Strengths Weaknesses Opportunities and Threats of Blended Learning: Students’ Perceptions (2023)

  • Journal List
  • Ann Med Health Sci Res
  • v.4(3); May-Jun 2014
  • PMC4071729

Strengths Weaknesses Opportunities and Threats of Blended Learning: Students’ Perceptions (1)

HomeCurrent issueInstructionsSubmit article

Ann Med Health Sci Res. 2014 May-Jun; 4(3): 336–339.

PMCID: PMC4071729

PMID: 24971204

S Hande

Author information Copyright and License information Disclaimer

(Video) Student Perceptions of using Blended Learning Instructions to Enhance the Learning Experience

Abstract

Background:

Blended learning (BL) in a cell biology course of the premedical program at the Kasturba Medical College International Centre, Manipal, India, commenced in 2006. The program provides training in basic sciences to students, especially from the United States and Canada. The approach to the study was phenomenographic, with a qualitative study design using an open-ended questionnaire, focused interviews and empirical observations.

Aim:

The aim of this study was to identify the strengths, weaknesses, opportunities and threats (SWOT) of BL in a premedical class.

Subjects and Methods:

It was a cross-sectional study. Ninety six students in a premedical cell biology class participated in the study. SWOT analysis of students’ perceptions was conducted manually. Statistical analysis included content analysis of qualitative data to classify data and aligning them into the SWOT analysis matrix.

Results:

The outcomes of the study revealed student perceptions in terms of SWOT of BL and the potential uses of this strategy.

Conclusions:

The study provides background for educators and curriculum experts to plan their modules while incorporating a BL approach.

Keywords: Blended learning, Online learning, Premedical, Qualitative study, Strengths, Weaknesses, Opportunities and threats analysis

Introduction

Blended learning (BL), defined as “the thoughtful integration of classroom face-to-face learning experiences with online learning experiences”[1] has been transforming higher education to provide more engaged learning experiences for students. BL integrates seemingly opposite approaches, such as formal and informal learning, face-to-face and online experiences, directed paths and reliance on self-direction and digital references and collegial connections, in order to achieve individual and organizational goals.[2]

The present study was conducted at the Kasturba Medical College International Center, Manipal, India, which was set-up in 2006. The program provides training in basic sciences to students, especially from the United States and Canada. Driven by the demand to increase access to learning opportunities, educators were continually challenged to develop and integrate instructional delivery options, one of which was BL. This was a first-time experience for the faculty at the institution.

Whenever new techniques are introduced and implemented, it is important that there is no impact on instructional integrity. How does the learner accept and value this? To try to answer this question, this study aimed to describe and understand the use of BL from students’ perceptions in terms of strengths, weaknesses, opportunities and threats (SWOT).

Subjects and Methods

A cross-sectional study was conducted where 96 students, in five different classes taking a cell biology course of a premedical program, were included in the study. Ethical clearance for the project was granted from the institutional review committee. Consent was obtained from the students and participation was on a voluntary basis.

Historically, phenomenography has been used to examine and understand both the experience of learning and the experience of teaching.[3,4] A phenomenographic approach in the present study allowed faculty to obtain information on how students experience, understand and react to the strategy of BL in the day-to-day classroom settings.

Qualitative research can help in the in-depth understanding of the feelings, values and perceptions. A qualitative study design was adopted as a means of analyzing student perceptions and generating ideas to be used to improve the educational program. Open-ended questions focused interviews and empirical observations were used to collect data on student views.

First, open-ended questions were administered in written form to each of the five classes, where students who were willing, responded. These open-ended questions included “What was your experience taking an assignment online?” and “What could be the advantages and disadvantages of using BL in this course?”

Second, to double-check the validity of the results obtained through open-ended questions, focused interviews were conducted. Students in groups of five from each class participated in these interviews so that more significant aspects of written responses written could be discussed and followed-up on. Students’ responses obtained from triangulation[5] were compiled into themes by the investigator. Empirical observations were made on the quality of assignments submitted by students in topics taught in the traditional manner and topics taught in a blended format.

The investigator grouped key pieces of information by SWOT analysis into four major categories. It is an important strategy for capitalizing on strengths of the method, improving on weaknesses, recognizing and acting on opportunities and trying to reduce the effects of threats.[6] SWOT analysis of student responses after triangulation was tabulated. The blackboard learning system (BLS) was used for teaching, assessments and course evaluations. Each course session was divided into both online (10-20%) and in-class activities.

(Video) Why e-learning is killing education | Aaron Barth | TEDxKitchenerED

Results

Responses to SWOT analysis are summarized in Tables ​Tables11 and ​and22.

Table 2

Key responses on opportunities and threats of BL

Strengths Weaknesses Opportunities and Threats of Blended Learning: Students’ Perceptions (3)

Open in a separate window

Strengths

Students learned some of the material independently and helped them to apply the learning in a more facilitated learning environment. They found that BL provided engaged the students more and that facilitated a more interactive classroom environment. The students opined that the length of the actual classroom time was reduced, thus reducing exhaustion, at the same time, classroom interactions were more productive through pre-work. The blended format encouraged them to use the out-of-classroom time in meaningful activities. Online quizzes helped students identify those areas that they need to review; questions, which gave immediate feedback on student answers, were helpful. Submitting homework, viewing course material, course objectives and reading material online was convenient. Use of multimedia and external links was useful to understand the subject. Posting class materials (PowerPoint presentations), assignments for formative and summative assessments and instructions for presentations and external links for reference, tutorials and self-directed learning topics saved classroom time. Online objective tests for self-assessment were graded automatically and instantly. Students’ grades in the online grade-book gave them convenient access. Creating online surveys for class sessions evaluation was instant. BL created a dialogue outside of the classroom among students and teachers, by discussions and forums provided in the software.

(Video) Students’ Attitudes towards Blended Learning Implementation in an EFL Classroom

Weaknesses

BL depends upon concretization, coordination, collaboration and communication across the organization, the reason why it is not so easy to do. Other weaknesses include poor Internet connectivity and speed, which is a must when time-limited online assignments are given. Both software and hardware are expensive in Indian settings. Certain configurations on the laptops/desktops had to be enabled to access BLS. Time limit on certain assignments made it stressful. The process of conducting online tests is entirely dependent on expensive technology that may or may not be available to all students staying outside the campus.

Opportunities

Reflecting on the opportunities, online exercises provide flexibility in terms of timing, especially when it becomes difficult to accommodate certain class schedules. Students enjoy the flexibility with which they can do the work assigned. There is a uniform reach of content to the student and international students are appreciative of online assignments. It can kick-off faculty shortage because a single teacher can enroll any number of students into the course. Once software and hardware is acquired and skills developed administering becomes very easy.

Threats

Threats were relatively few as perceived by the students. Internet shorthand (acronyms, emoticons and playful spelling) used in student assignments; dependency on computers for spellings would probably deteriorate their knowledge of the English language. Chat sessions while multitasking online proved to be a distraction. Exchanging IDs and passwords, students could complete assignments for others. There was an interesting comment such as “Teacher jobs may be cut down with 100% online modules!!”

Discussion

BL allows flexibility in adapting learning instructional methods to meet the needs of students who respond to repetition of subject matter provided in different modes of delivery. This accommodates different learning styles and different speeds of cognitive learning. Subject material can be presented in a variety of formats, each reinforcing another and can utilize subject experts for sections of the delivery. A well-designed blended method can make use of physical and virtual classrooms using technology ranging from primitive to state-of-the-art. This variety in delivery methods, ranging from experiential to instructional and structured to unstructured, can re-vitalize subjects that have lost their appeal. The variety in methods increases the interest, resulting in more effective learning. It is imperative that the delivery methods are matched to the subject matter and the audience.[7]

A SWOT analysis relies on perceptions but is, nevertheless, a place to start to evaluate your learning environment. Drawing on the opinions of others, including students who are currently placed with you, can help you to decide what strategic work needs to be performed.[8]

The outcomes of the study identify SWOT of BL. It was possible to explore students’ views on potential uses of BL, the effectiveness of such a study environment, the extent to which students are developing in educationally-meaningful ways and how they could improve their self-directed learning skills. The BL format is more interactive and triggers greater awareness of participants’ own knowledge gaps, which leads to deeper learning. The blended format with its online component for assessments afforded less pressure than face-to-face examinations, but there was still the pressure of keeping up. The study conducted to explore BL at the classroom level, argues that the blended version of the course provided more opportunities for student engagement and active learning.[9]

This study will help educators and curriculum experts to plan their modules while incorporating BL. As suggested by Klein et al.[10] “Innovative learning formats should be developed to address both perceived and unperceived education needs in a supportive environment that is both enjoyable and competitive” and BL, could possibly do that.

The study will help to discover new opportunities, to manage and eliminate threats and at the same time, make sure that we are in step with other educational institutions. As Saunders and Werner[7] appraise this approach, they quote “When one looks at the fundamentals of learning, it is clear that no single approach or method can achieve maximum learning across a variety of learners. Only a blend of methods and approaches can produce the richness and achieve the desired learning outcomes.” Learners represent different generations, different personality types and different learning styles; hence teachers and instructional designers should seek to use multiple approaches including face-to-face methods and online technologies that address the learning needs of a wide spectrum of students.[11]

Scope of this study

The use of technology in education is increasing by the day, offering better learning opportunities and access to information. While looking at the broader prospects of the study carried out in premedical settings, faculty can make use of “blended” virtual and physical resources as an alternative approach in teaching and learning in clinical settings. This study indirectly suggests the requirement of changed instructor roles, a need for updation of skills among instructors, increased connectedness, community and collaboration among students and faculty. A study such as this one would form a baseline study to help faculty who newly incorporate BL, to identify SWOT associated with the BL environment.

Limitations of the study

The study was limited to only one course and five classes of students taking that course.

Conclusion

The study will help stakeholders, educators and curriculum experts to plan their modules while incorporating BL in Indian settings.

(Video) Eye Level Kovan Math Are your children struggling in Math

Footnotes

Source of Support: Nil.

Conflict of Interest: None declared.

References

1. Garrison R, Kanuka H. Blended learning: Uncovering its transformative potential in higher education. Internet Higher Educ. 2004;7:95–105. [Google Scholar]

2. Rossett A, Frazee RV. New York, NY: American Management Association; 2006. Blended learning opportunities. [Google Scholar]

3. Bowden JA. The nature of phenomenographic research. In: Bowden JA, Walsh E, editors. Phenomenography. Melbourne: RMIT University; 2000. pp. 1–18. [Google Scholar]

4. Marton F. Phenomenography: Describing conceptions of the world around us. Instr Sci. 1981;10:177–2. [Google Scholar]

5. Cohen L, Manion L. 3rd ed. London, England: Routledge; 1989. Research Methods in Education. [Google Scholar]

6. Piercy N, Giles W. Making SWOT analysis work. J Mark Intell Plann. 1989;7:5–7. [Google Scholar]

7. Saunders P, Werner K. Finding the right blend for effective learning. Learn Technol. 2002. [cited 2011 April 20]. p. 4. Available from: http://www.ieeetclt.org/issues/april2002/index.html#2 .

8. Price B. Evaluating your learning environment. Nurs Stand. 2004;19:2. [PubMed] [Google Scholar]

9. Swan K. Introduction to the special issue on blended learning. [cited 2011 April 20];J Res Cent Educ Technol. 2009 5:1–3.g. Available from: www.rcetj.org/index.php/rcetj/article/viewArticle/20 . [Google Scholar]

10. Klein D, McCaffrey B, Frosst M, Stenerson H. Medical education conference Victoria; 2007. [cited 2011 April 20]. The strongest link: The evaluation of an innovative and interactive CME program, poster abstracts. Available from: www.mededconference.ca/archives/.../2007_am_poster_abstracts.pdf . [Google Scholar]

11. Picciano A. Blending with purpose: The multimodal model. [cited 2011 April 20];J Res Cent Educ Technol. 2009 5:4–14. Available from: www.rcetj.org/index.php/rcetj/article/viewArticle/11 . [Google Scholar]

(Video) A Comparative Study on the Students’ Perceptions’ about Online Learning vs Face-to-Face Learning

Articles from Annals of Medical and Health Sciences Research are provided here courtesy of Wolters Kluwer -- Medknow Publications

FAQs

What are the perception of students in blended learning? ›

With respect to the perception of BL process, participants of this study perceived BL to be less stressful and more effective than traditional in-class delivery. Our results are in agreement with the literature reporting that students show greater satisfaction in blended courses than in traditional lectures.

What is the strength of blended learning? ›

1. Blended learning programs provide a safer learning environment. By having students complete much of their coursework at home and only requiring in-person attendance a few times per week, institutions can create a learning environment to keep staff and students safe.

What are the threats of blended learning? ›

Some significant challenges to blended learning models include the expense of technology, inadequate training, technological issues, the need to adapt content for blended learning, decreased motivation, and weakened relationships between students and teachers.

What are examples of strengths and weaknesses in a student? ›

  • Strengths. Discipline. Problem Solving Skills. Focus. Critical Thinking. Time Management.
  • Weaknesses. Anxiety. Aversion to Criticism. Distraction. Fear of Failure.
  • Takeaways.
  • FAQs.
28 Mar 2022

What is the general perception of the respondents about blended learning? ›

This study also concludes that blended learning is as effective as face to face learning in developing and improving knowledge and skills. It reflects the students' negative impressions in some points as waste of time, easy cheating and social isolation…etc.

What are the perception of students in modular learning? ›

Modular teaching was appreciated as an effective method by 93.4% students. Case based teaching, small group sessions and problem based learning were considered most favored teaching methods (97.7%, 97.1% and 94.85%) respectively by the students.

What are the opportunities offered by blended learning? ›

It can promote deeper learning, reduce stress, and increase student satisfaction. Teachers can become more engaged with their students. Blended learning presents an increased opportunity for students to connect with their professors and teachers.

What are the threats of students? ›

Here are five of the biggest threats that I identified through my observations.
  • Trauma among students. Students often spoke and wrote about traumatic experiences. ...
  • Worse well-being for teachers and students. ...
  • Staff shortages and turnover. ...
  • Threat of closure. ...
  • Threats from the community.
2 Aug 2022

What are the opportunities of a student? ›

Some examples of opportunities can be targeting a good university, scholarships, campus placements, good mentors, etc.

What are examples of opportunities and threats? ›

Opportunities and threats are external—things that are going on outside your company, in the larger market. You can take advantage of opportunities and protect against threats, but you can't change them. Examples include competitors, prices of raw materials, and customer shopping trends.

What are the advantages of blended learning for students? ›

Teaching is less expensive to deliver, more affordable, and saves time. Blended learning offers flexibility in terms of availability. In other words, blended learning enables the student to access the materials from anywhere at any time while enjoying the benefits of face-to-face support and instruction.

What are the strength of students? ›

One student may be particularly strong in curiosity, love of learning, and perseverance, while another may be strongest in kindness, humility, and fairness; yet another could have zest, social-emotional intelligence, and teamwork as top strengths.

What are the strengths and weakness weaknesses? ›

Strengths are defined as character traits or skills that are considered positive. Strengths include knowledge, attributes, skills, and talents. Weaknesses are just the opposite. Weaknesses are defined as character traits or skills that are considered negative or not as well developed.

What are your strengths and weaknesses examples? ›

My strength are I am a quick learner, I always think in a positive manner so that's why I'm a self-motivated, hardworking person and I learn from my mistakes. Weaknesses : My weaknesses are I am over excited person and I am always wanted to be perfect.

What is student perception? ›

Student perceptions are thoughts, beliefs, and feelings about persons, situations, and events.

What are the effects of blended learning to the students? ›

Blended learning significantly improves K-12 students' overall performance (g = 0.65), particularly in the cognitive domain (g = 0.74). The effect of blended learning is impacted by the group activities, educational level, subject, knowledge type, instructor, sample size, intervention duration and region.

What are students perceptions of working while studying? ›

The second research question looked at positive and negative effects of working while studying. The findings showed that the participants have happy feeling and good time management. Additionally, they become more responsible and improved their personal life.

What is your perception of distance learning? ›

The data indicate that students strongly prefer distance education, largely because it allows them to balance their other commitments more easily. Respondents also perceive that they achieve higher quality educational outcomes in the distance learning environment.

What are the problems encountered by students in modular learning? ›

These include internet connectivity problems, inadequate learning resources, difficulty understanding the module contents and assessment instructions, overloaded remote learning tasks, poor learning environment, and mental health problems.

How can you overcome the challenges to blended learning as a student? ›

Overcoming the challenges of blended learning
  1. Provide a space for learning. The first step is to provide your kids with their own distraction-free space for learning. ...
  2. Craft a consistent routine. ...
  3. Teach them to become independent. ...
  4. Balance the use of gadgets. ...
  5. Make time for break time.
11 Nov 2020

How does blended learning help students and teachers? ›

By making in-person and online learning complementary, blended learning creates a truly integrated classroom where the needs of all types of learners can be met. Keeping students engaged, stimulated, and motivated also helps teachers to be more effective and make greater gains with their students.

What are 4 examples of threats? ›

9 examples of threats in a SWOT analysis
  • Social perception. With the rise of social media, consumers are increasingly aware of the business practices of the companies they support. ...
  • Natural disasters. ...
  • Technological changes. ...
  • Legislation. ...
  • Competition. ...
  • Globalization. ...
  • Data security. ...
  • Rising costs.

What are 4 examples of opportunities? ›

What are some examples of opportunities?
  • Get help on projects.
  • Propose working groups.
  • Get testers for new ideas or products.
  • Create a team to work on an idea you have.
  • Share your expertise or best practices in a particular field.

What are examples of threats? ›

Threats refer to factors that have the potential to harm an organization. For example, a drought is a threat to a wheat-producing company, as it may destroy or reduce the crop yield. Other common threats include things like rising costs for materials, increasing competition, tight labor supply.

What is the opportunities of learning? ›

Learning opportunity means various types of educational experiences, including classroom, online, blended, self-guided, mixed delivery, coaching, mentoring, and experiential course work. It may be delivered internally or externally, and must directly relate to the work situation.

What is multiple opportunities of students? ›

Multiple Opportunities to Respond is an instructional question, statement or gesture made by the teacher seeking an academic response from students (Sprick, Knight, Reinke, & McKale 2006), A teacher behavior that prompts or solicits a student response (verbal, written, gesture) (Simonsen, Myers, & DeLuca, 2010).

What are opportunities opportunities? ›

Opportunities. Opportunities are openings or chances for something positive to happen, but you'll need to claim them for yourself! They usually arise from situations outside your organization, and require an eye to what might happen in the future.

What are strengths and opportunities? ›

A strength is a resource or capacity the organisation can use effectively to achieve its objectives. A weakness is a limitation, fault, or defect in the organisation that will keep it from achieving its objectives. An opportunity is any favourable situation in the organisation's environment.

What are 3 examples of weaknesses? ›

Examples of Weaknesses.
  • Self-criticism.
  • Shyness.
  • Lack of knowledge of particular software.
  • Public speaking.
  • Taking criticism.
  • Lack of experience.
  • Inability to delegate.
  • Lack of confidence.

How do you answer what are your opportunities and threats? ›

You can frame your answer in a way that highlights the opportunity you see in this situation. For example, your answer to this question could be, 'While working under someone who has lesser experience than me may lead to some conflict, this will improve my ability to work in a team and my skills in handling conflict."

What are the disadvantages of online learning for students? ›

Disadvantages of Online Learning
  • Online Learning May Create a Sense of Isolation. Everyone learns in their own manner. ...
  • Online Learning Requires Self-Discipline. ...
  • Online Learning Requires Additional Training for Instructors. ...
  • Online Classes Are Prone to Technical Issues. ...
  • Online Learning means more screen-time.
28 Dec 2021

How will you determine the strengths and weaknesses of your students? ›

Identifying strengths, weaknesses and gaps (evaluation)
  • Student performance on assignments and activities intended to assess achievement of learning outcomes [link]
  • Review of course materials and assignments for clarity, sense, content and level of challenge.
  • Informal or formal surveys [link to section on surveys)

What is your top weakness as a student? ›

Lack of focus and a short attention span are common academic weaknesses for modern students. Students with this struggle to concentrate during a lecture or study for long hours. Of course, this might not be a character trait. Some students have attention deficit disorder and need professional help.

What are your 5 strengths and weaknesses? ›

They demonstrate that you are confident of this strength and that you will use it to succeed in this specific role.
  • Collaborative. I am very collaborative. ...
  • Technical know-how. ...
  • Detail-oriented. ...
  • Positive attitude. ...
  • Solving problems. ...
  • Self-criticism. ...
  • Fear of public speaking. ...
  • Procrastination.
16 Aug 2022

What are your top 5 Weaknesses? ›

List of Example Weaknesses:
  • Too self-critical.
  • Too critical of other people's work.
  • Difficulty delegating tasks.
  • Disorganized.
  • Too detail-oriented.
  • Need more experience in X.
  • Impatient with others.
  • Unfamiliar with X.

What are the examples of strengths? ›

Personal Strengths
AccurateAction-orientedAdventurous
ConfidentConsiderateCourageous
CreativeCuriousDecisive
DedicatedDeliberateDetail-oriented
DeterminedDisciplinedEducated
28 more rows

What are your weaknesses good examples? ›

Examples of weaknesses on the job
  • Inexperience with specific software or a non-essential skill.
  • Tendency to take on too much responsibility.
  • Nervousness about public speaking.
  • Hesitancy about delegating tasks.
  • Discomfort taking big risks.
  • Impatience with bureaucracies.
13 Dec 2021

What are the top 10 Weaknesses? ›

List of Weaknesses
  • Not taking criticism well.
  • Impatient.
  • Lazy.
  • Easily bored.
  • Procrastinate.
  • Persistent.
  • Takes things personally.
  • Strong willed.
19 Aug 2022

What is the impact of blended learning as as a student? ›

Blended learning provides a holistic understanding and transforms the learning experience for its end-users. By using a virtual environment, access to learning becomes unlimited. A student would be able to access their classrooms from any place eliminating the need for attending classes or training at a fixed place.

Why do students prefer blended learning? ›

Blended learning offers flexibility in terms of availability. In other words, blended learning enables the student to access the materials from anywhere at any time while enjoying the benefits of face-to-face support and instruction.

How does the blended learning affects the students performance? ›

Blended learning significantly improves K-12 students' overall performance (g = 0.65), particularly in the cognitive domain (g = 0.74). The effect of blended learning is impacted by the group activities, educational level, subject, knowledge type, instructor, sample size, intervention duration and region.

What are the 5 perceptions? ›

Types of Perception

This includes visual perception, scent perception, touch perception, sound perception, and taste perception.

What are the factors that affect students perception? ›

Students have a positive perception towards SET. There is a significant difference in the perception of students based on demographic variables such as age, gender, education, nationality, class capacity, and difference in courses. Non-instructional factors affect students' perception of SET process.

What are the 4 types of perception? ›

The question for cognitive psychologists is how we manage to accomplish these feats so rapidly and (usually) without error. The vast topic of perception can be subdivided into visual perception, auditory perception, olfactory perception, haptic (touch) perception, and gustatory (taste) percep- tion.

What are the benefits of blended learning to students and teachers? ›

Benefits of Blended Learning
  • Different people learn different things in different ways. ...
  • Using multiple modalities dramatically reinforces engagement, learning and retention. ...
  • Learners can control the pace of their learning. ...
  • Blended learning saves money. ...
  • Blended learning is modular and scalable.
11 Jul 2022

What is the impact of blended learning approach to your academic grades? ›

While face to face learning group final application score lessen 12 points, blended learning group score lessen 8 points. It can be confessed that according to the persistency of student achievement, blended learning method is more effective than face to face learning method.

What is blended learning and its advantages? ›

Blended learning, which mixes traditional face-to-face education with technology, has become increasingly popular in educational institutions over the years. This style of learning provides a way for faculty to engage students through visuals and online interaction.

Videos

1. High School Students' Perceptions of Distance English Language Learning Through Edmodo by Shabana K.
(TESOL Arabia)
2. Rethinking Remote Learning
(Maine Department of Education)
3. Researched-Backed Strategies for Effective Blended Learning
(Research Minutes (CPRE Research))
4. WCQR2022_77: An online problem-based learning, during the pandemic: the analyze SWOT of the...
(Ludomedia)
5. Approaches to Evaluating Blended Learning Programs January 2014
(Aurora Institute)
6. Blended Learning - Reading for Understanding, Analysis and Evaluation
(SATE)
Top Articles
Latest Posts
Article information

Author: Terence Hammes MD

Last Updated: 01/11/2023

Views: 6733

Rating: 4.9 / 5 (69 voted)

Reviews: 92% of readers found this page helpful

Author information

Name: Terence Hammes MD

Birthday: 1992-04-11

Address: Suite 408 9446 Mercy Mews, West Roxie, CT 04904

Phone: +50312511349175

Job: Product Consulting Liaison

Hobby: Jogging, Motor sports, Nordic skating, Jigsaw puzzles, Bird watching, Nordic skating, Sculpting

Introduction: My name is Terence Hammes MD, I am a inexpensive, energetic, jolly, faithful, cheerful, proud, rich person who loves writing and wants to share my knowledge and understanding with you.