COVID-19 has caused widespread panic and disease globally. [1] COVID-19 pandemic has had profound impact on the health-care systems and medical education. Due to lockdown during COVID -19, closure of medical schools and universities has disrupted the learning and education of future health professionals. Social distancing measures have forced educational institutes to adapt innovative ways to teach the students, however, providing adequate clinical experience is still a challenge. [2]

Medical education has many long-established pedagogical approaches to learning including face to face lectures in classrooms-via a teacher-centred model. [3] Due to COVID-19 pandemic, new methods of delivering education to medical students was introduced. Lectures have rapidly been developed to be delivered online as webinars using various online platforms such as Zoom to medical students. [4]

However, the over the last decades there has been a shift in medical education practice from traditional forms of teaching to other media which employ online, distance or electronic learning. This change from traditional learning to online learning is not without challenges. Increasing time constraints and demands are continually placed on students and educators, driving departments to find new ways of providing a more personalised, self-directed learning (SDL) experience. Therefore, the medical graduates of 21st century are expected to ‘hit the ground running’ requiring not only a traditional clinical education but also one that is up-to-date with the latest technologies/knowledge in order to ensure flexibility in a dynamic work place. [5]

Generally, traditional educational activities use the live experience of a facilitator with the students using printed material as resource material. This can be conducted in a large group or small group activity for teaching any of the three domains cognitive, psychomotor or affective. The revised curriculum by Medical Council of India mandates the revision in the traditional teaching-learning methods to include more interactive sessions, small group discussions with use of e-resources. [6]

E-learning is a newer concept in medical education, where electronic media or technologies (internet- or non-internet based) are used for learning. E- Learning has been less frequently practiced in medical education in developing countries such as India, due to lack of infrastructure, expertise and feasibility. [7] One of the advantages of online learning is that the students can participate/join in the learning sessions at any time. [8] Traditional teaching including using printed material as resource material are identified as cornerstone for learning by most medical students vs internet-based or non-online computer based learning. [9]

E-learning has emerged as the only possible mode of education during COVID-19 for school and college students. The medical education is more challenging and stressful as it involves practical’s, bedside and soft skills training which cannot get adequately represented through e-learning. Therefore, the present study aimed to assess the student’s perceptions towards E-learning during the COVID -19.

This was a cross-sectional online survey administered to the undergraduate medical students. The study was conducted in Department of Physiology, Dr. B.R. Ambedkar Medical College& Hospital, Bengaluru, Karnataka, India. Informed consent was obtained from the students. This study has been approved by the institutional ethics committee (Reference no.EC-277). The participants were provided with a questionnaire through an online Google form to assess their perceptions of online learning during COVID-19. Google form consisted of questions on the effect of lockdown on medical education, sources of study material, features of online sessions, academic progress during the lockdown, experience of online classes over regular classes, improvement of practical knowledge during online classes, benefits and challenges experienced by students. A total of 358 undergraduate medical students were participated. Among them, 1st year were 94, 2nd year students were 92, 3rd year students were 85 and final year students were 87. The data was downloaded from google form in Microsoft excel and was used for analysis. The data was assessed on 5-point Likert scale, where 1,2-meant not recommend, 3-neutral and 4,5-recommend/strongly recommend. Categorical variables were expressed in number and percentage.

A total of 358 undergraduate medical students were included in the study. The distribution of students from different batches was as follows: 1^st year students were 94, 2^nd year students were 92, 3^rd year students were 85 and final year students were 87. In this study, majority of the students were following text books 79 (84%), 80 (86%), 76 (89.4%) and 70 (80.4%) in 1^st, 2^nd, 3^rd and 4^th year respectively. In 3^rd and 4^th year, more than 75% of the medical students used power point with audio & video. Links/online materials were also used: 1^st year 15 (15.9%), 2^nd year 50 (54.3%), 3^rd year 59 (69.4), 4^th year 52 (59.7%) students and other sources of study materials as shown in table 1.  

Table 1: Sources of study material used by study participants during lockdown

Table 2 describes the different features of online sessions which were preferred and recommended by the learners. Majority of the students preferred link for additional teaching learning materials, online or live demonstrations, visual interface of the teacher, break between two consecutive lectures, option for questions/doubts during the lecture, interactive quiz during the lecture with mandatory responses, option for feedback about the class after the session, access platform for online classes in college/library and option for viewing the content later offline were preferred by most of the students (table 2).

Table 2: Features of online sessions preferred by learners

Assessed on 5-point Likert scale, where 1,2-meant not recommend, 3-neutral and 4,5-recommend/strongly recommend

Table 3 describes the response of the participants regarding the academic progress, online classes experience, and practical knowledge improvement. In this study, majority of the students reported that academic progress during lockdown was average 158 (44.1%). In this, experience of online classes over regular classes reported to be average 167 (46.6%). Regarding improvement of practical knowledge during online classes, 123 (34.3%) students agree, strongly agree by 50 (13.9%) and other details as shown in table 3.

Table 3: Response of participants regarding the academic progress, experience of the online class, and practical knowledge improvement among the students who have attended the online classes

Table 4 indicates the benefits and challenges of online teaching. The benefits of online teaching recognised by students were the cost-effectiveness of online education 245 (68.4%) and flexibility in the timing of classes 199 (55.5%). The majority of inconveniences faced by students in online classes were lack of internet connectivity 221 (61.7%), technical failure 209 (58.3%), lack of face-to-face interaction 199 (55.5%), distractions at home 155 (43.2%) and others as shown in table 4.

Table 4: Benefits and Challenges as Perceived by Students towards Online Teaching

COVID 19 pandemic has forced medical education reformers to make rapid preparations and radical adjustments. This questionnaire-based study gives us an understanding of perception of undergraduate medical students regarding online education. In this, 158 (44.1%) students found academic progress during the lockdown to be average, good by 90 (25.1%), excellent by 60 (16.7%) students. Very less number of students reported poor and unsatisfactory. This implies that medical students have adapted themselves so fast to the innovations in medical teaching. In a study by Lucieer et al. reported that self regulated learning would offer a tremendous boost to the academic performances of medical students. [10]

Majority of the students find it comfortable to have power point with audio & video. A study by Ramachandran K et al reported the similar findings. [11] Vaona A et al., conducted a study based on e-learning of health professionals in which they reported that e-learning could be more successful than traditional learning in particular in medical education settings. [12] However, a study from Pakistan involving 382 undergraduate medical and dental students, reported that 77.4% students showed negative perception about e-learning, of which 86% students felt e-learning has little impact on their learning. [13]

Concerned with challenges faced by students, limited internet access, lack of face-to-face interaction and technical failure were reported to be the major challenges. In support of our findings, a study conducted by Longhurst et al. reported that lack of practice sessions and difficulty in maintaining student-teacher relationships during online teaching as the major challenges. [14] Similarly, long screen time leading to visual fatigue was one of challenges faced by medical students. This finding was supported by Sindiani AM et al. [15] This also led to reduced concentration in class. The optimum duration of a session or class of 30 min will help improve the attention span of students and also reduce screen time at a stretch. [16]

This study has shown that the usefulness of online teaching as perceived by students. In a study by Rajab et al. reported that good teaching is always good teaching irrespective of whether it happens face-to-face or online. [17] In our study, a majority of students found online teaching beneficial because of its cost-effectiveness, flexibility in the timings of class, learning at your own pace, and easy recording of the class for further reference.

This study may conclude that COVID-19 pandemic has introduced new teaching methods for medical students. Majority of the students agreed that online learning has good impact on their education. Therefore, online teaching and learning cannot be ignored, with proper guidelines and facilities for better utilization of this new teaching modality. 

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