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Case study

Comparing the impact of virtual and face-to-face LI-CBL delivery in a preclinical Infectious diseases course (Microbiology section)

Arunee Suvarnajata, Tanit Boonsiri, Sirachat Nitchapanit, Piyanate Kesakomol, Pimwan Thongdee, Passara Wongthai, Putt Narongdej, Ketsara Khamsaen, Phattarawadee Nilphet, Sudaluck Thunyaharn, Anchali Thongaime, Pongthorn Narongroeknawin, Nitchatorn Sungsirin and Veerachai Watanaveeradej
Advances in Online Education: A Peer-Reviewed Journal, 4 (1), 88-105 (2025)
https://doi.org/10.69554/PGNP5397

Abstract

The COVID-19 pandemic disrupted global education systems, necessitating rapid adaptation to virtual learning modalities. In medical education, this situation triggered innovation in teaching strategies, including the implementation of digital and blended learning. Case-Based Learning (CBL), known for fostering clinical reasoning and critical thinking, has proven particularly effective in preclinical settings. At Phramongkutklao College of Medicine, a refined approach — Laboratory Integrated Case-Based Learning (LI-CBL) — was developed to integrate clinical case analysis with laboratory diagnostics, particularly for the Infectious diseases course (Microbiology section). This study aimed to evaluate and compare the academic performance and satisfaction of medical students participating in virtual LI-CBL and face-to-face LI-CBL sessions between 2021 and 2024. A cross-sectional, comparative study was conducted over four academic years (2021–2024) among third-year preclinical students enrolled in the Infectious Diseases course. In 2021, students participated in a fully virtual LI-CBL format, while face-to-face sessions resumed from 2022 to 2024. LI-CBL consisted of three structured phases: case study, laboratory diagnosis; and case summary. Learning outcomes were measured using pre- and post-test constructed-response questions (CRQs), and satisfaction was assessed via a ten-item Likert scale questionnaire. Data were analysed using paired t-tests and one-way ANOVA (p < 0.05). Across all years, students demonstrated significant improvement from pretest to post-test (p < 0.05). In 2021, the virtual format yielded a post-test mean of 4.12 ± 0.34 versus a pretest mean of 3.76 ± 0.32. Post-test scores further improved in subsequent face-to-face formats, reaching 4.33 ± 0.26 in 2024. Satisfaction scores were consistently high across all modalities, with face-to-face sessions showing slightly higher ratings in areas such as instructor facilitation and interpersonal skill development (eg 4.94 ± 0.38 in 2022 versus 4.79 ± 0.47 in 2021 for interpersonal skills; p < 0.05). The LI-CBL model effectively supports student learning and engagement in both virtual and face-to-face settings. Despite initial challenges, the virtual LI-CBL preserved key educational elements such as motivation, content comprehension and psychomotor skills. These findings emphasise the pedagogical robustness of LI-CBL and its adaptability as a valuable teaching strategy for infectious diseases education in evolving educational contexts. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.

Keywords: Laboratory Integrated Case-Based Learning (LI-CBL); virtual LI-CBL; face-to-face LI-CBL; constructed-response questions (CRQs); Likert scale

The full article is available to subscribers to this journal (subscription is free).

Author's Biography

Arunee Suvarnajata is a retired Faculty Member and currently serves as a Consultant to the Department of Microbiology at Phramongkutklao College of Medicine in Thailand. With a lifelong commitment to medical microbiology and clinical laboratory sciences, Arunee has dedicated her career to advancing medical education and fostering future generations of healthcare professionals. Throughout her tenure at Phramongkutklao College of Medicine, she played an active role in curriculum development, educational innovation and research. One of her key contributions was the implementation of laboratory integrated case-based learning (LI-CBL), which effectively bridges laboratory diagnostics with real clinical scenarios. This method has significantly enhanced students’ critical thinking and diagnostic skills. During the COVID-19 pandemic, Arunee led efforts to adapt LI-CBL into an online format to maintain the quality and continuity of medical training. This work sparked an enduring interest in digital learning tools and their integration into medical education. Arunee’s research interests have focused on infectious diseases, antimicrobial resistance and the evaluation of educational strategies in clinical microbiology. She remains passionate about ensuring that basic science education remains clinically relevant and accessible. Now, as a consultant, Arunee continues to support the department by mentoring faculty, advising on curriculum development and contributing to ongoing educational initiatives. Arunee remains committed to lifelong learning and collaboration in the medical education community.

Tanit Boonsiri currently serves as the Vice-Head of the Department of Microbiology at Phramongkutklao College of Medicine, Thailand. Tanit earned a PhD in Bacteriology from Jichi Medical University, Japan, in 2020, with research on the molecular mechanisms of methicillin-resistant Staphylococcus aureus (MRSA) and holds a Bachelor of Science in Medical Technology from Chulalongkorn University plus a Master of Science in Medical Technology (International Program) from Mahidol University. Tanit’s career began as a medical technologist in the Department of Paediatrics at Phramongkutklao Hospital and has served as an invited lecturer in pathology and microbiology across multiple institutions, including the Royal Thai Army Nursing College, Baromarajonnani College of Nursing Nopparat Vajira and the Faculty of Public Health at Bangkokthonburi University. Tanit’s current role includes overseeing curriculum development, implement innovative teaching strategies and fostering collaboration among faculty and students to enhance learning in microbiology and infectious diseases. Tanit’s educational research emphasises virtual and active learning approaches, including digital laboratories, game-based learning, case-based learning and project-based learning, plus co-authoring numerous presentations at national and international conferences, such as the Thai Medical Education Conference (2022, 2024) and the Association for Medical Education in Europe (2023), exploring students’ attitudes, engagement and learning outcomes with both traditional and virtual educational methods. Passionate about advancing medical education, Tanit is committed to mentoring students, promoting innovative teaching practices and preparing the next generation of healthcare professionals with strong scientific and ethical foundations.

Sirachat Nitchapanit earned a Doctor of Medicine (MD) degree from Phramongkutklao College of Medicine, developing a strong foundation in clinical practice and a deep appreciation for the complexity of infectious diseases. Following this, Sirachat completed a residency training in Internal Medicine at Phramongkutklao Hospital, specialising in diagnosing and managing a wide spectrum of medical conditions with a focus on patient-centred care. Currently, Sirachat serves as an instructor in the Department of Microbiology at Phramongkutklao College of Medicine combining a clinical background with a passion for medical education and microbiological sciences and a teaching emphasis on the clinical relevance of microbiology and its role in improving diagnostic precision and treatment strategies. Sirachat takes pride in guiding medical students to think critically and integrate basic science knowledge with practical patient care, and is involved in academic activities and curriculum development, aiming to make microbiology more engaging and applicable for future healthcare professionals. Sirachat’s interests include antimicrobial resistance, clinical-pathological correlation and the advancement of educational methods in microbiology and is committed to contributing to the development of well-rounded, knowledgeable and compassionate physicians who are equipped to face the evolving challenges of modern healthcare.

Piyanate Kesakomol holds a Bachelor’s degree in Medical Technology from Chulalongkorn University and a Master’s degree in Medical Science from the University of Glasgow developing (from a strong academic base) expertise in microbiology and molecular medical sciences. Currently, Piyanate serves as an instructor in the Department of Microbiology at Phramongkutklao College of Medicine, contributing to teaching and research in the field of infectious diseases. In 2023, Piyanate began a PhD in Advanced Molecular Microbiology at Imperial College London, focusing on microbial pathogenesis and the molecular mechanisms underlying infectious diseases. Driven by a passion for integrating clinical microbiology with advanced molecular techniques, Piyanate aims to bridge academic research with practical medical applications, emphasising interdisciplinary collaboration and international perspectives to support innovations in the diagnosis, treatment and prevention of microbial infections. Committed to academic excellence, advancing scientific knowledge and mentoring the next generation of medical professionals and through research and teaching, Piyanate strives to make a meaningful impact on the scientific community and global health.

Pimwan Thongdee Capt. Pimwan Thongdee, PhD, is a Lecturer at Phramongkutklao College of Medicine, Bangkok, Thailand, receiving a Bachelor of Science in Medical Technology from Thammasat University in 2008 and pursuing a PhD in Biomedical Sciences at the same university, supported by the Royal Golden Jubilee PhD Programme and research collaborations with the Liverpool School of Tropical Medicine, UK. Pimwan’s doctoral research focused on the roles of heme-oxygenase-1 and prostaglandin D2 in the pathogenesis of severe falciparum malaria, as well as genetic diversity in antimalarial drug resistance genes. Pimwan has been actively engaged in microbiology, immunology and parasitology research, particularly in malaria and antimicrobial resistance, and has been published in several international journals. Pimwan has also contributed to research on molecular epidemiology, diagnostic methods and host–pathogen interactions along with numerous international conferences and academic meetings, sharing findings through oral and poster presentations. Pimwan combines an academic role with ongoing research in microbiology and immunology with particular interest in applying molecular and diagnostic approaches to infectious diseases while also mentoring medical students and young researchers. Pimwan’s goal is to contribute to the advancement of biomedical science and medical education.

Passara Wongthai , MD, is a paediatrician with a strong academic interest in microbiology and paediatric infectious diseases, earning a Doctor of Medicine degree from Phramongkutklao College of Medicine and completing residency training in Paediatrics at Phramongkutklao Hospital. A clinical background has provided Passara with valuable experience in child health, particularly in the diagnosis and management of infectious conditions in paediatric populations. Passara serves as a lecturer in the Department of Microbiology at Phramongkutklao College of Medicine with an academic focus including host–pathogen interactions and the integration of microbiological knowledge into clinical practice. A particular interest is in bridging the gap between basic microbiology and its practical applications in paediatric care. In parallel with academic responsibilities, Passara is further pursuing specialisation in Paediatric Infectious Diseases through a clinical fellowship programme at Phramongkutklao Hospital, and this next stage of training reflects a continued commitment to advancing clinical expertise and contributing meaningfully to the care of children with complex infectious diseases. Passara is dedicated to medical education, with a passion for nurturing the next generation of healthcare professionals. In teaching, Passara strives to integrate clinical insight into basic science education, emphasising critical thinking, evidence-based practice and patient-centred care, aiming to promote excellence in paediatric medicine and foster the development of well-rounded, compassionate and scientifically grounded physicians.

Putt Narongdej , MD, is a Lecturer and Researcher in the Department of Microbiology at Phramongkutklao College of Medicine, Bangkok, Thailand, earning a Doctor of Medicine degree from Phramongkutklao College of Medicine in 2022 and currently pursuing a Master of Biomedical Science at the University of Melbourne under the Royal Thai Government Scholarship. Putt’s academic interests lie in bioinformatics, immunogenicity studies and vaccine discovery, with a focus on understanding T and B cell responses, cytokine repertoires and translational applications in infectious diseases. Alongside teaching responsibilities in microbiology, immunology and basic laboratory techniques for pre-clinical medical students, Putt actively contributes to departmental research, with work including studies on bacterial surveillance, influenza monitoring, diabetes and resilience and quality of life among medical students. Putt has presented research at both national and international conferences, earning recognition such as a second-place poster presentation award at the 20th Thai Medical Education Conference and has co-authored peer-reviewed publications, including research on influenza vaccine effectiveness in healthcare personnel. Putt has also served as a general physician at Fort Chakrapong Hospital, rotating through major clinical specialties and led a Medical Emergency Response Team. Putt’s experiences as both a clinician and educator have strengthened a commitment to integrating clinical practice with biomedical research with an aim to continue contributing to infectious disease research, medical education and the advancement of healthcare in Thailand.

Ketsara Khamsaen is a Microbiological Technician at the Department of Microbiology, Phramongkutklao College of Medicine, Bangkok, Thailand, having contributed significant laboratory preparation and technical support in student microbiology practice sessions significantly and in advancing technology-enhanced learning in microbiology, particularly during the COVID-19 pandemic when traditional lab instruction was disrupted. With a strong background in microbiology and laboratory sciences, Ketsara has consistently contributed to the smooth operation of academic labs by ensuring that all necessary materials, cultures and equipment are ready and functional before practical sessions begin, with responsibilities including preparing media and reagents, sterilising instruments, maintaining laboratory safety protocols and assisting in setting up microbiological experiments. Ketsara is recognised for precision, reliability and commitment to supporting both faculty and students in achieving educational excellence in microbiological training. Ketsara’s role is vital in creating an effective and safe learning environment, enabling students to gain hands-on experience with microbiological techniques, including culturing, staining and microscopy. This work plays a key part in fostering the next generation of medical and life science professionals.

Phattarawadee Nilphet holds a Bachelor of Political Science (2019) and a Master of Political Science in Leaders in Public and Private Sectors (2020), with an academic journey shaped by a passion for education, particularly in health science education, curriculum design and instructional innovation. During her master’s study, Phattarawadee conducted an independent research project titled ‘Developing the Military College of Medicine into the Best Medical College: A Case Study of Phramongkutklao College of Medicine (2020)’, which deepened a commitment to advancing educational excellence in the medical field. From 2019 to 2023, working as an educator in the Department of Microbiology at Phramongkutklao College of Medicine, she was involved in teaching, designing evaluation tools and planning instructional activities. In 2024, Phattarawadee joined the Faculty of Medicine Siriraj Hospital, Mahidol University as an educator in the MSc (Health Science Education) programme at the Siriraj Health Science Education Excellence Center. Her current role allows integration of a background in political science with health science education, fostering innovations that improve the quality of teaching and learning in medical education. Phattarawadee has received work recognition, including a Consolation Prize at the 50th Phramongkutklao Academic Conference (2022) for developing an online grading system that supported teaching and research. Interests include grading and scoring, designing evaluation forms and planning instructional strategies that promote learner-centred education, while remaining dedicated to contributing to the growth of future healthcare professionals through innovative and effective teaching practices.

Sudaluck Thunyaharn is a Microbiologist and Educator with extensive experience in clinical diagnostics and microbiology education in Thailand, serving for over 20 years as Head of Microbiology Technicians at Phramongkutklao Hospital and leading clinical microbiology operations, developing diagnostic protocols and supporting infection control practices in one of Thailand’s major military hospitals. Sudaluck also spent more than ten years as an instructor in the Department of Microbiology at Phramongkutklao College of Medicine, contributing to the training of medical students in laboratory diagnostics, infectious disease microbiology and antimicrobial resistance and has co-authored several academic publications, including studies on optimising antimicrobial regimens using Monte Carlo simulations, particularly for drug-resistant pathogens like carbapenem-resistant Acinetobacter baumannii and vancomycin-resistant Enterococci. Sudaluck has also contributed to national surveillance of antibiotic resistance in Streptococcus pneumoniae and explored educational innovations such as the use of interactive e-books to improve student learning in microbiology. Currently, an instructor at the Faculty of Allied Health Sciences, Nakhonratchasima College, in Nakhon Ratchasima, Thailand, Sudaluck continues to share expertise with future healthcare professionals, focusing on laboratory science, clinical microbiology and the application of research in healthcare settings. Sudaluck’s career reflects a deep commitment to advancing microbiological science, strengthening diagnostic capacity, and mentoring the next generation of medical and allied health professionals in Thailand.

Anchali Thongaime is a seasoned Educator specialising in curriculum and instruction, currently affiliated with the Faculty of Education at Kasetsart University, Thailand, completing doctoral studies in this field at Kasetsart University with a dissertation focused on the development of a knowledge-based platform for Thai language education in higher education. Anchali’s doctoral research involved creating and implementing an online resource (available at www.anchali-t.com/thaikb/) designed to support university-level Thai teachers and students, featuring Thai language materials, educational media resources and instructional design content. Anchali has published educational research on self-regulated learning, particularly investigating the use of reflective journaling to enhance curriculum innovation skills among graduate students in a Master of Education programme in curriculum and instruction at Dhurakij Pundit University. Anchali has over three decades of experience in teaching and curriculum development and scholarly work emphasising the integration of technology-enhanced learning, reflective practices and knowledge management systems in Thai language pedagogy. Through dedication to educational innovation and teacher development, Anchali continues to contribute to the improvement of Thai language instruction at the tertiary level plus leadership in designing digital platforms and advancing pedagogical research that reflect a commitment to supporting both learners and educators in Thailand’s higher education landscape.

Pongthorn Narongroeknawin Assistant Professor Pongthorn Narongroeknawin is a rheumatologist and academic leader currently serving as Head of the Department of Microbiology at Phramongkutklao College of Medicine, Bangkok, Thailand, earning a Doctor of Medicine degree from Chulalongkorn University in 1996, followed by residency training in internal medicine at Prince of Songkhla University and fellowship training in rheumatology at Phramongkutklao Hospital. Pongthorn also completed post-doctoral research in clinical immunology and rheumatology at the University of Alabama at Birmingham, USA. For more than two decades, Pongthorn served at Phramongkutklao Hospital in both clinical and academic roles, with leadership experience as Division Head of Rheumatology and Assistant Director of Medical Education, allowing contribution to institutional development while guiding young physicians and researchers. These experiences strengthened a dedication to medical education and the integration of clinical expertise with scientific innovation. Pongthorn’s research interests focus on autoimmune and rheumatologic diseases, particularly rheumatoid arthritis and systemic lupus erythematosus, as well as the advancement of medical education. With more than 39 published peer-reviewed articles in international journals, Pongthorn has contributed to the global understanding of autoimmune disease mechanisms and treatment. Through clinical, academic and research roles, Pongthorn remains committed to improving patient outcomes, advancing medical education and strengthening the role of academic medicine in Thailand.

Nitchatorn Sungsirin is currently pursuing a PhD in Microbiology at the Faculty of Medicine, Shimane University, Japan. Nitchatorn’s academic background and professional experience lie at the intersection of microbiology and medical education, with a strong commitment to improving how microbiological knowledge is applied and taught in clinical settings. Before beginning doctoral studies, she was a lecturer at Phramongkutklao College of Medicine in Thailand, with involvement in curriculum development and the implementation of innovative teaching strategies. Nitchatorn developed the laboratory integrated case-based learning (LI-CBL) approach, which merges real-life clinical cases with laboratory diagnostics to enhance medical students’ clinical reasoning and diagnostic skills. During the COVID-19 pandemic, Nitchatorn adapted this model for online delivery and conducted research on its effectiveness in virtual learning environments. Current research focuses on microbial pathogenesis, host-pathogen interactions and the development of educational models that integrate basic science with clinical application, with a passing for bridging the gap between scientific discovery and education, with the ultimate goal of contributing to better health outcomes through the training of competent and thoughtful healthcare professionals. She hopes, through his doctoral journey, to contribute both to the field of microbiology and to the advancement of evidence-based medical education.

Veerachai Watanaveeradej is a paediatric infectious disease specialist with over 40 years’ clinical and academic experience, contributing significantly to tropical medicine, paediatric infections and vaccine development, particularly as part of Thailand’s national dengue vaccine research team, supporting clinical trials and public health initiatives to reduce dengue across Southeast Asia. From 2018 to 2022, Veerachai served as Head of the Department of Microbiology at Phramongkutklao College of Medicine, leading curriculum reform, promoting clinical relevance in microbiology education and fostering research collaboration in infectious diseases. At Phramongkutklao Hospital, Veerachai continues to provide specialised care in paediatric infectious diseases, playing a key role in the hospital’s infection prevention and control (IPC) programme, especially during the COVID-19 pandemic. Veerachai supported the development and implementation of infection control strategies to protect patients and healthcare workers while ensuring clinical operations remained safe and effective, and research includes work on antimicrobial resistance, bloodstream infections in children, plus the use of molecular diagnostics in clinical microbiology. Veerachai has co-authored several publications addressing antibiotic resistance and paediatric infection management, and is known for dedication to clinical excellence, research and medical education, remaining committed to improving paediatric health and strengthening Thailand’s capacity in infectious disease prevention and control.

Citation

Suvarnajata, Arunee, Boonsiri, Tanit, Nitchapanit, Sirachat, Kesakomol, Piyanate, Thongdee, Pimwan, Wongthai, Passara, Narongdej, Putt, Khamsaen, Ketsara, Nilphet, Phattarawadee, Thunyaharn, Sudaluck, Thongaime, Anchali, Narongroeknawin, Pongthorn, Sungsirin, Nitchatorn and Watanaveeradej, Veerachai (2025, September 1). Comparing the impact of virtual and face-to-face LI-CBL delivery in a preclinical Infectious diseases course (Microbiology section). In the Advances in Online Education: A Peer-Reviewed Journal, Volume 4, Issue 1. https://doi.org/10.69554/PGNP5397.

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cover image, Advances in Online Education: A Peer-Reviewed Journal
Advances in Online Education: A Peer-Reviewed Journal
Volume 4 / Issue 1
© Henry Stewart
Publications LLP

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