Journal of Marine Medical Society

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 24  |  Issue : 1  |  Page : 7--10

Online teaching of undergraduate and postgraduate medical students in pediatrics: Single-center experience


Apoorv Saxena, Subhash Chandra Shaw, Biju M John, KM Adhikari 
 Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India

Correspondence Address:
Col (Prof) Subhash Chandra Shaw
Department of Pediatrics, Armed Forces Medical College, Pune - 411 040, Maharashtra
India

Abstract

Background: The COVID-19 pandemic has forced the world to change its approach to medical education with most of the undergraduate (UG) teaching shifting to online mode. As in other colleges in India, we also switched to online classes for both UG and postgraduate (PG) students in April 2020. We intend to share our preliminary experience about the acceptance and performance of these online classes in Pediatrics. Methodology: For UGs, we studied the attendance and marks of term ending summative assessment of batch of 2020 who attended online classes and compared them to the attendance and marks of the term ending summative assessment of the previous three batches (2017, 2018, and 2019). We also obtained a feedback on a prevalidated questionnaire from the UG as well as PG students. Results: The mean ± standard deviation (SD) attendance of the batch of 2020 was 81.6 ± 16.2%, while that of the 2017, 2018, and 2019 batch during the same period was 84.9 ± 10.9%, 92.6 ± 4.8%, and 83.0 ± 7.6% respectively. Similarly, the mean ± SD marks for the batch of 2020 was 74.8 ± 6.5% while it was 66.9 ± 9.4%, 58.6 ± 10.1%, and 60.9 ± 9.7% for 2017, 2018, and 2019 batches, respectively. The feedback obtained from both UGs and PGs was satisfactory in relation to the acceptance of the online mode. Conclusion: The online classes in Pediatrics are a reasonable alternative to the onsite classes in the prevailing situation.



How to cite this article:
Saxena A, Shaw SC, John BM, Adhikari K M. Online teaching of undergraduate and postgraduate medical students in pediatrics: Single-center experience.J Mar Med Soc 2022;24:7-10


How to cite this URL:
Saxena A, Shaw SC, John BM, Adhikari K M. Online teaching of undergraduate and postgraduate medical students in pediatrics: Single-center experience. J Mar Med Soc [serial online] 2022 [cited 2022 Jul 2 ];24:7-10
Available from: https://www.marinemedicalsociety.in/text.asp?2022/24/1/7/336196


Full Text



 Introduction



The COVID-19 pandemic in India has brought about unprecedented changes in all aspects of life, medical education being no exception.[1] As in several medical colleges, the undergraduate (UG) students of our medical college were also sent home in mid-March in 2020 and online classes in Pediatrics were started thereafter.[2] Similarly, the postgraduate (PG) classes in Pediatrics (case presentation, seminar, journal club, and faculty lecture) were also started online, and all the physical classes were suspended. Evidence exists that online training has the potential to enhance knowledge domain and can be definitely considered in medical teaching.[3] We aimed to study the acceptance and performance of online classes in Pediatrics as compared to the offline classes.

 Methodology



In our institute, the 4.5 years of MBBS are divided into 9 terms with each term being 6 months long. The VIII term usually lasts from January to May. The online lectures in Pediatrics for UGS were started in our institution from April 13, 2020 on Moodle platform. We started with one lecture per week and then went on to two lectures per week from 3rd week onward. “The lecture technique involved displaying the power point presentation with teacher explaining the slides using the interactive touch panel with pen (WACOM DTK - 2241) where he/she can use the interactive pen to draw/underline keywords while students were listening to the teacher and interacting with him/her using the chat option available. The online platform also enabled us to take attendance of the UG students who were logged in. Most of the lectures, related videos and documents were also shared with the UGs 1-2 days before the class.

We conducted multiple choice question (MCQ)-based assessment at the end of each capsule. Each capsule consisted of minimum 2 and maximum of 3 lectures. This ensured weekly tests for the UG students. The assessment was done with a view to get a formative internal assessment since the timing of return of these students was unpredictable, with a possibility of the entire remaining semester time being lost. The MCQs were assessed for best response out of 4 options available and were designed to provide approximately 40 s to answer one question.

We then decided to obtain a feedback from the batch of 2020 using a prevalidated questionnaire circulated using Google forms after 15 online lectures in June 2020. The responses were kept anonymous. Based on the feedback obtained, we introduced once a week case-based discussion through the online portal. The case-based discussion was conducted in small groups with the entire batch divided into five groups. Each week one case was discussed with one group to ensure that faculty takes the same case for all the groups. We then analyzed the attendance and the performance of VIII term students in the term-ending summative assessment examination. The summative examination consists of 40 marks with 28 MCQs comprising of 14 marks, 3 short answer questions (SAQs) of 4 marks each and 2 long answer questions of 7 marks each. In the year 2020, the VIII term was extended till July, and the term ending summative assessment was carried out in the end of July in an online form. The students were given question paper through E-mail 15 min prior to the start of examination and were asked to submit their answers in pdf format through return E-mail, for which extra 30 min were allotted.

We compared the attendance and marks of term ending summative assessment examination of batch of 2020 to the VIII term attendance and marks in Pediatrics of term ending summative assessment examination of the previous three batches (2017, 2018, and 2019) to understand how this method of training fared. The marks of previous 3 batches were obtained from records of the summative exam conducted at the end of VIII term. The batch size was 133, 135, 134, and 136 for 2017, 2018, 2019, and 2020 batches, respectively. A second feedback was obtained from VIII term students at the end of the examination using a prevalidated questionnaire circulated using Google forms.

The PG classes in Pediatrics were started on 25 April 2020 on Google meet platform. A monthly schedule was prepared and circulated to the students beforehand. The usual weekly schedule which our department follows is case presentation on Monday, seminar on Tuesday, journal club on Thursday and faculty lecture on every 2nd and 4th Friday.

Since the physical classes could not be scheduled even for the case presentation, the students were allotted cases on Saturday and were asked to prepare PowerPoint slides for the same. Similarly, the seminar, journal club, and faculty lectures were also done using PowerPoint slides only. Each participant for the PG classes would attend from his/her own workplace, and the discussion would be generated by the moderator. We also integrated the PG teaching with other teaching institutes of Armed Forces Medical Services (AFMS), and PG students from other institutes were also allotted academic activities on a regular basis. We obtained a feedback from PG students of all the AFMS teaching institutes using a prevalidated questionnaire circulated using Google forms. The responses were kept anonymous. The statistical analysis was done using IBM SPSS 23.0. The means of attendance and marks obtained by different batches were compared using one-way ANOVA test, and post hoc analysis was done using Tukey's test.

 Results



[Table 1] depicts the comparison of pattern of attendance and the marks of the term ending summative assessment examinations of batch of 2020 compared to those of 2017, 2018, and 2019 batches. The mean ± standard deviation (SD) attendance of the batch of 2020 was 81.6 ± 16.2%, while that of the 2017, 2018, and 2019 batch during the same period was 84.9 ± 10.9%, 92.6 ± 4.8%, and 83.0 ± 7.6, respectively. Similarly, the mean ± SD marks for the batch of 2020 was 74.8 ± 6.5% while it was 66.9 ± 9.4%, 58.6 ± 10.1%, and 60.9 ± 9.7% for 2017, 2018 and 2019 batches, respectively. Both attendance and marks were statistically significant on comparison of means. On post hoc analysis, marks of 2020 batch were significantly better than all the other batches. However, the attendance of 2020 batch was significantly lower than that of 2018 batch. The attendance of 2020 batch was lower than the 2017 and 2019 batch as well, although it was not statistically significant.{Table 1}

Most of the UG students felt that the duration of online classes was optimum. However, most rejected the idea of completely integrating the online teaching in UG curriculum in future. They also felt that mode of interaction in an online class is not really adequate, as compared to regular classroom teaching. Almost all students responded as not in agreement when asked whether they would be better prepared for examinations after participating in the online classes [Table 2]. The response of PG students to the questionnaire on the acceptance of online classes was satisfactory [Table 3].{Table 2}{Table 3}

 Discussion



The online teaching of UG and PG students is a feasible and viable substitute for offline teaching in the unprecedented scenario such as Covid-19 pandemic. Previously, innovative solutions were invented during the SARS and MERS outbreaks using the telephone as well as virtual environment.[4],[5] During the present pandemic also, similar efforts have been made.[6],[7],[8],[9] While Moskowicz et al. reported their experience for 10 students with the online teaching platform, Singh et al. reported the experience of 398 UG students, whereas a recent study from Libya interviewed 3348 respondents through questionnaire.[7],[8],[9] We analyzed the acceptance and performance of 135 UGs as well as obtained the feedback from them and 34 PG students.

In our experience, the attendance of the batch of 2020 was comparable to the attendance of the previous batches. However, the attendance of online classes for this batch (2020) improved significantly when compared to the offline attendance of the same batch (2020) in the prelockdown period. The reason of the same could be the ease of attending online classes from the place of their residence. Furthermore, the present batch scored higher marks in the term-ending summative assessment examination as compared to the previous batches. The difference could be due to the online assessment format where students appeared for the examinations unsupervised.

On the response to feedback questionnaire, there was mixed response from UG students. Most of the UG students felt that the online classes cannot replace the physical classes. However, they mostly felt that the content of topics discussed by the faculty was appropriate and duration of classes was also optimum. The response to some of the questions reduced when we obtained the second feedback probably highlighting the fatigue setting in for the online classes.

Most of the PG students were satisfied with the online classes with regards to the ability to generate adequate discussion, the content, and interaction with the moderator. Most of the students felt that the main advantage of online classes was the ability to interact with faculty from other AFMS institutes including the subspecialists, while the main disadvantage was the technical issues faced with respect to the software and/or internet. However, many of them advocated the resumption of bedside clinics, maintaining social distancing norms. The feedback is similar to the Libyan study, where only 21.1% respondents agreed that e-learning could be used for clinical aspects.[9] However, the PG students in our study wished to continue these e-classes, including the integration with other AFMS institutes, once the pre-COVID 19 format of teaching is restored.

There are challenges to the online teaching–learning method.[10] The students in areas with poor connectivity or bandwidth may not be able to attend these classes regularly. We learnt that internet connectivity was a major issue at times with frequent dropouts of both UG and PG students from the lectures. Lack of bedside teaching and training is likely to hamper the development of clinical skills. Assessment of the clinical skills is also difficult in the online mode of teaching learning. The online method of teaching–learning as well as assessment removes the physical barriers in terms of the need of suitable rooms, eliminating distances and transport requirements.[11] It also increases our capacity to simultaneously assess more number of students. This also provided us the opportunity to integrate our PG curriculum with other institutes. It also enabled our PG students to learn from various subspecialists who were available remotely.

The limitation of our study is the small number of online lectures (26) held till date. Notwithstanding, this form of online training of MBBS UG and PG students has been found to be reasonably effective. We continue to experiment with various ideas toward enhancing this form of training. The use of these online training methods is likely to increase in future, and it is incumbent on us to improvise and innovate to optimize the teaching–learning experience.

 Conclusion



The COVID-19 pandemic pushed us to change our approach toward teaching and training of students. In our experience, the attendance for online classes in Pediatrics for UGs was comparable to the offline classes. Their academic performance was also satisfactory. The feedback obtained suggested that the online mode was feasible and a viable alternative during the unprecedented circumstances like this pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Rose S. Medical student education in the time of COVID-19. JAMA 2020;323:2131-2.
2Supe A. Health professions education and corona times. Natl J Integr Res Med 2019;11:2-3.
3Pei L, Wu H. Does online learning work better than offline learning in undergraduate medical education? A systematic review and meta-analysis. Med Educ Online. 2019 Dec;24(1):1666538. doi: 10.1080/10872981.2019.1666538. PMID: 31526248; PMCID: PMC6758693.
4Patil NG, Chan Y, Yan H. SARS and its effect on medical education in Hong Kong. Med Educ 2003;37:1127-8.
5Park SW, Jang HW, Choe YH, Lee KS, Ahn YC, Chung MJ, et al. Avoiding student infection during a Middle East respiratory syndrome (MERS) outbreak: A single medical school experience. Korean J Med Educ 2016;28:209-17.
6Hodgson JC, Hagan P. Medical education adaptations during a pandemic: Transitioning to virtual student support. Med Educ 2020;54:662-3.
7Moszkowicz D, Duboc H, Dubertret C, Roux D, Bretagnol F. Daily medical education for confined students during coronavirus disease 2019 pandemic: A simple videoconference solution. Clin Anat 2020;33:927-8.
8Singh K, Srivastav S, Bhardwaj A, Dixit A, Misra S. Medical education during the COVID-19 pandemic: A single institution experience. Indian Pediatr 2020;57:678-9.
9Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H, Ashini A, et al. Impact of the COVID-19 pandemic on medical education: Medical students' knowledge, attitudes, and practices regarding electronic learning. PLoS One 2020;15:e0242905.
10Rajab MH, Gazal AM, Alkattan, K. Challenges to online medical education during the COVID-19 Pandemic. Cureus 2020;12:E8966.
11Mooney CJ, Peyre SE, Clark NS, Nofziger AC. Rapid transition to online assessment: Practical steps and unanticipated advantages. Med Educ 2020;54:857-8.