The offline-to-online shift of medical education during COVID-19 pandemic: A mixed method study of medical teachers and students from India

DOI: https://doi.org/10.21203/rs.3.rs-2771482/v1

Abstract

Introduction:

Most institutes worldwide have experienced a forced shift to online mode education during COVID 19 pandemic. As in Indian Medical Institutions e-learning is not a well-established mode of teaching, it disrupts the newly implemented competency based medical education (CBME). This sudden shift in educational methods introduced new experiences, opportunities, and difficulties among medical teachers and students. In this study we explore undergraduate medical students and teachers’ perception, detailed insights and learning experience on online medical education.

Method:

This is an institution based mixed methods study conducted at three medical institutes in India. A self-prepared semi structured questionnaire was applied to extract various prospective of teaching and assessment through online mode. Qualitative descriptive design was applied using focused group discussion. All FGDs were audio-recorded, transcribed verbatim and analyzed using thematic content analysis to identify themes and subthemes regarding perceptions of online and offline education.

Result:

A total of 323 medical students out of 510 and 35 medical teachers out of 71 were included in the study. Most students and teachers agreed to the fact that they faced technical difficulties, perceived less connected, and felt difficulty in achieving desired competencies. In qualitative analysis five major themes (Learning Environment, Technology, Competency, Health issues, Assessment) and multiple subthemes were identified.

Conclusion:

Improvement of the online teaching methods with appropriate technical advancement may help to reduce the gap between the online and offline teaching learning modalities.

Introduction

The Coronavirus disease pandemic has impacted globally in all aspects of our lives, including physical and mental health, the economy, education, and interpersonal relationships. (Sohrabi et al., 2020; Wang et al., 2020) Governments have implemented strict preventive measures such as closing schools, colleges, institutes, and offices, isolating people at home, restricting gatherings, maintaining social distancing, etc. As a result, all institutions have experienced a sudden transition from traditional face-to-face learning to online mode. (Sahu, 2020) On March 2020, UNESCO has estimated over 90% of the world’s students are not currently attending schools in the response to the COVID pandemic with over 1.5 billion learners affected.(COVID-19 Educational Disruption and Response | UNESCO) Although online education is developing rapidly around the world, still its applications are considered a supplement to traditional offline education. However, during the COVID-19 pandemic, the majority of institutions worldwide are solely relying on online/virtual mode education. Medical students and teachers have faced challenges the most, as contact with patients or subjects is an essential part of clinical learning in medical education. (Byrnes et al., n.d.)

In India, the newly implemented competency-based medical education (CBME) has focused on skill development and aims to deliver competent Indian medical graduates who are globally competitive and can meet society’s increasing health needs.(Nimavat et al., 2021) The COVID-19 pandemic has disrupted the whole process, as e-learning is not a well-established mode of teaching in Indian Medical Institutions. Previous studies have shown the popularity of online education is deemed to be increasing as more flexible learning, with no geographical restrictions, less time-consuming, and allows students to learn in their own space and comfort. (House et al., 2007) Online learning provides the opportunity to work with newer emerging technologies, producing a deeper level of thinking and understanding of course materials. (Bączek et al., 2021; Esani, 2010; Mukhtar et al., 2020)

Although there are pieces of evidence that suggest the students are missing a competitive learning environment, interpersonal communications, and peer interactions in online courses. (Geyer, 2007) The situation of forced conversion to online learning during the COVID pandemic had created the need for further research into the student and teacher experience to ensure the quality of education. The aim of this research is to explore students’ and teachers’ perceptions, detailed insights, and learning experiences on online medical education. Thus, this study was conducted to identify various aspects of online medical education among medical undergraduates and teachers in three medical schools in India.

Methods

Study Design: This is an institution-based mixed methods study conducted between October 2021 - May 2022. Both quantitative and qualitative data were collected to get a better perspective of the shift in teaching methods.

Participating Institutes:

The participating institutes where the quantitative part of the study has been conducted are AIIMS Gorakhpur, AIIMS Kalyani, and AIIMS Bathinda, and the qualitative part is conducted only in AIIMS, Gorakhpur. Ethical approval was granted by the Institute Human ethical committee of all individual Institutes.

Study Participants: All MBBS students enrolled in the academic years of 2019 and 2020 and teachers who had been involved in online teaching-learning sessions have been approached for enrollment in the study.

Inclusion criteria:

  1. Undergraduate students (MBBS) enrolled at participating institutes attending online academic activity via similar platforms.

  2. Teachers of MBBS subjects conducting online academic activity at above-mentioned institutions.

Exclusion criteria:

  1. Students and teachers who did not give consent to participate in the study

  2. Those who have a chronic physical and mental illness or internet addiction were excluded from the study.

Quantitative study

Tool: A self-prepared semi-structured questionnaire in English was used for the study. The questionnaires were separate for students and teachers. Students were asked about various perspectives of teaching and assessment through online mode and asked to score the same on the Likert scale of four. Zero is the lowest score and four is the highest score.

Qualitative Study:

A focused group discussion was conducted among the selected participants. Three sets of FGD were conducted with medical students (9 students each) and another FGD was conducted with medical teachers (8 medical teachers).

Data Collection:

Quantitative Study:

The questionnaires were circulated among the selected participants and they were requested to fill out the questionnaire. The questionnaires were sent to the personal mail of the students to ensure that it was not circulated in the open group.

Qualitative study:

We planned to conduct FGDs till the saturation point was achieved. For FGD, a total of 18 medical students and eight medical teachers are recruited into the study. Two FGD sessions with students (in a group of 9 participants each) and one FGD session with teachers (in a group of 8 medical teachers) were conducted in three different settings. The duration of FGDs was 45–50 minutes. All FGDs were conducted in the Hindi and English language with one investigator as moderator and another two investigators taking manual notes. The whole session was audio-recorded. The focused group discussion guide was designed by the team of investigators based on related context. The interviews were conducted in a comfortable environment to ensure open discussion and encouraged to share their own experience regarding online academic sessions. Data collection was stopped after reaching the data saturation point. The final transcripts data were read, re-read, and discussed between two investigators who are conversant in both languages (Hindi and English). Confidentiality was ensured as the participants’ identifiers were removed from the transcripts. The investigator team cross-checked each transcript using audio recordings and manual notes. All the transcripts were translated into English language.

Data Analysis:

Quantitative Data:

Data was compiled in a Google spreadsheet and transferred to a Microsoft excel sheet. The data was cleaned and analysis was done using Jamovi-2.3. (The Jamovi Project (2022). Jamovi. (Version 2.3)) The data was represented as numbers and proportions, mean (+/- Standard Deviation), and Median (with Inter-Quartile Range). The differences in the results in multiple groups were analyzed by Chi-square test.

Qualitative Data:

Data were analyzed by an inductive thematic approach. (Braun & Clarke, 2006) In the first step, the investigators generated initial codes by listing all ideas, keywords, and opinions used by the participants as indicators of important themes until a consensus was reached. In the second step, focused coding was done by eliminating, combining, or subdividing the initial codes, followed by a critical analysis was done to generate themes and sub-themes. Some relevant quotes have been used in the article with minor editing to increase clarity for the readers.

Results

Quantitative Component:

A total of 323 medical students out of 510 and 35 medical teachers out of 71 have responded voluntarily. Informed consent (through online google-forms) has been collected from all participants. [Figure-1]

A total of 323 students (Mean age: 20 years, SD:1.66; Male: Female = 1.78/1) were approached for inclusion in the study from this a total of 313 students provided consent for inclusion in the study. Finally, a total of 280 students were included in the study. Rest was excluded due to self-declaration of the presence of chronic diseases or addiction to the internet. From the 280 students include in the study, the mean age of the participants was 20 years with a median of 20 years and the age ranging from 17 years to 32 years. 36% of the participants were females and the rest were male.

The majority of students agreed to the fact that they faced technical difficulties during online classes. However, there was a significant difference in the issues between the male and female students. More than half of the students agreed that their doubts were not resolved satisfactorily during online teaching. However, there was a significant difference in response between male and female students. The majority of the students disagreed with the fact that their quest for knowledge increased after online teaching. When asked about the impact of online learning on self-confidence on the subject, most of the students responded that they have less confidence in the topics covered in the online classes. As per their response, the majority of students were not able to understand the topics in the online class and not able to learn practical skills. The majority were not able to connect effectively to their peers and teachers in the online classes. However, students disagreed with the statement that “online learning is more stressful than offline learning”. The detailed description of the questions asked and responses obtained were described in Table-1. When students were asked to rate the online learning and assessment on a scale of one to five, the mean score given was 2.3 (+/- 1.28) for learning and 2.28 (+/- 1.34) for online assessment. [Figure-2]

A total of 35 teachers were approached for the study, and from this 30 agreed to participate in the study. Among them 10 were female and the rest were male. The mean age of the participant teachers was 38.4 with a SD of 3.9.

When teachers were asked about the efforts required majority agreed that more planning and less timing are required for preparation. According to the response of the majority of teachers Online teaching methods are monotonous, hardly deliver skill competency and it is difficult to get student feedback during online classes. Majority of the teachers not agreed with the statement that the skill assessment is possible online. Most of the teachers agreed with the sentence that training is required to develop technical expertise in conducting online teaching. The detailed description of the questions asked and responses obtained were described in Table-2. When teachers were asked to rate the online teaching and assessment on a scale of one to five, the mean score given to the teaching was 2.10 (+/- 1.21), and for assessment was 2.03 (+/- 1.27) out of five. [Figure-3]

Qualitative Component:

After going through the individual transcripts verbatim several times, five broad themes were identified. The derived themes are Learning environment, Technology, Competency, Health issues, and Assessment. These have been presented in Figure-4 and explained below.

Theme-1: Learning environment:

The learning environment was one of the key areas that the majority of the students and teachers focused on during the discussion. Based on the information received, the following subthemes were identified:

Subtheme-1: Physical presence

Students described lack of communication (both verbal and nonverbal) with teachers as a major drawback of online academic sessions which leads to a lack of understanding of learning modules, diminished interest in academic sessions, and an increased number of absentees.

One student responded “Due to lack of eye-to-eye contact, it is impossible to understand anything” [Male student, 18 years]

“We are learning from the teacher in the offline class, seeing (his/her) expressions, and interests, we can guess the favorable time to ask doubts. But we feel hesitant in interrupting teachers in between ongoing online lectures, we can’t see expressions, the mood of teachers.” [Male student, 20 years] This comment emphasized the nonverbal communication between the teacher and students which helps students to learn better.

Some students emphasized that the act of teaching in physical class or teachers’ individual teaching style engages them better, which facilitates learning. For example, one participant commented:

“A teacher in a physical class, just draws a simple diagram on board, we can grasp more (than online teaching)” [Male student, 19 years]

Two students have shared opposite views in asking doubts in online sessions. One feels hesitant in asking doubts as teachers’ expressions are not visible, other one feels easy as it’s a matter of switching the mike on.

“Teachers are available after the class (offline), so we can clarify our doubts personally. Now we have to ask doubts by email which will be discussed in the next class only.” [Female student, 19 years]

“All are there in the class (offline) and I have to stand and ask doubts, but online I can ask a question by just switching my mike on.” [Male student, 18 years]

This feeling of missing the physical presence of the teacher is echoed by the teachers also who also think that the presence of students makes the class more interesting for them to teach. One teacher said, “I don’t get interested in teaching (online), it seems like speaking to a wall” [Female Teacher, 38 years].

They also felt that feedback through verbal and nonverbal communication makes the offline class more lively than the online class. “Non-verbal expressions, body language is not communicated (in online sessions), teaching is not like news... we are acting like news-anchors,” one teacher said [Male Teacher, 42 years].

Another teacher added “Most of the time we don't know actually the students are listening or not, he may be switching it on and sleeping also.... we don’t get any feedback... we are just talking to the screen, forwarding slides...” [Male teacher, 36 years].

One teacher compared the online and offline classes and said “Teaching at lecture theater has its own aura. Everyone is present, and remains attentive at 9 am for a good lecture. Online sessions never have that effect.” [Male teacher, 42 years]

One student identified the positive aspect of Online teaching i.e. multitasking during the class which is not possible in offline teaching. “I feel the classroom environment is monotonous… online sessions can be attended with home comfort…along with food and others.” [Female student, 20 years]

Subtheme-2: Distractors:

Participants were asked about their experience of learning at home in online media. Some students have reported a lack of ‘attention’ in the home environment creates difficulty in understanding critical concepts. They get more distracted by the presence of other family members. For example:

“It’s difficult to hold attention in online lectures. I can't hold attention throughout the lecture, feel distracted, sleepy as no learning environment has been generated” [Male student, 18 years]

‘I can grasp easily classroom teaching, sitting in a particular posture. Home comfort makes it difficult to understand the concept” [Female student, 21 years].

Getting a separate study area at home is another issue mentioned by a student. According to one student, “There are other family members at home doing household work (home distractions). I am not alone at home. I have asked all to keep quiet when switching my mike on.” [Male student, 19 years]

Subtheme-3: Peer interactions and competitive environment:

The majority of participants mentioned that lack of peer interactions is another major issue that brings a lack of motivation and competitiveness in the study. One student commented “In hostels or at the dissection hall, we used to have lots of discussions (peer interaction) and get prepared for the classes but in online (academic session), alone in the home, we miss that part… brings lack of seriousness in studies” [Female student, 19 years]. According to another student, “There was a healthy competition, when we are together, even during the class (offline). When someone is asking doubts, I feel, I also have to study and ask my own doubts” [Male student, 19 years]

One male student has shared his previous experience with online learning. “I have studied online during preparation for NEET (medical entrance examination) and cracked it. I prefer to study in isolation at that time but now I need to be more practically sound than only having theoretical knowledge. Group interaction is more important for me now which is not possible in online sessions” [Female student, 19 years]

Theme-2: Technology:

Technology is one of the important enabling factors in many health and health-related problems. In education, specifically in medical education, its role is recognized in India recently with the pandemic. Students have discussed both positive and negative points on this theme. We have divided it into two sub-themes.

Subtheme 1: Technical factors:

Students have identified some of the important positive points of online classes. Students mostly responded that the daily hassles of attending early morning lectures, and the incidence of skipping breakfast or late entries in classes are minimized with online classes. “A few morning classes are missed as we wake up late in the morning… that is not happening (in online sessions). Even if feeling sick, still can attend the class” a student [Male Student, 20 years] told. Another student [Male Student, 19 years] told “I usually miss 8 am to 9 am class more frequently. Now we can even enter (join online) at 8:30 am” [Male, 19 years]. The burden of taking class notes is less as recorded lecture sessions can be played multiple times for reference. A student told, “Burden of writing all the class notes is less as we can take screenshots”. This statement emphasizes the importance of online classes in reducing the burden of the classical system of teaching. The reach of online classes is wide according to the students. Even in illness or stuck in unavoidable circumstances, they were able to attend class.

“Internet issues are common… During a crucial moment of understanding critical concepts (during online sessions) or at the time of attendance… it becomes a major issue” [Female Student, 21 years].

“Our anatomy dissection classes and clinical postings are affected the most. I can't understand much; online videos are blurry. Spatially head & neck dissections are affected. Practical as a whole is not effective in (online mode teaching).” [Female Student, 21 years]

Teachers also have a similar view to that of the students. The use of technology during the class by the students was poor. Very few used this to connect with the teachers during the class. One teacher said: “The options for chat is not effective (for communication in online sessions). Hardly one or two students have ever communicated.” [Male teacher, 39 years]

Few teachers emphasized the fact that there is a serious lacking of training courses on the use of technology for teachers and students to make the classes more interactive. According to a Male teacher (36 Years), “Training for faculty, as well as students, is lacking (regarding online platform) to deal with technical issues. “

Subtheme 2: Financial factor:

Few students and teachers have emphasized the financial issues associated with technology use such as the cost of daily data or devices used. One student described “often, we are running out of data, sometimes video streaming is there in class… I sometimes prefer to stay at the hostel as its (internet) free” [Male student, 20 years]

Theme-3: Health issues:

Few students talked about their health issues associated with regular online sessions. Online sessions increase screen time significantly and also promote a sedentary lifestyle and other health effects. Few students talked about insomnia-like effects, eye-straining, excess watering of the eye, and headache. A student told “Online sessions leads to sedentary lifestyle. What happened with me is that I can’t sleep well at night but during offline sessions, I usually get tired attending lectures, and practical sessions and getting good sleep. Some kind of insomnia I faced at home” [Male student, 18 years]

Another comment by a female student “My screen time had increased much, I had some headache and watering in eyes as well” [Female student, 21 years]

Theme-4: Competency:

Another crucial point highlighted by the students is their concern about the lack of skill development in practical sessions and lack of confidence in the modules taught online. There are two important subthemes arose within the theme.

Subtheme 1: Skill:

All students discussed the difficulty of learning practical skills in an online learning format. According to one student, “I didn't get motivated in online practical sessions as we don't have to perform that. It feels like theory only” [Male, 18 years] Another student added “I have not visited medicine and OBGY (obstetrics and Gynecology) clinical posting for a single day (offline). Nervous system examination sessions of Physiology subject are conducted online” [Male, 20 years]. Like the students, teachers are also skeptical about the skill and knowledge development of students. One teacher said: “It's my duty to take classes, I am paid for that...I will put more effort so that the final output is good, but in online classes, I knew (have experience) the output will not be good, even if I put my full efforts.” This shows less confidence in teachers as a whole in online classes.

Subtheme 2: Knowledge:

The poor confidence in knowledge among the students got reflected in the following sentence “I don't have much confidence in the modules covered online compared to offline. I feel a lack of confidence… as we have an offline assessment on the topics taught online during the first year… I feel a serious difficulty…” [Female student, 21 years] This shows the lack of confidence in the student in the topics covered in online sessions.

Theme-5: Assessment

Students have mentioned some other advantages of online sessions, such as getting easy attendance and engaging in other important tasks in parallel with attending lectures. Few students have raised issues related to online assessments and parents' concerns about online sessions. All students expressed positive views regarding offline examinations/assessments. They feel motivated to perform and feel satisfied with their grades. They are not feeling confident enough in online assessments. The ‘seriousness’ of the examination is somewhere lacking. “Our online examination has only MCQ type of questions but offline has multiple types of written questions as well. We can score more in MCQs. We are happy with the scores but do not feel satisfied at the end of the examination. The environment of examination is absent in online assessments” [Male student, 21 years]

Teachers have pointed out another factor regarding the validity of the online assessment. “I fill like, online assessment, I have done it lots of time, they (students) can easily cheat.... we don't have any control, over whether they had open books or not. They can speak and even can communicate through online media (during examination)”

Discussion

This is an institution-based mixed methods study conducted in three medical teaching institutes in India. The study compared various dimensions of online and offline teaching among medical undergraduates, both teachers and students of the selected medical schools.

In this study majority of the students agreed that classroom teaching is better than online teaching. Similar findings were also reported by most of the studies. (Creative Methods of Assessment in Online Learning, 2016; Dost et al., 2020; Elshami et al., 2021; Nepal et al., 2020; Schlenz et al., 2020; Song et al., 2021) However, in the study by Hatter et al. in Jordan majority of the participants preferred online teaching. (Hattar et al., 2021) This may be because of the technical expertise of the students in the online platforms. In the current study, we also found that teachers also believed in a similar way. The majority of students complained that they were not able to connect to the teacher (61.1%) and they are not able to understand the concepts (78.6%). Similar results were also reported by other authors. (Dahiya et al., 2021)The reason for the same can be explained by the results obtained in the qualitative part of the study. The most notable finding was the differences in the learning environment (theme 1) between the offline and online methods. The majority of participants emphasized that teachers' physical presence, peer interactions, and competitive environment in the classroom are the biggest advantages of offline learning. Students attending online sessions at home have pointed out several household distractions and home comfort as major disadvantages of online sessions. Without peer interactions, healthy group discussions, and online sessions become monotonous which led to a lack of motivation to study. Lack of face-to-face interaction also affected the quality of teaching. Teachers mentioned that they feel as if they are talking to a digital screen without having any clue of the status of students’ understanding. Studies in the past have also demonstrated that the most challenging part of online education is to create an environment of ‘social presence’, so that the teachers and students fill as part of the teaching-learning community. (Aragon, 2003) The term ‘social presence’ is defined as the degree to which a person is perceived as a "real person" in any mediated communication.(Short et al., 1976) They describe social presence as a quality of the teaching-learning medium itself which may vary in their degree of social presence. The sense of social presence enhances teacher-student interactions and promotes higher satisfaction with learning. It supports cognitive and affective learning objectives by making group interactions appealing, engaging, and rewarding. (Mykota & Duncan, 2007) This connection and feeling are reported to be lacking in the most online mode of education. Students or teachers may feel isolated, and distracted which in turn decreases effective learning.(O’Doherty et al., 2018) These findings are also evident from this study. Rodgers et al. described the presence of teachers in the classroom is defined by the three most useful dimensions namely observation, analysis, and reflexive change in the way the teaching is progressing.(Rodgers, 2002, 2006) This is what a teacher adds to the whole process of teaching apart from what is written in the books. If we look at this aspect, it is the teacher’s involvement with the student that makes the whole process addictive for both student and teacher which they miss during online teaching.

While discussing with the students regarding the disadvantages of online learning, they highlighted the issues related to distraction. Similar reports were also provided by the students during the quantitative interviews. Students also reported they are more distracted in online than offline classes. Similar results of lack of attentiveness of students were also reported by other authors. (Abbasi et al., 2020; Bączek et al., 2021) More than 60% of students in the current study reported that online learning is more stressful than offline similar to that reported by Ansari et al. in Egypt. (Aziz Ansari et al., 2021)

Technology (theme 2) is another important theme we have analyzed from the focused group discussion. The technical aspects of online academics have both positive and negative perspective. Participants explained that time flexibility such as saving commuting time, less missed class, easy attendance, and less burden of taking class notes can be regarded as positive points which support online learning. The negative points as explained include technical problems such as several internet issues, interruptions, system errors, and the cost of the internet. Many students expressed frustrations when discussing technical problems which must affect their online learning. Lack of technical skills and handling knowledge is another negative factor mentioned by the teachers. Law et al. reported that students with smartphones and internet connections are more likely to accept online learning.(Online Teaching, 2022) Similarly, a study by Werang et al. listed that lack of technological familiarity is one of the key issues in online teaching. (Werang & Leba, 2022) Similar results were also reported by Mortagy et al. in the study conducted in Egypt and Motte-Signoret et al. in France.(Mortagy et al., 2022; Motte-Signoret et al., 2021) Reports on the education of children in COVID-19 published by UNICEF shows the difficulty in learning among the disadvantaged population due to a lack of personal devices like smartphones and personal computers. According to UNICEF inadequate technology infrastructure, and inadequate skills for remote learning were the key factors associated with poor teaching in online classes.(Situation Analysis on the Effects of and Responses to COVID-19 on the Education Sector in Asia, 2021) The Indian report of the same suggests that only 54% of the urban and 32% of the rural population has internet access. (India Case Study Situation Analysis on the Effects of and Responses to COVID-19 on the Education Sector in Asia, 2021)

Another important issue highlighted by the students was related to clearing doubts. The students also complained (53.9%) that they were not able to clear their doubts during online sessions which were similar to that reported by Schenz et al. in Germany.(Schlenz et al., 2020) This may be attributed to the inadequate experience of the students with online learning.

In the quantitative interview among the teachers, we found a majority of the teachers believe that online teaching makes their life easy. This is opposite to that reported by W. Elshami et al. in Sharjah and Song et al in China. (Elshami et al., 2021; Song et al., 2021) This may be due to more expertise of teachers on online platforms a priori. The difference in the timing of the study may one of the factors. The current study was conducted in early 2021 by that time the online classes were already in full flow and teachers were more acquainted with the technology.

Some students reported health issues (theme 3) linked with day-long use of digital screens such as insomnia, headache, eye-straining, eye-watering, etc. which may be one of the reasons for the negative preference for online learning among students. The health issues mentioned by the students are well-established facts and many studies have demonstrated the same. (Anderson et al., 2017; Carson & Janssen, 2012; Domingues-Montanari, 2017)

Development of competency on the subject (theme 4) was a major concern among teachers and students. The majority of students across the institutes feel a lack of confidence in theoretical knowledge, as well as in clinical skill competency development. Teachers also put forward their negative views on their output on achieving competencies among students. In the quantitative part of the study we found more than 95% of students and more than 90% of teachers agreed that skills can’t be learned through online classes. Similar results were reported by Dahiya et al in India, E motte et al. France and Ba Czek et al. in Poland. (Bączek et al., 2021; Dahiya et al., 2021; Motte-Signoret et al., 2021) Very few studies conducted among the students and teachers of Nursing found the same. (Dost et al., 2020; O’Doherty et al., 2018; Rodgers, 2002) Study by Kunavi ktikul et al. in Singapore found an under-preparedness feeling among nursing students following online classes. (Kunaviktikul et al., 2022) Nabolsi et al. conducted a qualitative study among nursing teachers and found that the teachers are less satisfied with the student’s competencies and skill learning outcomes.(Nabolsi et al., 2021) However, students in China, and Taiwan as reported by Cheng et al, preferred online more to offline teaching if the affiliated laboratory network is more available.(Cheng et al., 2021)

Conducting an online examination was a major challenge. When specifically asked about experiences of online assessment (theme 5), two major issues were highlighted, first, the satisfaction and engagement of students are lacking in online examination, and second, teachers have raised a serious concern about the validity or reliability of online examination as the tendency of cheating cannot be controlled among students. According to the article published on the Wiley website regarding the assessment of skills, and group tasks, the gradual unfolding of cases study are the most effective way of assessing the students’ skills in online assessment. (Creative Methods of Assessment in Online Learning, 2016)

Conclusion

Online medical education has many gaps as compared to its offline counterpart, which can be related to the learning environment, use of technology, and imparting competency. It also has some health hazards and feasibility issues related to assessments. With improved interactive teaching and learning technology the gaps between offline and online learning can be addressed.

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Tables

Table-1: Likert scale rating by students on various aspects of online teaching and assessment.

Sl. No

Questions

Sex

Strongly agree

 Agree

 Disagree

 Strongly disagree

P value*

1

There were technical difficulties that impaired my learning through online mode.

Total

43

151

71

15

 

Male

34

89

43

12

0.05

Female

9

62

28

3

2

My queries and doubts are satisfactorily resolved during online teaching.

Total

12

117

117

34

 

Male

7

73

69

29

0.04

Female

5

44

48

5

3

My quest for knowledge has increased after online-classes.

Total

12

88

141

39

 

Male

8

60

83

27

0.43

Female

4

28

58

12

4

I learn best from a teacher in a classroom than through online platform.

Total

128

97

50

5

 

Male

81

55

40

2

0.03

Female

47

42

10

3

5

Online learning affects my self-confidence.

Total

33

114

120

23

 

Male

25

65

73

15

0.46

Female

8

39

47

8

6

Online lectures are more understandable compared to classroom lectures

Total

15

45

128

99

 

Male

11

34

77

56

0.23

Female

4

11

51

43

7

I was able to connect with my peers and teachers effectively online.

Total

11

98

128

43

 

Male

7

66

74

31

0.29

Female

4

32

54

12

8

I feel more distracted to online-class at home-environment than the traditional class-room environment.

Total

97

132

38

13

 

Male

58

86

27

7

0.53

Female

39

46

11

6

9

Online learning is more stressful than traditional face-to-face learning.

Total

66

107

81

26

 

Male

41

64

57

16

0.50

Female

25

43

24

10

10

Practical skills can be acquired through online learning

Total

1

11

107

161

 

Male

1

8

70

99

0.70

Female

0

3

37

62

11

Online assessment methods make students more inclined to cheat.

Total

85

142

39

14

 

Male

55

80

31

12

0.01

Female

30

62

8

2

*= Chi Square test


Table-2: Likert scale rating by teachers on various aspects of online teaching and assessment.

Sl. No.

Questions

Strongly Agree

Agree

Disagree

Strongly disagree

1.

Training is required to develop technical expertise for conducting Online Teaching

10

17

3

0

2

More planning is required for preparation of Online teaching module

9

17

3

1

3

Less time is required for preparation of Online teaching module

4

7

16

3

4

Online teaching methods are monotonous

6

16

8

0

5

Online lectures are more understandable to students compared to traditional lectures.

1

1

18

10

6

Teaching in online mode is more stressful than traditional classroom teaching.

3

13

12

2

7

Online teaching hardly delivers skill competency.

11

16

3

0

8

Students feedback during Online teaching session is difficult to assess

7

20

3

0

9

Assessment of student’s knowledge can be achieved by Online assessment.

0

15

12

3

10

Skill assessment is possible using online methods.

1

7

16

6

11

Cheating in Online assessment is preventable by using technology.

0

14

15

1