Impact of Online Teaching on Mental Health and Quality of Life among Medical Teachers during COVID-19 Pandemic - A Cross-Sectional Study

Abstract

Background: 

Stress is the physiological and psychological response to internal or external stressors. The COVID 19 outbreak caused a sudden shutdown of conventionally designed medical teaching and new digital e-learning methods emerged which invariably affected the psychology of medical teachers.

Aims and Objective: 

To study the impact of the COVID-19 pandemic and distance teaching on the psychological status of medical teachers.

Materials and Methods: 

A total of 322 medical teachers were included in the study; an online survey was conducted through a social media platform between April and May 2021. The online consent was obtained from all the participants. Participants were asked to complete a modified validated Google Form questionnaire with perceived stress scale (PSS-10) which is a classic stress assessment instrument.

Results: 

The PSS-10 score was significantly high in the medical teachers who were using digital online e-learning methods first time during this COVID 19 pandemic lockdown. Male teachers reported more stress as compared to female teachers.

Conclusion: 

Higher perceived stress among medical teachers during the COVID-19 pandemic should be acknowledged and strategies to mitigate it should be recommended. Proper counseling services should be available to support the mental health and well-being of faculty.

INTRODUCTION

Corona virus disease-19 (COVID-19) is an acute highly infectious disease primarily involving the respiratory system caused by coronavirus SARS-CoV-2. It was first reported in Wuhan, Hubei province of China, in December 2019.[¹] The World Health Organization declared COVID-19 a global pandemic on March 11, 2020.[²] No proven efficacious drug and no vaccine are available so far for treatment or prophylaxis of COVID-19. Mask and social distancing have been one of the major measures adopted to prevent the spread of the disease. Educational institutions have been shut down all over the world for the safety of both students and communities. The COVID-19 pandemic has created uncertainty around the world. In the field of education, the online medium has become today's reality. Faculty members are feeling the huge stress of remaking their classes into effective digital forms. The additional workload and concomitant anxiety are heaped upon the already multifaceted responsibilities of faculty. This all has resulted in heightened stress among teachers because many of them were not using the online mode of teaching before. Hence, we planned this study to assess stress among teachers.

MATERIALS AND METHODS

After the institutional ethical clearance, this cross-sectional, online survey-based study was done on medical teachers. A snowball convenience sampling strategy was used to recruit teachers through social media and Whatsapp groups. A total of 322 medical teachers gave online informed consent and were included in the study. Participants with a history of psychiatric illness or substance use disorders were excluded from the study. The online survey form was distributed through a social media platform between April and May 2021 and participants were requested to complete the form and submit it.

Statistical analysis

The data were analyzed using the software SPSS (Statistical Package for the Social Sciences) Version 22.0 (IBM, Armonk, New York, USA). Frequency distribution tables for all pertinent variables were generated. The percentage for categorical data and mean ± standard deviation (SD) or median (interquartile range) for continuous data were calculated as per requirement. Student's t-test, Fisher's exact test, and Chi-square test were applied to find out the significant difference.

Survey instrument and related measures

Google Form was used to create the online survey. Three sections with overall 35 questions were included in this anonymous online survey. The first section consisted of five questions about participants' sociodemographic profiles including name, age, gender, designation, department, and college of faculty. In the second section of the online survey, 20 questions about online teaching, the device used, Internet speed, stress, response of students and parents, and experience of online teaching (by student and faculty) were included. The third section of the online survey included 10 items from the perceived stress scale-10 (PSS-10). PSS-10 is a 10-item questionnaire originally developed by Cohen et al.,[³] it evaluates the degree to which an individual has perceived life as unpredictable, uncontrollable, and overloading over the previous 1 month.

Perceived stress scale-10 calculation

Respondents report the degree to which situations in one's life have been unpredictable, uncontrollable and overloaded in the past month on a 5-point Likert scale (0 = never, 1 = almost never, 2 = sometimes, 3 = fairly often, 4 = very often). Scores for the four positively stated items (Items 4, 5, 7, 8) are reversed, change the scores: 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0.

Add up scores for each item to get a total.

Individual scores on the PSS can range from 0 to 40.

Higher scores indicating higher perceived stress.

• Scores ranging from 0 to 13 would be considered low stress
• Scores ranging from 14 to 26 would be considered moderate stress
• Scores ranging from 27 to 40 would be considered high perceived stress.

RESULTS

In the present Google Form-based online study, responses from 322 medical teachers were received, of which, 182 (56.5%) were males and 140 (43.5%) were females. Table 1 shows mean ± SD of PSS-10, positive factors-4, 5, 7, and 8 show high mean ± SD than negative factors (1, 2, 3, 6, 9 and 10) and the Mean ± SD of total participants is 1.85 ± 0.46. Table 2 shows mean ± SD of PSS-10 according to gender. The mean ± SD of PSS questions in female participants is 1.95 ± 0.51 and male participants' is 1.81 ± 0.47 and the difference is statically significant. Table 3 shows mean ± SD of PSS-10 score in the form of mild stress and moderate stress according to gender and found statically significantly. Table 4 shows stress levels in female and male faculty in form of percentages and found statistically significant. About 56.3% female and 43.8% male faculty having mild stress, 36.7% female and 63.3% male faculty having moderate stress and none of the faculty having severe stress. Overall, around 76% of teachers reported mild-to-moderate degree of stress during teaching remotely in the COVID-19 pandemic. Table 5-frequencies and percentage distribution of section 2 questions and association of stress level with different variables. Among respondents, 28.3% reported having little or no online teaching/learning experience before the pandemic. The challenges to online medical education during the COVID-19 pandemic, as reported by teachers, included issues related to communication (56.5%), limited/no opportunity for one-to-one discussion with students (56.5%), use of technology tools (56.5%), online experience (26.1%), difficulty in time management (10.9%). About 37% of respondents reported that college has not been offering resources to teach while 10.9% stated that co-workers are not helpful. Despite these challenges, most of the respondents (71.7%) successfully taught online from home in peaceful environment mainly using laptop. About 73.9% of medical teachers had high-speed internet at home. About 85.6% of medical teachers operate devices and software. 60% 0f parents supported their children's for remote learning but the response from students was average. Overall teachers are stressful to teaching remotely during the COVID-19 pandemic and students are stressful while learning remotely during the COVID-19 pandemic.

Table 1: Percentage and mean±standard deviation of Perceived Stress Scale-10

Table 2: Mean±standard deviation of Perceived Stress Scale-10 according to gender

Table 3: Mean±standard deviation of Perceived stress scale-10 score between male and female medical teachers

Table 4: Perceived stress scale-10 score between male and female medical teachers in percentage

Table 5: Frequencies and percentage distribution of section 2 questions and association of stress level with different variables

DISCUSSION

We are currently experiencing an unprecedented academic crisis due to COVID 19 due to the closure of colleges around the world. Online education has suddenly become an academic need. In our study, we measure this stress level in teachers due to the rapid transitions to online education because many of them are not previously taking online classes. The main challenge for online education in developing country like India is related to communication, face-to-face discussion with students, use of technology devices, access to hardware, software by computers, and speed of Internet during pandemic. Other challenges include online assessment of students, technical barriers and inexperienced online education increased anxiety over academic translation.

A similar study done by Kour et al.[⁴] in Jordan on 382 university teachers, revealed that 31.4% of respondents had severe distress and 38.2% had mild-to-moderate distress. Although gender was not associated with distress severity and age had a weak negative correlation (Rho = −0.19, P < 0.0001). In addition, Aperribai et al.[⁵] studied that indoor physical activity acts as preventive in lockdown situations, whereas the level of activity does not affect mental health. Also, teachers have experienced higher levels of distress due to the workload generated during the lockdown.

Many studies define the benefit of online teaching over traditional classroom teaching and conclude that online teaching brings opportunities and is the future of medical education.

According to Rajab et al.,[⁶] there has been a positive impact of the COVID-19 pandemic on online medical education at Alfaisal University. Challenges brought about by the pandemic included those related to communication, student assessment, use of technology tools, online experience, pandemic-related anxiety or stress, time management, and technophobia.

A study conducted by Bao et al.'s[⁷] "concluded five principles of high-impact teaching practice to effectively deliver large-scale online education, through the case analysis of Peking University's online education. Desai et al.[⁸] Studied that despite problems like poor Internet connectivity, or access to it, online classes were popular among students and proved to be a very pragmatic and feasible teaching option and can definitely supplement traditional classroom teaching. Hence, to conclude, we can deduce that soon enough people will get used to the online teaching environment, and blended learning comprising both online and offline teaching will be a part of our standard curriculum. Khan, et al.[⁹] took feedback from 367 students and 56 teachers. "Around — of the students (76.7%) and teachers (73.2%) were satisfied with online teaching. The themes generated for benefits of online teaching were similar for both students and teachers, but the perceived challenges differed. Students found online teaching more stressful, and teachers were apprehensive of the new technology and lack of a controlled environment. They recommend that the online teaching program developed during this pandemic lockdown should be used to promote SDL as envisioned in CBME." Piryani et al.[¹⁰] said that the COVID-19 pandemic changed the landscape of medical education. The situation has forced medical educationists to think "out of the box" and act innovatively using digital technology. It is said that challenges bring opportunities. COVID-19 may also bring opportunities. This is a new experience or opportunity to learn, understand and update about new needs and new modes of delivery of medical education. Goh and Sandars et al.[¹¹] conclude "Medical education across the world has experienced a major disruptive change as a consequence of the COVID-19 pandemic. Technology has been rapidly and innovatively used to maintain teaching and learning. The benefits and challenges of the use of technology in medical education are discussed with the intention of informing all providers on how the changes after the pandemic can have a positive impact on both educators and students across the world." Sahu.[¹²] recommended that faculty members should embrace technology and pay careful attention to student experiences to make the learning-rich and effective.

Psychometric properties of a European Spanish version of the PSS-10.[¹³] State regarding the possible influence of gender on perceived stress, Women had higher perceived stress scores than did men; this result was statistically significant both for the PSS-4 and PSS-10.

In our study, the PSS-10 score was significantly high in the medical teachers who were using digital online e-learning methods first time during this COVID 19 pandemic lockdown. Males having more stress as compared to female teachers. Developing countries like India started online teaching without ensuring proper facilities, like training of teachers and students about how to use software and hardware, how to communicate, provision of high-speed Internet, etc., In such a situation, it became difficult for faculty to cope up with the dazzling number of choices and poor Internet connectivity.

Disadvantages of online teaching are distractions caused by phone calls, social media notifications causing breach in the link and continuity of the class, continuous teaching with no breaks; and poor understanding of technology by the teachers.

SUMMARY AND CONCLUSION

New competency-based curriculum is introduced recently both in government and private medical colleges in India to improve medical education. Medical educators have initiated the process of transforming education and improving quality before the COVID-19 outbreak. The COVID-19 pandemic changed the scenario of medical education. The situation has forced to think innovatively to implement medical education online using digital gadgets, programs, and software. The pandemic presented various challenges to medical teachers like shifting from face-to face to online teaching, accessing Internet using technology and conduct assessment online. This new experiences to learn, understand and update about new modes of delivery of medical education demand greater effort and time so medical teachers are in stress. This additional workload and concomitant anxiety are heaped upon the already multifaceted responsibilities of faculty. As medical teachers reported significant levels of stress, proper counseling services should be available to support the mental health and well-being of faculty.

Expected output

To prevent health problems among teachers in future similar situations, teacher training in online educational methods for their favorable work development.

Limitations

A bigger sample size is always desirable and could have given somewhat different, perhaps better, results.

Financial support and sponsorship

This study was conducted solely by the authors without any grant, finance, logistic or material support of any person or institution and due permission of ethical committee was also taken.

Conflicts of interest

There are no conflicts of interest.