Medical students' perceptions towards distance e-Learning in gynecology ward during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has caused serious public health problems and compromised the health of individuals and communities [ 1 ]. The spread of the COVID-19 virus across the world has affected the educational systems worldwide, including in Iran. The closure of educational institutions have created numerous challenges for medical students and teachers [ 2 ]. In response to the COVID-19 situation, the Association of American Medical Colleges made an announcement on March 17, 2020, and issued guidelines for medical schools to pause clinical rotations [ 3 ]. The National COVID-19 Administration in Iran also announced an emergency state [ 4 ]. Hence, all medical schools were forced to search for creative techniques to foster clinical medical education. Distance e-Learning (DEL) emerged as the method of teaching to maintain the continuity of education during the pandemic [ 5 ]. DEL is defined as “using computer technology to deliver training, including technology-supported learning online, offline, or both” [ 6 ]. This shift was considered the best solution to clinical education problems in the era of COVID-19. The effectiveness of DEL amidst the COVID-19 crisis‏ has been investigated in several studies [ 5 , 7 , 8 ]. A survey by Al-Balas et al. showed that distance learning was the best solution to maintain clinical learning processes in emergency situations such as the COVID-19 pandemic [ 6 ]. In Iran’s medical education field, eLearning was not considered a new phenomenon in teaching medical students. The pandemic forced the use of virtual teaching and learning processes to complete the syllabus within the time frame. The Universities in Iran has implemented several technological tools to secure the remote clinical teaching process. Training sessions took place both for medical students and clinical teachers to learn how to interact via specific platforms, such as Adobe Connect, Skyroom, and Big Blue Button software. Nevertheless, the characterization of this format of teaching is perceived to be more difficult compared to face-to-face teaching for medical students [ 9 , 10 ]. In this regard, it is crucial to evaluate the perception of medical students on DEL approaches in the COVID-19 pandemic. This research focuses on the experience of DEL in clinical teaching at the Iran University of Medical Sciences from medical students’ viewpoints. This study aims to explore medical students’ perspectives on DEL in the Gynecology Ward during the COVID-19 pandemic.

The questionnaire was sent to 170 medical students. Of the 130 respondents 65% were female and 35% were male. There were 57 (43.8%) externs and 73 (56.2) interns. Preferred devices and locations for participation in Distance E-learning Courses is shown in Table 1 . Table 2 shows the frequency distribution of respondents regarding medical students’ perceptions of DEL in the Gynecology ward during the Covid-19 Pandemic.

Medical students had different opinion about importance and application of the distance eLearning in clinical education. Some of them believed that this method was a good tool that helped them in their coverage of most of the practical topics required in the Gynecology ward and their teachers had enough skills and experience to teach theoretical subjects virtually and this method provided an opportunity for discussion, teamwork and reflection for them. On the one hand, participants were not believed Distance E-Learning was an appropriate method for learning basic skills and practicing clinical skills effectively. Faculty development of medical teachers in online teaching methods also need to be considered. The results of this study have implications for policy and practice with regard to distance eLearning clinical education training in Iran.

This cross-sectional study was conducted at the Iran University of Medical Sciences from September 2020 to September 2021. The study sample included 130 medical students, in the fifth and sixth year of Medicine who participated in distance training courses in the gynecology ward during the COVID-19 pandemic. All medical students were included for the study. A self-administered questionnaire was used in this study. Questionnaires were developed through literature review and consultation with gynecology and eLearning experts. Face and content validity was measured using qualitative methods. To measure face validity, 5 expert were selected and asked to check the questionnaire items respecting simplicity and clarity. The same experts are asked to examine the content validity of items with respect to relevance and representativeness. In this process, some items were added, deleted, and revised. Internal consistency was assessed with Cronbach’s alpha (0.83). The Thirty-item questionnaire consisted of six factors: (Demographic data, preferred eLearning tools and location for use, theoretical education, practical skills education, and instructor and infrastructure using a five-point Likert scale ("strongly agree," "agree," "no idea," "disagree," and "strongly disagree"). The research objectives were explained to the participants before the study. In addition, written informed consent was obtained. An online questionnaire was provided using Porsline software in the Persian language. Microsoft office excel software used for the data analysis. The result of the study was analyzed by using descriptive statistics such as frequency distribution and percentage. The link to the questionnaire was forwarded to the students by email. The Broadband internet connections were available to a much wider group of medical student who has participated in this study. Internet access for those who lack home broadband internet, were mobile access via their smartphones. Some medical students turn to public internet use (hospital or library) to participate in online class. Broadband internet connections were available to the instructors also (gynecology faculties). They broadcasted from their homes or the hospital. Remote online classes were held synchronously via Adobe Connect, Skyroom, and Big Blue Button software and recordings were accessible afterwards. Online teaching was planned according to the educational calendar. We used some strategies for engaging medical student during online classes such as using online group debate that promotes individual and group reflections in class, watching interactive videos, using a quiz during a synchronous learning activity, setting collaborative group tasks and opening student and teacher webcams. The ethics committee approved this study at the Iran University of Medical Sciences (code: IR.IUMS.REC.1400.208).

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