The COVID-19 outbreak has forced medical schools to suspend campus learning in order to curb the spread of the virus. Currently, medicals schools in Sudan are closed due to the COVID-19 health threat. In such situations, E-learning is the best solution that provides an online interactive learning environment for medical students. Hugenholtzet al. found that E-learning is just as effective in enhancing knowledge as lecture-based learning.[10] In the developed world, many academic institutions are using E-learning for more than twenty years. However, the dominant mode of education around the world is the classic classroom-based interaction. In limited-resource countries, like Sudan, shifting towards E-learning requires many adjustments to be made in order to make sure the E-learning is held in a proper manner, as best as possible.
In the Faculty of Medicine -University of Gezira, undergraduate medical students have no exposure to E-learning. Recently, the Medical Education Development Center-University of Gezira offers On-line E-learning for a master's degree in health professional education. In our study, approximately two-thirds of respondents reported that good quality internet connection is too expensive for them and the affordable bandwidth is limited, which often contributed to slow speed of download and low quality of videos or visual outputs. Moreover, in remote rural areas telecommunication signal is quite hampered. The information on internet infrastructures and the availability of computers in our settings may provide baseline information regards challenges to e-learning implementation. In Sub-Saharan Africa inadequate computer facilities, internet connectivity problems, institute experiences of performing e-learning, poor attitudes among students and lecturers, and incompatibility of mobile devices with the university online management systems. [11, 12] A previous study from India reported that 82 out of 201 of the planned e-learning sessions were canceled due to technical reasons (20%) or no availability of the presenter at the host end (80%).[13]
We found 24% of our study population being hostile to accept E-learning for learning because they are unaware of the effectiveness of E-learning compared to the face-face teaching style and are unfamiliar with E-learning systems. Lack of face-to-face interaction was considered as an inhibitory factor for E-learning implementation by 15% of our study population. Therefore, faculty administrators should develop strategies for increasing and ensuring higher levels of students’ engagement in and during E-learning. This challenge was reported in several studies from sub-Saharan Africa. [14-17]
We found most respondents have smartphones with reasonable facilities while only one-third had computers. Therefore, E-learning software that is user-friendly and easy to operate with a smartphone is needed. Mobile E-learning applications have been developed to provide support for students in rural areas. [18, 19].
After summarizing the response of students to the open questions, we found that 42.4% of the respondents were worried that E-learning may need specific preparations. Further study is needed to further investigate what factors considered to make them worried about this topic. If lack of understanding of how the E-learning software runs, it means that the information technology staff must be educating/socializing in more detail to a more limited and specific group. There is also fear among our study population about the methods for online assessment and time flexibility in case of technical problems.
Medical students at the clerk level and those from outside Sudan were more likely to agree to start E-learning and attend the session and exams (p-value < 0.05). This could be because students from outside Sudan (Gulf countries) have access to a good quality internet connection. Further study is needed to explain why medical students at the clerk level were more likely to agree to start e-learning than those in pre-clerkship. To find out the efficacy of E-learning in our limited resource setting, further study is needed to map the examination results of the medical students pre-COVID and compare them to results with E-learning during COVID
The study has several limitations. The small sample size from a single medical school in central Sudan limits the generalizability of our results and the data should be interpreted with caution. Moreover, the sample may not be representative of all medical students as there is a potential for selection bias in distributing via the internet as medical students with access to the internet during the study period were more likely to participate in the study. In this study, data were collected at only one point in time (cross-sectional design) and the researcher could not manipulate the variables. Therefore, longitudinal research is required to enhance the understanding of correlation and interrelationships among variables.