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| ORIGINAL ARTICLE |
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| Ahead of print publication |
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Learning Behavior and Perspective of Medical Students in India on COVID-19 Pandemic
Suraj Kapoor, Vivek Anand, SK Kaushik, Arun Kumar Yadav
Department of Community Medicine, AFMC, Pune, Maharashtra, India
| Date of Submission | 11-May-2021 |
| Date of Decision | 20-Jul-2021 |
| Date of Acceptance | 30-Jul-2021 |
| Date of Web Publication | 01-Apr-2022 |
Correspondence Address:
Arun Kumar Yadav,
Department of Community Medicine, AFMC, Pune-411040
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jmms.jmms_69_21
Background: Medical colleges in India are opening gradually for resumption of medical education. Assessment of learning behavior and perspectives of students toward COVID-19 pandemic is essential for effective medical education as well as to assess their role in pandemic if need arises. Objective: The study aims to assess learning behavior and perspective of medical students on COVID-19 pandemic. Materials and Methods: A descriptive cross-sectional study was conducted from September to December 2020 among 392 medical students at various medical colleges of the country. An online self-administered questionnaire was designed to assess learning behavior of medical students about infection prevention and control practices in COVID-19 adopted during the course of pandemic. Snowball sampling method was used for data collection. Results: On assessment of 392 medical students about preventive measures during COVID-19 pandemic, more than 80% of medical students were aware of the importance of facemask, social distancing, frequent hand washing, and use of digital tools such as Aarogya Setu app in surveillance. Majority of students were aware of the symptoms, testing, and treatment protocols along with importance of self-reporting. Most of the students were aware of various sources of getting scientific and relevant information about pandemic. While majority of students were aware of rationale of quarantine, appropriate waste management technique, and post-COVID precautions, there was a lack of knowledge about appropriate disinfection measures. Conclusions: Medical students are an asset to health care; learning behaviors adopted by them can certainly help to assist health-care system in COVID times.
Keywords: COVID-19, disinfection, infection prevention and control strategies, medical students, quarantine
| Introduction | |  |
Coronaviruses (CoVs) are a broad family of viruses that are known to cause serious and sometimes fatal pulmonary diseases such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The novel SARS-CoV-2 belongs to the same family and has spread worldwide, causing huge loss to human health and lives.[1] The World Health Organization (WHO) declared COVID-19 a public health emergency on January 30, 2020, and later the outbreak was declared pandemic on March 11, 2020. Since then the world has recorded over 170 million cases and 3.77 million deaths due to COVID-19 as on 13 Jun 21.[2] Amid the restrictions imposed to curb the pandemic, educational institutions including medical colleges across India were closed and students sent home to curb the spread of infection. With the number of cases gradually going down, medical colleges in India are also opening slowly. During the pandemic, medical students across the country may have gained knowledge about COVID-19 and adopted various preventive measures such as appropriate use of face mask, social distancing, hand hygiene at home, during travel, and/or during quarantine. As prevention is currently the preferred way to counter disease transmission, good learning behavior and perspective toward the disease will play a fundamental role in control efforts against COVID-19. The paradoxical dual role of medical students is that, as the future health-care workers, they potentially form part of a health-care system's response to public health emergencies but, conversely, are considered nonessential in clinical delivery and might be restricted from clinical learning.[3]
In the current pandemic, employing future physicians to support understaffed and overworked health-care teams seems logical. However, before we consider to assign COVID-19 duties to medical students, it is important to gauge their preparedness to support response efforts. Medical students especially final MBBS students can not only help in managing patients but can also sensitize the community about maintaining personal hygiene, symptoms of COVID-19, and ways to prevent its spread. With this background, our study aimed to evaluate COVID-19-related knowledge, preventive behaviors, and risk perceptions among medical students about various aspects of COVID-19.
| Materials and Methods | | |
Study design, population, and sampling methods
A descriptive cross-sectional study was conducted from September to December 2020 among 392 medical students at various medical colleges of the country. A web-based self-administered questionnaire was designed using “Google Form” to assess general awareness, information sources, knowledge, and perceptions related to COVID-19. Questionnaire was formulated using reference material, fact sheets, and information leaflets on COVID-19 developed by the WHO, the Centers for Disease Control and Prevention (CDC), and the Atlanta and Ministry of Health and Family Welfare (MoHFW), India. Summary of the semistructured questionnaire is mentioned in [Table 1]. The questionnaire was distributed among the students via various media platforms such as WhatsApp, Gmail, and Facebook. The sampling technique followed was snowball sampling method. The consent of the participant was inbuilt in the questionnaire.
Study variables
The questionnaire included demographic information such as age, gender, and academic year followed by 22 questions to quantify their knowledge, preventive behaviors, and risk perception. Knowledge was assessed through questions about the modes of COVID-19 transmission, symptoms, incubation period, diagnostic procedures, treatment options, and preventive measures such as social distancing, use of face mask, hand hygiene, safe mode of travel, rationale and importance of quarantine, appropriate disinfection, and biomedical waste management.
Scoring criteria
Knowledge was assessed by giving a score of 1 to each correct answer and 0 to the wrong answer. The scale measured knowledge from maximum 22 to minimum 0. Scores >11 and ≤15 were taken as average, score >15 as adequate knowledge (score above 70% considered as adequate knowledge, score more than 50% and <70% considered as average score) “ with “A score of more than 70% (16 or above) were taken as adequate knowledge”. The study was given institutional ethical clearance, and the data were analyzed in aggregated and anonymized form.
Statistical analysis
The data were analyzed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. The categorical variables were summarized using frequency, proportions, and ratios, while Chi-square test was used to determine association between study variables. P < 0.05 was considered statistically significant.
| Results | | |
A total of 392 medical students responded to the questionnaire. The mean age of study participants was 19.75 ± 1.58 years. A total of 286 (73%) participants were male, giving a male-to-female ratio of 2.6:1. A total of 121 (31%) participants were first MBBS students, 95 (24%) were second MBBS, and 176 (45%) were third MBBS students.
On assessing general awareness about COVID, more than 90% were aware of symptoms, testing, and existing treatment protocols. Similarly, most of the students were aware of various sources to get authentic and scientific knowledge with significant difference in correct response among first, second, and third MBBS students. The main sources of information were government websites (WHO, MoHFW, and CDC) (n = 230, 58%), followed by social media (YouTube, Facebook, and Television) (n = 145, 36%). Most of the remaining participants reported that they got the information through print media (magazines and newspapers) or from their college resources such as newsletters, posters, and guest lectures or other sources. About 96% of males and 94% of females were aware of the digital tools being used in surveillance. On asking about the role of vaccine in the current pandemic, about 88% of study participants were aware of the importance of vaccine.
Students were asked about preventive measures, nonpharmacological interventions in general and during travel to prevent spread of infection, more than 95% students were aware of appropriate use of face mask, importance of social distancing and steps of hand hygiene. However, the knowledge was particularly lacking among 1st year MBBS students. More than 80% of respondents were aware of safer modes of travel and COVID appropriate behaviors to be adopted during travel.
Rationale and importance of quarantine was particularly lacking among 1st year MBBS students with only 81 (69%) students giving correct response. More than 90% of students were aware of precautions to be taken during and after release from quarantine and importance of self-reporting [Table 2]. | Table 2: Comparison of learning behavior and perspectives based on gender and MBBS batch
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On assessing knowledge score of medical students on pandemic, 73% of respondents were having adequate response, whereas the rest 27% students were having average response. The mean knowledge score was 16.11 + 1.48 (range from 13 to 21).
Female medical students were found to have better knowledge score than their male counterparts (P = 0.0015). Third MBBS medical students performed better than first and second MBBS medical students (P = <0.001) [Table 3]. | Table 3: Association between sociodemographic characteristics and knowledge score
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| Discussion | | |
This study aimed to assess the learning behaviors and awareness among medical students about COVID-19. Our study suggested good overall knowledge regarding various aspects of COVID-19 similar to the study done on H1N1 assessing knowledge, attitude, and practice among university students in South Korea, UK, and Hong Kong.[4],[5],[6] It may be due to their obligations and responsibilities to fight against this pandemic as future medical professionals which may drive them to develop more positive attitude and proactive practices during this public health emergency.[7]
Most respondents in our study had obtained knowledge about COVID-19 through government official websites (57%). Similarly, a study carried out by Bhagavathula AS et al. revealed that the participants' main source of information was official government websites (33%) followed by social media (30%).[8] However, in another study conducted among doctors and medical students, 68.2% of participants accepted receiving misinformation.[9] At present, wide range of information is available on the internet, including unverified biased deceptive information, which can easily misguide the public. Focus should be put on to educate and provide authentic information to the health science students, so that the right information could be conveyed to the community.
A study conducted among medical students in Jordon revealed good knowledge and positive attitude about the disease with more than 90% of students having good knowledge about epidemiological determinants of COVID.[10] In a recent study done on medical students in UAE, the majority of respondents were aware of COVID-19 symptoms, the incubation period, diagnostic testing, management, and the preventive measures.[11] Our study also showed similar results when enquired about symptoms, testing, treatment, and preventive measures, especially during quarantine. However, knowledge about appropriate disinfection practices were lacking especially among 1st year MBBS students in our study.
In a study conducted among medical students during MERS in Saudi Arabia,[12] 73% of study participants had good knowledge score, whereas in a similar study conducted in Iran[13] among medical students, only about 34% of medical students had good knowledge score. On assessing knowledge, the current study revealed about 73% of medical students were having adequate score, whereas 27% of students were having average score. Similar studies conducted among different occupational groups such as health-care providers, medical students, and public revealed knowledge score ranging from 69% to 91%.[8] About 84% of study participants in a similar study done at Saudi Arabia assessing knowledge and risk perception about COVID-19 had high knowledge score. Variation in the percentages may be attributed to different geographical and educational conditions. Also, in recent pandemic flow of information is faster and easy to assess compare to previous outbreaks due to ease of access to information. The high level of knowledge about COVID-19 among medical students in India may also be attributed to their access to multiple reliable medical platforms, health-care professionals, and government media briefings or training many of them had received as volunteers in the health-care system.
Several studies have indicated that age was a factor associated with knowledge about the virus,[14],[15] as increased age was associated with an increased level of knowledge. In our study also, third MBBS students exhibited significantly higher knowledge as compared to their counterparts. Similar studies conducted in Saudi Arabia[12] and Egypt[16] also revealed similar results. This finding suggests that experience in training during MBBS curriculum may influence learning behaviors and better knowledge score.
A study conducted in Saudi Arabia revealed better knowledge score among female students than male students[12] with similar difference on the basis of gender observed in studies in China as well.[17] Studies have shown that women have better knowledge and practices of preventive measures like hand hygiene of infectious diseases (e.g., H1N1, SARS, and MERS).[18],[19],[20],[21] In our study also, there was a significant relationship observed between sex and the level of COVID-19 knowledge (P < 0.05), with female students performing better.
Medical students are an asset to health care. They can certainly help nonclinical aspects of medicine such as COVID-19 phone-triaging, tele-health, phone-based patient care services, and providing childcare for health-care workers. In challenging times, they can be effectively utilized in patient care as well.[22] In addition, medical students are commonly referred to for health-care advice from family and friends.[23] Medical students in the final years offer a vast wealth of potential. However, to effectively participate in the provision of health care and to function in a role that serves a higher purpose than just educational benefit, students must be prepared.[24] Governments, regulatory bodies, and medical schools have a responsibility to both current and future patients to ensure that our future doctors are sufficiently trained and supported to deliver essential patient care, even in crises. The study results may help policy makers and educators to plan the training curriculum for medical students in respect of pandemic preparedness as well as the future roles of medical students in a pandemic-like situation.
| Conclusions | | |
Medical students can play an important role as volunteers during health emergencies, including pandemics. This study revealed that overall current knowledge and self-reported preventive behaviors of medical students pertaining to the COVID-19 pandemic were adequate with limited knowledge in few areas. Thus, students must be educated on each aspect of pandemic systematically to fill the gaps, especially for those in the earlier academic levels of medical training, as they are a vulnerable group that may underestimate the risks of COVID-19.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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