Journal of Medical Sciences and Health

Introduction

First case of coronavirus disease 2019 (COVID-19) was reported on December 31, 2019, from Wuhan Province of China. The WHO declared novel coronavirus outbreak as a public health emergency of international concern.[1] In India, first confirmed case of COVID-19 was reported from Kerala on January 30, 2020, and in March 2020, cases were also reported from Maharashtra, Delhi, Punjab, and Rajasthan, so Government of India declared nationwide lockdown from March 23, 2020, to May 31, 2020.[2,3] In view of social distancing, school and colleges were shut down and also many of the schools and hostels of the colleges and universities were converted into the temporary quarantine centers for COVID-19 by the government. As a result, many competitive examinations were also cancelled or delayed. To manage this crisis, many educational institutes started online teaching and evaluation of the students. Online teaching is a somewhat new concept in Indian context to both teachers and students.
As per study by Ms. Shenoy et al., tools used by faculty during lockdown for teaching and learning through online modes were Zoom, Google Hangouts, Skype meet up, Google classroom, earning learning management system (LMS), information communication tools, YouTube, etc.[4] However, the problems faced by students and other effects of lockdown were not studied. We, therefore, planned this study to find out the effect of lockdown on teaching process and various problems faced by the students while coping with e-learning process.

Materials and Methods

Institutional Ethical approval was obtained (Ref. SKNMC/Ethics/App/2020/656) dated May 30, 2020. A cross-sectional study was conducted among the students seeking higher education all over the India, sampling method used was snow ball sampling, duration is May 2020–August 2020, and data were collected using Google Forms. Predesigned structured questionnaire was prepared using Google Forms. Content validity of the questionnaire was tested by the four experts from the department and pilot tested among the students to test accuracy of responses and time required for filling the questionnaire. This questionnaire was translated in three languages, English, Marathi, and Hindi. The questionnaire in Marathi and Hindi was back translated into English by the other expert faculties and tested for uniformity with the original English version questionnaire. Suggested changes were done and then following Google link of this questionnaire was circulated through various social media platforms such as Email, Facebook, and WhatsApp group.[5] Confidentiality was maintained as the questionnaire did not ask for name, address, and mobile number of the participants. The first part of questionnaire was consent and the second part had questions related to online teaching-learning process. Data were collected through Google Forms and exported in the Excel sheet. Data analysis was done using Epi Info Version 7.2. 2.6. Chi-square test was applied to test the association between independent and dependent variable and P < 0.05 was considered as statistically significant.

Results

A total of 581 students participated in the study from 18 different states all over the India. Details are shown in Figure 1. Out of these, 301 (52%) were male and 280 (48%) were female. Most of them 536 (92%) were of the age group 18–25 years. Most of the students were seeking graduation 80%. Stream wise majority of the students were from medical and allied stream (66.26%) followed by engineering (26 %). Details are shown in Table 1.
When asked regarding the completion of syllabus for current academic year, 405 (70%) of the students said that the syllabus of the current academic year was not completed by the college and Zoom app was most common tool used for online teaching. However, some colleges used more than 1 tool for teaching (34.42%). Experience of students about online teaching is shown in Figure 2. Advantages and disadvantages of online teaching stated by students are shown in Table 2. Difficulties faced by the students while online teaching-learning is shown in Table 3. Effects of lockdown on teachinglearning are shown in Table 4. When asked regarding government’s decision about conducting examination of various courses, only for final year 46% of students agreed with the government decision.

Discussion

Out of total 581 students, 301 (52%) were male and 280 (48%) were female and 92% of them belong to the age group of 18–25 years. Students were participated from 18 different states of India, most of the students 336 (57.83%) were from Maharashtra as the investigator is from Maharashtra. Majority of the students were from medical and allied branches (66.36%) followed by engineering 26%, because these students are more compatible with new technology and as these students have tendency to react promptly than other students so their participation was good.
In this study, it is noted that most common online tool used by the colleges to complete the syllabus was Zoom app (53%), followed by Email (21.17%), Google Hangout (13.08%), YouTube (12.22%), LMS (3.95%), Microsoft Teams (3.95%), and others (8.77%) (Skype, WhatsApp, Webex, Google classroom, and Google Forms). These findings were correlated with other similar studies.[4,6,7] In spite of the security issues associated with Zoom app, it was the commonly used application because it is user friendly and free software.[8,9]
In the present study, most of the students 289 (50%) said that they read the books during lockdown, followed by participation in online courses 276 (47.50%), webinars 104 (18%), and e-library 75 (12.9%) and other 26 (4.4%) which include hobby classes and exercise. As the students did not want to waste time, they read the books available with them as well as from e-library and also attended the webinars and online courses to increase their skills. Female participants (Chi-square = 6.4460, df = 1, P = 0.011) and engineering students (Chi-square = 10.8116, df = 2, P = 0.0045) did significantly more online courses during lockdown. There was no statistical significance observed as per gender, age group, or stream in other methods of utilizing time.
In the present study, it was observed that 251 (43.9%) students rated online teaching-learning experience as satisfactory followed by good 110 (19%) students, it means that students are comfortable with the online teaching. Similar observations were found in other study.[6] However, nearly 23% reported as poor and bad.
In the present study, advantages of online learning reported by students were, lectures can be attended from anywhere (66.26%), lectures available at any time (49.22%), no need to travel (48.19%), saves time (25.99%), easy to understand the concept (23.92%), saves money (16.86%), and less distractions (11.70%); while disadvantages reported were less clearance of the concept (50.77%), no interaction with the teacher (45.77%), needs Wifi connectivity (46.47%), attention span is less (34.08%), lectures removed after specified time (31.67%), less time given to students (30.12%), and needs laptop (26.50%). These findings are correlated with the other similar studies.[7,10-13]
In the present study, females reported advantages of online teaching as it can be attended from anywhere (χ2 = 6.4350, df = 1, P = 0.011) and no need to travel (χ2 = 5.4490, df = 1, P = 0.019) and found statistically significant. Students from the age group of >30 years also reported no need to travel as advantage of online teaching and found statistically significant. (χ2 = 6.7076, df = 2, P = 0.035). Students of engineering stream reported advantages of online teaching as lectures are available at any time and found statistically significant (χ2 = 10.8116, df = 2, P = 0.0045). However, students from the age group of 18 to 25 years reported that it does not saves time and found statistically significant (χ2 = 9.214, df = 2, P = 0.01).
In the present study, females did not agree that less time is given for discussion in online teaching and found statistically significant (χ2 = 4.2098, df = 1, P = 0.0401). Engineering stream students reported that online teaching needs wifi and found statistically significant (χ2 = 9.5194, df = 2, P = 0.0086). Medicine and allied stream students reported that attention span is less in online teaching and found statistically significant (χ2 = 27.0155, df = 2, P = 0.000). Hence, students were having satisfactory experience of online teaching but it should be made more interactive and good network should be available.
In this study, the most common difficulties faced by the students while online learning was “lack of learning environment” (49%), “audio not clear” (43%), and “No internet facility” (30%). “Lack of internet facility” and “Poor connectivity” were significantly associated with engineering stream students. For medical students, “lack of Environment at home” was found significant (χ2 = 17.8762, df = 2, P = 0.0001) while for other streams and female students, “audio not clear” (χ2 = 15.57, df = 1, P < 0.001) was found significant. As most of the students were accessing lectures using the smartphone and from remote area where internet issues were present and as most of the families are joint families where overcrowding is present, students were not getting the good environment for attending the classes, similar challenge was noted by Raju.[14] Hence, it is necessary to establish the high-quality internet coverage in the country at the affordable cost including rural and remote areas. Furthermore, need to distribute the educational devices enabled for online learning to the students on the priority basis. In this study, 440 (75.73%) students were agreed that hands-on training of the curriculum was suffered because of lockdown as shown in Table 5. Overall, it is more for medical graduates but the difference was not found statistically significant. It is because as the students left the hostels, colleges, and went back to their hometown even though the lectures are being taken online, practical could not be carried out during lockdown, and for medical graduate, it was not feasible to carry out patient based clinics/practical’s.
These findings are correlated with the similar other study.[15,16] Hence, we require to include online practical training in the form of online demonstration of physical examination and procedures, use of objective structured clinical examination videos, and web-based video conference system for teaching surgical skills. It is already used in many developed countries such as Japan and America and proven helpful.[17-19] However, it should be supplemented with bedside clinical teaching through live video classes. It was noted that for 258 (44.41%) participants, examination was cancelled because of lockdown as per Table 5, this is comparable to the other studies.[20,21] Initially, because of lockdown, all the colleges were closed down till July 31, 2020.[22] After July 2020 as the pandemic was on its peak in India; parents, students, and many universities were protesting to conduct the physical examinations. In India as per UGC out of the 755 universities, 194 have already conducted examination (online/offline); and 366 are planning to conduct examination (online/ offline/blended mode) in August/September.[23] To complete the examinations, university may adopt the alternative and simplified modes of examinations of short duration which includes MCQ-based assessments, open academic book examinations, and presentation-based assessments.[24]
About 81% of the participants in this study were worried about their future and job placement. This is because of the almost all examinations were cancelled initially by UGC and decided to promote the students, without conducting exams in the current academic year, then supreme court directed to conduct and finish all the examinations till September.[20,23] which has extended the term.[25] Same has been quoted by some studies.[26,27] also there was fear in students mind that they will not be selected for particular jobs as students would be labeled as “COVID Batch.” Sanctity of their degree will remain questionable.[28] In view of COVID pandemic, many competitive examinations were postponed till September 2020 which questioned the job placement in the government setup.[29,30]

Conclusion

Although the overall experience of the online teaching was good for the participants in this study, still many difficulties were faced by them. Hands-on training of the curriculum were affected and examination was cancelled, so students were worried about the job placements in future.

Acknowledgment

A sincere thanks to all of the students who participated in the study.

Recommendations

This study recommends that as the COVID-19 pandemic is still going on and we cannot say how long it will continue. Hence, online teaching is the need of hour. There is a definite necessity for online practical sessions across all streams. Appropriate app needs to be identified for the same. For smooth conduction of teaching online, there should be good quality network made available in all the parts of the country which should also be cost effective. Furthermore, government should establish offline modes of teaching like using radio and television channels. Universities and colleges also need to adopt the online assessment method in near future for the students of higher education, so any of the pandemic or emergency situation will not lead to cancellation and postponement of examinations.

Limitations of the Study

As this is an online survey, students who were not having smartphones/laptops or having no access to internet were not included in this study, so these findings are not generalized to all the students of the country.