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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 3  |  Page : 156-165

The perception of the medical faculty and undergraduate students regarding online teaching in the era of COVID-19


1 Department of Obst and Gynae, ASCOMS, Jammu, Jammu and Kashmir, India
2 Department of Orthopaedics, Government Medical College, Jammu, Jammu and Kashmir, India
3 Department of Orthopaedics, ASCOMS, Jammu, Jammu and Kashmir, India
4 Department of PSM, ASCOMS, Jammu, Jammu and Kashmir, India
5 Department of Medicine, ASCOMS, Jammu, Jammu and Kashmir, India
6 Department of Anatomy, ASCOMS, Jammu, Jammu and Kashmir, India

Date of Submission27-Feb-2021
Date of Acceptance20-May-2021
Date of Web Publication28-Sep-2021

Correspondence Address:
Dr. Shalini Sobti
F-311, Sainik Colony, Jammu - 180 011, Jammu and Kashmir
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_27_21

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  Abstract 


Introduction: In this COVID-19 epidemic, most of the countries are facing issues regarding health care from the points of management, academic, and treatment. Online medical education as an alternate source has been utilized, but it entails certain solutions to the problems encountered in this new methodology of medical education. The study was conducted to enhance the knowledge about the barriers and the concurrent solutions and help improve online medical education in COVID era.
Materials and Methods: A prospective, cross-sectional study was conducted on 336 undergraduate medical students 61 medical faculty members of ABVMS, Jammu. The two online intake forms in the form of a voluntary, self-administered questionnaires were used to collect the data; whose link was made active from May 15, 2020, to May 30, 2020. The questionnaire was designed with 10 questions for faculty and 7 for students. The questions encompassed different subjects related to their preferences and perception of online learning. The data were entered in MS Excel and analyzed using the SPSS software version 20.0. P <0.05 was considered statistically significant.
Results: The medical faculty perceived online class discussions and assessments of the students as difficult barriers (27.87% and 40.99%, respectively) and access to books/images for teaching and lectures making and delivering as easy (50.82% and 52.46%, respectively). The students felt that the ease of theoretical learning was best with downloadable AV lectures (54.46%). A total of 48.15% students and 31.15% faculty members supported the use of online education in future (P < 0.0001).
Conclusion: The coronavirus pandemic appears to be an inflection point that is forcing disruption in how we teach medicine. While in the midst of this COVID-19 crisis, the medical faculty and the students are willing for a favorable change from offline to online medical education in view of an online instructional support/training, and infrastructural change.
The following core competencies are addressed in this article: Interpersonal and communication skills, Practice-based learning and improvement.

Keywords: COVID-19, medical education, online teaching, questionnaire


How to cite this article:
Gupta M, Singh M, Gupta R, Sobti S, Gupta P, Gupta V, Gupta A. The perception of the medical faculty and undergraduate students regarding online teaching in the era of COVID-19. Int J Acad Med 2021;7:156-65

How to cite this URL:
Gupta M, Singh M, Gupta R, Sobti S, Gupta P, Gupta V, Gupta A. The perception of the medical faculty and undergraduate students regarding online teaching in the era of COVID-19. Int J Acad Med [serial online] 2021 [cited 2021 Dec 2];7:156-65. Available from: https://www.ijam-web.org/text.asp?2021/7/3/156/326816




  Introduction Top


The unparalleled times of COVID-19 has presented a great challenge for medical education.[1] In the current scenario of worldwide lockdown, medical education has seen a major shift from the long established face to face classroom lectures toward online, distance, or electronic learning.[2]

“Electronic (e) or online learning can be defined as the use of electronic technology and media to deliver, support and enhance both learning and teaching and involves communication between learners and teachers utilizing online content.”[3] It has its rewards of providing easier “at home access” to the learning with a greater amount of information.[4] However, it poses challenges such as time constraints, digital literacy, and suffers from disadvantages of lacking a direct learning on the patient.[5]

On one hand, medical students are expected to be updated with the latest treatments and technologies in the setting of a global emergency, and on the other hand, the medical faculty have a daunting task to remain “digitally literate”[6] and teach them without hospital environment.[5]

A host of factors may guard the success of the online education, oscillating from student led factors to faculty led factors.[7],[8] It includes “cultural resistances,” eye to eye engagement, continuing medical education, overworked faculty in the background of increasing cases of COVID-19, and skills to integrate e-learning into teaching practices.[7],[9]

In an effort to support a strong evidence base for, or against, the study was conducted with an aim to account for the medical faculty and students' perception regarding online medical education. There have hardly been studies which have tried to ascertain the perceptions regarding the medical education at both fronts (students and faculty).[10],[11],[12] It is hypothesized that the index study may add to the knowledge about the barriers and the concurrent solutions and help improve online medical education.


  Methods Top


A voluntary prospective cross-sectional study was conducted with two different groups of subjects (1) undergraduate medical students (2) medical faculty, of ABVMS, Jammu. The two online Google (Alphabet, Inc., Mountain View, California, USA) forms in the form of self-administered questionnaires were used to collect the data; whose link was made active from May 15, 2020, to May 30, 2020.

For validation of the medical faculty questionnaire [Annexure 1] and medical students questionnaire [Annexure 2], we conducted Principal Component Analysis with varimax rotation to divide the items into factors. The number of factors retained was derived by considering the magnitude of the eigenvalues, Kaiser's (1960) eigen values (>1) rule, the proportion of variance extracted, item content, and the interpretability of the resulting factors. As for factor loading after the varimax rotation, items with a factor loading <0.5 on all factors were excluded. We investigated the internal consistency by calculating Cronbach's alpha and by calculating item-total correlations for each factor that was identified with the factor analysis, an Alpha >0.70 was considered acceptable and optimal item-total correlation was considered to be between 0.2 and 0.5.

For medical faculty questionnaire, results from the factor analysis indicated that there is only one factor that accounts for approximately 60% of the variance. Cronbach's alpha coefficients were greater than the accepted number of ≥0.70 and also showed optimal item-total correlation (above 0.2). The calculation of internal consistency (Cronbach's alpha 0.835) and cross validation provided evidence of reliability and lack of redundancy of items [Supplementary Table 1[Additional file 1]] and [Supplementary Table 2[Additional file 2]].

We found that the number of factors, the factor structure, and factors loadings was exactly comparable between the first randomly created sub-sample (n = 30) and the total sample (n = 61).

For the benefits of medical education domain in the questionnaire for medical students, results from the factor analysis indicated that each factor accounts for approximately 40% of the variance. Cronbach's alpha coefficients were >0.5 but showed optimal item-total correlation (above 0.2) except flexibility and learning at own pace [Supplementary Table 3[Additional file 3]].

We found that the number of factors, the factor structure and factors loadings were comparable between the first randomly created sub-sample (n = 30) and the total sample (n = 336).

The results from the factor analysis indicated that each factor accounts for approximately 15% of the variance. Cronbach's alpha coefficients were >0.5 except for technical factors but showed optimal item-total correlation (above 0.2) except less hands-on experience and less social interaction and less hands-on experience and less social interaction [Supplementary Table 4[Additional file 4]].

We found that the number of factors, the factor structure and factors loadings were for the greater part comparable between the first randomly created sub-sample (n = 30) and the total sample (n = 336). Differences were found in the harder to retain information, less social interaction, and cannot write/hi-lite online reading.

After validation of the questionnaires, the links were forwarded to faculty and students through mail and WhatsApp. The filling of the forms was considered to be a sign of a voluntary consent from the participants. A formal ethical committee meeting approved the questionnaire and the study.

All the 500 undergraduate students and 101 faculty members for the academic year 2020–2021 of the hospital and associated college were included in the study. Among them, the minimum sample size for the study was calculated separately for both the groups.

The sample size calculation for the medical faculty was based on the study of Kashora and Charles[13] who observed that 86.4% of medical faculty reported the usage of online-learning packages. Taking this value as reference, the minimum required sample size with 10% margin of error and 5% level of significance is 46 for medical faculty. To reduce margin of error, total sample size taken was 61.

The sample size calculation for the medical students was based on the study of Lakbala,[14] who observed that 93.8% of medical students recommended e-learning courses. Taking this value as reference, the minimum required sample size with 3% margin of error and 5% level of significance was 249 students. To reduce margin of error, sample size taken was 336 medical students.

The questionnaire was designed with 10 questions for faculty and 7 for students. The questions encompassed different subjects related to their preferences and perception of online learning. Various types of answers were included: Multiple choices, single choice or Likert's scale 1–5. After the minimum number of completed surveys during the online available link, the data were entered in the MS Excel spreadsheet and analysis was done using the Statistical Package for the Social Sciences software, IBM manufacturer, Chicago, USA, version 21.0.

Statistical analysis

Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± standard deviation (SD) and median. Qualitative variables were compared using the Chi-square test. P <0.05 was considered statistically significant.


  Results Top


The voluntary survey was taken by 336 undergraduate medical students pursuing MBBS course and 61 medical faculty from various clinical and para-clinical teaching departments of the college and associated hospital. The mean (± SD) age of the medical faculty was 44.87 (±10.3) years. The survey showed that the medical faculty used Powerpoint presentation (78.69%); blackboard (18.03%) and transparent slides (3.28%) for teaching on a routine basis. In a vast teaching experience of mean duration (±SD) of 12.21 (±7.42) years; 37.70% faculty members reported a previous use of online platform for teaching [Table 1].
Table 1: Demographic and teaching profile of medical faculty

Click here to view


Regarding the medical faculty perceptions in this survey, online class discussions and assessments of the students were found most difficult amongst all the barriers (27.87% and 40.99% respectively) and access to books/images for teaching and lectures making and delivering were found to be most easy (50.82% and 52.46%, respectively). The class calendars and scheduling was rated of an average ease by 45.9% faculty [Table 2].
Table 2: Perception of online teaching by medical faculty

Click here to view


The number of hours required to make online lectures (31.15% required >5 h) were borderline significantly higher as compared to offline lectures (requirement of >5 h 31.15% in online vs 13.11% in offline, P = 0.049) as shown in [Table 3].
Table 3: Comparison of hours spend on preparing lectures between offline and online

Click here to view


The students felt that the ease of theoretical learning was best with downloadable AV lectures since they may be revised anytime (54.46%); the practical learning was best by offline live mode (59.52%); effective communication and interaction between the teachers and the students was slightly better by offline mode as compared to online synchronous mode (48.51% vs 38.69%; 46.13% vs 44.05%) [Table 4].
Table 4: Perception of medical students for online education

Click here to view


Convenience (51.19%), learning at own space (63.39%), flexibility (61.61%) easier for shy students to participate (42.56%), structuring of own schedules (42.56%), and cost-saving (41.96%) were the common benefits of online learning as suggested by medical students [Figure 1].
Figure 1: Perception of benefits of online learning by medical students

Click here to view


Technical issues/resource insufficiency (66.07%, requirement of internet access (58.93%), and less social interactions (39.58%) were some of the common drawbacks as noted by the medical students [Figure 2].
Figure 2: Perception of drawbacks of online learning by medical students

Click here to view


The need of online training or instructional support for administering online education was expressed by 47.54% faculty and 23.81% medical students as opposed to 18.03% faculty and 35.71% students who did not. A major proportion (34.43% faculty and 40.48% students) were unsure and in the “maybe” category. There was a significant difference in the requirement of online training/support among medical students and faculty (P = 0.0003), as shown in [Table 5].
Table 5: Comparison of need of online training or instructional support for the use of online learning tools between medical faculty and students

Click here to view


The survey results showed that 30.36% students rejected the use of online education in the future as compared to 13.11% faculty members. There was a statistically significant difference in the preferences of online education in future among medical students and faculty (P < 0.0001), as shown in [Table 6].
Table 6: Comparison of preference of online education in future between medical faculty and students

Click here to view



  Discussion Top


The study holds strength in being one of the few studies to analyze the perception about online education at both fronts of teaching and learning. The main objective of the study was to investigate the views about online education to integrate them into teaching and learning.

Online education holds a great importance in limiting the dependency on the teaching faculty. As most of the doctors are occupied in the COVID-19 duties, it becomes a daunting task to simultaneously teach the medical students. Thus, with the use of e-learning, the problem of teaching and learning can be accomplished over the Internet that allows the schematic planning of teaching-material (through online availability of text books) which is then delivered over the webbing to the attending medical students.[15]

The present survey was done in the English language, where technical issues/resource insufficiency, requirement of internet access, making notes in the online reading, and less social interactions were some of the drawbacks and convenience, learning at own space, flexibility, and structuring of own schedules were some of the benefits of online learning as suggested by medical students. Our findings were in line with Lakbala. study, where inadequate access to the computer/internet, infrastructural support, English language problems, and lack of corroboration of online content with the medical curriculum were some of the barriers for online education.[14] Lack of guidance and information prior to enrolment in e-learning, perceived lack of support from faculty, and difficulties in contacting them have been reported in prior studies.[16],[17],[18] One of the latest systematic review findings suggest that the key barriers which affect the development and implementation of online learning in medical education include time constraints, poor technical skills, inadequate infrastructure, absence of institutional strategies, and support and negative attitudes of all involved.[5]

The factors which form a barrier in online education certainly depend on the digital literacy of the students and faculty, online reading ability, and time management skills.[19],[20],[21] In our study, the need of online training or instructional support for administering online education was expressed by 47.54% faculty and 23.81% medical students as opposed to 18.03% faculty and 35.71% students who did not. The significant difference among the faculty and the students in the requirement of additional online instructional support (P = 0.0003) points out the fact of generation gap between the two groups.[5],[22] The today's modern era is being flooded with online use and the students are thus already well-equipped with its use as opposed to the faculty which are gradually upgrading themselves with the changing times.

Regarding the lecturers' perceptions of online education in this study, online class discussions and assessments of the students were labelled above average difficult and access to books/images for teaching and lectures making and delivering were found to be easy. However, it was noted that the number of hours of input required to make online lectures (68.85% required 0–5 h) were borderline significantly higher as compared to offline lectures (86.89% required 0–5 h) with P = 0.049. In Lakbala study, English language comprehension, lack of research grants for e-learning, and lack of proper training on e-learning courses from the university were the most important barrier factors for the implementation of e-learning.[14] The internet barriers and adaptability to online teaching have been expressed a concern among the faculty in other studies as well.[5],[13],[14],[23]

To overcome this, it has been suggested to develop awareness towards embracing a wide array of Online approaches among the faculty and to impart both students and faculty with online training as a part of the medical university protocol.[24] This development shall enhance the online learning environment as teachers shall become more digitally educated with technology and the students shall have better learning outcomes.

Education is an interaction between the students and the faculty and medical students perceived online teaching an equivalent mode of interaction to offline teaching (44.05% vs 46.13%). However, medical learning involves much more than interaction and information, that it, it requires live patient practical learning which was found as a potential barrier with online learning as compared to offline (22.62% vs 59.52%) Taking this into account, it was seen that 30.36% students rejected the use of online education in the future as compared to 13.11% faculty members. Among the faculty members, 31.15% supported the use of online education in the future and 55.74% were unsure of it and were in the “maybe” category subjected to instructional online support, infrastructural support, and internet access. Among the students, 21.13% agreed to the simultaneous use of online with offline education, thus portraying the fact that e-learning's independent use in the field of medical education cannot be implemented in the current system. Our study results have been supported in the studies by Ruf et al.[25] who found that only 19.9% practitioners reported usage of online continuing medical education modules; and Ali et al.[26] where bedside teaching and journals were more popular than e-learning. Among few of the international studies in developed countries, the data is contrasting. As seen in the studies by Kashora and Charles,[13] Lakbala,[14] and Autti et al.,[27] the implementation of online education was highly supported (80%–90% of faculty and students). The reason being their online education system uses computerised simulation of clinical cases, interactive educational softwares, podcasting, tools for self-evaluation and the students and the faculty have a complete infrastructural support for online teaching and learning. The staff over there are digitally literate up to a high extent and feel no difficulty in imparting online education. In the previous studies, some researchers have also suggested precourse orientations to help manage students' and faculty calibre in the developing countries.[17],[21] Since the success of the new online education system depends on the knowledge and attitude of implementing technology,[14] the index study holds relevance in surveying the preferences and perceptions of the faculty and the students.

COVID-19 lockdown has led to an enthusiasm for online education, however, taking into account the local context, its implementation requires particular attention in order to avoid the “paradoxal” situations,[28] in which the implementation of e-learning would not produce the expected results. This is even more important in low-and middle-income countries such as ours where digital literacy is less and simulation clinical models are not used.

Limitations of the study

The study was limited in being conducted in a single centre with the use of questionaries based survey. Second, post graduate students of the medical college were not included in the survey. Third, the study was limited by a survey based research which has the inherent limitation of being not able to capture the full range of expression of the participants. Lastly, since the questions cannot be probed or explained, online recorded videos could have been confused with downloadable videos.


  Conclusion Top


The coronavirus pandemic appears to be an inflection point that is forcing disruption in how we teach medicine. While in the midst of this COVID-19 crisis, the medical faculty and the students are willing for a favorable change from offline to online medical education in view of an online instructional support/training, and infrastructural change. The addressing of the viewpoints of the medical faculty and students shall be helpful in bringing about a sustainable change in the online education system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

The authors of this manuscript declare that this scientific work complies with reporting quality, formatting and reproducibility guidelines set forth by the EQUATOR Network. This study was performed as a non-mandatory survey through a dedicated on line form among all the departments in the hospital. The voluntary filling of the form was considered to constitute passive consent of the teaching doctor or the medical student. The authors attest that this survey study was found to be non-interventional and exempt by their Ethics Committee.


  Annexures Top


Annexure 1: Medical faculty questionnaire

Perception regarding online teaching - An online survey for medical faculty

Please be a part of this online survey for improvement in the future medical education

* Required

1. Which department do you belong to? *

Your answer

2. What is your age ? *

Your answer

3. What is your period of teaching experience?

Your answer

4. Current platform that you used in the class *

  • Blackboard
  • Transparent slides
  • Power point presentation


5. Have you previously used any other online platform for teaching or learning ? *

  • Yes
  • No


6. Currently, are you delivering online lectures? Y/N If yes, what medium are you using for delivering online lectures *

Your answer

7. Please rate the following questions as Very easy, Easy, Average, Difficult, Very difficult*

  • Lecture making, presentations, delivering
  • Online class discussion
  • Online assessments
  • Class calendars and scheduling
  • Access to books and images for teaching
  • Lecture making, presentations, delivering
  • Online class discussion
  • Online assessments
  • Class calendars and scheduling
  • Access to books and images for teaching


8. How many hours do you spend for preparing the lectures (0-5, 5-10, >10 hours? *

  • Online
  • Offline class
  • Online
  • Offline class


9. Do u need any technical support to improve the planning and delivery of online teaching?

  • Yes
  • No
  • Maybe


10. Will you like to continue with the online teaching styles in the future ?

  • Yes
  • No
  • Maybe


Submit

Annexure 2: Medical students questionnaire

Perception regarding online teaching - An online survey for medical students

Please be a part of this online survey for improvement in the future medical education.

*Required

1. Which medical course are you pursuing currently?

  • MBBS
  • MD
  • Other:


2. Among ONLINE synchronous (live teaching sessions), ONLINE asynchronous (downloadable AV audio-video lectures) and OFFLINE (classroom teaching), which one do u prefer for the following parameters? *

  • Ease of theoretical learning
  • Practical learning
  • contributing to effective communication in the class
  • Interaction between the teachers and the fellow students
  • Ease of theoretical learning
  • Practical learning
  • contributing to effective communication in the class
  • Interaction between the teachers and the fellow students


3. In the future, what class format would you prefer?

  • Meeting regularly in a classroom setting, rather than completing coursework online
  • Completing coursework online, rather than meeting regularly in a classroom setting
  • A combination of meeting in a classroom setting and completing coursework online
  • Other:


4. What are the benefits of online teaching *

  • Convenience
  • Cost-savings (travel, materials)
  • Easier for shy students to participate
  • Flexibility (time, learning)
  • Increased participation
  • Learning at own-pace
  • Structuring own schedule (easier for adult, non-traditional students)
  • Fewer distractions


5. What are the drawbacks of online teaching *

  • Difficult to ask/get answer to questions
  • Technical issues/resources insufficiency
  • Less social interaction
  • Requires internet access
  • Increased distractions
  • Harder to be motivated
  • Less hands-on experience
  • Harder to retain information
  • Cannot write/hi-lite online reading


6. Were sound/image and text clear in the course *

  • 1
  • 2
  • 3
  • 4
  • 5


7. Would u want to take an online training or instructional support for the use of online learning tools?

  • Yes
  • No
  • Maybe


Submit



 
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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