Perception of Online Lectures among Students of a Medical College in Kathmandu: A Descriptive Cross-sectional Study

ABSTRACT Introduction: The COVID-19 global pandemic has affected all aspects of human life, with education no exception. Online lectures have been practiced in different academic institutions around the world. The objective was to know the perception towards online lectures by the undergraduate students of a medical college. Methods: This descriptive cross-sectional study was conducted among the undergraduate students of dentistry, medicine, and nursing at Kathmandu Medical College via self-administered online questionnaire. Data were collected from November to December 2020 after ethical clearance from institutional review committee (Ref. no. 0311202002). Students who had not attended even one hour of online learning per week were excluded. Responses were collected using Google Forms which were analysed in Microsoft Excel. Descriptive statistics are presented as means, standard deviations, frequencies, and percentages. Results: Out of 318 valid questionnaires, 143 (44.97%) students agreed that online lectures were effective but 138 (43.4%) disagreed that online lectures were more useful than traditional lectures. One hundred and forty five (45.60%) found online classes difficult to concentrate and 175 (55.03%) agreed that they preferred a combination of traditional teaching and online tutorials. Only two (0.63%) students strongly agreed on excellent internet during classes and 104 (32.70%) agreed it caused economic burden. Mean age of participants was 20.75±1.538 years; 202 (63.52%) were females; online learning per week was 18.75±9.157 hours; and duration of online learning was 20.28±9.997 weeks. Conclusions: Most of the students had a positive attitude towards e-learning when compared to similar studies. Further multicentric studies with larger sample size would better demonstrate whether online education partly or fully can be effective adjunct to traditional face to face interaction.


INTRODUCTION
The coronavirus disease (COVID-19) pandemic affected not only health but also education, business, and daily activities. Medical education and training are not useful unless the students acquire the minimum knowledge (cognitive aspect), skills (psychological/ motoric aspect), and obligatory conduct values (affective aspect). 1 Given the needs of the academic environment where learning can progress in optimal manner, the curriculum has to be frequently revised to improve the quality of health education. 1 The impact of the pandemic affected education at all levels and need for intelligent technology should be evaluated for future. 2,3 Studies have shown that students perceived online classes as a supplement to live lectures and did not prefer e-teaching over face-to-face teaching during the lockdown situation. 4 Education administration and faculty members should take necessary measures to improve e-learning for better learning during lockdown. 5 After adding 20% for non-response, sample size of 319 was calculated and we collected data from 318 participants. Data were collected electronically via Google Forms. Links to the forms were shared with all 864 students from the sampling frame via Viber. The questionnaire consisted of two parts: i) informed consent and ii) proforma with demographic details and questions. Informed consent was mandatory before proceeding to the questionnaire section. Only after they had read and clicked on the informed consent page, were they allowed access to the proforma section.
Data from Google forms were opened with Microsoft Excel Sheet and analysed. Descriptive statistics have been presented as means, standard deviations, frequencies, and percentages.

RESULTS
Out of total 318 valid questionnaires analysed, 151 (47.49%) participating students agreed that online lectures were helpful to their learning (  Figure  1).

Figure 1. Sex distribution of the participants in different academic programs.
Almost half 149 (46.86%) students were of MBBS academic program followed by BDS, and B.Sc. Nursing/BN programs (Table 2).

(100)
The online learning hours per week were 18.75±9.157 hours (SEM=0.513; median=18; mode=18) with minimum of one hour and maximum of 48 hours per week. The duration of online learning of the participants was 20.28±9.997 weeks (SEM=0.561; median=20; mode=18) with the learning going on for a minimum of one week to a maximum of 36 weeks. Almost all 306 (96.23%) participants used Zoom for online learning (Table 3).

DISCUSSION
Currently, the world is responding to a pandemic of contagious respiratory disease caused by a novel coronavirus, named COVID-19. In this circumstance, online lecture was better option to avoid gathering. Dental educators now have the capabilities and technologies to modernise their approaches. 7 Textbooks can be turned into e-textbooks which is helpful in acquisition of knowledge. Videos can be helpful for improving psychomotor skills. 'Synchronous'' and asynchronous communication through the internet is helpful in developing attitude. Assessments, for example multiple choice questions (MCQ) can be done online. Hence, online education is another useful instrument in the teaching toolbox. 8 Digitalisation offers great potential to revolutionise dental education to help prepare future dentists for their daily practice. 9 There are conflicting results on improvement in students' performance. 10 COVID-19 pandemic trajectory has disrupted routines in hospitals, medical schools, and beyond. There was a pause in clinical posting, conference presentation to examination. The panic situation is felt by students as well as faculties.
Chavarría-Bolaños et al. suggest it was necessary to categorise the academic courses depending on their virtualisation's possibility (curricula analysis and classification), to better understand the extent of the impact and the work needed to contain, as far as the possibilities are allowed. Teachers needed further training in the application of virtual strategies which they had not used before. 11 In the current study, majority of the respondents were from first and second year. This may be due to clinical posting and less lectures in third, fourth, and final years compared to first and second years. Instructors and faculty members must possess and master all technical achievements and new advancements offered by e-learning. 15 More specific study has shown that type of education had a significant effect on the theoretical test score (P <0.001) but had no significant effect on the clinical score (P=0.072). 16 Other studies have showed 48.6% 17 and 76% 12 of the participants intended to integrate the traditional lecture mixed with online learning whereas in this study, 70 (22.01%) of students strongly agreed and 55.03% of students agreed on combination of both traditional and online education. As suggested by Choules, we can go forward for change in current syllabus after through re-evaluation and further study. 8 Limitation of this study was that the perceptions of quality of online tutors were not measured and this study was conducted at a single institution with limited sample size.
CONCLUSIONS Student participants of this study had a positive attitude for online learning though they lacked concentration. In order to increase the effectiveness of online education, the online tutorials as well as internet connection may be improved. Further multicentric studies with larger sample size would better demonstrate whether online education partly or fully can be effective adjunct to traditional face to face interaction.