SATISFACTION LEVEL: STUDENTS OF RMU ON ONLINE CLASSES

 SATISFACTION LEVEL: STUDENTS OF RMU ON ONLINE CLASSES

 

AUTHORS:

1.      Malik Shehr Yar, Resident Internal Medicine, HFH

2.      Hassan Mumtaz, MPH: Health Services Academy, Islamabad

3.      Mehwish Mehmood, Resident surgeon, Nescom Hospital

4.      SYED MUHAMMAD ISMAIL, Dow University of Health Sciences

laureatefolks@gmail.com, WhatsApp: +923334446261

 

ABSTRACT

Coronavirus, a deadly pathogen, killed hundreds of thousands of people worldwide. It brought revolutionary changes with it, maintaining social distance, wearing a mask, getting vaccinated became a new normal after the pandemic. Moreover, it also ruined medical education and the system had to undergo a transition phase from physical to online classes. Whenever we discuss the education system, it would not be fair to conclude the discussion without knowing students' opinion, are they satisfied or not. In order to find out, we carried out a cross-sectional study at Rawalpindi medical university (RMU), using a preformed Bolliger and halup 2012 survey with additions and modification, 240 participants responded to the survey form, all of the students were undergraduate MBBS students, for analyses SPSS version 24 was used. The results highlighted that the preferred platform was MS teams. Regarding interaction, communication, collaboration, students were dissatisfied. Students preferred face to face learning over online classes, were not comfortable and overall satisfied with online classes.  In spite of technological advancements, the primitive format of teaching is still the best way, especially in third world countries. There are several barriers that need to be overcome for successful implementation and transition to an online system of education.

Keywords: Quality Improvement, Medical Education, Online Learning, Student Satisfaction, HealthiProfessioniEducation, Covid-19.

 

1.      INTRODUCTION

Pandemic a terrifying word simply means a disease spread over a large area or the whole world. In recent times this word became popular with coronavirus outbreak [1]. Covid-19 virus made history by spreading throughout the world drastically without giving anyone a chance to take any preventive measures. Where it did destroy economies, businesses, several industries, education was also put to halt as social gatherings were strictly prohibited as a measure to flatten the curve [2]. The world had to gather itself and come up with a solution to keep people healthy and alive, and support education and income sources. In order to revive and continue education and secure the future of our youth [3].

E-learning was a suitable alternative which helped students take the lectures and avoid social gatherings remaining safe at their homes. Moreover, it had far reaching impacts on the mental health as it made people psychologically depressed; anxious as they were cut off from the external environment, with media showcasing number of deaths around the globe further filled people with fear which also had an impact on their academic performance [4].

In third world countries like Pakistan there are immense hurdles in the way of e-learning like speed and connectivity issues of the internet, electricity shutdown, lack of environment to name a few [5]. It's a fresh thing to most of the population, people are not introduced to it, so to adapt to the system takes time.

Thisistudyiwas conducted toiassessithe effectiveness of online classes and whether students are comfortable and satisfied. As student’s satisfaction with the kind of education he is getting is necessary to ensure his interest, to keep him engaged, to boost his confidence and to produce the maximum out of him, to check whether these classes are providing a healthy learning environment [6].

It will help to recognize if there is a knowledge gap created by virtual learning, do students need some training sessions to use online platforms fruitfully. This will help evaluate any possible reforms and improvements needed to be made in order to improve learning experience and to enhance students' interest. This will highlight the difficulties in adapting to the e-learning in poor countries and how obstacles can be removed, and virtual learning can be made feasible and accessible [7].                 

2.      METHODOLOGY

Faculty at Rawalpindi Medical University (RMU) took immediate steps, came up with a plan and soon shifted the whole physical classes format to virtual learning to minimize the loss of medical students and to start the learning process, virtual classes commenced from September using different platforms like Google or MS teams and zoom. For the assessment of student's satisfaction regarding online setup, a cross-sectional study was done, a pre-validated Bolliger and Halup 2012 survey was used with some modifications and new questions [8]. The online questionnaire was disseminated among MBBS students from 1st till final year of RMU using forums like e-mail and WhatsApp. 240 students voluntarily participated in the survey.

The questionnaire was divided into three parts. Socio-demographics: This section included name, email, and year of study, gender, age, and field of study. The second section included yes/no questions and question asking about which platforms were used and preferred by students. The last section of the questionnaire consisted of liker-type questions with option from 1-5, with 1 being strongly disagree and 5 = strongly agreeing. It consisted of questions regarding effectiveness, satisfaction, and implications of virtual learning.

Results were obtained and statistical analysis was done using SPSS version 24. For liker scale questions descriptive analyses was used, and 28 items were encoded with 1= stronglyidisagree, 2= disagreei, 3= neutrali, 4= agreei, 5= stronglyiagree.

To determine the significance and correlation of satisfaction scales, gender and year of study-based differences chi-squareitest wasiperformed andivalues of p<0.05 were considered significant. A detailed analysis was done, and results are presented in percentages.

 

3.      RESULTS

240 students responded to the survey form, out of which more than ¾ of the population were females. Mean age of the students was 20.57. All the participants were MBBS students from first till final year. First years were predominant with 42% of the respondent population, the least number of students were from second year contributing less than 10%. (Refer to table.1)

		N	%
Gender	Male	50	20.7
	Female	189	78.6
Yearsiofistudy	Firstiyear	101	42.1
	Secondiyear	22	9.3
	Thirdiyear	51	21.4
	Fourthiyear	26	10.7
	Fifthiyear	36	15.0
Age	15	2	0.7
	18-23	219	91.4
	24-28	19	7.9

Table 1. Socio-demographics.

Initially, students were asked about whether university came up with online classes or not, 100% of the population replied positively, when they were asked regarding any prior experience of online classes before the pandemic ¾ replied in affirmation.

Moreover, students were inquired about any training sessions for online classes except for few all of the responses were negative. Students were asked about whether they prefer online or physical classes, majority of the responses were in favor of disagreement. (Refer table 2) Online classes are being conducted through different platforms, students were asked about which platform they prefer 60% of them were in favor of MS teams, 20% in favor of zoom and 11% in favor of Google teams, next they were asked about the platform used by their institute RMU, ¾ of the population replied MS teams, rest were Google teams and zoom.

 

	Yes N (%)	No N (%)
Have there been any online classes for your batch during covid-19	238(99.3%)	2(0.7%)
Have you had any experience of online classes before covid-19 pandemic	170(70.7%)	70(29.3%)
Were there training sessions regarding online classes	19(7.9%)	221(89.3%)
Do you prefer online classes over physical classes	41(17.1%)	190(79.3%)

Table no .2

Section 3 of the questionnaire consisted of liker scale questions, when the students were asked about interaction with teacher, effective addressing of queries, clear communication about topic, satisfaction with faculty availability, did they felt to be a part of class bulk responses showed strong disagreement. Then comes the assessment of technological implications whether it be communication through email, download durations or connectivity issues a set of balanced reactions were seen. Technical issues caused students to miss classes and there were frequent interruptions in classes on technical grounds. Furthermore, the principal part of the survey contained questions regarding satisfaction based on number of classes, self-directed assignments, quality of interaction, collaboration, level of effort required for online classes, and student feedback highlighted their dissatisfaction.

Questionnaire concluded with the outcome questions like level of understanding, comfortability in participating in online classes, application of the information learnt online, advocate and overall satisfaction of online classes none the less again students were not satisfied as overall the results reflected. Students also felt skill deficient. (Refer table 3).

 

					SD/D	N	SA/A
		M	SD(n)	N(n)	%(N)	%(N)	%(N)
Instructori	Interaction with teacher wasieasier online	2.26	81	58	60.7	24.0	15.0
	All your queries addressed more effectively during online teaching	2.25	67	50	65.0	21.0	13.6
	There was clear communication about topic and assignment	2.49	67	50	53.6	21.0	25.7
	Iiam satisfiediwith facultyiavailability and accessibility	2.51	120	65	50.0	27.0	22.9
	I felt to be theipart of classiand belongedito the onlineisession.	2.28	33	41	61.4	17.0	21.5
technology	Iiam satisfiediwith onlineicommunication includingiemail and iannouncements	3.01	41	51	36.4	21.4	42.1
	Iiam satisfiediwith the downloadiduration of the content shared	2.89	41	60	37.4	25.0	37.1
	I have internet and connectivity issues at home so difficult to attend online classes.	2.88	43	41	47.1	17.1	35.7
setup	Missed classes due to technical faults	3.41	26	50	25.7	21.0	53.6
	Time taken by download material was longer and it made you irritated	3.25	21	70	27.1	29.3	43.5
	Were there frequent break during online session due to technical issue	3.18	33	58	30.7	24.3	45.0
implications	It has financial implications due to family’s financial condition	2.19	84	39	67.9	16.4	15.7
	Stayingion screenifor a longitime wasi difficulti	4.11	14	19	13.6	7.9	78.5
satisfaction	Iiam satisfiediwith the numberiof onlinei sessionsi/iteaching hoursi	2.59	63	57	51.4	23.6	30.7
	I amisatisfied withiself -directedi assignmentsi	2.61	48	60	49.3	25.0	25.7
	Iiam satisfiediwith the qualityiof interactioni betweenime and ifaculty	2.39	60	67	55.0	27.9	17.1
	Iiam satisfiediwith icollaborative activitiesiduring onlineilearning	2.18	69	63	63.6	26.4	10.0
	Iiam satisfiediwith the leveliof effortiduring onlineiclasses	2.58	60	56	49.3	23.6	27.1
others	Onlineisession offerediflexible timingsiforiclasses	2.38	63	56	58.6	23.6	17.9
	Iienjoyed workingion projectsiassigned onlinei	2.38	62	67	55.7	27.9	16.5
Overall outcomes	Iican relateito leveliof understandingiwith otheristudents	2.40	58	56	57.1	23.6	19.2
	Iiam comfortableiwith participatingiinionline iclasses	2.59	62	43	52.1	17.9	30.0
	Iiam ableitoiapply whatiI learntiduring onlineiclasses	2.40	67	60	55.0	25.0	20.0
	Iifelt skillideficiency asicompared to physicaliclasses	3.94	26	26	15.0	10.7	74.3
	Iiwillirecommend onlineiclasses to iothers	1.96	115	48	70.7	20.0	9.3
	Iiam satisfiediwith onlineilearning as comparedito faceito iface	1.91	125	31	74.2	12.9	12.9
	Myilevel of isatisfaction encouragesime to advocateionline classesi	1.91	120	41	72.9	17.1	10.0
	OveralliI amisatisfied withionline classesiat myiinstitute	2.33	87	53	56.4	22.1	21.4

Table no.3 SD= stronglyidisagree, D=idisagree, N=ineutral, SA=stronglyiagree, A=iagree.

Significant association can be seen between gender and their preferences for learning as majority of the females disagreed when asked if they would prefer online classes over in-person classes while majority of the males agreed with it.

A substantial number of females disagreed on recommending virtual classes to others while the majority of the males agreed to it, proving its association with the gender. (Refer table 4)

parameters	gender				p
	Male		Female
	Disagreei N(%)	AgreeiN(%)	Disagreei N(%)	AgreeiN(%)
Quality of interaction during online classes	20(8.6%)	29(12.1%)	111(46.4%)	77(32.1%)	0.12
Did you feel skill deficient during online classes	3(1.4%)	46(19.0%)	33(13.6%)	156(65.0%)	0.34
Would you prefer online classes over face to face learning	26(10.7%)	24(10.0%)	153(63.6%)	36(15.0%)	0.001
Would you recommend online classes to others	27(11.4%)	22(9.3%)	142(59.3%)	46(19.3%)	0.03
Overall were you satisfied with online classes	24(10.0%)	26(10.7%)	110(45.7%)	79(32.9%)	0.43

Table no. 4 cross-tabulation of gender

Insignificant association can be seen between year of study and choices regarding interaction, skill deficiency, preference of online classes over face-to-face learning and overall satisfaction because the trends in responses from each year were more or less the same so there is no significant difference. (Refer table 5).

 

Parameter	Years of study										p
	1st		2nd		3rd		4th		5th
	Agreei N(%)	Disagreei N(%)	Agreei N(%)	Disagreei N(%)	Agreei N(%)	Disagreei N(%)	Agreei N(%)	Disagreei N(%)	Agree N(%)	Disagree N(%)
Quality of interaction during online classes	48(20.0%)	53(22.1%)	86(3.6%)	14(5.7%)	26(10.7%)	26(10.7%)	9(3.6%)	17(7.1%)	15(6.4%)	21(8.6%)	0.73
Did you feel skill deficient during online classes	84(35.0%)	17(7.1%)	22(9.3%)	0(0.0%)	28(20.0%)	3(1.4%)	21(8.6%)	5(2.1%)	27(11.4%)	9(3.6%)	0.07
Would you prefer online classes over face to face learning	24(10.0%)	77(32.1%)	7(2.9%)	15(6.4%)	17(7.1%)	34(14.3%)	3(1.4%)	22(9.3%)	10(4.3%)	26(10.7%)	0.78
Would you recommend online classes to others	27(11.4%)	74(30.7%)	7(2.9%)	15(6.4%)	17(7.1%)	34(14.3%)	3(1.4%)	22(9.3%)	15(6.4%)	21(8.6%)	0.55
Overall were you satisfied with online classes	53(22.1%)	48(20.0%)	7(2.9%)	15(6.4%)	17(7.1%)	34(14.3%)	10(4.3%)	15(6.4%)	17(7.1%)	19(7.8%)	0.44

Table no. 5 cross-tabulation year of study

4.      DISCUSSION

Online learning is adapted throughout the world due to Covid19 SOP's. And to assess students' satisfaction we conducted this study. At RMU MS teams were used as a mode of teaching, and the majority of students preferred MS teams, while in another study it was reported that zoom was the popular platform among students [9].

In this study, overall males were more satisfied with online learning than females, and it is contrary to what was highlighted in another study which indicates that females were more satisfied with e-learning [10].

When it comes to preference of e-learning over face-to-face learning, majority students were in favor of face-to-face learning, and the identical thing is being reported by study conducted in Switzerland [11]. Private and public sector universities differ in standards and have a better quality of environment, but the students there also did not prefer online learning [12].

This study revealed that students felt skill deficient and less productive and there are plenty of factors contributing to it, psychological AND social anxiety is one of the leading cause that led to downfall of skills among students [13, 14].

Having knowledge of student’s satisfaction regarding mode of learning is an essential tool for the betterment of students and faculty, this makes this study of immense importance [15]. Our study didn't take into account the post-graduate and sub specialty students, they were also on the receiving end, as professional exams were canceled, clinics were rescheduled, leading to waste of time and disturbing mental health [16].

There are far greater challenges to online learning than highlighted in this study, internet instability, electric shutdowns, availability of a smartphone or laptop, financial implications, staying on screen for  long time periods causes problems, lack of awareness and training, designing of content etc. [17,18]. Furthermore, living in a developed country can reduce certain difficulties as those countries and well-facilitate, with a better quality of time, but still cannot compensate for the face to face learning.

When it comes to overall satisfaction of students, faculty plays a pivotal role. Because teachers pave the path for students by boosting their confidence, encouraging, and engaging them in productive activities, giving them advice, beneficial for carving a bright future. So, one of the key reasons behind student’s dissatisfaction with online learning. Though there was online interaction with teachers, but it was also difficult for teachers to control the class, manage workload and convey the message properly [19]. Therefore for the success of the virtual education system, training sessions should be organized for both teachers and students [20]. It is a very vast topic and taking into account every possible thing is almost next to impossible.

5.      STRENGTHS AND LIMITATIONS

This study highlights student's perspective regarding online, it is conducted in a public sector university of a developing country so it will enlighten us with the problems and difficulties in the way of virtual learning. Our study did not included students in other faculties and faculty members. It also didn't take into account the psycho-social factors of covid19.

6.      CONCLUSION

After a thorough analysis of the results and literature review it can be concluded that covid19 pandemic brought many changes to daily lives, and medical education is no exception. Virtual education came up with a great alternative as education continued during tough times, but world is adapting to it gradually and more research is required to improve the experience of online learning.

7.      REFERENCES

1. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020 Feb 15;395(10223):470-473. doi: 10.1016/S0140-6736(20)30185-9. Epub 2020 Jan 24. Erratum in: Lancet. 2020 Jan 29;: PMID: 31986257; PMCID: PMC7135038.

2.Rose S. Medical Student Education in the Time of COVID-19. JAMA. 2020;323(21):2131–2132. doi:10.1001/jama.2020.5227

3.Sahi PK, Mishra D, Singh T. Medical Education Amid the COVID-19 Pandemic. Indian Pediatr. 2020 Jul 15;57(7):652-657. doi: 10.1007/s13312-020-1894-7. Epub 2020 May 14. PMID: 32412913; PMCID: PMC7387262.

4.Mukhtar S. Psychological health during the coronavirus disease 2019 pandemic outbreak. Int J Soc Psychiatry. 2020 Aug;66(5):512-516. doi: 10.1177/0020764020925835. Epub 2020 May 21. PMID: 32434402; PMCID: PMC7405632.

5. Al Samaraee A. The impact of the COVID-19 pandemic on medical education. Br J Hosp Med (Lond). 2020 Jul 2;81(7):1-4. doi: 10.12968/hmed.2020.0191. Epub 2020 Jul 20. PMID: 32730144.

6.Elshami W, Taha MH, Abuzaid M, Saravanan C, Al Kawas S, Abdalla ME. Satisfaction with online learning in the new normal: perspective of students and faculty at medical and health sciences colleges. Med Educ Online. 2021 Dec;26(1):1920090. doi: 10.1080/10872981.2021.1920090. PMID: 33974523; PMCID: PMC8118529.

7.GISMALLA MD, Mohamed MS, Mohamed MN, Elhassan MM, Ibrahim O. Students Perception Towards Challenges and Difficulties to Established E-learning Medical Education in a High Burden Developing Country.

8.  Bolliger DU, Halupa C. Student perceptions of satisfaction and anxiety in an online doctoral program. Distance Educ. 2012;33(1):81–98. [Google Scholar]

9. Abbasi MS, Ahmed N, Sajjad B, Alshahrani A, Saeed S, Sarfaraz S, Alhamdan RS, Vohra F, Abduljabbar T. E-Learning perception and satisfaction among health sciences students amid the COVID-19 pandemic. Work. 2020;67(3):549-556. doi: 10.3233/WOR-203308. PMID: 33185620.

10. Yekefallah L, Namdar P, Panahi R, Dehghankar L. Factors related to students' satisfaction with holding e-learning during the Covid-19 pandemic based on the dimensions of e-learning. Heliyon. 2021 Jul 21;7(7):e07628. doi: 10.1016/j.heliyon.2021.e07628. PMID: 34381894; PMCID: PMC8334372.

11. Zamberg I, Schiffer E, Stoermann-Chopard C. Novice and Advanced Learners' Satisfaction and Perceptions of an e-Learning Renal Semiology Module During the COVID-19 Pandemic: Mixed Methods Study. JMIR Med Educ. 2021 Jun 28;7(2):e29216. doi: 10.2196/29216. PMID: 34048357; PMCID: PMC8277391.

12. Abbasi S, Ayoob T, Malik A, Memon SI. Perceptions of students regarding E-learning during Covid-19 at a private medical college. Pakistan Journal of Medical Sciences. 2020 May;36(COVID19-S4):S57.

13. Veer IM, Riepenhausen A, Zerban M, Wackerhagen C, Puhlmann LMC, Engen H, Köber G, Bögemann SA, Weermeijer J, Uściłko A, Mor N, Marciniak MA, Askelund AD, Al-Kamel A, Ayash S, Barsuola G, Bartkute-Norkuniene V, Battaglia S, Bobko Y, Bölte S, Cardone P, Chvojková E, Damnjanović K, De Calheiros Velozo J, de Thurah L, Deza-Araujo YI, Dimitrov A, Farkas K, Feller C, Gazea M, Gilan D, Gnjidić V, Hajduk M, Hiekkaranta AP, Hofgaard LS, Ilen L, Kasanova Z, Khanpour M, Lau BHP, Lenferink DB, Lindhardt TB, Magas DÁ, Mituniewicz J, Moreno-López L, Muzychka S, Ntafouli M, O'Leary A, Paparella I, Põldver N, Rintala A, Robak N, Rosická AM, Røysamb E, Sadeghi S, Schneider M, Siugzdaite R, Stantić M, Teixeira A, Todorovic A, Wan WWN, van Dick R, Lieb K, Kleim B, Hermans EJ, Kobylińska D, Hendler T, Binder H, Myin-Germeys I, van Leeuwen JMC, Tüscher O, Yuen KSL, Walter H, Kalisch R. Psycho-social factors associated with mental resilience in the Corona lockdown. Transl Psychiatry. 2021 Jan 21;11(1):67. doi: 10.1038/s41398-020-01150-4. PMID: 33479211; PMCID: PMC7817958.

14. Dhahri AA, Arain SY, Memon AM, Rao A; Medical Education Pakistan (MEP) collaborator group, Mian MA. "The psychological impact of COVID-19 on medical education of final year students in Pakistan: A cross-sectional study". Ann Med Surg (Lond). 2020 Nov 12;60:445-450. doi: 10.1016/j.amsu.2020.11.025. PMID: 33251004; PMCID: PMC7683177.

15. Kim SH, Park S. Influence of learning flow and distance e-learning satisfaction on learning outcomes and the moderated mediation effect of social-evaluative anxiety in nursing college students during the COVID-19 pandemic: A cross-sectional study. Nurse Educ Pract. 2021 Sep 6;56:103197. doi: 10.1016/j.nepr.2021.103197. Epub ahead of print. PMID: 34537671; PMCID: PMC8419785.

16. Imielski B. The detrimental effect of COVID-19 on subspecialty medical education. Surgery. 2020 Aug;168(2):218-219. doi: 10.1016/j.surg.2020.05.012. Epub 2020 May 27. PMID: 32546305; PMCID: PMC7250764.

17. Almaiah MA, Al-Khasawneh A, Althunibat A. Exploring the critical challenges and factors influencing the E-learning system usage during COVID-19 pandemic. Educ Inf Technol (Dordr). 2020 May 22:1-20. doi: 10.1007/s10639-020-10219-y. Epub ahead of print. PMID: 32837229; PMCID: PMC7243735.

18. Aini Q, Budiarto M, Putra PO, Rahardja U. Exploring E-learning Challenges During the Global COVID-19 Pandemic: A Review. Jurnal Sistem Informasi. 2020 Oct 31;16(2):57-65.

19. Bidwell LM, Grether ST, Pederson J. Disruption and difficulty: Student and faculty perceptions of the transition to online instruction in the COVID-19 pandemic. InCOVID-19 2020 Dec 30 (pp. 31-46). Routledge.

20.  Nortvig A, Petersen A, Balle SH. A literature of the factors influencing e-learning and blended learning in relation to learning outcome, student satisfaction and engagement. Electron J E Learn. 2018;16:46–55. [Google Scholar]