Case Study Analysis: How the Shift From Textbooks to Digital Resources Affects Exam Performance in Health Science Courses

June 9, 2023

The rapid advancement of technology has transformed the way people access and consume information. This has also affected the health science education (HSE) field, where digital resources are increasingly replacing traditional textbooks. 

Digital resources refer to any electronic materials that support learning, such as e-books, online databases, virtual labs, podcasts, videos, and simulations. Many health science educators have made the switch from print resources, such as traditional textbooks, to digital ones in the hopes that they will be a beneficial investment. 

These resources offer several advantages over textbooks, such as being more accessible, interactive, up-to-date, and cost-effective. However, the research on the impact of digital resources on student performance and learning outcomes has varied results.

The Shift from Textbooks to Digital Resources

As the world continues to digitize and technologies become more advanced, it’s no surprise that the education industry has followed suit. Schools worldwide began incorporating digital tools into learning, such as purchasing tablets and laptops, as early as the 2000s. In 2020, the Covid-19 pandemic drastically increased the switch to online resources and learning, pushing digital tools to become the new standard.

In the health science education sector in particular, the shift from textbooks to digital resources has been driven by several factors: 

  • The need to keep up with the rapidly changing knowledge base in health sciences
  • The demand for more flexible and personalized learning experiences
  • The availability of various technological tools and platforms

The types of digital resources used in HSE vary depending on the discipline, level, and purpose of learning. Some of the common types of digital resources are:

  • E-books: Electronic versions of printed books that can be accessed online or offline through various devices
  • Online databases: Collections of information that can be searched and retrieved online, including sources like journals, books, reports, images, videos, and data sets
  • Virtual labs: Simulated environments that allow students to perform experiments and procedures without physical equipment or materials
  • Podcasts: Audio recordings that can provide lectures, interviews, discussions, or stories related to HSE topics
  • Videos: Videos that can provide demonstrations, explanations, animations, or case studies related to HSE concepts
  • Simulations: Computer-based models that mimic real-world situations or phenomena that are often difficult or impossible to replicate in real life, such as rare diseases, emergencies, or ethical dilemmas

But it’s not as simple as swapping older resources for any of the above. The process of transitioning from traditional textbooks to digital resources involves:

  • Selecting the appropriate resources: Educators need quality digital resources that are relevant, reliable, and appropriate for their learning objectives, curriculum, and audience. 
  • Integrating digital resources into the curriculum: These digital resources should complement rather than replace other forms of learning, such as face-to-face instruction, discussions, or practice.
  • Providing training and support for faculty and students: All students and faculty must be able to use the chosen digital resources and receive help when needed, or digital resources can become more of a burden than an asset. Without proper training and support, students and faculty can become overwhelmed, frustrated, and unable to focus on the material. 
  • Evaluating their effectiveness and impact: Educators should also continually monitor and evaluate the use and impact of digital resources on student performance and learning outcomes and make adjustments as needed.

In HSE, implementing more digital resources can bring numerous benefits to students, such as increasing comprehension, accommodating multiple learning styles, and enhancing student performance. However, do digital tools have more benefits than traditional ones?

Methods for Analyzing Student Performance

Various methods can be used to measure the impact of digital resources on student performance and learning outcomes in HSE. Some of the common methods are:

  • Comparing exam scores: Exam scores can be compared between groups of students who use different types of resources (e.g., textbooks vs. e-books) or between different periods (e.g., before vs. after the introduction of digital resources) to assess the effect of digital resources on exam performance.
  • Evaluating class participation and engagement: Class participation and engagement reflect students’ involvement, interest, and motivation in the learning process. These indicators can be assessed by observing students’ behaviors, attitudes, and interactions during class activities. For example, educators can note the number of times students raise their hands during a course and compare these rates between students with and without access to digital resources.
  • Student feedback surveys: Student feedback surveys are a common method of collecting data on students’ perceptions and experiences with digital resources. Surveys can provide information on students’ satisfaction, preferences, challenges, and suggestions for improvement regarding the use of digital resources. These surveys can also measure students’ self-reported learning outcomes, such as comprehension, skills, and confidence.

Impact on Exam Performance

The impact of digital resources on exam performance in HSE is a controversial topic that could use more research. While some studies have found positive effects of digital resources on exam performance, many have found no significant effects. 

For example, many studies comparing K-12 students with e-textbooks or traditional textbooks indicate little difference. A 2017 study by Bando et al. analyzed data from 271 elementary schools in Honduras and found no differences in Science and Mathematics test scores between children with and without laptops. However, a National Bureau of Economic Research study analyzing over 3,500 middle and high school students found that access to digital-assisted learning increased Mathematics test scores by 0.71 of a standard deviation.

As for studies on higher-level health science courses, some results show a positive correlation. A 2016 study from the Iran University of Medical Sciences divided 123 nurses into three groups: manual learning, electronic learning, and control. The study found significant differences between the groups, with the e-learning group scoring the highest. Additionally, a 2023 study found that replacing traditional textbooks with a new online interactive education program (OIEP) significantly increased NCLEX test scores.

Based on the results of these studies, it appears that the impact of digital resources on exam performance often relies on the type of e-resources available. For example, switching from a print textbook to a digitized textbook may bring no difference in performance. However, the additional videos, audio, photos, and other interactive digital content that comes with many e-textbooks and online programs can cater to various learning types. This individualization of the learning process and the convenience of digital access might be what results in improved performance in the above studies.

Student Engagement and Comprehension

Student engagement refers to the degree of involvement, interest, and motivation that students have in the learning process, while comprehension is the ability to understand, interpret, and apply the learned information. 

Digital resources may positively or negatively affect student engagement and comprehension depending on how learners use and perceive them. A 2019 study by the International Journal of Instruction found that interactive e-textbooks increased junior high participants’ engagement and interest in learning by 88.6%. Again it appears that the interactivity of certain e-resources supports diverse learning needs and can increase knowledge, confidence, and engagement.

However, a 2021 study from the Journal of Personalized Medicine surveyed 205 participants from an undergraduate nursing course in Lisbon, Portugal, finding less clear results from using digital educational technologies (DET). Out of the students surveyed:

  • 28% reported it “improved the student’s ability to analyze, synthesize and think critically.”
  • 41% reported it “improved the quality of the teaching-learning process.”
  • 72% reported “decreased interaction between students and teachers.”
  • 67% reported having “technical difficulties.”

Nonetheless, only 5% reported a “resistance to the use of DET,” indicating that lack of motivation was not a factor for these less favorable results. The study inferred that the quality of online educational materials is a significant factor in whether students will have increased engagement and comprehension. Additionally, proper training and support for the technical side of these tools is essential.


The implications of digital resources for HSE are complex and multifaceted. Depending on various factors, digital resources can enhance, hinder, or have no significant impact on student performance and learning outcomes. Therefore, it is important for educators and learners to be aware of the potential benefits and challenges of using digital resources and to adopt effective strategies to optimize their use.

A shift to digital resources might be beneficial when there is a need to update or expand the knowledge base in health sciences, to provide more flexible and personalized learning experiences for diverse learners, or to reduce the cost or environmental impact of learning materials.


Digital resources can offer many benefits for learners and educators, such as increasing access, interactivity, and flexibility in learning. Overall, the shift toward digitization in health science education seems to positively affect student performance. However, educators must choose their digital aids wisely to reap these benefits. Caduceus International Publishing offers a variety of high-quality digital resources catered to health science students. Explore our course topics to see whether we have the right interactive, performance-boosting resources for your students or staff members.

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