COVID-19 pandemic disrupted many sectors including education, according to UNESCO report more than 120 countries have closed educational institutes and adopt electronic learning and assessment to minimizing the spread of the virus among community, at lower costs and higher connivance for students and teachers [1,2,3-6]. In the health profession, online classes were held in a large group as well as in small group discussion on the online platform Cisco-WebEx and Zoom. During pandemic teaching staff were expected to rapidly adapt transition on the online platform, which was mandatory though it was not a smooth process that challenges both teachers and students. The quality of online classes and assessment is expected to comparable with traditional way of teaching though not to be compromised. 

Students’ response about their satisfaction towards online performance and internet connectivity problems during classes and assessment can provide direct and indirect quality indicators and is a conduit for constructive feedback for program administrators and faculty. Analysis of evaluation results can be used in the continuous quality enhancement of the online educational program.

In the pandemic of COVID-19, medical college adopted the online mode of teaching and assessment depending on the situation, still, its quality had not been evaluated at the level of students. This study aims to obtain medical student’s feedback to assess their attitude, their perceived preparedness and barriers to the transition to distance online learning imposed by the COVID-19 pandemic. To assess the above domains student’s satisfaction level towards online mode (classes and assessment) and network issues were evaluated. The students advice were also obtained about the comparison of online assessment with traditional methods, as almost half of syllabus was covered by traditional methods.

An observational type of cross-sectional study was conducted after taking permission from the institution research review board and ethical committee for assessing student’s satisfaction towards online learning and assessment. An online learning strategy was planned and implemented in crisis and risk management mode to minimize the spread of COVID-19 during the pandemic. A total of 250 students was eligible for study purpose, taught on the cisco-WebEx for large group teaching and zoom for small group interactive learning. Student’s feedback towards online learning was assessed by google form by voluntary participation. The study feedback google form link was shared on students WhatsApp group and the purpose of the study was briefed and confidentiality of the participants was insured. Those students not attending the online teaching or not responded to the google form were excluded from the study.

Total 241 student’s response were obtained in the feedback survey, after removal of 28 duplicate results and one incomplete form, remaining 212 student’s data were analyzed in Excel Microsoft and the Chi-square test was applied to find the significance level in various groups by the help of primer version-7. The p-value <0.05 was considered significant.

The present study was conducted on 212 medical students to assess their satisfaction level with online learning along with perceived barriers like internet problem and perceived preparedness in form of the online assessment. Less than half (40%) of medical students agreed with the effectiveness of online assessment while 1/3 (31%) disagreed and still 1/3 (29%) had neutral opinion (Figure 1).

Figure 1: Effectiveness of Online Assessment

About 40% of medical students acknowledge online assessment better than the conventional assessment approach. A quarter of students were neutral about it, while 35% not convinced by the online mode of assessment (Figure 2).

Figure 2: Student Outlook about Online Assessment Better than Conventional Assessment 

During online classes internet barriers was reported often by 46% and sometime by 48% students while during online assessment only 22% students often experienced network issue and 55% sometimes and the difference between the two was statically significant (p = 0.001) (Table 1).

Table 1: Comparison of Internet Network during Online Assessment and Classes

χ² = Chi-Square, df = degree of freedom, p-value = Level of Significance

Students’ satisfaction towards online classes (28.2%) were less than online assessment (51.8%), most of the students were neutral about online classes (42.9%) than online assessment (30%). Nearly 1/3^rd (29%) students not satisfied with online classes at the same time only 1/5^th (18%) students not happy with the online assessment approach. The statistically significant difference in opinion of medical students for online ways of learning and assessment were observed (Table 2). 

Table 2: Comparison of Satisfaction Level of Online Classes and Online Assessment

χ²= Chi-Square, df= degree of freedom, P-value= level of significance

The geographical settlement had not any statistically significant (p = 0.177) influence on students’ satisfaction towards the way of online assessment, though rural background students were more neutral than urban students (Table 3).

Table 3: Comparison of Student’s Satisfaction towards Online Assessment based on Geographical Settlement

χ² = Chi-Square, df = degree of freedom, p-value = level of significance

During the COVID-19 pandemic, medical college implicated advanced technology to continue medical education, which represents a revolutionary change in medical education. The online lectures were successfully delivered at the end of educators in most of the classes. The online assessment was also conducted by google form successfully. At the level of student, online assessment was effectively considered by more than 1/3^rd students while 1/3^rd was neutral and unfortunately remaining 1/3^rd not satisfied with the online way of assessment. At the same point half of the students did not acknowledge the online assessment as a better way to assess the students’ performance, again 1/3^rd was neutral about their opinion. Satisfaction level and internet accessibility were statistically significantly differed during online classes and online assessment.

Murphy [7] recently reported that most medical schools suspended clinical settings during the COVID-19 pandemic. This could be overcome by using virtual-reality simulators [8,9]. Barteit et al. [10] reported potential benefits of e-learning for low- and middle-income countries. The Horizon 2020 Teaching and Learning report highlighted the effectiveness of online teaching in overcoming the restrictions such as the shortage of venues for large group lectures. However, one of the main challenges of e-learning was in assessing the psychomotor, practical and clinical skills efficiently [11,12].

Similar to the present study, most of the students of the College of Medicine, Qassim University were unsatisfied with how some staff members practiced e-learning [13]. The teachers felt worried about the shift to a new educational strategy. Psychological assurance was recommended to encourage them to deal with the unknown consequences. Multiple discussion, meetings of staff members, peer sharing of experience and the help of the Information Technology (IT) sector solved the problem of medical college for online lectures. Others also reported successful collaborative online learning demanded the support of IT technicians [14,15].

The students’ assessment during the problem-based learning in practical sessions was difficult to assess as it is based upon their commitment, team spirit, interaction with peers and tutors, presentation skills and the ability to brainstorming and analyzing the phenomena. The students’ assessment during the practical sessions was based upon their performance during the session rather than their achievements through other summative assessment methods such as multiple-choice questions which are associated with higher chances of cheating. These findings are in agreement with the previous study, which observed that online problem based practical learning enhanced critical thinking, metacognitive skills, ability to solve problems and fulfilled the intended learning objectives [16,17]. 

Although student perception seems to be subjective, it is of prime importance to evaluate the experience under these circumstances and should be shared by the institutes and programs around the world to improve the online teaching for future perspectives. 

The present study explored the positive aspects of the shift towards e-learning and online assessment, which is a promising strategy with great educational potentials after the WHO’s declares of the COVID-19 pandemic. This successful digital learning environment was observed in terms of student satisfaction and improvement of technological educational skills. Medical students were agreed with the effectiveness of online assessment and satisfied by online mode of assessment in comparison to conventional assessment while one-third of students were having an indifferent opinion. The students’ satisfaction towards online classes and assessment had a statistically significant difference that was not influenced by geographical settlement. Internet connectivity was a barrier for online classes and assessment with a statistically significant difference.

Strength and Limitations: The present study strength is 85% response rate of medical students for online survey to assess the satisfaction towards online classes and assessment. The major limitation of the present study is that the feedback survey was only conducted to preclinical years, the paraclinical and clinical years were not included, thus the results not to be generalized to all the medical student population. Also, feedback survey depends on participant’s memory, so the recall bias may be present.

Acknowledgment

The authors would like to acknowledge the students for their time and contributions.

Author’s Contribution 

Dr Anuradha Yadav: Concept, Design, Data Collection, Analysis and Inferences and Drafting the article. Dr Manisha Sankhla: DataCollection and Analysis, Help in Drafting the article and revising it critically. Dr Kavita Yadav: Data Collection and Analysis and inference and drafting the article.

1. Daniel, S.J. “Education and the COVID-19 pandemic.” Prospects, vol. 49, 2020, pp. 91–96.

2. UNESCO. Education: From disruption to recovery. 2020, https://en.unesco.org/covid19/educationresponse. Accessed 7 Apr. 2021.

3. Lewis, K.O. et al. “Leveraging e-learning in medical education.” Current Problems in Pediatric and Adolescent Health Care, vol. 44, 2014, pp. 150–63.

4. George, P.P. et al. “Online e-learning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction.” Journal of Global Health, vol. 4, 2014, p. 010406.

5. Ruiz, J.G. et al. “The impact of e-learning in medical education.” Academic Medicine, vol. 81, 2006, pp. 207–12.

6. Masic, I. “E-learning as new method of medical education.” Acta Informatica Medica, vol. 16, 2008, pp. 102–17.

7. Murphy, B. “COVID-19: How the virus is impacting medical schools.” MedEdPublish, vol. 32, 2020, pp. 125–29.

8. Bateman, J. et al. “Virtual patient design and its effect on clinical reasoning and student experience: A protocol for a randomized factorial multi-centre study.” BMC Medical Education, vol. 12, 2012, pp. 62–66.

9. Goh, P.S. “E-learning or technology-enhanced learning in medical education-Hope, not hype.” Medical Teacher, vol. 38, no. 9, 2016, pp. 957–58.

10. Barteit, S. et al. “Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review.” Computers and Education, vol. 145, 2020, pp. 103726–29.

11. Brown, M. et al. 2020 Educause Horizon Report: Teaching and Learning Edition. EDUCAUSE, 2020, https://library.educause.edu/resources/2020/3/2020-educause-horizon-report-teaching-and-learning-edition#materials.

12. Goh, P.S. and J. Sandars. “A vision of the use of technology in medical education after the COVID-19 pandemic.” MedEdPublish, vol. 12, 2020, pp. 25–29.

13. Elzainy, A. et al. “Experience of e-learning and online assessment during the COVID-19 pandemic at the College of Medicine, Qassim University.” Journal of Taibah University Medical Sciences, vol. 15, no. 6, 2020, pp. 456–62.

14. McCoy, L. et al. “Developing technology-enhanced active learning for medical education: Challenges, solutions and future directions.” Journal of the American Osteopathic Association, vol. 115, no. 4, 2015, pp. 202–11.

15. Kolbaek, D. “Problem-based learning in the digital age.” CELDA, vol. 54, 2018, pp. 24–29.

16. Elizondo-Montemayor, L. “Formative and summative assessment of the problem-based learning tutorial session using a criterion-referenced system.” JIAMSE, vol. 14, 2004, pp. 8–14.

17. Gursula, F. and H. Keserb. “The effects of online and face-to-face problem-based learning environments in mathematics education on students’ academic achievement.” Procedia: Social and Behavioral Sciences, vol. 1, 2009, pp. 2817–24.