Dental e-learning before, during and after COVID-19 pandemic: a cross sectional study among Saudi dental students

International Journal of Community Medicine and Public Health Basudan AM et al. Int J Community Med Public Health. 2023 Jun;10(6):1971-1978 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20231670

Original Research Article

Dental e-learning before, during and after COVID-19 pandemic: a cross

sectional study among Saudi dental students

Amani M. Basudan*, Abdulrahman M. Almubarak, Abeer S. Al-Zawawi,

Fatemah M. Al-Ahmari, Hajer A. Aldulaijan, Hani S. Almoharib,

Marwa Y. Shaheen, Nahid Y. Ashri

Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia Received: 14 May 2023 Revised: 23 May 2023 Accepted: 25 May 2023 *Correspondence: Dr. Amani M. Basudan, E-mail: abasudan@ksu.edu.sa Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT Background: Dental education has been shifting from face‑to‑face learning to e-learning, and this was profound during the COVID-19 pandemic. This study aimed to assess the overall experience and satisfaction of dental students towards e-learning in Riyadh, Saudi Arabia, before, during, and after the COVID-19 pandemic. Methods: A cross-sectional questionnaire-based study was conducted between November 2022 and January 2023. The survey questionnaire comprised items for both qualitative and quantitative analysis of data. Non-parametric tests (Mann-Whitney U test and Kruskal-Wallis test along with Conover post-hoc analysis) were conducted to compare ‘e- learning experience’ and ‘overall satisfaction’, against the descriptive variables. Results: The sample of 250 participants comprised 52.4% females, 71.6% were in the age group 22 to 25 years, 96.4% were Saudi nationals, and 29.6% were 4th-year students. Approximately 72.8% of them described their IT skills as average and 55.2% of them had participated in e-learning activities before the COVID-19 pandemic. E-learning for practical/clinical sessions before the COVID-19 pandemic lockdown, during the complete lockdown, after partial return following the lockdown, and after complete return following the lockdown are statistically significantly higher in participants who had participated in e-learning before the pandemic. Conclusions: The present study ascertained the positive perceptions of dental students regarding e-learning as a preferred learning method. However, the students of the preclinical and clinical years have a varying preference between traditional face-to-face education and online learning. Keywords: E-learning, Online education, Face-to-face learning, Dental education, COVID-19

INTRODUCTION

Dental education has evolved over a century to meet the growing knowledge needs and this was challenged during the recent COVID-19 pandemic.1 The COVID-19 outbreak and lockdowns that followed posed a threat to the human community and had a substantial negative impact on different aspects of life, including education.2 The rapid spread of this virus required infection control measures and

physical distancing to prevent further spreading and help control the pandemic.3 As a preventative measure, face-to- face learning at schools and universities were suspended worldwide. Online education and e-learning were embraced as an alternative by the education sector world over and in Saudi Arabia it was mandated through the Saudi Ministry of Education, as early as March 2020.1,4 All Saudi universities, including medical and dental schools, expeditiously shifted to full-fledged e-learning systems,

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Basudan AM et al. Int J Community Med Public Health. 2023 Jun;10(6):1971-1978

leading to modification of teaching strategies for continued delivery of student courses.5

Contemporary didactic and practical teaching, within a dental school environment, plays a vital role in imparting knowledge, cognitive and psychomotor skills needed for the dental curriculum.6 Dental clinical education through “face-to-face” learning is best taught through patient demonstration, as it helps master communication skills and enhances self-confidence in patient handling.7 Over the last decade, e-learning has emerged as a popular mode of didactic and cognitive training, owing to its convenience, cost-effectiveness and time-efficiency. Even in medical and dental education, online teaching has gained prominence as it combines the benefits of limitless shared resources and ability of students to cope with the curriculum at their own pace.8, 9

Before COVID-19 pandemic, the concept of blended learning, a combination of face-to-face learning and e- learning, was introduced and used by many academic institutes globally, which also included Saudi Universities.7,10 Nevertheless, the online platforms remained under-utilized due to the lack of absolute necessity.10 While e-learning was seldom used for training psychomotor skills, the lockdowns due to COVID-19 pandemic signalled a paradigm shift in the way it was being used.4,10 Although research has confirmed that e- learning is effective in dental schools, it is challenged by technical intricacies, participant suitability, hands-on experience, limited student interaction, internet quality and lack of digital skills.9 It is therefore essential to understand if dental students were comfortable with the e-learning methodology and whether blended learning or traditional face-to-face learning was preferable.5 It is imperative that the extensive nature of the dental curriculum requires ample hours of clinical training in addition to didactics. While previous studies have assessed the overall student impact of online education during the COVID-19 pandemic.2,4,5,10,11 data pertaining to student perspectives on e-learning during different stages of the pandemic induced lockdown and more specifically its effect on didactic, practical and clinical dental education are not reported.

Therefore, the objective of our study was to determine the dental students’ perception, in terms of overall experience and satisfaction, regarding e-learning approaches before, during, and after the COVID-19 pandemic lockdown at dental colleges in Riyadh, Saudi Arabia.

METHODS

Ethical statement, study design, setting and participants

Following approval from the Institutional Review Board (IRB Project No. E-22-6875) at Ethical Sub-Committee for Health Sciences Colleges Research on Human Subjects, King Saud University – College of Medicine, a cross- sectional questionnaire-based study was conducted among

dental students in Riyadh, Saudi Arabia, during the time period from November 2022 to January 2023. A survey questionnaire comprising qualitative and quantitative data- analysis items was designed. Validity and reliability of responses was evaluated through a pilot sample (n=15). Queries arising after pilot survey were resolved in the final questionnaire, which was distributed randomly.

The final questionnaire had four parts which collected information as follows.

Part 1: demographic information (age, gender, year of study in dental school), IT skills study level of participants, and previous experience with e-learning platforms; part 2: information about advantages and disadvantages of e- learning, in the form of questions with multiple possible options; part 3: e-learning experience of participants, including theoretical, practical, and clinical exposure before, during, and after COVID-19 lockdown, in the form of questions with ordinal responses (never/rarely/sometimes/often/always); and part 4: overall satisfaction of participants towards e-learning before, during and after COVID-19 lockdown, in the form of questions with ordinal responses (excellent/very good/good/fair/poor).

The only inclusion criteria for the study was that students should have been studying in their respective dental schools for at least one year before the start of lockdown due to COVID-19. Students who did not undertake online study during the COVID-19 lockdown due to health concerns or as a result of break in study continuity, were excluded from the sampling frame. The sample size was estimated using ‘G*POWER’ open-source statistical software (Ver. 3.1.9.7, 2020). Assuming an effect size of 0.3 with alpha set at 0.05 and statistical power at 0.9, the desired sample size was estimated to be 240 participants.12

Data collection and statistical analysis

Collected data was tabulated and exported to statistical software (IBM SPSS Statistics Ver. 26, IBM Corporation, Armonk, NY, USA) for qualitative and quantitative analysis. All categorical descriptive variables (age groups, gender, academic level, IT skill levels, and previous participation in e-learning before the COVID-19 pandemic) were analysed for frequency and percentage. Non-parametric tests were conducted to compare mean ranks of “5-point” ordinal scale responses for ‘online learning experience’ and ‘overall satisfaction’, against descriptive variables. “Mann-Whitney-U test” was used for descriptive variables with two comparison groups (gender and previous participation in E-learning before the COVID-19 pandemic).

“Kruskal-Wallis test” was used when there were more than two descriptive comparison groups (age groups, academic level, and IT skill level). Conover post-hoc analysis was conducted for comparison between individual groups. A p value of <0.05 was used to report statistical significance.

International Journal of Community Medicine and Public Health | June 2023 | Vol 10 | Issue 6 Page 1972

Basudan AM et al. Int J Community Med Public Health. 2023 Jun;10(6):1971-1978

RESULTS

Participants

The study participants (N=250) comprised 52.4% females, 71.6% within an age group of 22-25 years, 96.4% Saudi nationals, and 29.6% students from the 4th year. Descriptive data of all the participants are shown in Table 1. Similarly, participant responses pertaining to the different types of digital resources and learning platforms used in e-learning, and the advantages and disadvantages of E-learning are described in Table 2.

While blackboard (84.8%) and zoom (82.8%) were the most commonly used platforms for e-learning, the ability to study from home was perceived as the greatest advantage of online education (72.8%) and technical difficulties were seen as the biggest disadvantage (76.4%).

Table 1: Descriptive statistics of the participants (N=250), including demographic characteristics, information technology skill level and participation in

e-learning before COVID-19 pandemic.

IT – Information technology

The construct of the MMA consisted of the following variables; pill count, recital dosage, regular clinic attendance, recall screen, self-report adherence, symptoms of hypo/hyperglycemia, and ETU/Hospital admissions. Table 2 demonstrates the results of the Man Whitney U test results for categorical variables; regular clinic attendance, recall screen, self-reported adherence, regular FBS, short-

term glycemic control, symptoms of hypo/hyperglycemia, and ETU/Hospital admissions.

Table 2: Distribution of participants’ responses towards the use of different type of digital e-learning,

and their advantages and disadvantages (N=250).

*Multiple responses

Dental e-learning experience of participants

Participants’ responses towards their experience with e- learning for lectures, practical and clinical sessions were assessed on a five-point scale (never, rarely, sometimes, often, and always). Their responses were stratified based on the timing of e-learning exposure in relation to COVID- 19 lockdown, either as before, during, after partial return or after complete return (Table 3). In terms of theoretical experience, participants never (33.2%) or rarely (32.0%) experienced e-learning before COVID-19 lockdown. On the contrary, during COVID-19 lockdown, participants underwent theoretical e-learning sessions most of the times (often – 8.4%; always – 76.4%). While this trend continued during partial return after COVID-19 lockdown, it showed evidence of moving back to pre-COVID scenario after complete return to normalcy post pandemic lockdown. The above findings are based on the participant responses, as shown in Table 3. Similarly, in terms of practical/clinical e-learning sessions, the response was “never, rarely or sometimes” both before COVID-19 lockdown (79.2%) and

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Basudan AM et al. Int J Community Med Public Health. 2023 Jun;10(6):1971-1978

after complete return (83.6%) from it. Although more than 50% of the participants agreed to undergoing practical/clinical sessions though e-learning during the complete COVID-19 lockdown, only less than 25% reported such similar session before COVID-19 or even after partial and complete return from lockdown.

Participants’ satisfaction with e-learning

Based on pre-COVID-19 experience, majority of the participants ranked their satisfaction as either good

(35.2%), fair (21.2%) or poor (20%). However, the satisfaction frequency showed an increasing trend when enquired about e-learning during COVID-19 lockdown (excellent/very good – 58.4%) and immediately after partial return from it (excellent/very good – 51.2%), as shown in Table 4.

Interestingly, there was a better frequency of satisfaction towards e-learning even after complete return from COVID-19 lockdown (excellent/very good – 44.4%), indicating a shift in perspective.

Table 3: Distribution of participants’ responses towards their experience with e-learning before, during and after

COVID-19.

h

Effect of participant characteristics on theoretical experience with e-learning

Considering the age groups of participants, before COVID-19 lockdown, those older than 25 years had the greatest mean rank of responses. However, during the lockdown and after partial and complete return from lockdown, the mean rank of responses became higher among those between 22-25 years. Except during pre- COVID-19 lockdown, the age group significantly affected mean rank of responses (p<0.05) for theoretical e-learning experience, at all other times. Based on gender, female participants had higher mean rank of responses to theoretical e-learning experience, before, during and after COVID-19 lockdown, with statistically significant differences (p<0.05) observable only before COVID-19. Comparing the academic levels, statistically significant differences (p<0.05) in mean rank of responses were observed based on theoretical e-learning experience during COVID-19 lockdown and after return from lockdown. In the case of undergraduate academic levels, mean ranks were higher for 4th and 5th year students before, during and after lockdown. On the contrary postgraduate students responded with higher mean ranks only before and after complete return from lockdown. In line with their IT skill levels, the mean ranks of responses were always higher among those with above average IT knowledge, which was

only statistically significant (p<0.05) when considered during the lockdown and after partial return from it. Interestingly, after complete return from lockdown, the mean rank of responses was higher in participants with both average and above average IT skill levels, indicating a probable perspective change due to greater exposure to e-learning. While, previous participation in e-learning before the pandemic signalled a significantly higher mean rank of responses before and after lockdown, the pandemic induced lockdown made e-learning statistically indifferent for both new and old users. (Table 5).

Effect of participant characteristics on practical and clinical experience with e-learning

Statistically significant differences in mean rank of responses (p<0.05) with respect to practical/clinical e- learning experience was observed in all age groups, before, during and after COVID-19 lockdown. While the mean ranks were highest in those aged 26 years or older, before and after lockdown, during the lockdown it was highest among participants less than 22 years. A similar trend in mean rank of responses to practical/clinical e-learning experience was observed based on academic levels, wherein the younger age group matched lower levels and the older age group the higher levels. Nevertheless, statistically significant difference in mean rank of

International Journal of Community Medicine and Public Health | June 2023 | Vol 10 | Issue 6 Page 1974

Basudan AM et al. Int J Community Med Public Health. 2023 Jun;10(6):1971-1978

responses (p<0.05) with respect academic level was seen only after complete return from pandemic lockdown. In line with theoretical e-learning experience, female participants also showed better mean rank of responses for practical/clinical e-learning too. However, there were no statistically significant differences. While level of IT skills, did not seem to play a significant role in altering the mean rank of responses for practical/clinical e-learning, before, during and after COVID-19 lockdown, prior participation in e-learning activities significantly improved mean rank of responses (p<0.05) at all times surrounding the pandemic (Table 5).

Effect of participant characteristics on overall satisfaction with e-learning

Comparing the mean rank of responses for overall satisfaction with e-learning against age groups of participants, the greatest statistically significant mean rank (p<0.05) was observed among those younger than 22 years and after partial return from lockdown. Participants older than 25 years, had the lowest mean rank of responses for overall satisfaction, during COVID-19 lockdown and after partial return from it. Although not statistically significant, overall satisfaction with e-learning was higher among males than females, based on their greater mean rank of responses. With respect to the difference in mean rank of responses for overall satisfaction based on academic levels, statistically significant difference was observed only during the partial return from COVID-19 lockdown, wherein interns had a poor mean rank of response. Neither IT skill level nor previous participation in e-learning had a significant effect on the mean rank of responses for overall satisfaction, irrespective of the timing surrounding lockdown. (Table 6).

Table 4: Distribution of participants’ responses towards their overall satisfaction with e-learning

experience during different stages of COVID-19

lockdown (N=250).

Table 5: Comparison of mean ranks of participants’ responses towards their experience with e-learning before,

during and after COVID-19 in relation to descriptive variables.

Continued.

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