Knowledge, attitudes and practices of medical students towards electronic learning in a tertiary care centre in central India: a cross-sectional study

INTRODUCTION

Electronic learning is a method of teaching and learning using electronic media.¹ E-learning is also called Web-based learning, online learning, distributed learning, computer-assisted instruction and Internet-based learning.² Developing countries are growing in the use of computer and internet-based learning compared to their usage in the last decade.³

Pandemic situation like COVID-19 cause suspension of medical training through clinical rotations. Other challenges include a fear that medical students may contract the virus during their training and may transmit it to the community.⁴ Additionally, students are required to stay at home and to abide by social distancing guidelines. Therefore, we must develop a medical education curriculum that provides students with opportunities for continuous learning, while also avoiding delays due to the pandemic.⁵

Some of the most commonly proposed methods include scheduled live online video lectures with interactive discussions and the utilization of several different programs or self-study online recorded lectures made available online for medical students in each university. Hence, online classes became a key component in the continuity of education.^6,7

The biggest challenge faced by the growing countries is availability of computers and access to internet, financial support in terms of administration and faculty time and training.¹ Software skills in computer both rural and urban areas along with hesitation to accommodate newer methods in learning lay a setback in adapting e-learning.⁸ It is therefore important to assess the usability of online learning methods as well as determine their feasibility and adequacy for medical students. Through this study we have aimed to provide an overview of medical student’s knowledge, attitudes, and practices towards electronic learning.

Study objective

To study knowledge, attitudes, and practices of medical students towards electronic learning during covid pandemic in a tertiary care centre in central India. To give suitable recommendations based on the study findings.

METHODS

A cross sectional study was conducted in a tertiary care centre in central India from October 2021 to January 2022. Study participants were students pursuing MBBS course and MBBS interns. MBBS students and interns who gave consent for the study were included in the study.

Sample size

With reference to the study done by Alsoufi et al, 97.1% of the participants reported suspended lectures due to COVID-19 pandemic.¹⁴

Absolute precision = 2%

Desired confidence level (1-α) %= 95%

Calculated sample size = 270

Considering 20% non-response rate, final sample size: 270+54=324.

Since there were 250 students each in 1^st and 2^nd year MBBS and 200 students in 3^rd year, final year MBBS and MBBS interns, probability proportional to size (PPS) sampling was done as follows: 1^st year MBBS= 74 students; 2^nd year MBBS= 74 students; 3^rd year MBBS= 59 students; final year MBBS= 59 students; MBBS interns= 59 students.

A total of 325 MBBS students and interns were taken as study participants. Data was collected using a preformed, semi structured questionnaire regarding the knowledge, attitude and practices towards e-learning that was distributed as Google form by means of social media (WhatsApp, email). Data was analysed using Microsoft excel 2007 and statistical software Epi Info 7. Approval from the Institutional Ethics Committee was sought.

RESULTS

Basic demographic characteristics

Figure 1 shows distribution of study participants according to their gender. 148 (46%) of the study subjects were female and 177 (54%) of the study participants were male. Age of the study participants ranged from 18-30 with mean age 21.55 (1.67) years. Figure 2 shows distribution of study participants according to their educational year. 240 (73.8%) study participants were hostellers while 85 (26.2%) were day scholars. 216 (66.5%) of the respondents resided in urban area and 109 (33.5%) resided in rural area.

Study results shows that 46.2% had good and 19.4% had acceptable level of proficiency in using various electronic devices. 163 (52.2%) felt that the quality of available internet service is good. 310 (95.4%) personally owned and utilized smart phone for their medical education.

Education of the students mainly depended upon self-study utilizing various educational sources i.e 275 (84.6%). Main use of internet was for medical education and e-learning i.e. 294 (90.5%) and social media and E-mail i.e. 221 (68%).

Figure 3 shows that majority of the study participants (253) used 4^th generation internet service.

Knowledge of medical students toward e-learning

Table 1 shows the respondent’s understanding of e-leaning. Among the respondents, 80.9% had some idea about e-learning, while 90.2% were aware of the services provided through e e-learning. Most of the respondents (73.2%) considered e-learning as being part of tele-education. For further analyses, each response of “true,” “false,” or “I do not know” was scored quantitatively.

A score of 1 was assigned to “true,”, and a score of 0 was assigned to a “false” or “I do not know” response. Scores ranged from 6 (maximum) to 0 (minimum). A cutoff score of 5 was considered to indicate an adequate understanding, while <5 was considered to indicate a poor understanding. Among 325 participants, the mean (SD) score was 4.27 (0.084) with a variance of 2.33, while 169 (52%) had an adequate understanding and 156 (48%) had a poor understanding of e-learning.

Attitudes of medical students toward e-learning

Table 2 shows attitudes of medical students toward e-learning. It was assessed through questions based on the applicability and usability of e-learning in medical schools. Each response was scored using a Likert-type scale (strongly disagree, disagree, neutral, agree, and strongly agree). 48.6% disagreed that e-learning can be used for clinical aspects of medical sciences while 26.8% are neutral. 47.3% agreed that e-learning is more convenient and flexible than conventional learning while 32.6% had a neutral view for the same. 60.3% of the respondents disagreed that e-learning can cover the practical aspect of medical education curriculum.

Medical students’ practice evaluation of e-learning

Table 3 describes the participant’s responses to e-learning practices. Majority i.e. 193 (59.4%) of the students had participated in online medical education program. 275 (84.6%) used the internet regularly in their studies. 242 (74.5%) study participants used to download content related to your medical education in a periodic manner. 290 (89.2%) used online applications and platforms for medical education purposes.

For further analyses, each “yes” or “no” response was scored as 1 or 0, respectively. Scores ranged from 11 (maximum) to 0 (minimum). A cutoff score of 8 was considered to indicate an adequate level of practice, while <8 was considered to indicate an inadequate level. Among 325 participants, 167 (51.4%) exhibited an adequate level of practice, whereas 158 (48.6%) fell in the inadequate practice range.

DISCUSSION

This study focused to evaluate medical student’s knowledge, attitudes, and practices regarding e-learning, as it was the only platform for providing medical education during the covid outbreak. The results revealed an acceptable level of knowledge, attitudes, and practices regarding e-learning, which evidences the usability of e-learning during the COVID-19 outbreak. The findings also highlight its potential to reach medical students and transform medical training.

In this study 148 (46%) of the study subjects were female and 177 (54%) of the study participants were male. Age of the study participants ranged from 18-30 with mean age 21.55 (1.67) years. The study findings show that majority of the students use social media 244 (75.1%) as a source of COVID-19 knowledge. Study results shows that 46.2% have good and 19.4% have acceptable level of proficiency in using various electronic devices. 163 (52.2%) feels that the quality of available internet service is good. 310 (95.4%) personally own and utilize smart phone in their medical education.

In a study by Alsoufi et al, in Libya, participants were predominately female; the sample included 2,390 females (71.4%) and 958 (28.6%) males.¹⁴ The mean age was 21.87 years. Most participants (3,117; 93.1%) reported owning a smartphone. Additionally, 3,039 (90.8%) and 2,603 participants (77.7%) reported that they used the internet for social media and medical education purposes, respectively similar to our study findings. While, study done by Dhahri et al, at Lahore Pakistan, 1753 (65.9%) were female while 908 (34.1%) male participants.¹⁸

In this study, 48.6% disagreed that e-learning can be used for clinical aspects of medical sciences. 47.3% agreed that e-learning is more convenient and flexible than conventional learning while 32.6% have a neutral view for the same. 60.3% of the respondents disagree that e-learning can cover the practical aspect of medical education curriculum.

Majority i.e. 193 (59.4%) of the students had participated in online medical education program. 275 (84.6%) used the internet regularly in your studies. 242 (74.5%) study participants used to download content related to your medical education in a periodic manner. 290 (89.2%) used online applications and platforms for medical education purposes.

Similarly, in the study by Alsoufi et al, in Libya, 49.7% of the respondents agreed that e-learning can cover practical lessons. Approximately 38.2% agreed that e-learning can replace traditional teaching methods, although 73.6% disagreed and they believed that the quality of the local internet was not good enough to facilitate e-learning platforms. 75.6% had some idea about e-learning, while 71.6% were aware of the services provided through e-learning. Most of the respondents (82.3%) considered e-learning as being part of tele-education. 86.1% reported that they used the internet for medical education purposes.

In a study done by Rajab et al, most respondents (76%) intended to integrate online expertise gained during the COVID-19 pandemic into their teaching/learning strategies.¹⁷

Most of the students (68.6%) felt that it is better to help out in hospitals during the pandemic. Similarly, in study done by Choi et al, in United States, majority respondents agreed that assisting in hospitals during the outbreak would be a valuable learning opportunity.

This study has few limitations. In this study, we observed that most medical students had access to electronic devices and were able to use them. We also found that medical students displayed acceptable levels of knowledge, attitudes, and practices regarding e-learning. However, our study was performed in Central India with specific settings. Therefore, the results may not be generalized and they must be validated by further studies and centers to obtain an overview of the utility of the online learning platform as a mode of teaching.

The lack of knowledge in computer skills along with poor technological infra structure and resource can be a challenge for implementation of e-learning in some regions.

CONCLUSION

The study results shows that e-learning is a useful tool to ensure continuity of medical education as well as helpful in minimizing the effects of pandemics like COVID-19 on medical education and on the progression of training.

There is a critical need for academic coaching programs that will help students engage in continued learning with supervision and follow-up by their teachers. This will prevent students from becoming less motivated, and will increase communication skills between learners and educators. Further studies should be done to understand and similarly find solution for continuation of medical education in future medical aspirants.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Ruiz JG, Mintzer MJ, Leipzig RM. The impact of e-learning in medical education. Acad Med. 2006;81(3):207-12.
2. 2. Yapa YM, Dilan MM, Karunaratne WC, Widisinghe CC, Hewapathirana R, Karunathilake I. Computer literacy and attitudes towards eLearning among Sri Lankan medical students. Sri Lanka J Bio-Med Inform. 2012;3(3):82-96.
3. 3. Williams CD, Pitchforth EL, O’Callaghan C. Computers, the internet and medical education in Africa. Med Educ. 2010;44(5):485-8.
4. 4. Khasawneh AI, Humeidan AA, Alsulaiman JW, Bloukh S, Ramadan M, Al-Shatanawi TN, et al. Medical students and COVID-19: knowledge, attitudes, and precautionary measures. A descriptive study from Jordan. Front Public Health. 2020;8:253.
5. 5. Ross DA. Creating a “quarantine curriculum” to enhance teaching and learning during the COVID-19 pandemic. Acad Med. 2020.
6. 6. Chiodini J. Online learning in the time of COVID-19. Travel Med Infect Dis. 2020;34:101669.
7. 7. Mian A, Khan S. Medical education during pandemics: a UK perspective. BMC Med. 2020;18(1):100.
8. 8. Link TM, Marz R. Computer literacy and attitudes towards e-learning among first year medical students. BMC Med Educ. 2006;6(1):1-8.
9. 9. Woolliscroft JO. Innovation in response to the COVID-19 pandemic crisis. Acad Med. 2020.
10. 10. Calhoun KE, Yale LA, Whipple ME, Allen SM, Wood DE, Tatum RP. The impact of COVID-19 on medical student surgical education: implementing extreme pandemic response measures in a widely distributed surgical clerkship experience. Am J Surg. 2020;220(1):44-7.
11. 11. Vadlamani S, Kandipudi LP, Bhimarisetty DM. Assessment of knowledge, attitude and practice towards e-learning among undergraduate medical students, Andhra Medical College, Vishakhapatnam. Int J Community Med Public Health. 2019;6(12):5235-40.
12. 12. Chandragirish S, Mhesh V, Shashank KJ. Assessing the effectiveness of online learning in anatomy among first MBBS students during COVID-19. Indian J Clin Anat Physiol. 2021;8(2)145-8.
13. 13. Bagewadi HG, Desai S, Patil BV, Zahid SH. A questionnaire based study among second year medical students to assess the effectiveness of the usage of Computer Assisted Learning (CAL) as an adjuvant to teaching og pharmacology practicals at Gulbarge institute of medical sciences, Kalaburagi. IP Int J Comprehen Adv Pharmacol. 2018;3(2):35-8.
14. 14. Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H, Ashini A, et al. Impact of the COVID-19 pandemic on medical education: medical students’ knowledge, attitudes, and practices regarding electronic learning. PloS One. 2020;15(11):e0242905.
15. 15. Choi B, Jegatheeswaran L, Minocha A, Alhilani M, Nakhoul M, Mutengesa E. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey. BMC Med Educ. 2020;20(1):1-1.
16. 16. Hammond D, Louca C, Leeves L, Rampes S. Undergraduate medical education and Covid-19:engaged but abstract. Med Educ Online. 2020;25(1):178137.
17. 17. Rajab MH, Gazal AM, Alkattan K. Challenges to online medical education during the COVID-19 pandemic. Cureus. 2020;12(7).
18. 18. Dhahri AA, Arain SY, Memon AM, Rao A, Khan MM, Hafeez G, et al. The psychological impact of COVID-19 on medical education of final year students in Pakistan: a cross-sectional study. Ann Med Surg. 2020;60:445-50.