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Table of Contents
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 188-197

Medical education at the time of COVID-19: A national multi-institutional experiences in undergraduate education in Saudi Arabia

1 Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
3 Department Medical Education, College of Medicine, Umm Alqura University, Makka Almukarama, Saudi Arabia
4 Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
5 Department of clinical biochemistry, College of Medicine, King Khalid University, Abha, Saudi Arabia
6 Department of Surgery, College of Medicine, King Faisal Specialist Hospital, Alfaisal University, Riyadh, Saudi Arabia
7 Department of Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
8 Family Medicine and Medical Education, King Saud University, Riyadh, Saudi Arabia
9 Department of Medical Education, Dean, College of Medicine, Qassim University, Qassim, Saudi Arabia
10 Department of Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
11 Department of Surgery, College of Medicine, Kind Saud University, Riyadh, Saudi Arabia
12 Medical Education and Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission04-May-2021
Date of Decision17-Aug-2021
Date of Acceptance28-Feb-2022
Date of Web Publication28-Apr-2022

Correspondence Address:
Mona M Soliman
Department of Physiology and Medical Education, College of Medicine, King Saud University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnsm.jnsm_50_21

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Background: The coronavirus disease-2019 (COVID-19) pandemic has disrupted medical education worldwide. This study investigates how Saudi medical colleges face the pandemic and proceed with teaching and assessment plans. The study also highlights the best practices employed by Saudi medical colleges during the time of COVID-19 crisis and proposes a contingency plan in the event of future outbreaks necessitating similar containment measures. Methods: This cross-sectional study was conducted among medical colleges in Saudi Arabia between June and August 2020. A convenience sampling method was applied. An online questionnaire was designed. The questionnaire consisted of six main parts: basic demographic data, curriculum, teaching and learning, learning management systems (LMS), assessment, and lessons learned. The questions targeting the educational process focused on what was happening before and what was done during the pandemic. Data were collected using Google Forms. The data was analyzed using SPSS. Results: A variety of teaching modalities were used before the pandemic, including class lectures (95.46%), problem-based learning (70%), case-based learning (47.25%), team-based learning (43.67%), videos/online interaction (24.58%), and flipped classroom (18.13%). During the pandemic, 97.87% of the participants used video lectures. During the pandemic, PBL and tutorial usage were reduced to 40.09% and 48.44% compared to 71.59% and 64.91% before the pandemic, respectively. Most faculty members (65.39%) reported no problems (nor did they encounter any obstacles) during online classes. Fully 96.18% of participants used Blackboard LMS during the pandemic. During the COVID-19 pandemic, 50.83% of participants reported utilizing continuous assessment, and 50.35% reported that the summative (final) assessment they performed was an online assessment. Most participants reported (85.68%) use online multiple-choice questions, followed by students' projects (34.84%), online SAQs (25.53%), and online objective structured clinical examinations (21.47%) if the pandemic were to continue. Conclusions: This study's value lies in the large sample of faculty and nationwide distribution of responses. Study results enable an understanding of early heuristic responses to online education, which may be used as a guide for mitigation efforts and to identify success stories, obstacles, key issues, and solutions.

Keywords: Assessment, COVID-19 pandemic, medical colleges, medical students, online learning, Saudi Arabia, Blended learning, team-based learning, flipped classroom, problem-based learning, online assessment

How to cite this article:
Alrumaihi N, AlSheikh MH, Zaini RG, Alamri A, Patel A, Alassiri A, Ageely HM, Abdulghani H, Alamro A, Alrumayyan A, Neel KF, Soliman MM. Medical education at the time of COVID-19: A national multi-institutional experiences in undergraduate education in Saudi Arabia. J Nat Sci Med 2022;5:188-97

How to cite this URL:
Alrumaihi N, AlSheikh MH, Zaini RG, Alamri A, Patel A, Alassiri A, Ageely HM, Abdulghani H, Alamro A, Alrumayyan A, Neel KF, Soliman MM. Medical education at the time of COVID-19: A national multi-institutional experiences in undergraduate education in Saudi Arabia. J Nat Sci Med [serial online] 2022 [cited 2022 May 21];5:188-97. Available from: https://www.jnsmonline.org/text.asp?2022/5/2/188/344211

  Introduction Top

The coronavirus disease-2019 (COVID-19) pandemic is considered the largest global crisis since World War II. The pandemic has gravely wounded the world's economy and health and education systems, with serious consequences that have critically impacted government, communities, and individuals. Complete lockdowns dominated major cities, starting with the first wave of the pandemic in March 2020. Social distancing protocols and measures were then applied to all aspects of life, including health care, education, and entertainment.

The impact of COVID-19 on medical education is unprecedented. The highly contagious nature of the virus and social distance protocols make it difficult to proceed with face-to-face activities. There has been widespread termination of clinical placements, face-to-face teaching sessions, and examinations that require a physical presence. The fundamental consideration of governments, health-care facilities, and medical colleges is to embrace the well-being of students, patients, and hospital staff.[1] However, the consequences of these actions may pause substantial issues for the learning experience and professional development of medical students.[2]

In Saudi Arabia, all colleges and universities, including medical colleges, were suspended due to the pandemic between March and September 2020. All learning, teaching, and assessment activities took place through distance learning through online delivery and electronic assessment. All clinical clerkships and bedside teaching were suspended. This sudden change in educational processes and plans imposed great challenges for medical colleges, staff, and students.

Many studies have reported their experiences and practices, yet there is a general agreement between the adopted measures in many aspects.[1],[2],[3],[4] All face-to-face theoretical teaching, including lectures, small-group teaching, and educational seminars, were suspended and replaced with online education. Many computer-assisted learning platforms were utilized (synchronized or unsynchronized) to facilitate students' distance learning. Among these platforms are learning management system (LMS) platforms, videoconferencing and virtual meetings, web-based podcasting, mobile applications, video case vignettes, and virtual patient simulators. Practical and clinical simulation sessions were also suspended or rearranged for online delivery.

Since William Osler's vision revolutionized medical education by bringing clinical teaching from the lecture hall to the bedside in 1903, best-practice medical education focuses on developing competent physicians with longitudinal clinical training and early clinical exposure. However, COVID-19 poses unique challenges to the clinical clerkship model, fundamental to medical student education. Clinical teaching and placement in all health facilities, such as hospitals, general practice, and community settings, were canceled or postponed in most countries.[1],[5] In addition, students' access to simulation models was suspended. This raised a general concern among educators about the level of clinical skills competence among students.[2] Most of the clinical teaching were replaced by other cognitive teaching sessions that were delivered online.

Student assessments have also been considerably challenged by the pandemic across all medical colleges.[2] Most medical colleges adopted remote e-examinations during the pandemic. Different synchronous and asynchronous assessment methods were applied, including electronic multiple-choice question examinations, open-book examinations, assignments, and oral examinations.[6] Clinical examinations were also mostly suspended or converted to an online form. Other medical clinics proceeded with face-to-face objective structured clinical examinations (OSCEs) within new arrangements to provide safety and social distance measures.[7]

All these arrangements raised controversy. Many difficulties have been raised, including potential technical complications related to Internet accessibility and connectivity, the validity of e-examinations in measuring clinical skills, and concerns regarding academic dishonesty.[6] The transition from face-face learning to distance learning and assessment has challenged medical college leadership, faculty, students, and support staff in many aspects.[3]

This study aims to explore faculty perceptions of the educational practices of medical colleges in the kingdom before the pandemic, how were they affected by the COVID_19 pandemic lockdown, and vision of the new normal or a contingency plan in the event of a future outbreak that may necessitate similar containment measures.

This study's value lies in its large sample of faculty and nationwide distribution of responses. The results of this study shed light on the early heuristic responses concerning the transition to online education and can be used as a guide for mitigation efforts and to identify successes, obstacles, key issues, and solutions.

  Methods Top

Study design

This is a cross-sectional study conducted among medical colleges in Saudi Arabia between June and August 2020.


A convenience sampling method was applied. To communicate with a representative from each medical college, the researchers gathered all the governmental and private medical colleges in Saudi Arabia in a shareable document. All colleges were asked to participate in the study by completing an online questionnaire designed by the researchers. Second, the invitation was sent as a link through E-mail and WhatsApp to every medical college dean, medical education department director, and faculty member, requesting that it to be distributed to every subordinate. Finally, gentle reminders were sent to encourage the participation. Participation was voluntary and anonymous. This study was conducted from June 2020 to August 2020.

Study variables

A self-administered questionnaire was designed after an exhaustive literature review to achieve the objectives of the study related to teaching/learning of medical education. The validation process of this customized survey included several meetings of expert medical educationists from various universities. The tools used were brainstorming, debate, and consensus voting. The end result was a questionnaire of six sections. The prepared version contained a total of seven main section elements that were subjected to detailed debate among a panel of four authors with experience in medical education, pedagogy, and educational research. Six main sections were agreed upon after two meetings and significant discussion among the panel. The study variables were represented through the respondents' position/role, college type (governmental or private), and location. The first part was the demographic information including university, region, and role. The second part was teaching/learning modalities used before and during the COVID-19 pandemic. The third part was an experience of LMS. Forth part was online teaching experiences and barriers. The fifth part was technologies to be adopted in the future in medical education, and the sixth part was about what assessment methods were used during the (COVID-19) pandemic. The educational process questions focused on what was happening before and what was done during the pandemic. Incomplete surveys were excluded from the study.

Data collection

An online-based survey was distributed using Google Forms.

Sample size

The sample size was calculated using Thompson's formula (Vincent, K., and Thompson, S, Thompson, 2017). The required sample size was estimated at the 95-confidence level with an estimated 50% response distribution and a margin of error of ± 5%. In the current study, a sample of 419 faculty members of 25 medical colleges in Saudi Arabia share their experiences with undergraduate medical education during the physical distancing period of COVID 19 pandemic. The estimated sample size for this study was 370. Nevertheless, to fully meet the sample size needs for our study, we invited all eligible medical education staff (those involved in the medical education, dean, faculty member, course organizer, etc.) to participate in the survey, and we also requested all medical colleges to take part in the study.

Statistical analysis

The numerical data were entered and analyzed in Microsoft Excel using SPSS Statistics, version 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics (frequencies, and percentages) were used for summarizing the study and outcome variables. Since each item reflected a distinct context rather than an underlying latent construct, Cronbach's alpha was not calculated for this questionnaire. We also did not use the Chi-square test because most of the items were multiple selections.

Ethics approval and consent to participate

The study was approved by the Institutional Review Board (IRB), College of Medicine, King Saud University Ref. No. 20/0551/IRB on June 30, 2020. All methods were performed in accordance with the relevant guidelines and regulations. This research was conducted to explore faculty and leadership perceptions regarding educational practices in Saudi medical colleges during the COVID-19 pandemic lockdown. The participants were asked for their informed consent to participate in this study, and their identities remained confidential. In addition, the researchers received permission to use questionnaires and datasheets from other authors for academic and research purposes.

  Results Top

The COVID-19 pandemic has pushed the world into quarantine and moved most of the work, learning, socializing, and relaxation to the online space. In the current study, 419 faculty members joined 25 different governmental and private medical colleges in Saudi Arabia to share their experiences with undergraduate medical education during the COVID-19 pandemic era.

The largest universities represented in the sample in the current study were King Khalid University (20.05%), followed by Al-Imam Muhammad Ibn Saud Islamic University (10.26%) and Princess Nourah (9.31%) [Table 1].
Table 1: Demographic information about universities, region, and participants

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The majority of respondents are faculty/college members (lecturer, assistant professor, and associate professor) (83.78%), chairperson (6.20%), vice dean (5.01%), and dean (2.38%). Only 2.62% of respondents hold other positions (such as research analyst).

Regarding the type of medical curricula that are implemented in the different institutes, the participants reported integrated curriculum (40.57%), problem based (33.65%), hybrid (28.40%), and discipline based (21.00%). Only 10.26% of participants described their curriculum as community oriented. In addition, 74.46% of respondents reported that they implemented SaudiMED competency curricula in their universities or institutions.

Teaching methods

Teaching methods before the pandemic

Before the pandemic, the respondents used a variety of teaching/learning modalities, with class lectures being the modality used by nearly all (95.46%) participants. Similarly, clinical skill laboratories and problem-based learning were used by more than 70% of the participants. Following these, case-based learning was used by 47.25% of participants, then team-based learning (TBL) (43.67%), bedside teaching (60.14%), simulation (44.39%), videos/online interaction (24.58%), and flipped classroom (18.13%) [Table 2].
Table 2: Teaching/learning modalities used before and during the coronavirus disease-2019 pandemic

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Teaching methods during the pandemic

During the pandemic, the class lecture transformed into a video lecture with different forms, such as synchronous and synchronous. During the pandemic, most (97.87%) of the participants used video lectures to address students. In contrast, problem-based learning (PBL) and tutorial usage were reduced during the pandemic to 40.09% and 48.44%, respectively, compared to 71.59% and 64.91% before the pandemic [Table 2]. Participants also report challenges during the pandemic students' online classes. While 65.39% of faculty members reported that they had no problems or faced no obstacles during online classes, 33.1% reported facing some obstacles during online classes, including Internet connection problems (34.3%), technical problems (29.7%), or lack of student interaction (16.9%).

Utilization of learning management system before and during the pandemic by faculty members of different universities

During the pandemic, faculty members were more involved with different LMS resources. The current study reported that during the pandemic, the utilization of LMS increased. Blackboard LMS use was reported by 96.18% of participants during the pandemic compared to 70.8% before the pandemic. Similarly, Moodle was use by 16.94% of participants during the pandemic and 7.2% before the pandemic, and custom-built tools 8.59% during fore. Other online tools such as Canvas, edX, Zoom, and Microsoft teams increased ~20% compared to before the pandemic [Table 3].
Table 3: Uses learning management system before (coronavirus disease-2019) and during (coronavirus disease-2019) pandemic

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Experience of faculty with the usage of learning management system during the pandemic

[Table 4] summarizes the overall LMS experience of faculty members during the pandemic. Most (90.45%) of all Saudi university faculty members have a positive experience delivering lectures through LMS. Moreover, most of the faculty members (79.2%) agreed to continue using LMS after the pandemic. Similarly, 83.8% of faculty members reported that they recommend an LMS to other colleagues.
Table 4: Overall experience about uses of learning management system during pandemic

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Experience of faculty with online teaching experiences and challenges

[Table 5] summarizes the overall experiences and challenges of faculty members teaching online classes. A total of 40.81% of participants reported that they did not feel any barrier or lack of experience when transforming the class lecture to online teaching or video lectures. The current results showed that issues involving personal anxiety/fear of technology (51.07%), technology involvement can be confusing (46.30%), increased workload (47.30%), lack of administrative and technical support (44.90%), and time commitment (45.80%) were not perceived as barriers. However, the results showed that all the other statements were somewhat a barrier. For example, 43.19% of faculty members reported facing some barriers during online classes due to a lack of online teaching experience. A total of 38.18% of faculty members had anxiety about online teaching. In addition, 47.30% of participants reported that they perceived barriers regarding the “lack of standards/guidelines in online education,” while 43.90% of participants reported some barriers concerning “frequent technology failures.”
Table 5: Faculty online teaching experiences and barrier

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In the current results, 41.3% of the participants felt that lacking or missing social interaction/engagement within the class created significant barriers, with 39.1% noting a lack of visual cues from students, 31.5% experiencing frequent technology failures, and 37.2% experiencing attendance issues.

Learning technology adaptation in the future in medical education after the pandemic (The New Normal)

[Table 6] summarizes the future adaptation of learning technologies in medical education. Most (91.16%; strongly agree + agree) of the participants agreed to use flipped classroom/increased interactivity and active learning. In the current study, it was noted that the majority (86.63%) of the participants agreed that they would provide more mobile-friendly/online content access in the future. Additionally, 94.0% of the participants agreed to the increased use of video/multimedia tools. Similarly, 87.08% reported increased engagement outside the classroom, and that 84.09% of courses were more self-paced/customized according to students' needs.
Table 6: Learning technologies to be adopted in future in medical education after the pandemic

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In the current results, participants reported that 97.37% used the same multiple-choice questions (MCQs) that they used before the pandemic. In addition, 64.91% used students' projects/assignments, with almost the same percentage of participants (64.20%) using the OSCE. Over half of the participants (59.42%) used short-answer questions (SAQs). Assessments given during the COVID-19 pandemic have been a major challenge for universities and institutions. Every institution has taken some action regarding continuous assessments as well as final assessments. A total of 50.83% of participants reported continuous assessment, and 50.35% reported the summative (final) assessments carried out as an online assessment. A total of 33.89% continuous assessment and 23.62% summative (final) assessments used other methods. Major challenges faced by the participants during the pandemic were OSCEs (43.91%), followed by written assessments (43.44%), structured oral examinations (22.67%), others (10.50%), and portfolios (8.35%). Furthermore, if the pandemic were to continue and participants would have to choose which methods to use, most (85.68%) reported that they would utilize online MCQs, followed by students' projects (34.84%), online SAQs (25.53%), oral examinations (24.58%), and online OSCEs (21.47%) [Table 7].
Table 7: Assessment methods used during the (coronavirus disease-2019) pandemic

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  Discussion Top

The faculty in Saudi Arabia had a positive perception of online education during the COVID 19 pandemic crisis. The advance of e-learning in the last two decades reduced the burden of adjusting to the sudden shift to online education. The major obstacles in online education as perceived by instructors were lack of social interaction, lack of visual cues, and technology failures . These findings are similar to previous studies elsewhere[8-13]. It contradicts with many studies that revealed a negative perception[12],[14],[15],[16] of instructors for online teaching. In our study, faculty considered the LMS a support system that helps them to manage their online courses and were interested in the continued use of LMS and online education after the pandemic. This agrees with two other studies in the Kingdom of Saudi Arabia (KSA) and Libya.[17-18] The early phase of this study revealed that most of the teaching were lecturing with less small-group teaching. This is expected as the technical expertise in using the various e-learning platforms, for example, running break-out rooms and online PBL and TBL, was still building up. Similar fndings were reported in China and Indonesia, as both students and instructors were not [19-20] satisfed with small-group teaching. Other studies have reported a smooth transition to online teaching of small-group discussions such as PBL and tutorials. Faculty reported comfort toward online education and did not report that it [21]was time consuming, as was found in other studies. A very interesting narrative about online teaching describes the[22] online instructor's life as a 24/7 commitment. A PhD thesis discusses the advantages and disadvantages of online education and states that online education is perceived by instructors as[23] requiring more time and efort. The main concern was lack of bedside teaching and the poverty of clinical psychomotor [24],[25],[26],[27],[28],[29],[30],[31] skills as well as communication and interpersonal skills. The timing of this study was during the initial crisis phase that involved complete lockdowns and curfew. The disruption of teaching and assessment practices during this pandemic varied with the degree of readiness to online teaching and learning. This includes the e-learning platforms, resources, staf and students' technical and pedagogical readiness for online teaching and assessment, and administrative and technical [24, 32, 33] assistance. A recent study aimed to create a reliable tool to measure readiness of instructors for online teaching revealed [29] similar fndings. Majority (79%) of the participating colleges had an innovative integrated problem-based curriculum. Although most of the participants were from Riyadh (34.4%), the capital of Saudi Arabia, 64% of the problems faced were Internet and technical failures. Reports about Internet access and technical failures as the main limitation of online education were made from diferent parts of the world regardless of its level of development.[34-39] The main pedagogical problem was the lack of students' engagement in online learning.[40-43] Many medical colleges in the Kingdom have applied the concept of programmatic assessment with multiple encounters, formative and summative assessments, assignments, workplace-based assessments, and portfolios or logbooks.[32] Therefore, at the start of the pandemic, instructors were confused and uncertain, expressing their concern for measuring clinical competence virtually. When the rules for physical distancing eased, there was an additional concern of whether it was fair to conduct face-to-face practical examinations such as OSCEs for students who had not had access to clinics, wards, or bedside teaching and who were taught only by watching online videos. Accordingly, medical colleges had three choices: Postpone examinations to the following year, run online oral examinations and adopt a pass/fail marking system, or evaluate students based on written work and their previous performance before the lockdown. A similar experience was reported by other medical schools worldwide.[44-46] Online education is not new in the Kingdom. Medical students have had access to Blackboard LMS and synchronous and asynchronous lectures, online medical resources, online group chat and debate, and social media for almost two decades before the pandemic. Most universities invested a large part of their budget in establishing the infrastructure of e-learning studios, technology, platforms, e-resources, technical staf, and faculty development modules. The rapid growth in e-learning posed some challenges, as infrastructure grew much more rapidly than human resources. [5,47-49] All these e-learning modalities have been used in addition to face-to-face education as a blended learning strategy.[50] The main concern of educators worldwide is that online teaching and assessment solutions might compromise the quality of medical education outcomes.[32] One study that compared the efectiveness of online education to traditional face-to-face instruction showed no diference.[51] We need to address the diference between the impact of using online teaching as an additional modality to enrich education from using it as the only medium of instruction.[52-54] Often, medical students found these additional communication channels with peers and instructors to be useful, leading to improved knowledge and competency.[55-57] The use of online and interactive technology tools during regular medical college sessions also increased student motivation and engagement.[58] Similar to previous research,[59-63] this study showed that barriers to online education included lack of knowledge or skills regarding technology, lack of ready-made e-learning resources, diminished learner engagement, lack of motivation, communication difculties, and a lack of visual cues from students One unexpected gain with online education in the Kingdom was the freedom to teach both genders. Education in Saudi Arabia is gender segregated in the preclinical phase. With the transformation into online teaching, female instructors could teach both genders and vice versa. This had two advantages: halving the teaching load for faculty and unifying teaching quality in the male and female campus. The faculty perceived a lack of visual interaction with students. Since most students do not open the video camera during lectures or online PBL sessions, the instructor is unable to see their facial expressions, which is normally the main cue to their grasp of what is being discussed or their attentiveness. This is similar to previous studies that described the importance of students' facial expressions in the educational process and instructors describing their experience as teaching in a vacuum.[40],[64] Some information technology solutions have been developed to aid instructors detect students' reactions.[65]

Assessment in medical education has progressed extensively in the last two decades. Most medical colleges apply some shade of programmatic assessment, including multiple encounters and formative and summative components. Multimedia written assessments and virtual patient e-OSCEs have been in practice for almost a decade[66] and included reflective journals, health case reports, comparative health reports, medicine of the mind, annotated bibliographies, and poster presentations. The first OSPE/OSCE was implemented in the Kingdom at “King Faisal University” in 1986 in basic sciences.[67] Practical examinations have become the norm for clinical rotations, and OSCEs started to have more weight in terms of the total grade in clinical subjects or blocks (and were even a hurdle in some). Workplace-based assessments, such as mini-CEX, DOPs, and portfolios, are commonly used as formative assessment tools.[68] The main tool used in this study was online MCQs, followed by SAQs, OSCEs, and oral examinations. Formative assessments were markedly affected and totally dismissed or replaced by online MCQs or assignments. This was similar to another study.[69],[70],[71] A group of other studies report successful application of online formative assessment.[72] It is probably due to the fact that these studies were conducted at a later phase in the pandemic after the initial crisis. The greatest challenge in assessment during the COVID-19 pandemic was reported to be OSCEs. Only 21% reported using online OSCEs. This is related to the early phase of the pandemic when strict physical distancing rules were imposed by the Ministry of Health and Ministry of Education. Later, when the fall semester started, many colleges performed face-to-face OSCEs under strict disinfection precautions or developed the skills and experience to conduct online OSCEs. However, these were not reported in this survey due to the reason mentioned above.


This study was based on instructors' perceptions and was not triangulated with students' or administrative views. Another limitation is that the data was collected in the early crisis phase of the COVID 19 pandemic during the complete lock-down period. Hence, it reflects the early ad hoc efforts to replace face-to-face education and not the organized efforts that followed.

  Conclusions Top

Faculty of medical colleges in the KSA perceive online teaching during the COVID 19 pandemic positively. The disruption afected mainly small-group teaching, clinical psychomotor training, and formative assessment. An unexpected gain was freedom to teach both genders in the same class. The main obstacles to online education were lack of visual cues and social interaction which limited student engagment, lack of instructorsr knowledge or skills regarding technology, lack of ready-made e-learning material, and Internet access and technical failures.


The authors wish to thank all the medical educators who participated in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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