Abstract:

Introduction:
In the academic year 2013/14, Nursing students of Warsaw Medical University participated in the "Law in health protection" course conducted in the form of blended-learning. The e-learning course was put on Moodle e-learning platform: http://www.nzd.moodle.wum.edu.pl/ and it comprised a total of 11 thematic modules; 10 modules ended with a test in the following format: best answer from a list of possible answers (MCQ, multiple-choice question). Students awarded credits for the course and seminars were allowed to take a final exam conducted in the form of a paper-and-pen test.

Aim of study:
Assessment of efficiency of teaching with the use of a combination of e-learning tools and traditional "in-class" teaching, with reference to the results of the final exam evaluating the competence in the „Law in health protection” course.

Materials and Methods:
351 Nursing students, including first-year (n = 148) and second-year (n = 114) full-time Master's degree students as well as first-year part-time students (n = 89). The results achieved during the e-learning part of the course were obtained in 10 tests (240 random questions) conducted in the MCQ format. The results of the final competence evaluation exam were obtained in 60 MCQs.
The correlation between the results obtained in the form of computer-aided assessment and the final exam results (paper-and-pen test) was analysed to assess the efficiency of e-learning.

A non-parametric median comparison Mann-Whitney U test and non-parametric Kruskal-Wallis rank test were used for the analysis of differences between the results obtained in e-learning tests and the final exam.
The quality of the exam was assessed by establishing the level of simplicity and differentiating power of particular questions and the reliability of the exam was assessed by estimating Cronbach's α coefficient (the Kuder-Richardson coefficient for dichotomous items).
The significance level for all analyses was established at p<0.05.

Results:
The correlation between the results obtained in the computer-aided assessment and those obtained in the final exam (paper-and-pen test) amounted to r = 0.33 (p<0.001). The correlations between the results obtained in e-learning tests and the final exam with reference to the Nursing legislation and General and medical law were also statistically significant (r = 0.21 and r = 0.16, respectively, p<0.003). The results of computer tests were markedly better among second-year full-time students, as compared to first-year part-time students (p = 0.032).

The reliability of the exam was at α = 0.675. Following a content-related analysis, questions with low differentiating efficiency were removed, which increased the exam reliability to the value of α = 0.714. Moreover, the strength of correlation between the results of the exam and e-learning tests in the thematic areas of Nursing legislation (r = 0.24, p < 0.001) and General and medical law (r = 0.192, p<0.001) was also improved.
Conclusions

Well-planned blended-learning, in which remote teaching methods support traditional in-class education, may be a very effective tool in teaching the Law in health protection course. The use of battery of tests in e-learning allows students to achieve necessary competence that can be well verified in a well-planned final exam. MCQ tests, as a form of competence check, constitute a convenient method to assess student achievements that is at the same time relatively easy to be evaluated and improved.

Keywords:

Medical education, distance learning, multiple-choice questions (MCQs), computer-aided assessment.