Introduction: Regarding the importance and status of virtual education in higher education, the present study was conducted with the aim of design, implement and evaluate the blended learning courses in Zanjan University of Medial Sciences.
Methods: This study was a quasi-experimental-interventional research. The teachers who wanted to involve in the combined courses were determined and the sessions related to the course plan were divided into two groups, the combined and traditional ones. Virtual sessions consisted of four sessions for each lesson that was completed with one in-person session for each two virtual sessions, while the traditional training sessions were six sessions. Learners' knowledge was assessed through a researcher-made test in the combined compared to the traditional sessions. Students' attitudes to the combined compared to the traditional sessions were also assessed through a standard user satisfaction questionnaire.
Results: The results showed that more than 90% of students were satisfied with the combined courses and acknowledged that this educational method increases the retention of content. Conclusively, the average level of knowledge and attitude of students in the combined courses significantly increased compared to the traditional courses (p <0.01).
Conclusion: The results of this study indicated that interactive combined education would be an effective way to increase knowledge and attitude in students.
 
The Effect of Blended Teaching Approach Compared with Classical Teaching Approach on Student’s Knowledge and Attitudes in Zanjan University of Medical Sciences
 Introduction: In this century, there is a need to new methods and tools of learning due to the development of technology and communication. Communication networks including internet along with advanced educational facilities have caused a transformation in educational methods and on the other hand have made education possible for students all over the world, far and near area, without necessity of face-to-face education. The novel educational learning identified as the virtual learning that has been one of the most advanced educational methods in the world. In this method, all the educational materials were transferred to student through multimedia contents. Therefore, blended or hybrid learning prepare opportunity to both methods of education either traditional or new virtual methods for students. Moreover, medical education should adapt along to the new educational methods due to its great role in human health.  Regarding the importance and status of teaching in higher education, the present study was conducted and targeted to design, imply and evaluate the blended learning courses in Zanjan University of Medial Sciences.
Materials and methods: This was a quasi-experimental-interventional research. The total participations were 283 students in general medicine, dentistry, bachelor and masters of midwifery and nutritional sciences. All participants have proved informed consent. An inclusion criterion was the course selection in the recent semester. In addition, students who were absent for one or more sessions were excluded. At first, a call to organize virtual meetings was sent through the virtual education center of Zanjan University of Medical Sciences. Then, the goals and standards of electronic content preparation were fully explained to the professors who wanted to participate in the mentioned courses. According to the topics and the opinion of the professor, virtual sessions were determined in the number of four sessions in each lesson. While for every two virtual sessions, one face-to-face session was considered for teaching in a combined method. Then six sessions were also taught in a completely traditional education for the same students. And afterward, the educational level of the sessions in both traditional and combined methods was standardized by the respective professor. In order to produce electronic content, consultation with content production experts and software experts were done, and Storyline software version 5.3 was used to design and produce this educational content, too. In next step, package usage and virtual system were explained to the students in a brief session. To assess the learners' knowledge in two combined and the traditional sessions, a researcher-made questionnaire contained ten questions were designed in various levels of Bloom; next, the knowledge assessment test based on the curriculum was developed and approved by five expert professors of each field. The reliability of the tool was calculated by performing a retest on fifteen students from each group of students with a number of 0.84. Furthermore, students' attitudes to the combined compared to the traditional sessions were also assessed through a standard user satisfaction questionnaire; and attitude was carried out in the form of pre-test and post-test. The face and content validity of this questionnaire was also confirmed by ten professors. Its reliability was also determined through Cronbach's alpha method with an 89%. Moreover, this questionnaire contained thirty questions with two parts; the first part included three questions about the demographic characteristics of the participants, whereas the second part included 27 questions related to the motivation. The motivational questions in the questionnaire were designed based on the Likert scale; and in each of the questions, the answers were valued from 1 to 5 score.  The Kolmogorov–Smirnov test was also used to normality assessment. To the end, data were analyzed using SPSS software (V.19).
Results and discussion: To achieve goals of this study, content retention rate, content transfer speed, and interactive content-produced were compared in the two educational methods. Constant access to the educational contents and interactivity resulted in students’ satisfaction; findings showed that more than 90% of students were satisfied with the combined courses and acknowledged that this educational method increases the retention of content. The average level of knowledge (8.6±0.45 vs. 3.34±0.78 p<0.001) and attitude (100±5.45 vs. 55.2±10.5, p<0.001) of students significantly increased in the combined courses post-test compared to the pre-test. Moreover, number of knowledge (8.6±0.45 vs. 4.32±0.89, p<0.001) and attitude (100.5±5.45 vs. 78.7±6.5, p=0.009) were significantly higher in the combined compared to traditional educational method post-test. The obtained data revealed that combined education was preferred by students and the durability of the content increased due to constant access to the produced content. In addition, the interactive nature of the produced content was added to its effectiveness. Results of the present study were in accordance with previous studies that the convenience and easy access to educational content through the computer have led to an increase in the learning ability of students. Moreover, face-to-face teaching in a classroom bring about the fatigue and the requirement to learn at a specific and predetermined time which can cause to the limitation of the learner in learning process. In a systematic review on sixteen studies, online continuing education illustrated similar effects to the traditional method and only in six studies the effect of virtual learning was higher. Another research showed that the learner has been considered a key person in distance education and her/ his attitude, diagnosis, and learning style are important variables in education, and also attitude is the most important factor in this process. This was the first comparative study on traditional and combined education in students of Zanjan University of Medical Sciences. Large sample size was one of the advantages, however participants were heterogeneous that was considered as a limitation; in addition, the present study was only designed for theoretical courses. Hence, it suggested that future studies should be carried out on practical-laboratory and clinical courses, taking into account the students' educational levels. Validity of the used tools and questionnaires must be also investigated in future studies.
Conclusion: This study showed that interactive combined education can be an effective way to increase knowledge and attitude in students.