Table 3.

Study characteristics

Reference	Participants	Study Design	Research Aims	Laboratory	Key Findings
Moreno-Ger et al. (37)	143 medical undergraduates	Randomized control trial design Experimental group (EG), n = 66, used the virtual laboratory simulation prior to the physical laboratory Control group (CG), n = 77, attended the physical laboratory only Student perception: 5-point Likert survey	To investigate: If having prelab virtual simulation decreases the perceived difficulty for the physical laboratory. If having prelab virtual simulation increases the experimental precision during physical laboratory. The students’ attitudes toward a prelab virtual simulation.	Aim: To develop students' skills to quantify different parameters from a blood sample taken from an experimental animal. Virtual tool: Virtual laboratory simulation Mode of delivery:*Blended Asynchronous	The EG perceived that the procedures were easier to understand and displayed a higher level of precision in determining the hematocrit. The EG reported a more positive experience.
Motz et al. (38)	173 undergraduates from the Department of Psychological and Brain Sciences	Quasiexperimental study design EG, n = 104, CG, n = 69, Pretest and posttest results were compared.	To investigate if the computer program improves students’ conceptual understanding of neurophysiology.	Aim: To discover the lateralization of cognitive function, the anatomy of the brain, and the spatial frequency hypothesis. Virtual tool: Computer program, Lateralizer. Mode of delivery: Virtual Asynchronous	EG made stronger improvements between the pretest and posttest than CG. However, due to significant inconsistency between CG and EG, the comparison between CG and EG was considered invalid. Nonetheless, the improvement within the EG was significant.
Mutlu et al. (39)	71 undergraduates from a nursing faculty	Randomized control trial design High-fidelity group (HFS), n = 36, used Nasco Smartscope Simulator Low-fidelity group (LFS), n = 35, used computer-based simulator Pretest and posttest results were compared.	To determine the effects of high- and low-fidelity simulators on student nurses’ learning of heart and lung sounds.	Aim: To develop students’ skills to accurately identify heart and lung sounds. Virtual tool: Low-fidelity simulator (computer-based simulator)† Mode of delivery:Virtual Synchronous	The high-fidelity simulator was more effective compared with the low-fidelity simulator in supporting students’ conceptual understanding in heart and lung sounds.
Wang et al. (16)	63 undergraduates (Bachelor of Medicine and Bachelor of Surgery)	Randomized control trial design Living tissue laboratory group, n = 23 Virtual laboratory group, n = 18 Blended group, n = 22 Median postlaboratory quiz score (points) compared between groups Student perception survey (4-point Likert-scale format).	To investigate the impact of the virtual laboratory simulation in supporting students’ learning and perceptions of neurophysiology. To assess the validity of the virtual laboratory simulation as a useful pedagogical tool for neurophysiology.	Aim: To enhance students’ understanding on the generation and conduction of neural action potentials. To provide basic training of measuring neuronal excitability and signal conduction.Virtual tool: Virtual laboratory simulation Mode of delivery: Virtual and blended Synchronous	Both the live tissue laboratory and the blended laboratory were more effective in supporting conceptual learning than the virtual laboratory. The live tissue, blended, and virtual laboratories were equally effective in supporting students’ technical learning. Delivering animal experiments via virtual means was deemed less attractive compared with the physical and the blended delivery modes.
Chen et al. (24)	173 medical undergraduates 34 teachers who taught the blended laboratory course	Within-subject design Students undertook the traditional laboratory course in 2015 and a blended laboratory course in 2016. Average scores for laboratory quizzes were compared. Student and teacher perception surveys were conducted.	To investigate if the blended laboratory course supports students’ understanding in threshold concepts and improves their abilities of self-learning, understanding, and problem solving.	Aim: Not applicable as the study evaluated multiple laboratories. There is no explicit description of the laboratories. Virtual tool: Blended laboratory course, including micro videos Mode of delivery:Blended Asynchronous	The blended laboratory course was effective in enhancing test scores. Students preferred the blended laboratory course compared with the traditional methods. Teachers had ascertained the effectiveness of the blended model of virtual physiology laboratories in supporting students’ conceptual and motivational learning.
Dantas and Kemm (7)	31 undergraduates studying a physiology course in a Science degree	Within-subject design Students completed e-Learning activities as prelab exercises. Student perception survey (5-point Likert-scale). Correlation between e-learning marks and final examination marks was analyzed.	To investigate student use of e-learning in the laboratory-based course.To evaluate the learning outcomes that are enhanced by active learning facilitated by the e-learning component of the course.	Aim: Not applicable as the study evaluated multiple laboratories. There is no explicit description of the laboratories. Virtual tool: e-Learning platform, with active learning promoted through hypothesis testing and predictions for physical laboratories. Mode of delivery: Blended Asynchronous	The majority of the students did not agree that the virtual physiology laboratory motivated them to learn. The e-learning marks correlated with final examination masks.
Dobson (40)	25 undergraduates from the Department of Applied Physiology and Kinesiology	Crossover study design. EG 1, n = 12, completed the traditional exercise physiology laboratory before undertaking a knowledge assessment. Next, the group completed the Virtual Physiology of Exercise Laboratory (VPEL) program before undertaking a knowledge assessment. EG 2, n = 13, completed the VPEL program before undertaking a knowledge assessment. Next, the group completed the traditional exercise physiology laboratory before undertaking a knowledge assessment.	To compare student learning (experimental setup, conduct, and data analysis) from the VPEL program with that from traditional exercise physiology laboratory activities. To determine if the order in which the different types of laboratories were delivered affects students’ conceptual understanding in exercise physiology.	Aim: To enhance students’ conceptual understanding in lactate and ventilatory threshold and maximal oxygen consumption during exercise. To allow students to practice the processes of setting-up and conducting experiments, and analyzing the data collected. Virtual tool: VPEL simulation Mode of delivery: Virtual Synchronous	No significant differences between the 2 groups for experimental assessment.
Durand et al. (41)	350 medical undergraduates	Cross-sectional study design Group A, n = 120, conducted animal laboratory classes. Group B, n = 122, conducted both animal and virtual laboratory classes. Group V, n = 108 conducted virtual laboratory classes. Student perception survey was carried out.	To compare the students’ perceptions of animal laboratory classes versus video/computer-based learning in physiological sciences associated with the effectiveness of the PBL method.	Aim: Not applicable as the study evaluated multiple laboratories. Virtual tool: Online videos with interactive activities Mode of delivery: Virtual‡ Synchronous	Both the animal-using laboratories and the virtual physiology laboratories were found to support students’ motivational and conceptual learning. Students viewed the use of animals as more effective to stimulate their motivational learning. Students agreed that both the animal-using laboratories and the virtual physiology laboratories were effective to support technical learning, however, they differed in terms of the skill sets that they developed.
Elmer et al. (25)	33 undergraduates from the Department of Kinesiology and Integrative Physiology	Crossover study design Section 1, n = 16, undertook the laboratories in the order of: blended neuromuscular power laboratory, traditional maximal oxygen consumption laboratory, blended blood lactate laboratory, traditional muscle electromyography (EMG) laboratory. Section 2, n = 17, undertook the laboratories in the order of: traditional neuromuscular power laboratory, blended maximal oxygen consumption laboratory, traditional blood lactate laboratory, blended muscle EMG laboratory. Student perception survey was carried out.	To compare student performance and perceptions between blended and traditional laboratories in an undergraduate exercise physiology.	Aim: Not applicable as the study evaluated multiple laboratories. There is no explicit description of the laboratories. Virtual tool: Video demonstrations and knowledge checks Mode of delivery:Blended Synchronous	The blended model of virtual physiology laboratory was equally effective as the traditional living tissue experiments in improving students’ performances. The majority of the students agreed that the virtual component of the blended model greatly enhanced their conceptual learning and engaged them to perform physiology experiments. The majority of the students preferred the blended model to the traditional model.
Gopal et al. (13)	165 undergraduates undertaking the Anatomy and Physiology course	Quasiexperimental study design EG, n = 80, had access to the virtual learning platform CG, n = 85, did not have access to the virtual learning platform Students’ lab tests scores and their usage of the virtual platform were analyzed.	To compare student performance among undergraduate students with access to a virtual learning platform to students without access to the platform.	Aim: Not applicable as the study evaluated multiple laboratories. There is no explicit description of the laboratories. Virtual tool: Web-based cardiovascular system platform Mode of delivery: Blended Synchronous? (this is unclear)	Students with access to the virtual platform took advantage of the virtual platform, with EG showing higher performance than CG.
Modica et al. (42)	227 medical undergraduates	Quasiexperimental study design EG, n = 120, completed the experimental curriculum, including web-based musculoskeletal tutorial, pathophysiology-focused cases, and facilitator preparation. CG, n = 107, completed a traditional musculoskeletal curriculum. Multiple-choice examination and student perception survey were carried out.	To assess the effectiveness of the experimental curriculum on teaching students the musculoskeletal exam as compared with a traditional curriculum. To assess students’ and preceptors’ satisfaction when exposed to our experimental teaching method.	Aim: To enhance students’ conceptual understanding and technical skills in musculoskeletal examination. Virtual tool: A web-based curriculum, including musculoskeletal tutorial, pathophysiology-focused cases, and facilitator preparation. Mode of delivery: Blended Asynchronous (web-based tool) and synchronous (practice session)	No significant differences between the two groups for the examination. Students viewed the PFCs (virtual laboratory component) as the most useful in supporting their conceptual learning. The additional resources offered through the blended model of virtual physiology laboratory made the blended model the preferred mode of delivery to traditional laboratories for students.

EG, experimental group; CG, control group. *Mode of delivery refers to the form of learning undertaken by the studies in offering the virtual instruments. †Only low-fidelity simulator is applicable, as the high-fidelity simulator (nasco smartscope simulator) is a mannikin simulator that can only be used in physical laboratory settings. ‡Blended is not included as group B experienced a transition from having only animal laboratories to having only virtual laboratories.