In December 2019, Wuhan, China reported cases of novel coronavirus disease (nCoV): a strain of the severe acute respiratory syndrome coronavirus (SARS-CoV-2). It struck globally, affecting human life in various ways, including the healthcare system, education, transportation and travel, social life, and business opportunities. India reported the first COVID-19 case on January 30, 2020; later, in March, the World Health Organization (WHO) declared the disease a pandemic. India entered a phase lockdown to curb the spread, which started on March 24, 2020.
Most countries had closed schools/colleges, affecting 87% of the world’s enrolled students’ learning loss. This led to the transition from the conventional mode of education to the virtual (online) mode.
In medical and dental training, the practical/clinical aspect of teaching has significant challenges in the E-learning platform.
Indian studies report the experience, perception, and satisfaction among medical and dental undergraduate students toward E-learning in individual colleges and institutions.[5-8]
This study aims to evaluate the perception, experience, and satisfaction among medical and dental undergraduate students toward E-learning during the COVID-19 pandemic in various healthcare institutes of eastern India.
MATERIALS AND METHODS
Study site and sample
A questionnaire-based multicentric cross-sectional survey was organized among first to final-year undergraduate students pursuing MBBS and BDS courses meeting the inclusion and exclusion criteria of the study among five healthcare institutes (Banaras Hindu University, Uttar Pradesh [BHU]; Dental Institute RIMS, Ranchi [DI RIMS]; Ragas Dental College, Chennai [Ragas]; Rajendra Institute of Medical Sciences, Ranchi [RIMS]; Hazaribagh College of Dentistry Sciences and Hospital, Jharkhand [HCDSH]; and Rajasthan University of Health Science [RUHS Jaipur]) in India. The snowball sampling technique was employed and sample size estimation was done to achieve a 5% margin of error with a 95% confidence interval (CI). The sample size of a minimum of 357 samples was calculated but 500 participants were considered.
A well-structured questionnaire was drafted with discussion among the investigators involved in online classes for the medical and dental students. The self-administered questionnaire comprised 16 closed-ended questions, including demographic data (age, education year, and name of institution), perception, satisfaction, and experience of E-learning during the COVID-19 era. The questionnaire was designed on Google form and transferred on Google surveys (http://www.surveys.google.com) and was distributed to the students through e-mails to reach a total of 500 participants.
A pilot study was conducted using the same questionnaire on 20 participants, which were not considered for the final analysis. The internal consistency and validated items show an intraclass correlation of 0.82.
The gathered data were exported from the Google form spreadsheet to Microsoft Excel (Excel V.16.29, 2019) and analyzed using the statistical package for social sciences (SPSS Inc. Chicago, IL) software version 21 to obtain the results. Descriptive statistics were used to calculate frequency distributions and the Chi-squared test for relationships among variables and P <.05 was considered statistically significant.
Informed consent was obtained from the participants of the study. Ethical approval from the institutional ethical board was not deemed necessary as no active modifications in teaching procedure were there due to the study.
The demographic details like gender, course of study, year of study, and college are explained in Table 1. The gender participation among different institutes was statistically significant (Chi-square, P value = 0.001). The association between professional year of study and students showed statistically significant results.
The mobile smartphone was opted by most as the medium of attending online classes and the majority reported 6-8 hours of electronic gadget usage per day, including online classes which was statistically significant (P = 0.00). Maximum participants (n = 274, 72.7%) among which majority of first year (n = 90) reported using cellular data as an internet connection, (Chi-square; P = 0.00).
Almost half (49.6%) of the participants including majority of first year (n = 70; P = 0.001) felt that the duration of online lectures for effective learning to be four classes of 45 minutes each.
Two hundred fifty nine (68.7%) preferred clearing their doubts at the end of the online class, 62 (16.4%) chat mode, 20 (5.3%) mailed the question/doubt following class, and 90 participants (first year) ask the teacher at the end of class which was statistically significant (P = 0.001). Two hundred ninety two (77.5%) agreed that an online demonstration of practical skills help improve learning (P = 0.034), whereas 85 (22.5%) denied [Table 2].
It was observed that two-thirds of the total participants had an E-learning experience before the COVID-19 pandemic, which was in contrast with previous studies where more than two-third of the respondents never attended any online classes.[9,10] Mobile smartphones opted as the medium for online classes compared to laptops and tablets, as reported earlier in their study; participants preferred mobile devices for online learning.[8,11] Mobile devices are handy and easy to carry and access, which adds to the popularity of devices compared to other devices. The laptop was the most common gadget for online learning among medical students in Malaysia. This shows a significant difference when comparing Indian and Malaysian medical students owning to the majority of our participants belonging to poor socioeconomic status and foreign institutes recommending laptops as educational tools for medical/dental undergraduate students.
The use of mobile cellular data was the choice of internet connectivity among the study participants, as seen in previous studies;[11,12] in contrast, two-thirds of the respondents used cellular data and Wi-Fi in E-learning during the pandemic. However, a similar study observed that their studied population had used mobile broadband for their internet connection. Wi-Fi/broadband was unavailable on the respondent’s campus premises. Owing to low internet speed in cellular data, class disruptions are common, voice clarity is lost, and videos are paused, leading to inappropriate learning. A strong and stable broadband internet with Wi-Fi in the organization improves interactions among educators and learners. Screen time is the total of activities performed online using electronic gadgets (screen) and is generally expressed in hours. A small number of respondents (18.5%) had a screen time of more than 10 hours, beyond the recommended value, which affects their mental health leading to anxiety, low emotional stability, risk for depression, and psychological problems.[14,15]
Excessive screen time leads to eyestrain (54.6%), followed by headache (41.6%) and obesity and disturbed sleep patterns (18%). This finding was that among those who observed, 56.1% experienced eyestrain followed by 31.1% of headaches and 70.8% health was not affected by online classes.
The majority of the respondents (49.6%) selected four classes of 45 minutes each, followed by 43% of the participants opting for four classes of 30 minutes each as also an earlier reported schedule of online classes. Online class environment was not distracting for most respondents; however, the option of multiple URL opening websites gives the students an option to visit Facebook, WhatsApp, and OTT applications. During the online class, most surveyed students stated the following sequence; WhatsApp, Facebook, and OTT applications as commonly visited social networking sites. Facebook and WhatsApp are commonly used applications with several benefits like engagement, collaboration, and feedback, but negative aspects include distraction, addiction, and invasion of privacy. Online learning demands self-control to deal with tech-related distracters. The potential of social media in an educational setting provides a chance for the students to share and express information and knowledge with one another.
Students’ evaluation during the pandemic by conducting offline examination was not possible; hence, online examinations for their evaluation was the only option. Undergraduate students prefer a combination of written and viva voce, whereas organizing viva voce provides an overall impression, presentation, and communication skills; together these things can achieve substantial appraisal.
The offline mode of learning by the healthcare students was the obvious choice as it leads to lesser distraction and interaction with students, increases student competition, and helps in classroom communication and extracurricular activities. Respondents did not favor E-learning due to ineptitude in focusing on the curriculum for fear of the pandemic or technological restraints faced during online learning.
Online learning is advantageous owing to the comfort of staying at home and learning, saving time (conveyance, grooming, etc.). The advantages of online teaching appear to be that it improves efficiency, accessibility of time and place, suits a variety of learning styles, repeatability of lecture, and students can attend outstation eminent lectures without any extra expense.
Clearing doubts about E-learning comes with known challenges. Resolving them at the end of the class sometimes leads to students losing focus, so texting their queries in chat mode simultaneously with the ongoing lecture may seem the obvious choice rather than waiting for the class to get over. The doubt clearing is a vital part of learning for better understanding the concepts; some students in online learning mode reach back to their teachers via phone or e-mail, whereas others find it difficult, and participants believed they had learned better with face-to-face learning.[20,21] Online education negatively impacted practical training with phantoms during the pandemic under the instructor’s supervision. Hence, the skill acquired for practice and later working on patients was not developed to its full potential. The curriculum should be implemented in combined or blended mode, considering the pros and cons of each learning method. The blueprint of blended learning, replacing lectures with online training, appears to be in the exact direction. The rapid switch to online learning during COVID-19 lacks a discrete curriculum framework; thus, futuristic solutions could be integrated into a consolidated framework with due evidence from all available learning methods.
The study highlights the impact of changing teaching and learning methods; E-learning should be included in the curriculum in a more strategic way weighing the advantages and disadvantages, as many participants believed offline training is better than online, especially for practical training. The change during the COVID-19 pandemic, the online teaching started as an emergency, and the only viable alternative to the traditional method, which was not an orderly or supervised transition. The changing scenario and the experience we have gained for the online learning model can be blended with the traditional or offline methods as a “hybrid” model for wider and more effective teaching and learning methods.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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