ORIGINAL ARTICLE
Year : 2021 | Volume
: 4 | Issue : 3 | Page : 220--225
The impact of COVID-19 pandemic on undergraduate medical teaching: An experience of Saudi Arabia medical colleges
Sarah H Al-Mazidi
Department of Physiology, Faculty of Medicine, Imam Mohammed Bin Saud Islamic University, Riyadh, Saudi Arabia
Correspondence Address:
Sarah H Al-Mazidi
Department of Physiology, Faculty of Medicine, Imam Mohammed Bin Saud Islamic University, P.O. Box: 5701, Riyadh 11432
Saudi Arabia
Abstract
Objectives: To evaluate the tools used during online education and examination of undergraduate medical students from students and medical instructors' experience and means to improve students' and instructors' online education experience in future. Materials and Methods: Two surveys were deployed online through social media (WhatsApp, LinkedIn, and Twitter) to medical students and instructors from all medical colleges in Saudi Arabia. The surveys include demographic data, tools used in the education process during coronavirus disease 2019 (COVID-19) pandemic, tools used in students' examination, and both groups' opinions about these tools. Descriptive statistical analysis was used to analyze the items included in the survey. Responses were presented as frequencies and percentages. Results: Responses from medical colleges in Saudi Arabia were collected and analyzed with a response rate of 72.2%. Data from 518 students and medical instructors showed that online education transformation had a positive feedback from both students and instructors for theoretical sessions teaching with limitations in the practical and clinical sessions. Conclusion: Online education in medical schools is new in Saudi Arabia. This mandatory shift to online teaching made us aware of the importance of restructuring and implementing the medical curriculum to support virtual education, especially in practical and clinical sessions learning.
How to cite this article:
Al-Mazidi SH. The impact of COVID-19 pandemic on undergraduate medical teaching: An experience of Saudi Arabia medical colleges.J Nat Sci Med 2021;4:220-225
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How to cite this URL:
Al-Mazidi SH. The impact of COVID-19 pandemic on undergraduate medical teaching: An experience of Saudi Arabia medical colleges. J Nat Sci Med [serial online] 2021 [cited 2023 Mar 21 ];4:220-225
Available from: https://www.jnsmonline.org/text.asp?2021/4/3/220/322327 |
Full Text
Introduction
Online teaching has been implemented in universities and colleges as one of the teaching methods combined with blended and face to face teaching methods. In medical colleges, it was an available option that medical instructors could use, and technical support and training are available.[1] During the coronavirus disease 2019 (COVID-19), online teaching was no longer an option, and it is necessary to continue teaching using the available online tools. The virus is transmitted from one person to another, mainly by the respiratory droplets produced by coughing or sneezing of an infected person.[2] These droplets can land on a person 1.8 m away.[3] There is no cure yet for COVID-19, but prevention guidelines were recommended by the World Health Organization (WHO) to limit the spread of infection and transmission of the virus. These guidelines focus on hand hygiene, sneezing and coughing etiquette, wearing a mask if in contact with COVID-19 patients, isolation of patients diagnosed with COVID-19 and most importantly, social distancing.[4] Furthermore, vaccination was recently added as one of the preventive strategies against coronavirus.[5] Because of the WHO guidelines for social distancing to prevent the rapid spread of the virus, most countries, including Saudi Arabia, implemented strict actions to limit social gatherings in many social events, including entertainment, sports, religion, and educational activities.[6] As a result, education was shifted to online teaching. This pandemic allowed for broader adoption of online medical education and training tools. Thus, an objective and comprehensive assessment of the currently available tools is warranted. Furthermore, developing an online implemented curriculum with proper training to medical instructors would ensure a high-quality medical education to be virtually accessible at any available settings.[7]
The online teaching tools that were used in undergraduate medical teaching include teleconferencing and adapting modified tools to measure students learning, such as adaptive research and simulated clinical sessions.[8] Furthermore, medical schools utilized different online teaching platforms such as Zoom, Microsoft teams, and Blackboard. These tools are deployed immediately to ensure the continuity of the educational process. Universities had invested in online teaching years before this pandemic, which allowed for a smooth transition. Some of these investments are made as part of the national accreditation requirement.
This research aims to evaluate the teaching and examination tools deployed during the COVID-19 pandemic in undergraduate medical schools, targeting faculty members, and students' experiences to assess the available options to improve virtual and online medical teaching and training in future. Medical students are the most stressed students and have concerns about their learning and training during online education.[9],[10] Hence, it is essential to find the best strategies to support their education.
Materials and Methods
This was a cross-sectional study approved by University Institutional Review Board (IRB number 28-2020) on June 21, 2020.
Two 17-items self-administered online surveys using Google Forms® (Google LLC, Mountain View, CA, USA) were prepared and administered through Google forms to the students and teaching staff of all medical schools in Saudi Arabia. The surveys were available during the COVID-19 pandemic from June 2020 to September 2020.
Participants included medical students and instructors of different academic levels. Consent was obtained from all the participants. Both surveys included an introductory paragraph that explains the aims of the study and that their participation was voluntary and complete anonymity was ensured, and they are allowed to withdraw from the study at any time.
Two medical students and two medical instructors were invited to pilot test the survey's initial drafts to validate the survey, and minor modifications were made based on their feedback. Then, the surveys were distributed using social media, including Twitter, WhatsApp, and LinkedIn.
Clear instructions were given to participants; students' survey inclusion criteria are: studying in a Saudi medical school at any level of the 6-year program or internship year. Medical instructors survey inclusion criteria are as follows: teaching as a full-time or adjunct faculty member at one of Saudi Arabia medical schools and were involved in students teaching during the COVID-19 pandemic.
The surveys included closed-ended questions and subjectively assessed the following variables:
The quality of online lectures delivered during the COVID-19 pandemic for both students and facultyThe students' and faculty's experiences and opinions on the online evaluation processThe overall experience of online teaching and evaluation.
Statistical analysis
All the statistical tests were performed using Graphpad Prism 5 (Graphpad Software, CA, U. S. A.). Descriptive statistical analysis was used to analyze the items included in the survey. Responses were presented as frequencies and percentages. Statistical analysis was made with Mann–Whitney to compare the responses between students of different education levels (1st year to internship). P < 0.5 was considered statistically significant.
Questionnaire questions that compare the online experience with the classroom experience were categorized as (poor, acceptable, better than the classroom, and as good as the classroom) or (yes/no) and were classified in the statistics according to the participant's responses.
The cutoff value for the questions with ratings (0–5), 3 and above was considered a positive response, and below 3 was considered negative.
Results
A total of 518 participants from medical schools in Saudi Arabia were enrolled in this study. They were grouped as follows: 156 faculty members of medical schools and 362 medical students (168 clinical year students and 194 preclinical year students) from different medical schools. The Mann–Whitney test was used to compare the students' responses of different educational levels from the 1st year to internship, and no significance was found. Both clinical and preclinical students showed similar responses throughout the survey. Hence, students' responses were combined and referred to as Student's responses. [Table 1] describes the study demographics.{Table 1}
The detailed responses are depicted in [Table 2]. Many students (57.5%) never attended any online classes or lectures before the COVID-19 pandemic. Most students (73%) depended on the university online classes [Figure 1] which was mostly through Zoom (86%) as the main source of information in their learning [Figure 2]. Furthermore, most students communicated easily with the instructors during (86%) and after (47%) online classes.{Table 2}{Figure 1}{Figure 2}
Students indicated that the problem-based learning (PBL) and other theoretical sessions were mostly acceptable, and others indicated that they were as good as the classroom or even better. In contrast, their learning experience in practical sessions such as pathology and anatomy laboratory sessions was mostly poor (43.3%).
Overall, students considered their online learning as a positive experience (71.7%) and 60% had enough resting time between classes.
In response to the student's evaluation process during online teaching, 66% were evaluated using an online examination program. Only 0.3% of students reported that they were not assessed during the online teaching period.
While 65% stated that the evaluation tools reflected their understanding of the scientific material, 64% reported that their grades did not represent their actual performance.
Overall, 61.7% of the students rated their online evaluation experience as positive experience as well. Finally, the majority of students preferred the online teaching and evaluation during the pandemic, 72.5% and 54%, respectively.
The other part of this study compares the student's online teaching experience with the instructors' experience. [Table 2] summarizes the comparison between students' and instructors' responses to the online education process during the COVID-19 pandemic.
In response to online teaching, we found that instructors' responses agree with the student's responses in many points. For example, 68% of faculty members did not give online lectures before the pandemic, which was also through the Zoom program (83%) [Figure 3]. In addition, 95% reported that communication was easily achieved during and after the teaching session. Faculty member's response to PBL and theoretical teaching sessions was similar to student response. Fifty-six percent reported that their experience was as good as the classroom or even better than the physical classroom (23%), but it was poor in practical sessions (47%), which is similar to that of the students.{Figure 3}
Overall, the online teaching experience was rated very well (65%) by the instructors.
In response to the online evaluation, online assignments (51%) and examination (49%) were the most used means of assessment, but 59% stated that the student's grades did not reflect the actual performance of the students. Overall, most instructors preferred having online teaching (82%) and evaluation (63%) during the pandemic rather than not having an education at all.
Discussion
Despite the rapid closure of universities, undergraduate medical teaching and evaluation were not suspended due to the available online platforms such as Zoom and Blackboard. The learning process was not disrupted and was smoothly transferred to online structured education because most universities encouraged faculty members and students to use the available learning software Blackboard as part of the learning and communication means with students before the pandemic. Although these online platforms were previously available, the pandemic enforced their use, which made virtual classes possible during this pandemic. This study aimed to identify the impact of the COVID-19 pandemic on undergraduate medical students' and faculty members' teaching and evaluation. Medical schools in other countries reported that learning transition of theoretical and small group lectures such as PBL, especially in preclinical years, were fruitful as reported in this study.[11]
However, practical sessions were poorly delivered, as stated by both instructors and students in the present study. Practical sessions such as anatomy and pathology practical sessions are believed to be challenging during online teaching for both instructors and students because the hands-on experience is essential in the learning process.[12] Solutions such as three-dimensional modules and special software are recommended.[13] Developing software for practical sessions in undergraduate medical teaching should be implemented in the undergraduate medical curriculum.[14] These programs would be a good alternative for on-demand practical learning, even off-campus. These programs should be available for students and introduced to instructors and would have been a good alternative during this pandemic.
In the present study, clinical teaching was not evaluated. According to the ministry of education recommendation, all clinical teaching was suspended and compensated for all students in the next academic year or on their internship training. Universities also adopted these recommendations in the USA.[15] However, the University of Pennsylvania implemented a new online clinical teaching for head and neck surgery rotation by interactive live-streamed surgeries, outpatient telehealth visits and virtual small group teaching, which was a fruitful experience.[16] Other universities recommended teaching for surgical rotations mainly by simulation.[17],[18] Innovative solutions are encouraged at this time to ensure continuing clinical and surgical training.[19],[20]
In this study, both groups stated that the online teaching and evaluation during the pandemic were necessary and applying them was satisfying. However, the online assessment was a challenge because it required rapid restructuring of the examination means, which was a massive undertaken given the sensitivity of this matter. Some of these examination solutions raised serious issues as it depended heavily on the students' integrity and their home settings, such as network connectivity and an appropriate home environment for conducting an online exam.[21],[22] Our results agree with similar recent studies reported an overall positive impact of shifting to online teaching in the medical colleges of Saudi Arabia during the COVID-19 pandemic.[23],[24],[25] Previous studies showed limitation on the currently available online teaching tools such as Blackboard because these programs' learning features were not utilized properly due to the lack of formal training for both students and instructors.[26] This might be one reason Blackboard was not the first choice in online education in our study. In this study, the first program of choice for both students and instructors was the Zoom program, which agrees with a recent study conducted in Saudi Arabia.[27] This might be because of its many features, such as screen sharing, easy recording, and direct verbal and nonverbal communication between students and instructors, available in different Zoom rooms.
It is essential to learn from our recent experience in COVID-19 pandemic and previous experience from such medical emergencies such as the severe acute respiratory syndrome (SARS) epidemic and the challenges of continuing medical education to improve our online medical education in the future. For example, in the SARS epidemic, a study provided a decision tree for deciding upon teaching methods in pandemics and solutions for possible challenges such as minimizing clinical training on real patients to role-play, simulation or virtual teaching.[28] A similar system is required in Saudi Arabia for future medical emergencies.
Re-opening the university campus in this academic year 2020/2021 was challenging, with the currently available teaching techniques. Some studies recommended the importance of physically going back to school because young adults and children have a low rate of getting COVID-19 and low side effects in case of infection.[29] Furthermore, another recommendation is to have all students tested every few days to prevent an outbreak with following preventive interventions to reduce the severity of transmission of infection.[30] In Saudi Arabia, recommendations were given to continue distance learning for theoretical and practical sessions that can be delivered virtually. Face to face is recommended for practical sessions, such as anatomy and pathology courses, by dividing students into subgroups of no more than 10 students per session with a 1.5-m distance between students. Extraprecautions were recommended while attending face to face clinical sessions, such as wearing special face masks and using clinical simulation instead of real-life patients. Other countries, such as Taiwan, recommended an additional two main re-opening strategies, which are containments (contact tracing and quarantine) and mitigation (social distancing and hygiene).[31]
There are several limitations to this study. The clinical rotation teaching experience was not covered because clinical teaching was postponed in Saudi Arabia when the study was conducted. This study was also conducted in the early period of online transition, where online medical education was a new teaching approach for both students and medical instructors. Despite these limitations, this study provides insights into our current online medical education's status, which might lead to the implementation of high-quality virtual medical education in the medical curriculum in future.
Conclusion
In conclusion, there was a significant impact on undergraduate medical education on medical students' and faculty members' during the COVID-19 pandemic. Despite the sudden transition to online platforms, most students and faculty accepted this change. This shift made us more aware of the importance of restructuring undergraduate medical learning and implementing new distance learning strategies such as simulation and a three-dimensional module for clinical and practical sessions that require hands-on learning.
Recommendations
Although crises cannot be predicted, it is essential to prepare for such a transition by adjusting the medical curriculum to support virtual education to allow the educational process to continue. Furthermore, the medical curriculum should be adjusted to include technology that allows students and instructors to access medical resources anywhere at any time.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
| 1 | Ferrel MN, Ryan JJ. The impact of COVID-19 on medical education. Cureus 2020;12:e7492. |
| 2 | Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic transmission of SARS-CoV-2 – Singapore, January 23-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69:411-5. |
| 3 | Ali I, Alharbi OM. COVID-19: Disease, management, treatment, and social impact. Sci Total Environ 2020;728:1-6. |
| 4 | WHO. Infection Prevention and Control during Health Care When Novel Coronavirus ( nCoV( Infection is Suspected: Interim Guidance; 2020. Available from: https://www.who.int/publications/i/item/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125. [Last accessed on 2020 Sep 30]. |
| 5 | Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 2021;384:403-16. |
| 6 | Yezli S, Khan A. COVID-19 social distancing in the Kingdom of Saudi Arabia: Bold measures in the face of political, economic, social and religious challenges. Travel Med Infect Dis 2020;37:1-4. |
| 7 | Chen BY, Kern DE, Kearns RM, Thomas PA, Hughes MT, Tackett S. From modules to MOOCs: Application of the six-step approach to online curriculum development for medical education. Acad Med 2019;94:678-85. |
| 8 | Liang ZC, Ooi SB, Wang W. Pandemics and their impact on medical training: Lessons from Singapore. Acad Med 2020;95:1359-61. |
| 9 | Theoret C, Ming X. Our education, our concerns: The impact on medical student education of COVID-19. Med Educ 2020;54:591-2. |
| 10 | Abdulghani HM, Sattar K, Ahmad T, Akram A. Association of COVID-19 pandemic with undergraduate medical students' perceived stress and coping. Psychol Res Behav Manag 2020;13:871-81. |
| 11 | Schuiteman S, Ibrahim NI, Hammoud A, Kruger L, Mangrulkar RS, Daniel M. The Role of Medical Student Government in Responding to COVID-19. Acad Med 2021;96:62-7. |
| 12 | Pather N, Blyth P, Chapman JA, Dayal MR, Flack N, Fogg QA, et al. Forced disruption of anatomy education in Australia and New Zealand: An acute response to the COVID-19 pandemic. Anat Sci Educ 2020;13:284-300. |
| 13 | Pacheco LF, Noll M, Mendonça CR. Challenges in teaching human anatomy to students with intellectual disabilities during the COVID-19 pandemic. Anat Sci Educ 2020;13:556-7. |
| 14 | Sandhu P, de Wolf M. The impact of COVID-19 on the undergraduate medical curriculum. Med Educ Online 2020;25:1-2. |
| 15 | Goldenberg MN, Hersh DC, Wilkins KM, Schwartz ML. Suspending medical student clerkships due to COVID-19. Med Sci Educ 2020;30:1273-6. |
| 16 | Chao TN, Frost AS, Brody RM, Byrnes YM, Cannady SB, Luu NN, et al. Creation of an Interactive Virtual Surgical Rotation for Undergraduate Medical Education During the COVID-19 Pandemic. J Surg Educ. 2021;78:346-50. |
| 17 | Okland TS, Pepper JP, Valdez TA. How do we teach surgical residents in the COVID-19 era? J Surg Educ 2020;77:1005-7. |
| 18 | Newman NA, Lattouf OM. Coalition for medical education – A call to action: A proposition to adapt clinical medical education to meet the needs of students and other healthcare learners during COVID-19. J Card Surg 2020;35:1174-5. |
| 19 | Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 Era: A systematic review. In Vivo 2020;34:1603-11. |
| 20 | Chick RC, Clifton GT, Peace KM, Propper BW, Hale DF, Alseidi AA, et al. Using technology to maintain the education of residents during the COVID-19 pandemic. J Surg Educ 2020;77:729-32. |
| 21 | Choi B, Jegatheeswaran L, Minocha A, Alhilani M, Nakhoul M, Mutengesa E. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: A national survey. BMC Med Educ 2020;20:206. |
| 22 | O'Byrne L, Gavin B, McNicholas F. Medical students and COVID-19: The need for pandemic preparedness. J Med Ethics 2020;46:623-6. |
| 23 | Rajab MH, Gazal AM, Alkattan K. Challenges to online medical education during the COVID-19 pandemic. Cureus 2020;12:e8966. |
| 24 | Khalil R, Mansour AE, Fadda WA, Almisnid K, Aldamegh M, Al-Nafeesah A, et al. The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: A qualitative study exploring medical students' perspectives. BMC Med Educ 2020;20:285. |
| 25 | Alanazi A, Alshaalan Z. Views of faculty members on the use of e-learning in Saudi medical and health colleges during COVID-19 pandemic. J Nat Sci Med 2020;3:308-17. |
| 26 | Al-Drees A, Khalil MS, Meo SA, Abdulghani HM. Utilization of blackboard among undergraduate medical students: Where we are from the reality? J Taibah Univ Med Sci 2015;10:16-20. |
| 27 | Hilburg R, Patel N, Ambruso S, Biewald MA, Farouk SS. Medical education during the coronavirus disease-2019 pandemic: Learning from a distance. Adv Chronic Kidney Dis 2020;27:412-7. |
| 28 | Lim EC, Oh VM, Koh DR, Seet RC. The challenges of “continuing medical education” in a pandemic era. Ann Acad Med Singap 2009;38:724-6. |
| 29 | Munro AP, Faust SN. Children are not COVID-19 super spreaders: Time to go back to school. Arch Dis Child 2020;105:618-9. |
| 30 | Paltiel AD, Zheng A, Walensky RP. Assessment of SARS-CoV-2 Screening Strategies to Permit the Safe Reopening of College Campuses in the United States. JAMA Netw Open 2020;3:e2016818. |
| 31 | Cheng SY, Wang CJ, Shen AC, Chang SC. How to safely reopen colleges and universities during COVID-19: Experiences from Taiwan. Ann Intern Med 2020;173:638-41. |
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