The present study reports the final results from 13 040 participants who responded to our survey, which showed that the overwhelming majority of medical students in Russia were trained with the predominant use of online learning methods during the COVID-19 pandemic.
A major finding in this study was the relatively poor evaluation score for the level of knowledge gained, regardless of the field of study: clinical, natural sciences, or social humanities. Our assumption that it is more important for medical students to acquire clinical skills at the bedside, while other sciences can be learned remotely, was not confirmed. A previous study carried out in India revealed that more than half of the students surveyed reported that they could not get more benefit from online classes compared to traditional learning. In addition, more than 50% of the participants confirmed that the discipline level was affected due to continuous online learning 10. The present results are in accordance with those of another previous survey, where only 8.8% of the students of Pakistani medical schools agreed that the classes offered during the pandemic were quite effective 11.
To better understand the reasons for such surprising results, associations between VAS scores with the presence of an online learning experience and those with the use of simulators and MOOCs by schools were investigated. Our hypothesis that the level of knowledge would be affected by the lack of experience of studying remotely was confirmed by the results of statistical analysis for all 3 categories of disciplines, suggesting that the importance of proper training on how to study online cannot be exaggerated.
The survey showed that medical schools in Russia did not make sufficient use of MOOCs during the pandemic, despite the fact that there are such resources available on the platforms of the World Health Organization, Coursera, Harvard Medical School, London School of Hygiene and Tropical Medicine, University of Pittsburgh, as well as on Russian Open Education platforms and on the educational portal of Sechenov University. Students did not indicate whether they had access to paid resources that gather not only the most interesting lectures, and videos, but also interactive simulators. The experience of Kazan Medical University in the use of the Cyberpatient platform showed that student satisfaction and motivation increase with the use of virtual simulators 12. The results of the correlation analysis within the present study are concordant with the findings obtained previously, confirming our assumption that the insufficient use of MOOCs and simulators has partially determined the poor VAS scores.
During the pandemic, some of these platforms, such as the online simulation platform called CyberPatient, were open to medical students in all countries for free. The use of such modern gaming technologies is important for medical education, not only during a pandemic, but also within conventional education. However, their high cost creates limits to universities. It seems that the acquisition of the rights to use such resources should become part of national strategies for the advancement of medical education, especially in those countries where it is developing within public universities.
It should be noted that the geographical distribution of the results by regions of Russia illustrates the existing heterogeneity in terms of the availability of essential facilities and equipment to study online. In the Southern and North Caucasus federal districts, slightly more or less than half of the students did not find it possible to use a PC or laptop for online learning. The current findings might indicate two circumstances. Firstly, the case may be that not all undergraduates are equipped with multiple devices for studying, most of them have only smartphones. Secondly, that there is insufficient availability of the Internet, other than via mobile connectivity in particular regions of Russia, which can be explained by the different speeds of digital infrastructure development in the areas within the country. A similar survey conducted in India showed the opposite proportion for the country, in which more than 70% of trainees were prone to attending classes with the use of mobile devices 13.
The relationship between the use of smartphones to attend classes and satisfaction with remote learning has been hypothesized to be negative. However, statistical analysis has not confirmed that statement. In contrast, almost two-thirds of the respondents who studied using a smartphone favor at least certain elements of DL. Overall, despite the fact that certain differences in student satisfaction with DL depending on the device used were statistically significant, they cannot be considered practically meaningful, as the variance in percentages was minimal.
We also found that the new learning conditions have led to variations in academic workload. According to almost two-thirds of the respondents, the transition to remote training has led to a considerable increase in the time to self-study. Statistical analysis showed the growth of the workload for more than 60% of students within the group who dislike DL, suggesting that the finding has to be added to the list of disadvantages of online education delivery.
According to the data obtained, there are certain benefits of DL from the student perspective. These include more personalized training, less time and money spent on travel, and the promotion of self-control in the course of studies. It is important to note here that slightly less than one-third of the respondents enjoy the new way of studying fully and advocate for adherence to the 'new normal' even beyond the pandemic. Almost the same number of trainees support certain elements of the modified training. In particular, one-third of them prefer online lectures to live ones. Meanwhile, another third of the participants are against online learning or could not shape their opinion on the matter.
Addressing the international experience, the overwhelming majority of Indian undergraduates choose the traditional (50%) or blended (39,5%) mode of training 10. Therefore, Indian medical students who favor DL belong to the minority 13. At the same time, the trainees in Pakistan have developed a solid opinion against studying online as stated by 86,4% of the study participants 11.
Feedback obtained from learners appears to be one of the most useful tools for the refinement of existing teaching strategies, making them more efficient from the perspective of students 10. Universities and teachers in Russia should consider the findings of the present study when developing educational programs, focusing their efforts on creating quality content on electronic educational platforms and developing assessment tools that require students to be active and creative.
Limitations of study
A few areas of concern were not described in the study, such as the level of stress students have experienced due to the pandemic, the quality of preliminary training, the availability of technical support, mentoring provided by schools, the speed of the Internet, and related issues. In addition, the online-advertised study could have resulted in volunteer bias.