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Online teaching of undergraduates in pathology during COVID-19 pandemic: An opportunity to grab or dismiss?


 Department of Pathology, Bharati Vidyapeeth (deemed to be university) Medical College, Pune, Maharashtra, India

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Date of Submission30-May-2021
Date of Decision12-Jul-2021
Date of Acceptance13-Jul-2021
Date of Web Publication26-May-2022
 

   Abstract 


Introduction: Covid 19 pandemic has brought human life one on one with the pace of growth. The indispensable lockdown and social distancing norms have posed challenges to continue education in various fields. Distance learning via online teaching has emerged as a savior in the pandemic. In the current scenario, it is very important to keep learners in the loop and obtain feedback from students at the end of online teaching, for understanding its strength and weaknesses which will eventually assist in developing strategies to improve its quality. We intend to share our experience with the online teaching. Methodology: The study was conducted from March 2020 to Feb 2021, which includes 8 months of online teaching classes and practicals, one online examination (mid term exam), and 1 offline examination (final professional exam). The marks obtained by the students who attended online classes (batch II) in 2020-21 session was compared with previous batch i.e 2019-20 (batch I). Also the marks obtained by batch I during online exam (mid-term exam) were compared with their marks during offline exam (final professional exam). Results: Batch II scored higher marks than batch I in theory and practical (p-value < 0.05). However, the marks of viva for both batches were equitable. Conclusions: We feel that the online teaching is a reasonable alternative to conventional teaching in the current scenario.

Keywords: COVID19, online teaching, pathology


How to cite this URL:
Singh P, Swami R, Kelkar A, Adsul B, Mulay S, Karandikar M, Nimbargi R C, Mani N S. Online teaching of undergraduates in pathology during COVID-19 pandemic: An opportunity to grab or dismiss?. Indian J Pathol Microbiol [Epub ahead of print] [cited 2022 Nov 27]. Available from: https://www.ijpmonline.org/preprintarticle.asp?id=345880





   Introduction Top


The COVID-19 Pandemic has brought human life one on one with its pace of growth. The indispensable lockdown and social distancing norms have posed challenges to continue education in various fields.[1] Like in several medical colleges, our students were also sent home on 20 March 2020, and online classes were started. Medical education is one of the most demanding of its types, which needs a very meticulous and thorough theoretical and practical guidance and teaching. At this time of crisis, where combatting with the COVID appears to be a little more exigent, keeping up with medical education is important. Distance learning via online teaching has emerged as a savior to kick-start this halt. Evidence exists that online training has the potential to enhance the knowledge domain and can be considered in undergraduate medical teaching.[2] Though adopted as a temporary measure amid this pandemic, the effectiveness or the loopholes of this pattern of learning will prepare us for the best. In this scenario, it is very important to keep learners in the loop and obtain feedback from students at the end of online teaching, for understanding its strength and weaknesses which will eventually assist in developing strategies to improve its quality.[3],[4],[5] We intend to share our experience with online teaching.


   Methodology Top


The study was conducted in the Department of Pathology, over a period of 1 year from March 2020 to Feb 2021, which included 11 months of online teaching classes and practicals, three online examinations, and one offline examination (final professional examination. First, an online exam was held after 2 months of offline classes followed by 3 months of online classes (mid-term theory). One more online exam was conducted after 6 months of online classes (end term theory, practical, and viva). The final examination was held after 9 months of online classes with an offline exam. The study was designed to assess the efficacy of the online teaching curriculum in achieving learning goals as defined by the Medical Council of India, as well as the areas for improvement, through a rigorous process of online teaching, evaluation, and students' feedback. Prescheduled computer-assisted online, live theory and practical classes were conducted by the faculty from the Department of Pathology, to be attended live by the students from home. The teaching was PowerPoint based on Microsoft Teams software.

Online examinations were scheduled and conducted without supervision. Scanned theory question papers were uploaded to each student on their registered email/WhatsApp at an allotted time. The students were instructed to be prepared with adequate internet connection and speed, scanner, and writing material to ensure “standardization” of the procedure. The answers were handwritten on a paper, scanned, and sent back to the same email address, after completion of a duration of 3 h. Ten min were given additionally to ensure submission by all students, beyond which the student were marked absent/exam unattempted, until personal reporting of inability to upload answers was reported. Score and attendance were assessed by the faculty.

Online practical exams were conducted after the theory exam on prescheduled and informed dates. Pathology practical assessment was done by uploading scanned images of gross specimens and slides along with questions to each student at an allotted prefixed time. The assessment was divided into spotting exercises same as predefined by MCI. Hematology and urine practical assessment were based on test result Interpretation only from the uploaded image (and not performance skills) only. Tissue diagnosis and viva were performed online via live interaction between student and examiner. Attendance and score were marked. The student's performance assessed in the form of marks scored was used as the measure of the degree of achievement of the learning goals. At the end of 11 months, the students underwent a revision for practicals offline according to MCI guidelines, followed by offline traditional theory and practical examinations (final professional exam). The score of each student was obtained. The average marks obtained by these students (batch II) after the offline examination (final professional exams) were compared with marks obtained by the students of the academic year 2019–2020 (batch I) in their final professional examination. Also, the marks obtained by this batch of students (batch II) during mid-term and term online exams were compared with average marks obtained in the same topics by the previous batch i.e., (batch I), which were taught conventionally (offline).

The conclusions of the study were strengthened by an expert and construct validated questionnaire developed for students' feedback. Each student was given an information sheet and consent form to ensure voluntary participation. Students' identity was revealed following the personal choice of the student.

Questionnaire development – After the literature review questionnaire, focused group discussions, and random students' feedbacks inputs, a questionnaire covering ease of attendance, benefits, difficulties, and discomfort and inputs regarding students' engagement and attention during classes, was prepared for seeking participant responses. The drafts were reviewed and refined by two content experts and one medical education expert. The questions framed were mix closed and semi-open type. Each question had multiple options, with one or more possible marking options, to be completed and sent back within 30 min.

The designed feedback was administered to the students twice during the study. First, after completion of 3 months of online teaching and exam. The questionnaire was reviewed and revised as necessary after the first administration and used for the second administration to the same students.

Statistical analysis

The data collected were tabulated and analyzed by using the Statistical Package for Social Sciences (SPSS) version 23.0. Mean scores were compared between batch I and II using the students' t-test. P value < 0.05 was considered significant.

The responses to the feedback questionnaire were based on the Likert scale ranging from strongly disagree = 0, disagree = 1, neutral = 2, agree = 3, and strongly agree = 4. This questionnaire was modified after the pilot study to suit the needs. An item analysis, internal consistency reliability (Cronbach alpha), and test-retest reliability were assessed after the pilot study.


   Results Top


Online exams, as well as final professional exam, resulted in a higher average score in theory and practicals for batch II as compared to batch I which were taught conventionally. However, the mean average score obtained in viva was equitable by both batches. [Table 1] shows mean average scores of batch II obtained during 3 online examinations and final professional examination as compared to mean average scores obtained by batch I.
Table 1: Mean scores obtained by the batches I and II in various examinations.

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   Discussion Top


We feel that online teaching is a reasonable alternative to conventional teaching in the current scenario. Challenges to online education reported in the medical literature so far include issues relating to time management, use of technology tools, students' assessment, communication, and the lack of in-person interaction.[6],[7],[8],[9] We try to dissect our experience to adopt, reject, and modify our strategies to give our best to our future generations. Analysis of what has changed during the transition is as under:

  1. Environment- Both teaching and learning environment is one of the major factors which have experienced a drastic change. All students were enquired about their personal welfare and welfare of their families individually by different faculties; however, this was not the part of prevalidated questionnaire circulated to the students. Fortunately, none of the students suffered from the most feared and dreaded outcomes of the COVID pandemic i.e., physical or financial losses due to health of self or family. From the learners' point of view, as obtained by feedback from the students, when asked in favor of online classes, showed that 37% of the learners enjoyed online teaching due to the freedom to change postures, take refreshments, whereas 27% claimed minimal physical exhaustion and that they were mentally more relaxed and “available” for learning. Twenty-five percent felt that the experience was more “personalized,” which helped them to focus. Whereas 7% liked no colleague distractions. We felt that feedback suggests that students long for frequent breaks during lectures and ask for non-judgmental freedom to feel physically more comfortable during their classes to increase their concentration and output if the system continues conventional teaching. The other important things to be considered while conducting online classes were attention span and side effects of increased screen time. In our survey, 44.8% of the students reported an attention span of ≤45 min, 40.3% reported an attention span of ≤30 min, 7% each reported it to be ≤60 min and ≤15 min. Eye strain was the most experienced physical discomfort by the students as reported by 47.4%, followed by headache (24.3%) and sleep disturbances (5%). Whereas 23% of the students had no physical discomfort. However, these side-effects were experienced after a day's routine of online classes.


  2. Feedback on environmental factors not favoring online teaching was broadband connectivity or the speed, which created verbal and visual lags in the presentation was experienced by 57% of the learners, 21% experienced surrounding interference and disturbance. This makes us think that not a high number of our medical students might have their space, environment, and resources conducive for this pattern of education back at home. And that, before stepping onto the next level of teaching, we really have to ensure infrastructures and resources at both levels. As far as the finances are concerned, none of the students reported unaffordability to obtain internet services or software installation.

    As far as teachers are concerned, the environmental factors were very much of something which did not bother them except for broadband connectivity and speed.

  3. Learning process- This unprecedented situation had to face unpreparedness. There was not much that could be done before executing online education. The modalities of teachings remained the same i.e., podcast lectures with PowerPoint. The faculty did try to use more visually stimulating formats such as animations and videos, more flow charts, and diagrams. However, the faculty reported that most of the animation videos could not be downloaded or required paid software at both teachers and learner level, which questions its feasibility until preplanned. On top of that, the videos consumed a significant proportion of lecture timings and did not contain satisfactory professional information. Videos were the preferred mode by the students especially for pathology practicals, especially for those procedures involving multiple steps such as urine chemical examination, peripheral blood staining. So here, it requires self-made institutional videos in the original student laboratory depicting all reagents, steps, and interpretation. The students faced major detestation in learning microscopy of lesions online. Here, the photomicrographs used were downloaded images. To resolve the issue, we tried digital pathology mode to teach through scanned slides. It needs not be mentioned that this required an additional investment done by the institution. However, utility is still questionable at the level of undergraduate teaching. Students still found it difficult to identify the lesion on the microscopy unguided. The majority of the students strongly proposed to take practical microscopy of all the lesions offline. Despite the feedback, they were able to score higher marks in practical as compared to batch I. The probable reason could be that students memorized the diagnosis from microscopic images of the lesions from the pictures provided during training sessions, however finding it difficult to identify their true pathological features on their own.
  4. Learning outcome- assessed in terms of knowledge, behavior, skills, and understanding. The study includes theoretical and practical skill evaluation. What changed was 1. Mode of testing i.e., use of electronic media 2. Mode of attempting the examination. Theoretical and great part of the practical evaluation was unsupervised, as the exams were attempted from home and scanned copies submitted, and was more of an open book type. Following on from the recent success of Imperial College London's first-ever online exam for final years,[10] other medical schools are also adopting a similar approach to ensure students remain engaged with their studies, with many universities adopting an open-book examination (OBE) approach. The highlight here is that the main premise for open book exams is that teachers can devise questions that require students to answer in more critical and analytical ways thus encouraging high-order thinking skills in their students; as compared to a closed book or traditional exams that tend to encourage rote learning and more superficial application of knowledge. What are the pitfalls? The main issue that arises when making use of open-book exams is that teachers may not know how to develop and devise effective exam questions that require students to apply their knowledge through analysis and critical thinking, and students may be lulled into a false sense of security by the scores.



   Conclusion Top


Based on our experience, we can safely conclude that online teaching was a reasonable alternative to conventional teaching. Switching to electronic media, medical schools can take solace in these dark times. Advocates of this viewpoint believe that online education is as effective as traditional classroom education.[11] However, to inculcate it as a regular teaching modality, its effectiveness needs to be tested after the utilization of newer online teaching practices. What we learn from our online teaching experience is that changing learning processes is THE NEED of the hour. 1) The faculty needs to be motivated and trained to adapt new modalities in teaching. Testing flipped classrooms; real-time chalk talks could prove useful. If we opt to continue OBE, the questions need to be devised that require students to apply and make use of the information from their textbook or notes rather than simply requiring them to locate and rewrite this information. 2) Build infrastructure, e.g., computers with high-speed internet, software to interact with students, equipment such as mics, speakers, battery backups as also the technical assistance, system troubleshooting, and training of staff. A dedicated IT lab with all the above-mentioned facilities is required to support online teaching, which will require a separate and substantial budget to be kept aside by medical colleges if not already available. 3) Build up a video record library, especially for practicals. 4) Increase faculty-student ratio to encourage short group teaching. Short group teaching we feel is the most imperative modality to adopt in the current scenario, especially to impart practical skills, to keep communication with teachers, to straddle the gap, to amalgamate theoretical with practical knowledge, and retain an interest in the subject. 5) Problem/clinical scenario-based learning should be given preference over didactic lectures to develop psychomotor domain as vicarious experience to clinical exposure. Adoption of objective structured practical examination (OSPE), for assessment of the same, could be one of the options. If we can adopt these new methods, we recommend the use of a hybrid online-cum-offline mode even after the pandemic is over.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Correspondence Address:
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5/5 Stavley Road, Near Wanowarie Post Office, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_534_21




 
 
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    -  Singh P
    -  Swami R
    -  Kelkar A
    -  Adsul B
    -  Mulay S
    -  Karandikar M
    -  Nimbargi R C
    -  Mani N S


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