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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 4  |  Page : 176-183

Evaluation of e-learning of undergraduate medical students during the COVID-19 pandemic lockdown by an Objective Structured Practical Examination


Department of Microbiology, N.C. Medical College and Hospital, Israna, Panipat, Haryana, India

Date of Submission01-Jun-2020
Date of Decision18-Jun-2020
Date of Acceptance18-Jun-2020
Date of Web Publication09-Dec-2020

Correspondence Address:
Dr. Gurjeet Singh
Department of Microbiology, N.C. Medical College and Hospital, Israna, Panipat-132107, Haryana.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_56_20

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  Abstract 

Background: E-learning resources have a broad range of uses in medical education. Skills require the teaching of numerous domains, including cognitive and psychomotor domains in medical education. Feedback supports better competence in medical education, it has been shown that multimedia and e-learning tools have improved testing in both cognitive and psychomotor domains. Aims and Objectives: This study was conducted to evaluate the e-learning of undergraduate medical students with an Objective Structured Practical Examination (OSPE). Materials and Methods: A total of 96 of 150 medical students participated in a single group in e-learning, as this study was purely Internet based, so it may be that the remaining 54 students did not participate due to no Internet connectivity. By using OSPE, we have created two stations (video based), one was hand hygiene and the second was biomedical waste management. At the start of 30min, students were sensitized to lectures (one-way teaching) followed by a 30-min video of each station using the GoToMeeting app. In the end, the students were asked to correct steps of hand hygiene and segregation of biomedical waste, according to the color-coding system. Results: Of 96 students who took both the tests and gave their feedback on the questionnaire, 95.83% felt that they were given adequate time at each station, 68.75% responded that the teaching material provided in the e-learning resources were clear and easy to understand, 73.96% responded that the e-learning resources covered a wider range of knowledge than the traditional examination, 86.46% said that the e-learning resources were helpful in understanding basic hand hygiene concepts, 94.79% said that the e-learning resources were helpful in memorization and revision of hand hygiene practical skills, 61.46% opined that e-learning resources were easier to pass than traditional examination, 96.88% responded that the OSPE assessment of the e-learning process helped in scoring better than the traditional assessment methods and was less stressful, 81.25% said that OSPE helps in e-learning as well as evaluation in competency-based medical education (CBME), and 96.88% said that OSPE should be implemented in medical education as an assessment tool for both formative and summative evaluation. Conclusion: e-Learning advances can possibly substitute face-to-face address in medical education, especially during this pandemic. Such methodologies may not exclusively be vital for successfully handling the clinical training quandary during this present emergency; however, it will likewise serve to establish the framework for educating during future calamities and past.

Keywords: Coronavirus disease 2019, e-learning, undergraduate medical students, medical education, pandemic


How to cite this article:
Singh G, Singh R. Evaluation of e-learning of undergraduate medical students during the COVID-19 pandemic lockdown by an Objective Structured Practical Examination. MGM J Med Sci 2020;7:176-83

How to cite this URL:
Singh G, Singh R. Evaluation of e-learning of undergraduate medical students during the COVID-19 pandemic lockdown by an Objective Structured Practical Examination. MGM J Med Sci [serial online] 2020 [cited 2021 Oct 21];7:176-83. Available from: http://www.mgmjms.com/text.asp?2020/7/4/176/302802




  Introduction Top


Over the past few years, the concept of e-learning has been rapidly accepted as an important component of medical education.[1] The definition of e-learning is varied; however, in its most rudimentary form, e-learning is a method that uses Internet-based resources for teaching and learning purposes. In surgery, e-learning is not seen as a single entity but rather a combination of teaching methods, such as online lectures, tutorials, or virtual case studies.[2] The literature has described a number of advantages of e-learning, including ease of access, increased flexibility of student learning, increased interactivity between educators and students, decreased content review times, and opportunity for immediate self-assessment.[3],[4],[5]

E-learning resources have a broad range of uses in medical education and they are especially adept at teaching clinical skills. Clinical skills require the teaching of multiple domains, including declarative knowledge (underlying facts), procedural steps (the “how” of performing a task), and clinical reasoning.[6] Although we understand that repetition and feedback support better competence in clinicians, it has been shown that multimedia and e-learning tools have improved testing in both declarative knowledge and procedural step domains.[7],[8]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) moved rapidly through China, and the virus had spread to more than 60 countries and infected nearly 90,000 patients by March 5, 2020. On the basis of data for 72,314 cases of novel coronavirus or coronavirus disease 2019 (COVID-19), 14% of people have severe disease, 5% have a critical illness, and 2·3% die. COVID-19 is not a conventional disease, and rapid changes in the provision of critical care have been needed to meet the needs of patients. Health emergencies (such as the COVID-19 outbreak) can be a huge challenge for critical care physicians, who need strong comprehensive skills to respond effectively. Critical care related to continuing medical education has an important part to play in preparing for and responding to such emergencies.[9]

In the second week of March, state governments across the country began shutting down schools and colleges temporarily as a measure to contain the spread of the COVID-19. It is close to a month away and there is no certainty when they will reopen. This is a crucial time for education, especially in medical education, where the students who have clinical teaching (teaching on patients) apart from other practicals, are all held during this period. As the days pass by with no immediate solution to stop the outbreak of COVID-19, schools, colleges, and university closures will not only have a short-term impact on the continuity of learning for more than 285 million young learners in India but also engender far-reaching economic and societal consequences. The structure of teaching and learning, including teaching and assessment methodologies, was the first to be affected by these closures. Needless to say, the pandemic has transformed the centuries-old, chalk–talk teaching model to one driven by technology. This disruption in the delivery of education is pushing policymakers to figure out how to drive engagement at scale while ensuring inclusive e-learning solutions and tackling the digital divide. A multipronged strategy is necessary to manage the crisis and build a resilient Indian education system in the long term.[10]

The need to prepare future physicians has never been as focused as it is now on the setting of a global emergency. The profound effects of COVID-19 may forever change how future physicians are educated. This pandemic presents practical and logistical challenges and concerns for patient safety, recognizing that students may potentially spread the virus when asymptomatic and may acquire the virus in the course of training. This viewpoint discusses the current status of medical education, describes how COVID-19 may affect pre-clerkship and clerkship learning environments, and explores potential implications of COVID-19 for the future of medical education.[11]

For more than a decade, medical colleges have been working to transform pedagogy by eliminating or reducing lectures, using technology to replace or enhance anatomy and laboratories, implementing team-facilitated, active, and self-directed learning, and promoting individualized and interprofessional education.[12],[13] The development of ineluctable professional activities and competency-based learning with identified milestones for achievement has transformed assessment. Many medical colleges have decreased the basic science curriculum to 12 or 18 months while integrating clinical medicine within this time frame and revisiting the basic sciences later in medical colleges.[14]

Today, in most medical schools, students convene in physical settings during the first 12–18 months for interactive problem solving or discussions in small groups; their physical presence in both inpatient and outpatient settings has been an unquestioned tenet of early clinical immersion experiences and the clerkship curriculum. The last 18 months of medical school may be individualized, with students participating in advanced clinical rotations, sub-internships before residency, or scholarly projects. COVID-19 has the potential to affect students throughout the educational process.[11]

A key to the educational dilemma involves looking at the length of the epidemic. If indeed, as seems to be the case, it was set to last several months; this would lead to a substantial loss of learning time for students and probable depreciation in confidence, although the slight loss of clinical skills would likely be quickly rekindled once students are back in a clinical environment. With the emergence of e-learning platforms, both can be combined to fill in the gaps that would otherwise, normally be learned from lecturers or clinicians on the wards. As a side note, learning should always be placed in the modern context, and great novels of the plague, such as Daniel Defoe’s Journal of the Plague Year, Manzoni’s The Betrothed, or Camus’s La Peste, can provide students with highly relevant perspectives to the current predicament we find ourselves in. This will not only illustrate why microbiologists have worried about “the big one” for so long but may even motivate students to pursue a career in infectious disease and help in the prevention of future outbreaks.[15]

Aims and objectives: The aims and objectives of this study are as follows:

  1. To evaluate the e-learning of undergraduate medical students by an Objective Structured Practical Examination (OSPE)


  2. To analyze the students’ feedback for the e-learning evaluation


  3. To analyze how OSPE is useful to assess the competency of the medical students during the COVID-19 pandemic lockdown



  Materials and methods Top


A prospective study was conducted at the Department of Microbiology and Medical Education Unit, N. C. Medical College and Hospital in Israna, Panipat, Haryana, India, over a period of 3 months from March to May 2020. A total of 96 students from MBBS’ first professional year were included in the study.

Inclusion criteria

All first professional year students, of either sex, who gave written informed consent to participate in the study.

Exclusion criteria

Those who did not give written informed consent were excluded from the study.

Online teaching and evaluation with GoToMeeting app

GoToMeeting is a web-hosted service created and marketed by LogMeIn. It is an online meeting, desktop sharing, and video conferencing software package that enables the user to meet with other computer users, customers, clients, or colleagues via the Internet in real time. GoToMeeting was developed in July 2004, using remote access and screen sharing technology from GoToMyPC and GoToAssist to allow web conferencing. The later releases of GoToWebinar in 2006, and GoToTraining in 2010, expanded GoToMeeting capabilities to accommodate larger audiences. In February 2017, GoToMeeting became a product of LogMeIn as a result of a merger between LogMeIn and Citrix’s GoTo business.[16]

Of 150 students preinformed, sensitized, and motivated for participation, 96 students agreed and actively participated in this study, as this study was purely Internet based, so the remaining 54 students did not participate due to no Internet connectivity. The students were taken in a single group in e-learning.

By using OSPE, we have created two stations (video based): one was hand hygiene and second was biomedical waste management. We selected these stations in keeping in mind COVID-19 pandemic, as students must be aware of the importance of hand hygiene, which is most important in the prevention of spreading COVID-19, and waste segregation, which as per the guideline updated time to time is also equally important in the prevention of spreading COVID-19 in the hospital area or in the health-care area.

In the starting 30min, the students were sensitized to lectures (one-way teaching) followed by a 30-min video of each station using the GoToMeeting app. In the end, the students were asked to correct steps of hand hygiene and segregation of biomedical waste, according to the color-coding system [Figure 1]. Care was taken to have things that were comparative as far as targets to be evaluated as additionally the trouble level, for both the arrangements of stations [Table 1] and [Table 2].
Figure 1: Topic for e-learning

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Table 1: Objective structured practical examination stations grouped by the domain tested

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Table 2: Objective Structured Practical Examination Stations

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For practical skills evaluation of students for hand hygiene, the students were told to make a video following complete steps of hand hygiene and send on the teacher’s e-mail id or WhatsApp number; students were also told that their face must be in the video for recognition and prevention of sharing and copying of video, and 10 multiple-choice questions (MCQ) were given to students and were asked for submission on e-mail or WhatsApp Number [Table 3]. However practical skills evaluation of biomedical waste was conducted by giving 10 multiple-choice questions (MCQ) to students and asking them to submit on e-mail id or WhatsApp number [Table 4].
Table 3: Evaluation sheet for hand hygiene

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Table 4: Evaluation sheet for biomedical waste

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It was completed within one and a half hours after the students were provided with a table in which the students were told to tick mark the table of each question such as agree or disagree or neither agree nor disagree, only one of these three can be ticked, but all three or two of a single question cannot be ticked. Questions were asked, such as the following: Was adequate time given for each station? Was teaching material provided in the e-learning resources clear and easy to understand? Did e-learning resources cover a wider range of knowledge than traditional examinations? Were e-learning resources helpful in understanding basic hand hygiene concepts? Were e-learning resources helpful in memorization and revision of hand hygiene practical skills? Were e-learning resources easier to pass than traditional examinations? Did OSPE assessment of the e-learning the process help in scoring better than traditional assessment methods and is it less stressful? Does OSPE help in e-learning as well as evaluation in competency-based medical education (CBME)? And should OSPE be implemented in medical education as an assessment tool for both formative and summative evaluation? [Table 5].
Table 5: Post-study survey results on the e-learning resources for feedback purposes

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  Results Top


In this study, of 150 students, preinformed, sensitized, and motivated for participation, 96 students agreed and actively participated in this study. The students were taken in a single group in e-learning.

From the study regarding hand hygiene, it is apparent that of 96 students, 55 (57.29%) were doing all 10 steps correctly as per their video, and marks were given accordingly, 20 (20.83%) students were doing 8 of 10 steps correctly, 12 (12.50%) students were doing 7 of 10 steps correctly, and 9 (9.38%) students were correctly performing 4 of 10 steps correctly. Regarding biomedical waste, of 96 students, 60 (62.50%) had written all 10 answers correctly, 30 (31.25%) students wrote 9 of 10 answers correctly, and 6 (6.25%) students wrote 5 of 10 correctly. Of 96 students who took both the tests and gave their feedback in questionnaire, 95.83% felt that they were given adequate time at each station, 68.75% responded that the teaching material provided in the e-learning resources were clear and easy to understand, 73.96% responded that the e-learning resources covered a wider range of knowledge than traditional examination, 86.46% said that the e-learning resources were helpful in understanding basic hand hygiene concepts, 94.79% said that the e-learning resources were helpful in memorization and revision of hand hygiene practical skills, 61.46% opined that e-learning resources were easier to pass than traditional examination, 96.88% responded that the OSPE assessment of the e-learning process helped in scoring better than the traditional assessment methods and was less stressful, 81.25% said that OSPE helps in e-learning and evaluation in CBME, and 96.88% responded that OSPE should be implemented in medical education as an assessment tool for both formative and summative evaluation [Table 5] and [Figure 2].
Figure 2: Post-study survey results on the e-learning resources for feedback purposes

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  Discussion Top


According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), since the episode of COVID-19 began, some 1.37 billion students in 138 countries worldwide have been impacted due to shut down of their educational centers. About 60.2 million educators are no longer in the examination lobby. As the whole country is under lockdown, e-learning is the best bet left? School resources are setting up accounts on online video conferencing stages, for instance, Zoom, Skype, Google Classroom, and GoToMeeting, among others, to interface with students. This new method of teaching and learning holds out the opportunity for on-demand access to content at whatever point, wherever, on any modernized contraptions, be that as it may, this unconstrained virtualization of preparation wound up being going after for both the association and students. Computerized instruction today is a blend between existing social shows such as existing understanding material and course books and shows of programming new media such as portable document format (PDF).[17]

There are many favorable circumstances for online classes that are worth noting. Changing learning into the current timetable is probably the best bit of leeway. The adaptability helps in keeping up a vacation while taking a shot at instruction. Students of online classes are frequently given the opportunity to finish exercises before a set cutoff time. This permits students to finish their coursework without giving up hours at their present place of employment or valuable time spent with family. Online training is regularly, increasingly moderate, and the cost of heading off to college is probably the most compelling motivation that hopefuls understudy to keep away from trying out a program. Notwithstanding, saving students the expense of making a trip to grounds, the adaptability of Internet adapting frequently permits them to keep procuring cash at their current occupation.

At the point when the Internet is used to provide education for health-care professionals, educators have used a range of approaches. Early models used e-mail correspondence, just as mechanical advances happened, elaborations incorporated the option of assets on the web (on web pages or as downloadable records), sound, video, slideshows, movement, and extra methods for a correspondence (live visit rooms, announcement sheets, and sound). Notwithstanding utilizing the Internet, a few courses were joined with an eye to eye show draws near, for example, talks and little gathering learning—frequently alluded to as mixed learning. This assorted variety of approaches in the utilization of the web for instructive purposes has brought about a blast of terms used to depict it—web‐based learning or course, Internet‐based learning or course, e‐learning, mixed learning or courses, and online classes.[2] The main shared trait between these terms is that Internet innovation is some way or another used in the instructive procedure—be it to give learning materials, empower correspondence among students and guides, and to give criticism on execution. As such, there is no agreement on the favored term.[18]

The expansion being used of the Internet as a method for giving instruction and preparing for health-care professionals has not been without its difficulties. Starting concerns spun around the inquiries of adequacy—would it be able to work in any case? Such an inquiry brought about many “evidence of ideas” examinations that looked at the utilization of the Internet against no instructive mediations. Another territory of concern was whether the Internet when utilized for instructive designs was at any rate in the same class as progressively customary educating groups. This worry prompted the scope of the “media correlation” contemplated. This development in essential research has likewise been reflected by an expansion in the number of proof unions attempted. The orderly survey and meta‐analysis by Cook et al.,[19] Internet‐based learning in the Health Professions: a meta‐analysis, merits specific notice as it covers the student bunch this report is worried about. This thoroughly directed survey covers concentrates from 1990 to 2007, their discoveries were that contrasted with no mediation Internet‐based learning better and proportional to customary techniques.

When compared to traditional methods, Internet‐based learning was neither innately better nor second rate. The end they come to is that the information holes are not, at this point, worried about whether Internet-based learning works. We can be certain that we can do it.[19],[20] Where there is more prominent questionable is unmistakably summarized by the creators of this survey “By what means can Internet‐based real actualized?” and “When ought to Internet‐based learning be utilized?[19] Like numerous instructive mediations, the results that can be accomplished from Internet‐based learning is exceptionally setting subordinate.[21]

In our study regarding hand hygiene, of 96 students, 55 (57.29%) were doing all 10 steps correctly as per their video and marks were given accordingly, 20 (20.83%) students were doing 8 of 10 steps correctly, 12 (12.50%) students were doing 7 of 10 steps correctly, and 9 (9.38%) students were correctly performing 4 of 10 steps correctly. In biomedical waste, of 96 students, 60 (62.50%) wrote all 10 correctly, 30 (31.25%) students wrote 9 of 10 correctly, and 6 (6.25%) students wrote 5 of 10 correctly. Of 96 students who took both the tests and gave their feedback on questionnaire, 95.83% felt that they were given adequate time at each station, 68.75% responded that the teaching material provided in the e-learning resources was clear and easy to understand, 73.96% responded that the e-learning resources covered a wider range of knowledge than traditional examination, 86.46% said that the e-learning resources were helpful in understanding basic hand hygiene concepts, 94.79% said that the e-learning resources were helpful in memorization and revision of hand hygiene practical skills, 61.46% opined that e-learning resources were easier to pass than traditional examination, 96.88% responded that the OSPE assessment of the e-learning process helped in scoring better than traditional assessment methods and was less stressful, 81.25% said that OSPE helps in e-learning and evaluation in CBME, and 96.88% said OSPE should be implemented in medical education as an assessment tool for both formative and summative evaluation [Table 5]. Similar to the study reported by Manjula et al.,[22] 81% of their students felt OSPE as a fairer tool of examination in practical exercises and 62% of students perceived it as well structured. They also reported that 36% of their students perceived OSPE to be less stressful, 55% felt that it was more useful than traditional examination, 42% opined that OSPE reduced the chances of failing, and 72% felt that it highlighted their areas of weakness. In a similar study by Faldessai et al.,[23] 90% of their student participants opined that OSPE was a better examination pattern than traditional examination and it was better structured and uniform; 88% of students in their study opined that OSPE assessed the relevant practical skills and 80% opined that it covered the appropriate knowledge area consistent with the learning objectives; 50% of students in their study said that OSPE was less stressful, and 78% opined that this pattern of the examination was helpful in bringing out their areas of weakness.


  Conclusion Top


As social insurance frameworks are set to be additionally extended with the expanding weight of COVID-19, disturbances in medical education are inescapable all over the world. Game plan should be made whereby students can hold clinical skills and knowledge. In spite of the fact that e-learning is not without its issues, e-learning advances can possibly substitute face-to-face address and clinical-based educating, especially during this pandemic. Such methodologies may not exclusively be vital for successfully handling the clinical training quandary during this present emergency; however, it will likewise serve to establish the framework for educating during future calamities and past. The COVID-19 pandemic has been a significant troublesome change to education all over the world and the utilization of innovation has been quickly and creatively utilized trying to keep up teaching and learning. Maximum students felt that they were given adequate time at each station, and they responded that the teaching materials provided in the e-learning resources were clear and easy to understand, and also responded that the e-learning resources covered a wider range of knowledge than traditional examination; students said that the e-learning resources were helpful in understanding basic hand hygiene concepts and they also said that the e-learning resources were helpful in memorization and revision of hand hygiene practical skills. Students also opined that e-learning resources were easier to pass than traditional examination, and they also responded that the OSPE assessment of the e-learning process helped in scoring better than traditional assessment methods, and it was less stressful. They said that OSPE helps in e-learning and evaluation in CBME, and also they agreed that OSPE should be implemented in medical education as an assessment tool for both formative and summative evaluation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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