Registrars’ perspectives towards virtual teaching in an academic department during the COVID-19 pandemic.

doi:10.21203/rs.3.rs-3081766/v1

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Research Article

Registrars’ perspectives towards virtual teaching in an academic department during the COVID-19 pandemic.

https://doi.org/10.21203/rs.3.rs-3081766/v1

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Background

The COVID-19 pandemic brought about unprecedented times that resulted in measures of social distancing that had to be put in place. The Department of Anaesthesiology at the University of Witwatersrand had to comply with these regulations and switched the teaching of registrars from in person format to a virtual platform. The study aimed to look at the perceptions registrars had towards virtual teaching during the COVID-19 pandemic.

Methods

This cross-sectional quantitative study was conducted in the Department of Anaesthesiology at the University of Witwatersrand via an online self-administered questionnaire that was distributed to the registrars registered in the department. The used validated questionnaire was developed following a literature search and an adaptation from two validated questionnaires. The study was conducted from December 2021 to February 2022.

Results

The department has a total of 100 registrars, and the response rate was 90%. The study highlighted that virtual teaching did have a positive impact in teaching in the academic department, with 91% (n = 81) finding virtual teaching to be effective and 63.9% (n = 53) of respondents preferring virtual teaching over in-person teaching.

Conclusion

The COVID-19 pandemic brought about a disruption to the academic programme in the Department of Anaesthesiology at the University of Witwatersrand, resulting in virtual teaching being implemented. This move has been met with a positive response among the registrars in the department.

Anaesthesia

COVID-19

virtual teaching

registrars

perspectives

Traditionally in the Department of Anaesthesiology at the University of Witwatersrand (Wits) postgraduate teaching included in-person interaction: namely morning meetings, specialist anaesthetists lead tutorials, lectures, and combined meetings where registrars would also be given the opportunity to participate. These in-person interactions would therefore take place in a meeting room where medical officers, registrars, and anaesthetic specialists would gather.

The Coronavirus (COVID-19) pandemic resulted in the disruption of activities that included the gathering of people. The activity disruption affected teachings at all levels of education and postgraduate teaching at the Wits Department of Anaesthesiology was no exception to this disruption. The novel coronavirus, which was first identified in Wuhan City of China on 31 December 2019, resulted in COVID-19 disease.[1] The COVID-19 disease was declared to be a global public health emergency of great concern worldwide by the World Health Organisation (WHO). [2] As a result of the rapid spread and catastrophic consequence to the human population across the globe, COVID-19 was declared a pandemic by WHO on 11 of March 2020. [3] On 5 of March 2020, the first positive COVID-19 case was confirmed in South Africa. [4] The head of the National Disaster Management Centre subsequently declared COVID-19 pandemic a national disaster on 15 of March 2020, this was in accordance with the South African Disaster Management Act, 2002 (Act No. 57 of 2002) under section 23. (1)(b).[5–7]

Due to the COVID-19 pandemic having catastrophic consequences leading to death in many, the risk needed to be minimised and decreased as far as possible as directed by the South African Disaster Management Act of 2002.[6] These preventative measures to curb the spread of COVID-19 were advised by WHO and the Centres for Disease Control and Prevention (CDC). These included personal hygiene, isolation of those who presented with symptoms or tested positive for COVID-19, self-quarantine for those who encountered an individual who tested positive for COVID-19 and social distancing. [8–10]

In accordance with the amended South African Occupational Health and Safety Act, Act 85 of 1993, [11] The South African Minister of Employment and Labour stated that working and teaching environments needed to be as safe as possible for all individuals. [11] A circular by the Department of Employment and Labour regarding COVID-19 of workplace preparedness, stated that health risk due to COVID-19 infection to employees should be circumvented. [12, 13]

Virtual learning became a feasible platform to conduct teaching during the COVID-19 pandemic in many teaching facilities at all levels of education across the globe. [3, 14–16] The South African Department of Employment and Labour set out administrative controls to prevent the spread of COVID-19, which meant that a virtual teaching platform was instituted at the post-graduate level in the Department of Anaesthesiology at Wits to continue in training registrars to becoming specialist anaesthetists. [12, 17] Therefore, the usual academic meetings and in-person teaching platforms needed to be changed to comply with set out restrictions by the government for the lockdown regulations.

Since the invention and inception of the world wide web by Sir Tim Berners-Lee in 1989,[18] online and virtual teaching has been made possible by many education facilities including those at the higher education level and postgraduate level.[19] Similarly to postgraduate anaesthesia training programmes in many countries where training to become specialists had to continue via a virtual platform, the Department of Anaesthesiology at Wits has had to adapt to postgraduate teaching being conducted on virtual platforms such as Zoom® meetings and Microsoft Teams® meetings. [19–22] These teachings included morning tutorials ideally before commencing daily work duties that are held and conducted by specialists, and afternoon tutorials ideally after work duties, which are normally chaired by specialists and presented by a registrar, some of the tutorials are also conducted by specialists at combined departmental meetings. These meetings would cover the topics and syllabus essential for the successful completion of specialist training in anaesthesiology as outlined by the College of Medicine of South Africa (CMSA) stipulated by the College of Anaesthetists.[23] Lectures in the form of “Updates” were also introduced as a form of teaching that was also held via a virtual platform. These would be held as a full-day event that would take place on a Saturday. With these virtual teaching meetings, the presenter could share their presentation on screen. [24]

The meetings led to isolated teaching and a lack of human contact at most times. Although the examination results remained positive, the study aim was to look at the registrars’ perspective on the change of teaching platform to virtual teaching amidst the COVID-19 pandemic and the challenges they face with accessing virtual teachings. Furthermore, to determine if virtual teaching is a sustainable form of teaching registrars in an academic setting, such as that of the Department of Anaesthesiology at Wits, even post the COVID-19 pandemic.

Approval to conduct this study was obtained from Wits PG Ethics committee certificate number M210930 and other relevant authorities.

A cross-sectional quantitative method was followed via an online self -administered questionnaire which was distributed to the registrars registered in the department via RedCap®.[25] The study was conducted from December 2021 to February 2022. A questionnaire was developed following a literature search and an adaptation of questions from two validated questionnaires following the authors permission. [26, 27] The questionnaire was content, and face validated prior to distribution to the registrars by three senior specialists in the department with an interest in postgraduate education. Participation in the study was voluntary; anonymity and confidentiality of the participants were maintained. A declaration letter was included in the online questionnaire for the participants to give their consent prior to completion; and proceeding with the questionnaire implied consent. [28]

The questionnaire was used to assess the registrars' perspectives on virtual teaching at Wits' Department of Anaesthesiology. In addition to assessing the demographics of the registrars, the study also examined how COVID-19 disease affected their training to be specialist anaesthetists, as well as their perceptions of virtual teaching.

Participants for the study were exclusively the registrars in the Department of Anaesthesiology at Wits during the COVID-19 pandemic. The department had 100 registrars and the calculated sample size was 85 respondents in order to obtain a 95% confidence with a 5% margin of error using a population proportion of 50%.[29, 30]

The questionnaire included demographic profile, the participants’ personal perception of teaching during the COVID-19 pandemic, as well as the participants; perspectives on virtual teaching.

The inclusion criteria to participate in the study were anaesthesia registrars registered in the Department of Anaesthesiology at Wits. Exclusion criteria were registrars not registered in the Department of Anaesthesiology at Wits, registrars who refuse to participate in the study, medical officers, interns, and consultants.

To analyse data, and to compare the attendance of tutorials based on demographics, the chi-squared test was used for categorical variables while the two-sample t-test was used for continuous variables. For the categorical data, Fisher’s exact test was used and in the case of continuous data, the Kruskal Wallis test was used.

In comparing the perspectives by registrars of the morning and afternoon tutorials the Mcnemar test was used. Frequencies and percentages were used to describe categorical data of the updates lectures.

Table 1: Participants’ demographics

Demographic Information
Variable	Category	N = 90, n (%)
Age in years	Mean (SD)	34.3 (4.4)
Gender	Male	43 (47.8)
	Female	47 (52.2)
Marital status	Married	55 (64.0)
	Single	24 (27.9)
	Cohabiting	4 (4.6)
	Other	3 (3.5)
Number of dependents	0	34 (39.5)
	1	18 (20.9)
	2	17 (19.8)
	3	10 (11.6)
	4	6 (7.0)
	5	1 (1.2)
Registrar year of training	First	24 (27.0)
	Second	16 (18.0)
	Third	17 (19.1)
	Fourth	31 (34.8)
	Extended registrar time	1 (1.1)
Completed part 1 exams	Yes	87 (97.8)
	No	2 (2.2)

Table 1 demonstrates participants’ demographics. A total of 90 registrars responded out of the 100 registrars registered in the Department of Anaesthesiology at Wits. The mean age was 34.3 years, and the study was composed of 52.2% females and 47.8% males. There were 64.0% (55) married, 4.6% (4) cohabiting and 27.9% (24) single registrars. There were 39.5% (34) of the registrars had no dependents.

Table 2: Registrars COVID-19 exposure and its effect on teaching

COVID-19 and Teaching n (%)
Ever been quarantined for COVID-19	Yes	58 (64.4)
	No	32 (35.6)
Reason for quarantining	Tested positive	39 (67.2)
	Contact with a case	13 (22.4)
	Symptoms	5 (8.6)
	Other	1 (1.7)
Learning anxiety due to COVID-19	Yes	55 (61.1)
	No	35 (38.9)
Anxiety level^*	Median (IQR)	7 (5 – 8)
Training disruption due to COVID-19	Yes	75 (83.3)
	No	15 (16.7)

(^*Anxiety was measured as a scale of 1 to 10 where 1 is “not at all stressful or anxiety provoking” and 10 being “extremely stressful or anxiety provoking” on the questionnaire, with 7 being the median and an interquartile range of 5-8.)

Table 2 demonstrates COVID-19 and its effect on teaching. There were 64.4% (58) of the participants quarantined for COVID-19 infection during the period preceding and up to our data collection. Of those, 22.4% (13) had encountered a positive case with no symptoms and 8.6% (5) had symptoms of the COVID-19 disease. A total of 61.1% (55) of the participants felt that the COVID-19 crisis brought about anxiety. In addition, there were 14% (13) of the participants commented that they may have ‘missed opportunities in terms of exposure to elective cases’ and were ‘worried about quality of teaching,’ and that ‘personally they do not like virtual teaching’. While 83% of the 90 participants found that COVID-19 brought disruption to their registrar time teaching and training, with a common response being that it ‘delayed completing research’.

Table 3: Perspectives on virtual teaching platform

Virtual teaching perspectives
Variable	Category	n (%),
Was the implemented virtual teaching effective?	Yes	81 (91.0)
	No	8 (9.0)
How comfortable with virtual teaching.^**	Median (IQR)	7 (5 – 8)
Frequency of attending morning tutorials	None	23 (25.6)
	Once a week	25 (27.8)
	Twice a week	18 (20.0)
	Three times a week	15 (16.7)
	Four times a week	5 (5.6)
	Five times a week	4 (4.4)
Frequency of attending evening tutorials	None	16 (18.2)
	Once a week	33 (37.5)
	Twice a week	29 (32.9)
Attended updates	Yes	39 (43.8)
	No	50 (56.2)
Overall impact of virtual teaching on reg training	Extremely negative	6 (6.7)
	Neutral	36 (40.0)
	Extremely positive	48 (53.3)

(^**How comfortable the participant was with virtual teaching was ask on a basis of a scale of 1 to 10, where 1 is uncomfortable and 10 significantly comfortable.)

The frequency of attendance of morning or afternoon tutorials was variable, 25.6% (23) of the participants reporting not attending morning and afternoon tutorials and 18.2% (16) reported not attending afternoon tutorials. Ninety one percent of the participants (81) felt that the implementation of virtual teaching was effective. More than 50% of the participants felt that virtual teaching had a positive overall impact on their teaching during registrar training. (Table 3)

Table 4: Perspective of virtual teaching post COVID-19

Virtual Teaching post COVID-19		n (%)
Prefer virtual teaching to in-person teaching	Yes	53 (58.9)
	No	30 (33.3)
Compare virtual teaching to in-person teaching	Virtual teaching > in-person	21 (23.3)
	Virtual teaching = in-person	33 (36.7)
	Virtual teaching < in-person	26 (28.9)
Want to continue with virtual learning post COVID	Yes	66 (73.3)
	No	17 (18.9)
Prefer a combined virtual and in-person programme	Yes	62 (68.9)
	No	21 (23.3)

Table 4 looked at perspective of virtual teaching post COVID-19, 83 of the 90 participants indicated that they attended at least either the morning or afternoon or both tutorials. When looking at the perspectives of registrars towards virtual teaching post COVID-19 pandemic of the 83 participants that attended at least either the morning or afternoon tutorials, 58.9% (53) preferred virtual teaching to in-person teaching.

There were 73.3% (66) participants that indicated that they would want to continue with virtual teaching post COVID-19 pandemic, while 18.9% (17) did not want to continue with virtual teaching post COVID-19. However, there were 68.9% (62) of the 90 participants that had indicated that they would also prefer to have a combination of both virtual and in-person teaching. When comparing virtual teaching to in-person teaching, 41.3% reported that they found that virtual teaching was the same as in-person teaching. There were 28.9% (26) of the participants that preferred in-person teaching over virtual teaching. Of the 83 respondents that attended the tutorials 73.3% (66) said they would want to continue with virtual teaching post the COVID-19 pandemic, while 68.9% (62) preferred a teaching programme with combination of virtual and in-person teaching.

Table 5: Tutorial Attendance by Demographics

Variable		Morning Tutorials			Afternoon Tutorials
		Not-Attend n = 23	Attend n = 67	p-value	Not-Attend n = 16	Attend n = 74	p-value
Age: Mean (SD)		33.0 (4.3)	34.7 (4.4)	0.12	32.5 (2.0)	34.7 (4.7)	0.07
Gender	Male	15 (34.9)	28 (65.1)	0.052	10 (23.3)	33 (76.7)	0.19
Gender	Female	8 (17.0)	39 (83.0)	0.052	6 (12.8)	41 (87.2)	0.19
Marital status	Married	14 (25.5)	41 (74.5)	0.73	10 (18.2)	45 (81.8)	0.60
	Single	7 (29.2)	17 (70.8)		3 (12.5)	21 (87.5)
	Other	1 (14.3)	6 (85.7)		2 (28.6)	5 (87.5)
Number of dependents	0	10 (29.4)	24 (70.6)	0.44	9 (26.5)	25 (73.5)	0.33
	1	5 (27.8)	13 (72.2)		1 (5.6)	17 (94.4)
	2	2 (11.8)	15 (88.2)		3 (17.6)	14 (82.3)
	³3	6 (35.3)	11 (64.7)		3 (17.6)	14 (82.3)
Registrar level of training	First	8 (33.3)	16 (66.7)	0.20	5 (20.8)	19 (79.2)	0.64
	Second	6 (37.5)	10 (62.5)		4 (25.0)	12 (75.0)
	Third	4 (23.5)	13 (76.5)		2 (11.8)	15 (88.2)
	Fourth	4 (12.9)	27 (87.1)		4 (12.9)	27 (87.1)

In both the morning and afternoon tutorials, there was no significant difference in attendance based on demographics. With each of the demographic variables of both the morning and afternoon tutorial attendance having a p-value greater than 0.05.(Table 5)

Table 6: Perspectives according to registrar training level in years

Variable	First Median (IQR)	Second Median (IQR)	Third Median (IQR)	Fourth Median (IQR)	p-value
Confidence with virtual teaching	7.5 (6.5 – 8)	7 (5 – 8.5)	6 (5 – 8)	7 (5 – 9)	0.68
Was the implemented virtual teaching effective?	n (%)
Yes	22 (91.7)	14 (87.5)	16 (94.1)	27 (90.0)	0.96
No	2 (8.3)	2 (12.5)	1 (5.9)	3 (10.0)	0.96
Overall impact of virtual teaching on registrar training
Extremely negative	0 (0.0)	2 (12.5)	2 (11.8)	2 (6.4)	0.64
Neutral	11 (45.8)	7 (43.8)	7 (41.2)	11 (35.5)
Extremely positive	13 (54.2)	7 (43.8)	8 (47.0)	18 (58.1)

Virtual teaching perspectives were analyzed in relation to registrar training levels (Table 6). The confidence of registrars using virtual teaching showed no significant difference across the levels of registrar training (p-value = 0.68). According to the analysis of the responses by the registrars based on level of registrar training, the effectiveness of the implementation of virtual teaching was not significantly different (p-value= 0.96). The overall positive impact of virtual teaching on registrar training was among first year and fourth year registrars at 54.2% (13) and 58.1% (18) respectively; however, there was no statistical significance shown (p-value= 0.64).

Table 7 (page 26-29) compares perspectives of the morning and afternoon tutorials only the data from participants who attended both morning and afternoon tutorials (n=61) was used.

Table 7: Barriers to morning and evening tutorial attendance

Parameter n = 61		Morning	Afternoon	p-value
Teaching barriers
Data Costs	Yes	10 (16.4)	10 (16.4)	0.052
Data Costs	No	3 (4.9)	38 (62.3)	0.052
Technical difficulties	Yes	12 (19.7)	14 (22.9)	0.008
Technical difficulties	No	3 (4.9)	32 (52.5)	0.008
Difficulties following tutor	Yes	0 (0.0)	8 (13.1)	0.11
Difficulties following tutor	No	2 (3.3)	51 (83.6)	0.11
Timing	Yes	37 (60.7)	11 (18.0)	0.22
Timing	No	6 (9.8)	7 (11.5)	0.22
Other	Yes	1 (1.6)	5 (8.2)	0.10
Other	No	1 (1.6)	54 (88.5)	0.10
Benefits of current slot
Convenient	Yes	6 (9.8)	9 (14.8)	0.51
Convenient	No	12 (19.7)	34 (55.7)	0.51
Can get tutorials at the end of the day	Yes	17 (27.9)	22 (36.1)	<0.001
Can get tutorials at the end of the day	No	4 (6.5)	18 (29.5)	<0.001
Accommodates all sites	Yes	25 (41.0)	9 (14.7)	0.82
Accommodates all sites	No	10 (16.4)	17 (27.9)	0.82
Tutorial after pre-operative assessment^***	Yes	0 (0.0)	4 (6.6)	0.13
Tutorial after pre-operative assessment^***	No	0 (0.0)	57 (93.4)	0.13
Factors that influence attendance
Prefer morning/afternoon tutorials	Yes	1 (1.6)	7 (11.5)	0.061
Prefer morning/afternoon tutorials	No	16 (26.2)	37 (60.7)	0.061
Enjoy the content covered	Yes	14 (23.0)	8 (13.1)	0.49
Enjoy the content covered	No	11(18.0)	28 (45.9)	0.49
Proximity to exams	Yes	16 (26.2)	7 (11.5)	0.37
Proximity to exams	No	4 (6.6)	34 (55.7)	0.37
Other reasons	Yes	2 (3.3)	7 (11.5)	0.18
Other reasons	No	2 (3.3)	50 (81.9)	0.18
Factors that influence non-attendance
Tutorials not beneficial	Yes	0 (0.0)	2 (3.3)	0.50
Tutorials not beneficial	No	0 (0.0)	59 (96.7)	0.50
Too early / late	Yes	3 (4.9)	6 (9.8)	0.32
Too early / late	No	10 (16.4)	42 (68.9)	0.32
Too many tutorials in the week	Yes	7 (11.5)	6 (9.8)	0.23
Too many tutorials in the week	No	11 (18.0)	37 (60.7)	0.23
On call or post call	Yes	28 (45.9)	13 (21.3)	0.39
On call or post call	No	9 (14.8)	11 (18.0)	0.39
Disadvantages of current slot
None	Yes	1 (1.6)	1 (1.6)	0.13
None	No	6 (9.8)	53 (87.0)	0.13
Interferes with driving to work	Yes	13 (21.3)	36 (59.1)	<0.001
Interferes with driving to work	No	1 (1.6)	11 (18.0)	<0.001
Interferes with preparation to go to work	Yes	12 (19.7)	19 (31.1)	0.002
Interferes with preparation to go to work	No	4 (6.6)	26 (42.6)	0.002
Interferes with family responsibilities	Yes	13 (21.3)	1 (1.6)	<0.001
Interferes with family responsibilities	No	24 (39.4)	23 (37.7)	<0.001
Interferes with night call handover/duty	Yes	12 (19.7)	4 (6.6)	0.003
Interferes with night call handover/duty	No	18 (29.4)	27 (44.3)	0.003
Other disadvantages	Yes	0	2 (3.3)	0.50
Other disadvantages	No	0	59 (96.7)	0.50
Content preferred in the tutorials
Preparation for short answer questions	Yes	27 (44.3)	10 (16.4)	0.53
Preparation for short answer questions	No	13 (21.3)	11 (18.0)	0.53
Preparation for multiple choice questions	Yes	12 (19.7)	6 (9.8)	0.003
Preparation for multiple choice questions	No	22 (36.1)	21 (34.4)	0.003
OSCE type preparations	Yes	20 (32.8)	5 (8.2)	0.004
OSCE type preparations	No	19 (31.1)	17 (27.9)	0.004
Paper case preparations	Yes	27 (44.3)	6 (9.8)	0.050
Paper case preparations	No	15 (24.6)	13 (21.3)	0.050
Other topics	Yes	2 (3.3)	2 (3.3)	1.00
Other topics	No	2 (3.3)	55 (90.1)	1.00
Domains preferred in the afternoon
Fundamentals of anaesthesia and pain management	Yes	26 (42.6)	7 (11.5)	0.78
Fundamentals of anaesthesia and pain management	No	6 (9.8)	22 (36.1)	0.78
Anaesthesia for major and trauma surgery	Yes	31 (50.8)	9 (14.8)	0.65
Anaesthesia for major and trauma surgery	No	11 (18.0)	10 (16.4)	0.65
Obstetric anaesthesia and analgesia	Yes	28 (45.9)	8 (13.1)	0.49
Obstetric anaesthesia and analgesia	No	11 (18.0)	14 (23.0)	0.49
Anaesthesia for cardiac, thoracic and vascular surgery	Yes	32 (52.5)	4 (6.6)	0.002
Anaesthesia for cardiac, thoracic and vascular surgery	No	19 (31.1)	6 (9.8)	0.002
Anaesthesia for neurosurgery	Yes	27 (44.3)	6 (9.8)	0.009
Anaesthesia for neurosurgery	No	19 (31.1)	9 (14.8)	0.009
Anaesthesia for ENT, eye, dental, maxillofacial and head and neck surgery, including airway management	Yes	26 (42.6)	6 (9.8)	0.033
	No	16 (26.2)	13 (21.3)	0.033
Paediatric anaesthesia	Yes	30 (49.2)	7 (11.5)	0.35
Paediatric anaesthesia	No	11 (18.0)	13 (21.3)	0.35
Intensive care medicine	Yes	26 (42.6)	8 (13.1)	0.20
Intensive care medicine	No	14 (23.0)	13 (21.3)	0.20
Pain medicine	Yes	23 (37.7)	9 (14.7)	0.30
Pain medicine	No	14 (23.0)	15 (24.6)	0.30
Anaesthesia in remote location	Yes	22 (36.1)	7 (11.5)	0.18
Anaesthesia in remote location	No	13 (21.3)	19 (31.1)	0.18
Education, self-direct learning and research	Yes	19 (31.1)	10 (16.4)	0.32
Education, self-direct learning and research	No	6 (9.8)	26 (42.6)	0.32
Professionalism and ethics in practice	Yes	26 (42.6)	10 (16.4)	0.47
Professionalism and ethics in practice	No	7 (11.5)	18 (29.5)	0.47
Quality, safety, management and health economics	Yes	27 (44.3)	11 (18.0)	0.071
Quality, safety, management and health economics	No	4 (6.6)	19 (31.1)	0.071

(^*** preoperative assessments of patients booked for the following day elective surgical list are done by the registrars when the surgical list has been constructed and handed in by the surgical teams of that particular surgical list. These assessments are usually done at the end of the current day’s surgical list which can end before 16h00 or at 16h00 or after 16:00 but on most days the lists end either at 16h00 or after 16h00.)

Technical difficulties as teaching barriers were different between groups (p-value= 0.008). Data cost experienced was marginally different (p-value of 0.052). There was no significant statistical difference regarding the convenience of the tutorials (p = 0.51). There was a significant difference with the perspective towards benefit of tutorial timing being accessible at the end of the day (p <0.001).

The disadvantages of the time slots of the tutorials showed significant statistical differences with timing interfering with either daily personal or work duties. There was no significant statistical difference between factors that influenced registrar tutorial attendance and registrar tutorial non-attendance.

The content that was preferred to be covered in both the morning and afternoon tutorials, with significant statistical difference was preparation for the part 2 fellowship of anaesthesia exam (FCA 2) with the multiple-choice questions (p =0.003), OSCE type preparation (p = 0.004), and exam paper case preparations (p = 0.005). Preparation for short answer questions did not show any significant difference (p = 0.53) and other topics to be covered also did not show any statistically significant difference (p = 1.00).

Responses on perspectives of the domains as outlined by the College of Anaesthesiology of CMSA, the domains that the registrars wanted to be covered included anaesthesia for cardiac, thoracic and vascular surgery (p = 0.02), anaesthesia for neurosurgery (p = 0.009), airway management anaesthesia for ear nose and throat (ENT), eye, dental maxillofacial and head and neck surgery (p = 0.033). The other domains that are outlined by the college did not show significant statistical difference.

Table 8: Registrars’ perceptions towards “Update” lectures

Variable	Category	n (%), N = 39
Satisfied with subject updates offered.	Yes	36 (92.3)
Satisfied with subject updates offered.	No	3 (7.7)
Reason for Dissatisfaction
Updates too expensive	Yes	3 (100)
Updates too expensive	No	0 (0.0)
Days of updates inconvenient	Yes	1 (33.3)
Days of updates inconvenient	No	2 (66.7)
Duration too long	Yes	0 (0.0)
Duration too long	No	3 (100)
Topics not relevant	Yes	0 (0.0)
Topics not relevant	No	3 (100)
Other	Yes	2 (66.7)
Other	No	1 (33.7)

The updates that run on the weekend were attended by 39 of the 90 participants included. Ninety-two point three percent (36) of those who attended found that the updates were satisfactory with the subjects that were offered. Of the 7.7% (3) participants who responded that they were not satisfied with the subjects offered, 100% of them responded that the updates were too expensive. However, 100% of them did not find that the duration was too long nor did they find the topics irrelevant. The 66.7% (2) of the three participants who were dissatisfied did not consider the days to be inconvenient. (Table 8 Registrar updates lectures)

The frequency of the updates attendance in order of the popularity to the least attended were, neuroanaesthesia “update” at 59% (23), paediatric “update” at 51.3% (20) participant and, obstetric “update” had an attendance of 11 (28.2%). Regarding primaries (FCA 1) subjects attendance, physics, physiology and pharmacology had an attendance of 15.4% (6), 7.7% (3) and 7.7% (3) respectively.

There were 84.6% (33) participants who indicated that they would appreciate attending an intensive care update, 69.2% (27) indicated that they would be interested in an “update” on cardiothoracic and vascular surgery, 59% (23) were interested in an “update” on ethics, pain management had an interest of 56.4% (22) participants. Forty-eight point seven percent (19) participants indicated that they would like an “update” on head and neck anaesthesia, while 28.2% (11) would be interested in an “update” on remote location anaesthesia. (Table 9, page 30-31).

Table 9: Types of attended “Updates” and suggested future subjects

Variable	Category	n (%), n = 39
Neuroanaesthesia	Yes	23 (59.0)
Neuroanaesthesia	No	16 (41.0)
Paediatrics	Yes	20 (51.3)
Paediatrics	No	19 (48.7)
Obstetrics	Yes	11 (28.2)
Obstetrics	No	28 (71.8)
Physics	Yes	6 (15.4)
Physics	No	33 (84.6)
Physiology	Yes	3 (7.7)
Physiology	No	36 (92.3)
Pharmacology	Yes	3 (7.7)
Pharmacology	No	36 (92.3)
Other	Yes	6 (15.4)
Other	No	33 (84.6)
Subject areas would like to be covered
Pain management	Yes	22 (56.4)
Pain management	No	17 (43.4)
Head and neck	Yes	19 (48.7)
Head and neck	No	20 (51.3)
Intensive care	Yes	33 (84.6)
Intensive care	No	6 (15.4)
Cardiothoracic and vascular	Yes	27 (69.2)
Cardiothoracic and vascular	No	12 (30.8)
Ethics	Yes	23 (59.0)
Ethics	No	16 (41.0)
Remote location anaesthesia	Yes	11 (28.2)
Remote location anaesthesia	No	28 (71.8)
Other	Yes	1 (2.6)
Other	No	38 (97.4)

In this study, we found that the participants’ perception towards virtual teaching was positive as evidenced by their responses in regards to the beneficial impact it had on the teaching and that virtual teaching should continue post COVID-19. The registrars at all levels of training agreed that the implementation of virtual teaching during the pandemic had a positive impact.

Similarly the study by Rana et al [27] of surgical residents found that COVID-19 brought about a state of consternation in both their personal lives and their training. The study by Aisa et al [31] noted that COVID-19 resulted in disruption to training of Anaesthesia and Critical care residents in Spain. In this study a number of the registrars noted that COVID-19 would result in their training being disrupted.The participants also indicated that they were anxious because of the COVID-19 disease and its possible effects on their learning. Some of the registrars commented that they were anxious about the “risk of contracting the virus”. They were “too anxious to read the material and participate in tutorials” and that “majority of our learning is experience based.”

The current study findings were similar to the study by Adnan et al [32] where the participants revealed that they were comfortable with the virtual teaching platform. In contrast, Adnan et al (33) found virtual teaching to lack socialisation and less effective than in person interaction, in our study the registrars found that the implementation of virtual teaching was effective. The registrars in the current study preferred virtual teaching over in-person teaching. From the study, it was evident that the registrars would prefer virtual teaching to continue post the COVID-19 pandemic in spite of the attendance of online tutorials being low for both the morning and the afternoon tutorials.

The study highlighted that the timing of the online tutorials did interfere with registrars family or home responsibilities and duties.

There were similar comments made by the respondents in the study by Khalil et al [33] to the current study of online learning affecting family time. Some of the comments by the registrars that were similar to those made by the respondents in the Khalil et al study, included comments such as "It interferes with family time". However, registrars' marital status and number of dependents did not significantly affect whether they attended tutorials.

Akin to the barriers faced by the respondents in the study by Dost et al (26), such as the timing of the tutorials, the current study found that the timing of the morning tutorials were a barrier to attendance as they commonly coincided with driving to work making it difficult to follow the tutorial discussion. The study also found that attending morning tutorials was challenging because registrars had to participate. Morning preparations for theatre also created barriers to tutorial attendance, with some theatre cases being complex and requiring extensive preparations.

Registrars reported that they were able to obtain tutorial content at the end of the day. Registrars preferred the morning tutorials over the afternoon tutorials to prepare for the FCA 2 final exams since the morning tutorials were specialist-led and covered topics specific to the CMSA college of anaesthesia domains.

Updates attendance was not as high as the tutorial attendance, with less than half of the participants attending Updates. Among the 100 registrars registered in the Department of Anaesthesiology at Wits and the 90 survey participants, only 39 attended at least one Update, which is not significant for establishing the effectiveness of the Updates and assessing registrars’ perception. Most of the updates attendees were closer to writing their FCA 1 or exit FCA 2 exam and this could be the likely reason for this low attendance.

The training of doctors in their specialities has been affected by the COVID-19 pandemic as there is less exposure to skills and experience, such as that seen in the study by Ehrlich et al, Hau et at and Rose et al, [34–36]. This lack of exposure to speciality training was experienced by the registrars in the Department of Anaesthesiology at Wits. Training and teaching of registrars in the Department of Anaesthesiology at Wits include both theory and practical skills. Due to social distancing, the COVID-19 pandemic limited close contact, which caused some elective procedures to be cancelled. Patients who tested positive had to be postponed, therefore limiting the amount of skills exposure. Registrars had to seek other ways to learn skills, as some have expressed concern that they were ‘worried that they were not getting enough experience’ and they were ‘not doing the same amount of cases as before.

Although the study was small and only looked at the registrars registered in the department of Anaesthesiology at Wits, the study is of benefit to the department going further post COVID-19 pandemic in knowing what teaching method is preferred by the registrars. This study will also be of benefit to the Department in guiding the online tutorials. The study will also be of benefit to the registrars going forward with the incorporation of issues addressed by the consultants. This then allows for the equitable teaching of registrars irrespective of their rotation and location. All the formal morning and afternoon tutorials have remained virtual.

The teaching platform shift to virtual online classes that had to be made during this pandemic has expanded the access to learning resources even post-pandemic.

Limitations

The limitations that were experienced with the study included the sample size that was contextual and small as it was only looking at registrars only in the Department of Anaesthesiology at Wits, thus possibly creating bias. Thus far at the time of conducting the study there had been no study found that looked at post-graduate anaesthesia registrars’ perspectives on virtual teaching during the COVID-19 pandemic.

The range of registrars was from first year up to fourth year registrars, with some of the first-year registrars having recently joined the department at the time the survey was conducted. Comparison of perspectives of virtual teaching to in-person face-to-face teaching conducted in the Department of Anaesthesiology at Wits by the first-year registrars who had not been part of the department before the COVID-19 pandemic could result in bias. While the senior registrars, they were preparing for their exit (part 2) exams in becoming specialist anaesthetists who would have experienced both virtual and in-person face-to-face teaching they, however, make up less than half of the respondents. Nonetheless, due to the senior registrars preparing for their final exams some if not most would be making use of online learning and virtual teaching platforms as part of their preparation for the exam.

The study was conducted as an online survey this could have created some level of bias by the respondents which could be limited by in-person interviews. Collection of the data was conducted during the pandemic when social distancing was paramount. Therefore, due to the nature of the current pandemic requiring social distancing, in-person interviews could not be conducted to eliminate respondent bias.

Barriers that affect virtual teaching such as connectivity, data cost and technical difficulties could also impact the completion of the survey as it is also an online survey. This therefore could be a reason for the number of participants not being the complete 100 registrars registered in the Department of Anaesthesiology at Wits.

With the COVID-19 pandemic having disrupted the academic programme in the department of Anaesthesiology at the University of Witwatersrand, virtual teaching had to be implemented for the continued training of registrars in the department in preparing them for their specialist CMSA FCA 2 final exams. Topics covered in the virtual teachings are those that are outlined by the CMSA college of anaesthesia curriculum and examined in the final CMSA FCA 2 final exams, with the morning tutorials that are presented by an anaesthetic specialist consultant in the department, that take place on most mornings before registrars start their theatre preparation for the day. The afternoon tutorials that take place usually after most elective lists are done for the day, these are presented by one of the registrars and facilitated by an anaesthetic specialist consultant from the Wits anaesthesia department, these were topics also based on the outline by the CMSA college of anaesthesia curriculum that would be examined in the final CMSA FCA 2 exam. This study showed that virtual teaching in the Department of Anaesthesiology at Wits encountered difficulties, such as anxiety related to the pandemic, barriers with adapting to virtual teaching such as connectivity and interreference with personal time. It has been found that registrars attended online tutorials and expressed a positive perspective toward virtual teaching. These perceptions have been expressed in similar studies where a positive response by the registrars was seen to continuing with virtual teaching even post the pandemic.

For an overall assessment of registrars’ perspective and overall outcome of virtual teaching a follow up study would be beneficial to assess effectiveness of virtual teaching outcomes. Therefore, data for the outcomes of examination results of those registrars who were taught via virtual teaching, to compare the outcomes of results of the groups prior to COVID-19 and those who had to be taught virtually would be of value. This will further assist to determine the impact that virtual teaching had and the competency consequence that have resulted with COVID-19 pandemic on registrars for the department. Furthermore, including other anaesthesiology departments outside of Witwatersrand and other disciplines within the University of Witwatersrand to assess the overall impact of virtual teaching as a result of the COVID-19 pandemic on education and competency at a postgraduate level of training registrars to become specialists.

Conflict of interest

No conflict of interest to declare

Ethics approval and consent to participate. - All methods were carried out in accordance with the principles of the Declaration of Helsinki and the South African Guidelines for Good Clinical Practice. Ethics clearance was obtained from the Human Research Ethics Committee (Medical) at the University of Witwatersrand to conduct research and application to the Gauteng Health Research Committee for National Health Research Database Approval was done. Permission to conduct the study was requested and granted from academic head of the University of Witwatersrand Anaesthesia Department. Informed consent was obtained from participants prior to completion of the online questionnaire, this was done by providing an information sheet and the option to opt in or opt out from participating in the study. Anonymity and confidentiality of the participants were guaranteed.

Consent for publication - Not applicable

Availability of data and materials - The datasets generated and analysed during the current study are not publicly available due to anonymity and confidentiality that was guaranteed to the participants upon completion of questionnaire but are available from the corresponding author (Dr Lerato Nomonde Mpemnyama) on reasonable request.

Competing interests - None to declare

Funding - Will be provided by the University of Witwatersrand

Author contribution - Dr Hlamatsi Jacob Moutlana, Dr Sithandiwe Dingezweni and Prof Palesa Motshabi Chakane were the supervisors to my research. They assisted in formulating the research idea and questionnaire. Data collection was done by Dr Lerato Nomonde Mpemnyama, data analysis was done with the assistance of a statistician. The write up of the article was done by Dr Lerato Nomonde Mpemnyama.

Acknowledgements - I would like to acknowledge and give a great amount of gratitude to my supervisors for their continual support with my research and extensive professional guidance, and their continuous encouragements and pushing me to get through my MMED.

I would like to acknowledge my statistician for all the help with the statistics and data analysis.

I would like to give thanks to the God for everything He has done and continues to do for me. I want to thank my family who pushed me to the best version of myself, especially during the times when I felt I could not go on and for the unconditional support they give to me daily. My “Mila” for keeping up with a mother who was always busy and my motivation to continue going.

Coronavirus disease 2019 (COVID-19) [https://emedicine.medscape.com/article/2500114-overview]
da Rosa Mesquita R, Francelino Silva Junior LC, Santos Santana FM, Farias de Oliveira T, Campos Alcântara R, Monteiro Arnozo G, Rodrigues da Silva Filho E, Galdino Dos Santos AG, Oliveira da Cunha EJ, Salgueiro de Aquino SH et al: Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr 2020:1-6.
The impact of COVID-19 pandemic on education: Navigating forward the pedagogy of blended learning [https://www.researchgate.net/publication/340899662 The impact of COVID-19 pandemic on South African Education: Navigating forward the pedagogy of blended learning]
First case of COVID-19 Coronavirus reported in SA [https://www.nicd.ac.za/first-case-of-covid-19-coronavirus-reported-in-sa/]
Declaration of a national state of disaster [https://www.gov.za/sites/default/files/gcis_document/202003/43096gon313.pdf]
Government Gazette Disaster Management Act No. 57 2002 [https://www.cogta.gov.za/cgta_2016/wp-content/uploads/2016/06/DISASTER-MANAGEMENT-ACT.pdf ]
Woods J, Hutchinson NT, Powers SK, Roberts WO, Gomez-Cabrera MC, Radak Z, Berkes I, Boros A, Boldogh I, Leeuwenburgh C: The COVID-19 pandemic and physical activity. 2020.
World Health Organisation Coronavirus disease (COVID-19) advice for the public [https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public]
Güner R, Hasanoğlu I, Aktaş F: COVID-19: Prevention and control measures in community. Turk J Med Sci 2020, 50(Si-1):571-577.
Cirrincione L, Plescia F, Ledda C, Rapisarda V, Martorana D, Moldovan RE, Theodoridou K, Cannizzaro E: COVID-19 pandemic: prevention and protection measures to be adopted at the workplace. Sustainability 2020, 12(9):3603.
Government Gazette Occupational health and safety act 1993 [https://www.gov.za/sites/default/files/gcis_document/201409/act85of1993.pdf]
Government Department of employment and labour COVID-19 occupational health and safety measures in workplaces COVID-19 (C19 OHS), 2020. 2020 [https://www.gov.za/sites/default/files/gcis_document/202004/43257gon479.pdf]
Government Department of Employment and Labour Republic of South Africa Workplace Preparedness: COVID-19 (SARS-CoV-19 virus). 2020 [https://www.labourguide.co.za/workshop/1773-covid-19-guideline-mar2020/file]
Ottinger ME, Farley LJ, Harding JP, Harry LA, Cardella JA, Shukla AJ: Virtual medical student education and recruitment during the COVID-19 pandemic. Semin Vasc Surg 2021, 34(3):132-138.
Gopalan C, Butts-Wilmsmeyer C, Moran V: Virtual flipped teaching during the COVID-19 pandemic. Adv Physiol Educ 2021, 45(4):670-678.
Masterton G, Zargaran A, Zargaran D: Virtual teaching during the COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2021, 74(5):1101-1160.
The Department of Employment and Labour Workplace Preparedness: COVID-19 (SARS-CoV-19 virus) [https://www.labourguide.co.za/workshop/1773-covid-19-guideline-mar2020/file]
Internet Hall of Fame Innovator Tim Berners-Lee[https://www.internethalloffame.org/inductees/tim-berners-lee]
Phipps R, Merisotis J. Quality on the Line: Benchmarks for Success in Internet-Based Distance Education. 2000 [https://files.eric.ed.gov/fulltext/ED444407.pdf]
Microsoft teams [https://www.microsoft.com/en-za/microsoft-teams/log-in]
Torlinski T, Mullhi RK, Parekh D, Basra R, Midgley-Hunt A, O’Connell M, Ali M: Postgraduate education and specialty training in anaesthesia and intensive care medicine during the COVID-19 pandemic: experience from a large teaching hospital in the United Kingdom. Anaesthesiology intensive therapy 2020, 52(5):434-437.
Sneyd JR, Mathoulin SE, O'Sullivan EP, So VC, Roberts FR, Paul AA, Cortinez LI, Ampofo RS, Miller CJ, Balkisson MA: Impact of the COVID-19 pandemic on anaesthesia trainees and their training. Br J Anaesth 2020, 125(4):450-455.
CMSA The Colleges of Medicine of South Africa [https://www.cmsa.co.za/view_exam.aspx?QualificationID=1]
Coe TM, Jogerst KM, Sell NM, Cassidy DJ, Eurboonyanun C, Gee D, Phitayakorn R, Petrusa E: Practical Techniques to Adapt Surgical Resident Education to the COVID-19 Era. Ann Surg 2020, 272(2):e139-e141.
Registrar's perception of virtual teaching in an academic department during the COVID-19 pandemic [https://redcap.core.wits.ac.za/redcap/surveys/?s=K749KW3HJFN9YJC8]
Dost S, Hossain A, Shehab M, Abdelwahed A, Al-Nusair L: Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students. BMJ Open 2020, 10(11):e042378.
Rana T, Hackett C, Quezada T, Chaturvedi A, Bakalov V, Leonardo J, Rana S: Medicine and surgery residents' perspectives on the impact of COVID-19 on graduate medical education. Med Educ Online 2020, 25(1):1818439.
Aziz Ansari K, Farooqi FA, Qadir Khan S, Alhareky M, MA CT, Abidi T, M M: Perception on Online Teaching and Learning Among Health Sciences Students in Higher Education Institutions during the COVID-19 Lockdown - Ways to Improve Teaching and Learning in Saudi Colleges and Universities. F1000Res 2021, 10:177.
A basic approach in sampling methodology and sample size calculation [http://www.medtextpublications.com/open-access/a-basic-approach-in-sampling-methodology-and-sample-size-calculation-249.pdf]
Petrie A: Statistics in orthopaedic papers. The Journal of bone and joint surgery British volume 2006, 88(9):1121-1136.
Aisa I, Llau J, Gonzalez JM, Delgado C, Otero M, Romero C-S, Catala J, De Andres J: Impact of COVID-19 Pandemic on Anesthesia and Critical Care Residents in Spain. Anesthesiology and pain medicine 2021, 11(4).
Adnan M, Anwar K: Online Learning amid the COVID-19 Pandemic: Students' Perspectives. Online Submission 2020, 2(1):45-51.
Khalil R, Mansour AE, Fadda WA, Almisnid K, Aldamegh M, Al-Nafeesah A, Alkhalifah A, Al-Wutayd O: The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students’ perspectives. BMC medical education 2020, 20(1):1-10.
Ehrlich H, McKenney M, Elkbuli A: We asked the experts: virtual learning in surgical education during the COVID-19 pandemic—shaping the future of surgical education and training. World Journal of Surgery 2020, 44(7):2053-2055.
Hau HM, Weitz J, Bork U: Impact of the COVID-19 Pandemic on Student and Resident Teaching and Training in Surgical Oncology. J Clin Med 2020, 9(11).
Rose A, Aruparayil N: Postgraduate Surgical Training in the UK: the Trainees' Perspective. Indian J Surg 2021:1-5.
Wilcha R-J: Effectiveness of virtual medical teaching during the COVID-19 crisis: systematic review. JMIR Medical Education 2020, 6(2):e20963.

No competing interests reported.

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Registrars’ perspectives towards virtual teaching in an academic department during the COVID-19 pandemic.

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