Objectives: To explore healthcare tutor and student perceptions of the advantages of, and barriers to, computer-assisted learning (CAL) and the perceived influence of CAL on student reflection and reasoning skills.

Subjects: The research focused on tutors and undergraduate students within a department of clinical and health studies within a university in the north of England. A purposive sample of 34 tutors and 304 students within the physiotherapy, podiatry, midwifery, and health & sports courses were the target populations for the survey element, and a purposive sampling strategy employing maximum variation sampling was used for the selection of subjects for follow-up interviews.

Design: A mixed method design was chosen employing questionnaire surveys and semi-structured interviews. Two questionnaires were developed, to survey the two populations of participants, with resulting response rates of 197 students (64.8%) and 31 tutors (91%). Illuminative follow-up semi-structured interviews were undertaken on an individual basis with 23 students and 13 tutors.

Analysis: The questionnaire datasets were analysed descriptively, and inferentially using the non-parametric Mann-Whitney procedure, to test for differences between age groups, gender and year of training. The interview transcripts were thematically analysed and inductively coded. Member checking by transcript checking, and by discussion of emergent themes by two student, and two tutor, focus groups was undertaken.

Results: The student and tutor questionnaires and interviews highlighted common perceived advantages of CAL. These included a perception of CAL as an adjunct or support tool rather than a primary approach to teaching and learning. CAL was seen as a tool for improving work presentation, facilitating communication, enabling formative assessment, helping organise notes and as an information source. It was also perceived as giving flexibility to learning. CAL was seen as able to save time, and induce positive emotions when things went well.
Common barriers to CAL were lack of time to develop or use CAL and time wastage, limited computer literacy/skill level, negative emotions, inadequate training and support, access issues, cost and lack of portability. Loss of face-to-face contact with tutors/peers with CAL was also a barrier to its use.
For both tutors and students, CAL was not the preferred means of engendering reflection and reasoning skills, although more scope was identified for the latter via interactive simulated patient databases.
Emergent theory: A critical triad is identified which impacts upon student/tutor engagement with CAL as part of the learning experience.

Conclusion/Recommendations: When compared to prior research, the study shows a close parallel between the health students and other Higher Education (HE) students in their perceptions of advantages and barriers to CAL. Perceived barriers to CAL highlight training and support needs of students and tutors as being a key factor in CAL usage/development.
The area of clinical reasoning/reflection development via CAL is undervalued by students and tutors. Better student access to computers in clinical settings, clinical case based virtual learning environments, roll out of mobile technology and closer relationships between HE and clinical Trusts are all identified as ways to integrate blended learning in a more seamless way into the clinical environment.