Reports on Global Health Research (ISSN: 2690-9480)

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A Literature Review of the Learning Methodologies Applicable to Graduate Students Earning Advanced Degrees in Healthcare Administration

Urmala Roopnarinesingh1, Alan S. Whiteman2*

1Claremont-Lincoln University and Florida Atlantic University, College of Business, USA

2Health Administration Programs in the Management Programs Department Liaison, Florida Atlantic University, USA

*Corresponding author: Alan S. Whiteman, Health Administration Programs in the Management Programs Department Liaison, Florida Atlantic University, 777 Glades Road Boca Raton, FL 33431, USA

Received Date: 30 November, 2019; Accepted Date: 16 December, 2019; Published Date: 20 December, 2019

Citation: Whiteman AS, Roopnarinesingh U (2019) A Literature Review of the Learning Methodologies Applicable to Graduate Students Earning Advanced Degrees in Healthcare Administration. Rep Glob Health Res 2: 110. DOI: 10.29011/RGHR-110.100010


Despite the growth in online programs at universities throughout the United States, some healthcare administration graduate students still choose to enroll in face-to-face programs at predominantly online universities. This need for the delivery of graduate programs in a traditional format at these predominantly online universities requires further research as there is a void in the literature [1]. In higher education, e-learning is gaining more and more impact, especially in the format of blended learning, and this new kind of traditional teaching and learning can be practiced in many ways. Several studies have compared face-to-face teaching to online learning and/or blended learning in order to try to define which of the formats provides, e.g., the highest learning outcome, create the most satisfied students or have the highest rate of course completion. However, these studies often show that teaching and learning are influenced by more than teaching format alone. Many factors play significant roles, and this literature review will look further into some of them [2]. The purpose of this literature review was to identify the key factors influencing health administration graduate students’ choices of these programs to complete their degrees. Glasser’s choice theory and Bandura’s self-efficacy theory guided this review. How do graduate students perceive success in a face-to-face learning environment? The research questions focus on student perceptions of face-to-face versus fully online programs, motivational factors, learning experiences, and the impact of life issues on students’ choices of face-to-face programs. The findings of this review are significant for online university administrators as they identify innovative practices within predominantly online institutions [1].


The purpose of this literature review is to investigate the reasons healthcare administration graduate students choose to attend face-to-face programs at predominantly online universities. The findings of this literature review are useful and significant to universities and students for recruitment, appropriate student course placement advising for academic and future success, retention students and face-to-face graduate programs and identify gaps in the current literature. A comprehensive literature search resulted in discovery of a gap of published articles providing qualitative assessment of the reasons graduate students choose to attend face-to-face programs at predominantly online universities [1].

In this review of the literature on e-learning, we present and discuss definitions of e-learning, hybrid learning and blended learning, and we review the literature comparing different online teaching formats with traditional on-campus/face-to-face teaching. With this point of departure, we explore which factors affect students’ learning experiences in different online formats in higher education [2].


The literature search on which the present review is based serves the purpose of identifying papers that may contribute to answering the following research question. What are the reasons graduate students choose to attend face-to-face programs at predominantly online institutions [1]?


Postsecondary learners have increased with the advent and popularity of online learning. Throughout peer-reviewed educational literature, a host of definitions exist for the nontraditional postsecondary learner [3]. The nontraditional learner is most often defined as being 25 years of age or older [4]; however, a more recent reclassification defines college-aged students 18 to 24 years of age as nontraditional learners [5].

The graduate student population today is comprised largely of what might be identified as nontraditional characteristics not only in terms of age but also of military veteran status, undergraduate education, previous exposure to online courses, and many other factors [6]. Student veterans range widely in age, from 18 to senior citizen status, but average 33 years of age. Potentially contributing to the challenge, student veterans are likely the first in their family to attend college [7].

Today’s college students are parents, caregivers, full-time employees, and retirees [8]. In fact, estimates suggest that 40% of the current undergraduate population at American colleges and universities is nontraditional [9]. Additionally, 60% of nontraditional undergraduate students have completed an online course or program prior to their most recent search for an online program [10].

Nontraditional students typically have a less clear journey in pursuit of college education than traditional students due to complexities of their backgrounds and unique needs [3]. The NCES [11] attributed many different characteristics to nontraditional students, including the following: (a) 25 years of age or older, (b) full-time employment, (c) delayed postsecondary enrollment after high school, (d) financial independence, (e) having dependents, (f) being a single parent, and (g) not possessing a standard high school diploma. Notwithstanding the plethora of issues impacting nontraditional student enrollment, they are the fastest growing segment in the United States of postsecondary education enrollments [12].

According to the DOE [13], graduate students represented 14% of the total college population but 26% of the online population in the fall of 2014. Clinefelter and Aslanian [14] reported that younger students are one of the fastest-growing segments of the online student population, with age decreasing over time at both the undergraduate and graduate levels. The mean age of undergraduate online students decreased from 34 years old in 2012 to 29 in 2016 [14]. The mean age of graduate online students decreased from 35 years old in 2012 to 33 in 2016 [14]. Further, “In 2014, more than one in four (28%) of all college students were taking at least one of their courses at a distance, with over two-thirds (67%) doing so at a public institution” [15].

Kryczka [16] noted that the growth in online student enrollment in higher education in the United States is transforming postsecondary education because academic courses and degree programs become accessible to more students. Those taking courses online and enrolled in online programs are becoming a larger segment of the overall student population. Many faculty members, however, do not accept the value and legitimacy of online education and view it as inferior to traditional on-campus instruction [16]. Thus, a divide exists between the faculty’s negative perceptions of online programs, as well as courses and the students who continue to enroll in these programs and courses in record numbers [16].

Young and Duncan [17] conducted a study that compared online and face-to-face learning and satisfaction. In their study, with 172 online courses and 470 on-campus courses within various programs, 8,000 students were randomly assigned to either an online section or a face-to-face section of the same course. The instructor was the same for both courses, and the course materials were matched carefully. The results showed that overall, students’ midterm and final examination scores were similar regardless of the delivery format; however, when points of students for course assignment were included to derive final grades, students in the face-to-face section had a significantly higher average course grade than students in the online section [17].

In this study, the more detailed examination indicated that online students who submitted course assignments did not earn lower grades on these assignments. Rather, larger numbers of online students failed to submit some of these assignments, suggesting that personal, face-to-face contact with the instructor may influence and motivate students to turn in assignments. Finally, the researchers used end-of-course evaluations to determine student satisfaction. They found that the instructor was rated significantly higher in the face-to-face course, although student ratings of the instructor were very high for both groups [1,17].

DiRienzo and Lilly [18] compared students’ learning outcomes on both “basic” and “complex” assignments for a business course using two different delivery methods, traditional and online [18]. The researchers used performance on the Test of Understanding College Economics as the measure for learning outcomes. Based on delivery method, no significant difference in student learning outcomes was found [18].

Other researchers have also found few differences between traditional and online course delivery. Farmakis and Kaulbach [19] reported that well-structured online courses could lead to identical levels of quality as traditional courses. Murdock, Williams, Becker, Bruce, and Young [20] investigated skills acquisition of students enrolled in face-to-face and online counseling courses. The authors decided based on the students’ level of acquired skills that online education could be as effective as traditional classroom teaching. Similarly, after conducting a quantitative research study based on students’ performance in the online and face-to-face instruction methods, Pai [21] concluded that there were no significant differences in learning outcomes between traditional and online learning even when gender and differences in learning styles were considered.

Moreover, several studies [17,22,23] have shown that the effectiveness and advantages of online learning relative to traditional face-to-face lectures are influenced by a host of factors. These factors include, but are not limited to, students’ knowledge base of course materials, their technical capabilities to navigate throughout the online course, course design complexity, and the degree of difficulty of course assignments and time intensity.

Additional factors have also been shown to affect students’ perceptions of online versus face-to-face courses. These include the nature of course communication (i.e., synchronous or asynchronous) and its frequency between the instructor and students and student academic course load [24]. According to Alsaaty et al. [24], additional factors were curriculum design, technology infrastructure, and course quality, especially in developing countries.

As pointed out by Bork and Rucks-Ahidiana [25] in a qualitative study of 47 college students in Virginia that included data collected through interviews, some students favored online courses due to their flexibility and convenience (and for some, personal learning preferences). Other students rejected online courses due to the weaker instructor presence, and to a lesser extent, the weaker student-student interaction. Each student had individual ways of balancing between these considerations when faced with the choice of whether to take a particular course online or face-to-face. In some cases, there was no choice: A needed course was simply not available face-to-face at a time when the student could attend, and the student thus found it necessary to enroll in an online section [25].

Several studies have compared face-to-face teaching to online learning and/or blended learning to define which format provides the highest learning outcome, creates the most satisfied students, or has the highest rate of course completion [1]. However, these studies often show that teaching and learning are influenced by more than teaching format alone [2]. The essential elements include a strong educator presence along with quality program course content in programs that successfully facilitate online student engagement and learning [2]. The establishment of strong educator presence in online program courses can be achieved in a number of ways, such as through regular communication with students, consistent feedback, and critical discourse modeled by the educator. Online students need to feel connected to the educator, to other students in the program courses, and to the program course content [2].

In most cases, however, students made a conscious decision to enroll in a particular course online, based on three factors specific to the academic subject area: (a) whether the subject area was well suited to the online context; (b) whether the course was “easy” or “difficult”; and (c) whether the course was “interesting” and/or “important” [25]. Lastly, a 2013 Gallup poll [26] regarding online education in the United States revealed that some respondents perceived online education positively because it offers flexibility and a wide range of courses at reasonable costs. However, other respondents perceived online education negatively because they believed it involved less qualified instructors and less demanding testing. Additionally, employers perceived online learning with less confidence compared to the traditional face-to-face learning mode of instruction [26]. A NAPSA supported study found that as students felt more strongly that their work and classes conflicted, their odds of persisting decreased by about 78%. In contrast, as students felt more strongly that the institution was responsive to their needs, their odds of persisting increased by about 63%. The researchers also found controlling for campus environments negated the significant effect of work–class conflict, which suggests that providing a supportive campus environment can mitigate the challenges of working and raising a family [8].

Online programs are typically defined as courses in which at least 80% of the content is delivered online without face-to-face meetings [24]. Face-to-face instruction is defined as program courses in which all content is delivered only in a traditional face-to-face setting. In addition to online and face-to-face learning programs and courses, hybrid programs may be offered with courses which combines the benefits of face-to-face meetings with the technology often used in online courses [24]. According to Allen and Seaman [15], courses are considered hybrid/blended when 30% to 79% of course content is delivered online. A fourth type of program course exists, referred to as web-facilitated programs and courses, in which 1% to 29% of the course’s content is delivered online. Although this type of program and its courses are actually face-to-face, web-based technology is used to supplement the face-to-face instruction provided to students [15].


This review of recent literature identified major underlying concepts guiding the development of parameters for this study. Topics included the Nontraditional Learner, Changing Educational Patterns and Learning Outcomes, For-Profit and Nonprofit Online Universities, Why Students Attend For-Profit Online Universities, Choosing Programs Offered at Local Online Universities, Offer ing Students Career Services, Student Demographics at For-Profit Institutions, and Delivery Modes of Graduate Programs Defined. In addition, literature was reviewed on Synchronous Communications and Associated Issues, Asynchronous Communication and Associated Issues, Issues with the Online Learning Environment, Student Motivations, Integration of Information, Communication and Technology in Learning, Relationship between Grades and Learning Modes, and Program Demands and Preferences.

Much of the literature focuses on the development of online education and student experiences [15,27-29]. However, no research was discovered investigating the reasons graduate students choose to attend face-to-face programs at predominantly online universities [30,31]. Most of the prevalent research concentrates on undergraduate experiences, with minimal focus on the needs and experiences of graduate students. As previously mentioned, a gap exists in the research that contributes to understanding the reasons graduate students choose to attend face-to-face programs at predominantly online universities. Such research is needed to foster greater understanding of this graduate student population. This qualitative study will help educators meet their unique needs for a quality educational experience [27].


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