Perception towards Online Classes during COVID-19 among MBBS and BDS Students in a Medical College of Nepal: A Descriptive Crosssectional Study

ABSTRACT Introduction: Sudden outbreak of COVID-19 pandemic has affected the educational system worldwide, forced the medical colleges to close due to lock down, and disrupted the classroom face-to-face teaching process. As a result, medical colleges shifted to an online mode of teaching. The aim of this study is to find out the perception towards online classes during COVID-19 lockdown period among MBBS and BDS students at a medical college of Nepal. Methods: This was a descriptive cross-sectional study carried out at Universal College of Medical Sciences and Teaching Hospital among first and second year Bachelor in Medicine, Bachelor of Surgery and Bachelor in dental surgery students from 1st June 2020 to 30th August 2020. Ethical approval was taken from Institutional Review Committee of Universal College of Medical Sciences and Teaching Hospital (IRC UCMS, Ref: UCMS/IRC/025/20). Convenient sampling method was used. Semi-structured questionnaire was used. Statistical Package for Social Sciences 22 was used for analysis and frequency and percentage was calculated. Results: One hundred fifty six (73.93%) students were enjoying online learning only to some extent, 135 (63.98%) felt online class not equally effective as face-to-face teaching. The students had disturbance during online classes as internet disturbance 168 (79.60%), and electricity problem 47 (22.3%). Similarly, many students 155 (73.50%) felt external disturbance, headache 26 (12.3%), and eye strain 26 (12.3%). Conclusions: Most of the students suffered from disturbances during online classes probably because of internet and electricity problem. When compulsory to conduct online classes, students felt that not more than three online classes per day should be conducted to avoid eye strain and headache.


INTRODUCTION
The global pandemic COVID-19 has made an impact on each and every field. Medical education is no exception to it, with lockdown and social distancing measures face to face classes are abandoned. 1 This forced educational institutions to shift to an online mode of teaching-learning, which is an imperfect yet quick solution to the crises. 2 As per guidelines of Ministry of health and education, Universal College of Medical Sciences (UCMS) also started online classes. 3 Online learning is a relatively new phenomenon, currently both the Teachers and students are struggling with the idea of its implementation and adaptation respectively. 4 In a developing country like Nepal, several technological, education/literacy background and socioeconomic challenges exist, which might act as a hindrance to the online learning process. 5,6 The aim of this study is to the perception towards online classes and learning during COVID-19 lockdown period among MBBS and BDS students at a medical college of Nepal. . The objectives of the study were briefed to respondents. Written informed consent was taken from the students and additional verbal consent was taken from the students' parents through telephone for those students who were below 18 years of age. The data was used only for this study purpose and confidentiality of the data has been maintained.

METHODS
All the medical and dental students studying in 1 st and 2 nd year at UCMS Bhairahawa, Nepal and wiliness to participate in the study were included in the study. Similarly those who were not wiliness to participate and those who did not fill questionnaire completely until the study period were excluded from the study. Convenient sampling method was used. A total of 211 questionnaires were completely filled and included in the study.
The minimum sample size was estimated using the following formula: Collected data were cross checked every day to ensure all the questions have been filled. All the collected data were entered into Microsoft excel and exported to SPSS version 22 for analysis. Simple frequency tables, cross tables and mean tables have been used to analyze data related to the study. Characteristics of the sample were categorized using mean and standard deviation.

RESULTS
The mean age was 20.13±1. 19 years for the respondents. The age of the respondents was categorized on the basis of mean age 20. The finding revealed that nearly two-third 132 (62.56%) of the students were less than equal to 20 years. Twothird of respondents 140 (66.35%) resides in rural municipalities. Caste/Ethnicity was categorized as per Nepal caste and ethnic groups with regional divisions and social groups ( Table 1). Regarding online classes nearly one-fourth of the respondents were not enjoying the class as per regular lecture class. Nearly two third 135 (63.98%) of the respondents felt online classes was not equally competent as regular lectures. A large number 178 (84.36%) of students found a great variation of online teaching from teacher to teacher (Table 2). The findings revealed that nearly two-third of the respondents had taken less than and equal to 4 hours online classes (Table 3).   In our study, majority of students had disturbance during online classes as Internet disturbance 79.6%, and electricity problem 22.3%. Similarly, many students 73.5% felt external disturbance during online classes. This finding is in consistent with the study by Subedi S, where more than half of the students 63.2% got disturbed for their online class because of electricity problem, and 63.6% because of internet problem. 10 An alarming response that we received from this study was student's response to headache and eye strain during online classes which was 25% directing towards lockdown myopia. 11 The sample of our study was taken only from one college, so the findings cannot be generalized to other medical colleges. The reliability of our data is entirely based upon the correct reporting of the participants. So, call bias might occur. Furthermore, an in-depth qualitative study is necessary.

CONCLUSIONS
Most of students enjoyed the online classes to some extent where as understanding the subject content was moderate.
Most of the respondents suffered from disturbances during online classes probably due to internet and electricity problem. When it is compulsory to conduct online classes, students felt that not more than three online classes per day should be conducted to avoid eye strain and headache.