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Table of Contents
MEDICAL EDUCATION
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 144-148

Changes in undergraduate medical education practices during COVID-19 pandemic


1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of ENT, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
3 Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
4 Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Submission16-Nov-2021
Date of Acceptance17-Nov-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Dr. Priyadarshini Mishra
Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcfm.ijcfm_92_21

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  Abstract 

Introduction: The countrywide lockdown in response to COVID-19 pandemic necessitated a shift from conventional teaching to online teaching. This study aimed to find the issues and challenges faced by medical teachers on the virtual platforms of teaching during lockdown.
Material and Methods: A cross-sectional survey was conducted among the medical teachers of a tertiary care hospital between august to october 2020. A google form with study questionnaire was circulated among participants.
Results: Online live lectures were major mode of online teaching. 36.5% of teachers felt that they were successful and only 19.2% felt, they were unsuccessful in engaging most of the students. Discrepancies between efforts and outcome (20.54%), absence of definite guidelines (20.54%), unwanted disturbances (19.17%), lack of technical expertise (19.17%), absence of uniform format (10.95%), and lack of knowledge (6.84%) were the challenges faced. A change in the content of slides (52.8%), increased use of videos, charts, and figures (41.5%), changes in lesson plan (32.1%), including assessments after each class (28.3%) and division of content into sub-topics for better understanding and easy upload (22.6%) were the modifications made by faculty for online teaching. Around half of the faculty members disagreed that teaching can be conducted online postlockdown.
Conclusion: The pandemic is a situation that should encourage all medical educators to be trained and adapt to online teaching methodologies.

Keywords: Medical education, online teaching, problems and solutions, virtual classroom


How to cite this article:
Sable M, Sarkar S, Hallur V, Mishra P. Changes in undergraduate medical education practices during COVID-19 pandemic. Indian J Community Fam Med 2021;7:144-8

How to cite this URL:
Sable M, Sarkar S, Hallur V, Mishra P. Changes in undergraduate medical education practices during COVID-19 pandemic. Indian J Community Fam Med [serial online] 2021 [cited 2022 Jul 4];7:144-8. Available from: https://www.ijcfm.org/text.asp?2021/7/2/144/333668




  Introduction Top


The medical curriculum demands many face-to-face interactions between teachers and students and patients. The COVID-19 pandemic has thrown an unforeseen challenge to medical educators worldwide. Medical educators have responded to this challenge by bringing about a change in their teaching practices.[1] With lockdowns becoming a norm during the pandemic, virtual teaching-learning (TL) practices replaced the regular classes. The focus shifted from real-life lecture theatres and bedside teachings to technology-driven virtual platforms.[2] This change brought about issues in many aspects of teaching and learning in medicine, like participation of students, interaction, and assessment.[3] Furthermore, the over-reliance on technology entailed a certain amount of digital fluency among medical educators.

There was a complete lockdown for 5 months in India (March to August 2020) announced by the government on account of the COVID-19 pandemic.[4] This included a complete cessation of all face-to-face TL activities at all educational institutions. Higher educational institutions were allowed to open for students only from September 2020 as part of Unlock 4.[5] During this period of 5 months, all educational activities were conducted online in the institute. Faculty had a varied experience with online TL processes. This study was conducted in a tertiary care hospital to find the issues, challenges, and strategies adopted by teachers while using the virtual platforms during the lockdowns due to the pandemic.


  Material and Methods Top


This was a cross-sectional observational study conducted between August and October 2020 in our medical college. All medical and nursing faculty of the institution were included as participants in this study. A self-administered, pretested questionnaire was constructed on Google Form® (Google LLC, Mountain View, CA). The questionnaire had an introductory paragraph, which included information regarding the survey's aim, assuring confidentiality of participants. The questionnaire's main structures were four sections to identify the general information, teaching methods used, experience, and future perspectives for online teaching. The questionnaire included 21 questions. Nine were close-ended questions, six were open-ended questions, and the rest were a mixed type of questions. The questions probed the experience of faculty in online teaching, the methods employed by them, their feedback of experiences, and the future possibility of integrating online teaching into the regular schedule of classes.

An e-mail invitation was sent to all faculty of the institute through institutional E-mail. All responses received in the time period of the study were analyzed. No incentives were offered to get responses, and participants voluntarily responded to the survey.

Statistical analysis

The responses were tabulated and analyzed in Microsoft Excel version 1909. Descriptive statistics were employed to assess the responses.


  Results Top


Participants information

Out of 202 medical faculty, 55 (27.2%) responded to the questionnaire. Twenty six (47.2%) of the respondents had more than 10 years of teaching experience, 22 (39.6%) had teaching experience between 4 and 10 years, and only 7 (13.2%) had a teaching experience of <4 years. Out of all faculty members, 35 (64%) were from clinical branches and 10 (18%) were from preclinical and para-clinical subjects. All the respondents were involved in both undergraduate and postgraduate teaching. The number of classes conducted by individual teachers were ranging from 1 to 21 classes with the median of 6 classes during the study period. Less than 5, 6–10, and >10 classes were conducted by 32%, 12%, and 11% teachers, respectively.

As per participants' responses, before COVID-19 pandemic the major TL method for theory classes to undergraduate medical students was didactic lecture (41.17%), followed by seminar (23.52%), tutorials (20.16%) and flipped classroom (4.2%). Other methods (10.92%) used were bedside teaching, case-based discussions, demonstrations, and Unconventional Learning Experience. During the COVID-19 pandemic, 43/53 (81.1%) teachers conducted theory classes via online live lectures. Furthermore, 26/53 (49.1%) and 9/53 (17%) circulated pdf copies of PowerPoint slides and recorded videos to the students, respectively. Only 13/53 (24.5%) conducted webinars.

Fourty nine (88.7%) of teachers did not have any formal training in online teaching. The leading online teaching platforms used were Google Meet (82.4%), Zoom (43.1%), and Google Classroom (17.6%). WhatsApp-based video meeting, Go To Meeting, and YouTube Live were conducted by 6 (11.8%), 1 (2%), and 1 (2%) teachers, respectively. None of the participants used other platforms like Facebook live, Twitter, Blogs, etc., [Figure 1].
Figure 1: Distribution of online platforms used for conducting online classes (n=51)

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Out of 52 respondents, 32 (61.5%) were comfortable, and 9 (17.3%) were uncomfortable with online teaching, while 11 (21.25%) were noncommittal. Although 44.2% of teachers were unable to give an opinion about the success in engaging most of the students, 36.5% of teachers felt that they were successful, and only 19.2% felt as they were unsuccessful.

The challenges reported during online teaching during the COVID-19 pandemic compared to conventional teaching were discrepancies between efforts and outcome (20.54%), absence of definite guidelines (20.54%), unwanted disturbances (19.17%), lack of technical expertise (19.17%), absence of uniform format of teaching (10.95%), and lack of knowledge (6.84%). To ensure the participation of the students during online classes, the most common method applied by the teachers were asking a question in between (53%), sharing of the class link beforehand (10.63%), chatbox discussion (8.5%), and assessment (8.5%) [Table 1].
Table 1: The distribution of difficulties faced and methods applied to ensure the participation of student during online teaching

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The modifications that the faculty made in their teaching style for the conduct of online classes were changes in the content of slides (52.8%), increased use of videos, charts, and figures (41.5%), changes in lesson plan (32.1%), including assessments after each class (28.3%), division of content into sub-topics for better understanding and easy upload (22.6%) [Figure 2].
Figure 2: Distribution of different modifications performed by the faculty while conducting online classes (n=53)

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Faculty perspectives about the advantages of online teaching included exposure to more comprehensive content, the flexibility of conducting classes, greater freedom of structuring the content, the scope of more interaction with students, better student compatibility, and no time-bound classes [Figure 3].
Figure 3: Faculty perspectives of advantages of online teaching

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While 47.2% were noncommittal, 34% of faculty responded that they would prefer to continue with online classes postlockdown, and 18.9% were not interested in continuing online teaching. 64.2% felt that online classes should be a part of the regular teaching schedule in the future. 55.3% of the faculty felt that online classes should comprise up to 25% of the teaching schedule [Figure 4]. 54.7% of faculty disagreed that practical and bedside teaching can be conducted online, and only 17% felt that this could be done online. Suggestions for conducting the same were through the use of video demonstrations with or without interaction, simulation platforms, role-play, and google glass. 69.2% of faculty assessed students during the online classes. The methods employed by majority of the faculty to evaluate students were MCQs and SAQs. [Figure 5].
Figure 4: Percentage of faculty who agreed for online teaching with its extent into to the regular curriculum (n=53)

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Figure 5: Distribution of various methods of assessment used by faculty during online teaching

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  Discussion Top


Pandemic transgresses international boundaries and affectes a large number of people[6] The current pandemic of COVID-19 has forced governments worldwide to implement stringent measures to prevent transmission. The sudden implementation of these preventive measures in the recent pandemic caught the medical educators worldwide unawares. These challenges have compelled medical colleges to change their existent strategies for teaching and learning.[3],[7] It has also created opportunities to explore newer forms of teaching and learning strategies using virtual platforms.

Just above one-fourth of the faculty members responded to the survey. The poor response from faculty could have been due to their engagement in multiple COVID care activities in the institute. It could also have been due to the numerous online surveys being conducted by various institutes and educational groups and continuous engagement of faculty in other online activities (webinars, online conferences, and CMEs) apart from coursework. Google Meet was the most common online platform used for TL activities by the faculty, followed by Zoom and Google Classroom. Though there are many web-based learning management systems like Moodle, Blackboard, WebCT, ECollege, etc,[8] the Google classroom was the only learning management system used by the faculty.

The google classroom has been adapted to middle and low-income countries as it is cost-effective and easy to navigate.[9] It involves no additional cost to the institute concerned or individual user. Lack of formal training and a certain degree of digital literacy can impede the successful implementation of online learning and achievement of learning objectives.[10] Majority of the faculty members did not have any formal training in online teaching.

Limited direction and poor communication were reported as a barrier to online teaching and learning.[11] Lack of skills and time, inadequate infrastructure have also been implicated as causes of poor implementation of online teaching.[12],[13]

There may be a problem with interactivity with students during the conduct of online classes. To counter this issue, the faculty of our institute employed various strategies to ensure the Student's participation during online classes. In contrast, McSmith et al.,[14] used the Blackboard as a learning management system and included postassignment discussions and exchange of Student's viewpoints with the faculty, which was facilitated through the use of probing questions, prompts for clarifications and summarising.[14]

Online teaching has its advantages like it promotes asynchronous learning, where the student learns at his/her own pace[15] Other advantages are that students learn more than just the course, newer technical adaptations, and awareness and access to more online resources.[16],[17] Assessment forms a significant challenge with online teaching during the lockdown. There is a tendency to rely too much on the objective type of questions like MCQs, true/false, etc which was also seen in the present study. However, these methods may not be sufficient to assess the in-depth knowledge of the students.[18]


  Conclusion Top


Despite challenges, medical education continued in institutions opening up newer horizons in online teaching and learning methodologies, as seen in the present study. This pandemic is an eye-opener that should encourage all medical educators to get trained and adapt to online teaching methodologies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Freeman M, Bamford A. Student choice of anonymity for learner identity in online learning discussion forums. Int J ELearn 2004;3:45-53.  Back to cited text no. 15
    
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Thurmond VA. Examination of Interaction Variables as Predictors of Students' Satisfaction and Willingness to Enroll in Future Web-Based Courses While Controlling for Student Characteristics. University of Kansas: Society for Information Technology & Teacher Education International Conference; 2003. p. 528-31.  Back to cited text no. 16
    
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Weiner C. Key ingredients to online learning: Adolescent students study in cyberspace – The nature of the study. Int J Elearn 2003;2:44-50.  Back to cited text no. 17
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]



 

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