ critical evaluation skills and promote a novel online approach to teaching and assessment which students find interesting and enjoyable.

This work represents an advance in biomedical science because distance learning group assessments promoted online learning communities and the development of key transferable digital skills.