INTRODUCTION
The Government of India declared nationwide lockdown due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) pandemic, suspended public gathering, imposed suspension of all training, research and educational institutions, closure of all commercial and private establishments.[ 1 , 2 ] This was a difficult and challenging situation, especially medical institutions to continue regular classes along with managing the present situation. Hence, online classes were started for medical undergraduates throughout India.[ 3 ]
These online classes were started mainly to build confidence in students, to keep in touch with them, to continue the course and complete syllabus. This method of teaching was new to both faculty and students. Various e-learning platforms were adopted by medical colleges such as Google Meet, Google classroom, Medwhiz, Web-Ex, Microsoft teams and zoom with a trial and error basis.[ 4 ]
This pandemic was a barrier to continue the conventional teaching method which provides an efficient way of interaction, communication and sharing of knowledge amongst students. The best alternative in this situation was e-learning. Due to the pandemic, to continue regular classes, educational institutions tried various teaching, learning methods and started online classes. Hence, this study was undertaken to evaluate the effectiveness, advantages and disadvantages of e-learning classes conducted for medical students during the COVID-19 pandemic.
MATERIAL AND METHODS
A descriptive, online questionnaire-based survey was conducted for undergraduate medical students studying at Tertiary care medical college, Bengaluru. The study was conducted after obtaining Ethical clearance from the institutional ethics board. The questionnaire was prepared using Google forms and students were asked to answer questions with the most appropriate response. The questionnaire was designed to collect the following information. Section 1: the demographic characteristics (age, sex and year of study), available technologies, usage of media and their experience with e-learning. Section 2: contained questions on the comparison of e-learning with face-to-face learning, was graded based on a 5-point Likert scale, with 1 being extremely ineffective and 5 being extremely effective. It included questions related effectiveness of e-learning in terms of increasing knowledge, increasing clinical skills, social competencies, effective communication and understanding of subject. Section 3: contained questions with multiple options on advantages, disadvantages and challenges faced during e-learning. Six options were given under each headings; students were asked to choose all possible correct options.
Statistical analysis
Data were analysed using descriptive and inferential statistics. Chi-square and Z -test for 2 proportions were used to test the level of significance. A P value <0.05 was considered statistically significant.
RESULTS
A total of 560 MBBS undergraduate students took part in the study. The survey was carried out after 6 months of online classes. Amongst the 560 participants, 41.6% were male and 58.4% were female. Their mean age was 21.5 (range 18 to 26). A total of 198 (30.9%) 1st MBBS, 129 (20.2%) 2nd MBBS, 154 (24.1%) 3rd MBBS and 79 (12.3%) 4th MBBS students participated in the study.
Student’s state of mind during online classes is shown in Figure 1 . Majority of students (33%) reported no change, 29% were anxious, 26.1% were relaxed and 10.2% of students reported feeling depressed. The assessment of technology availability and usage among study participants is shown in Table 1 . Majority of participants, 77.3% had very good IT skills, 55.7% of students used mobile phones as major media for online classes and 58.4% reported access to internet services were neutral, about 79.5% of students had previous experience with e-learning.
Figure 1: State of mind of participants
Table 1: Assessment of technology availability and usage
The effectiveness of e-learning compared to face-to-face learning is shown in Table 2 . Most of the medical students rated e-learning as equally effective as regular face-to-face learning in increasing knowledge, social competences, understanding subject and meeting individual learning needs. However, e-learning is ineffective in increasing clinical skills and effective communication compared to regular face-to-face learning. All responses showed a statistically significant difference between ineffective and effective groups with P < 0.005.
Table 2: Effectiveness of e-learning compared to face-to-face learning
The main advantage of e-learning was reported to be ability to stay at home (73.2%), 68.8% reported the ability to record meeting, more than 50% reported access to online materials, learning on their own pace and comfortable surroundings as advantages of e-learning (Table 3 ).
Table 3: Advantages of e-learning
Lack of clinical skills was reported as a major disadvantage of e-learning (93.2%), 64.8% reported a lack of concentration, 58% reported a lack of interaction and 54% reported more of theoretical as disadvantages of e-learning (Table 4 ).
Table 4: Disadvantages of e-learning
A major challenge faced by students during e-learning is effect on mental health (60.8%), followed by communication (55.1%) and understanding of the subject (52.4%) (Table 5 ).
Table 5: Challenges faced by students during online education
DISCUSSION
COVID-19 pandemic has brought various changes in the regular teaching methods.[ 5 ] It has necessitated mandatory e-learning in medical education. In the present study, we assessed students’ perception towards e-learning, its advantages, disadvantages and major challenges they faced during their new teaching–learning method.
In the present study, factors which affected the mental health of students include, 29% were anxious and 10.2% had depressed feeling during the time of online classes. COVID-19 outbreak, the lockdown, online classes, lack of communication and interaction all these factors affecting the mental health of medical students. A study[ 6 ] conducted during the early phase of the COVID-19 pandemic reported similar findings. The authors[ 6 ] found that 22.7% of students have suicidal tendencies, 21.6% had moderate-to-severe depression, and 11% of medical students had anxiety symptoms.
Majority of participants in our study reported that they had very good information technology skills and previous experience with e-learning, but the availability of internet services was neutral and very poor. About 55.7% of students used mobile phones as major media for online classes. Similar to our study, other studies had reported that poor internet services and lack of infrastructure are major barriers to e-learning.[ 7 , 8 ] Another study from Uganda concluded that poor quality of internet, high data costs, lack of availability of personal computers, laptops and smartphones have been considered as possible barriers to e-learning.[ 9 ] A study[ 10 ] done in Kerala reported that network issues affected accessing to e-learning in 43.7% of medical students during the COVID-19 pandemic.
Most of the students rated e-learning as equally effective as regular face-to-face learning in increasing knowledge, social competences, understanding subject and meeting individual learning needs. However, e-learning is ineffective in increasing clinical skills and effective communication compared to regular face-to-face learning. All of the responses were found statistically significant. Clinical skills and practical knowledge are very important in medical education that cannot be acquired through online classes. It has been reported that for medical students to gain effective clinical knowledge, contact with the patient is critical rather than textbooks alone.[ 2 , 11 ] In medical education, e-learning lacks practical or clinical exposures.[ 9 ]
The advantage of e-learning includes the ability to record meeting, ability to stay at home, access to online materials, learning on their own pace and comfortable surroundings. However, a lack of clinical skills is a major disadvantage of e-learning, and others include lack of interaction, lack of concentration and more of theoretical. According to a study from Poland, strongest advantages of e-learning are easy to access to study materials and the ability to choose the time and place to study. The main disadvantage was the lack of interaction with patients. Learning from real case scenarios in a hospital setting is crucial for medical education and that cannot be replaced with e-learning; technical issues were the second major disadvantage.[ 12 , 13 ] Another study concluded that online classes are effective to some extent in some parameters but inadequate in others.[ 4 ] To avoid this limitation blended learning is advised, to combine the advantages of both online teachings and classroom teachings.[ 4 , 14 , 15 ]
There were many challenges for e-learning as it was introduced for the first time in medical education. Major challenge faced by students is the effect on mental health, followed by communication, understanding of the subject, etc., A review[ 2 ] described poor technical skills, infrastructure, lack of institutional strategies, time management and a negative attitude towards online education as challenges for medical e-learning.
Limitations of the present study were, that this was a single-centre study with a relatively small sample size; the results of the present may not be generalised. Other limitations included inability to measure educational outcomes of e-learning and comparing them to face-to-face teaching. Further studies are required to address educational outcomes as well as faculty members’ perceptions and opinions towards distance e-learning.
The implementation of distance e-learning in medical education is challenging, especially in developing countries like India. E-learning reported increasing knowledge, easy access and better environment. But lack of clinical skills, technical problems, mental health are major barriers for e-learning in medical education. Although e-learning is the best alternative in the present scenario, it cannot replace the traditional teaching method. It can be used along with regular face-to-face learning to make teaching more effective.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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