Evaluation of the Experience of Online Classes for Medical Students during Covid- 19, Majmaah University, Saudi Arabia 2020

Introduction:

Coronavirus disease (COVID-19) is an infectious disease caused by new modern viruses. This virus can spread from person to person through air droplets of an infected person's saliva produced by coughing or sneezing and getting in contact with surfaces contaminated with the virus [1]. On March 11, 2020, the World Health Organization (WHO) declared the coronavirus to be a pandemic [2].

Since the start of COVID-19, which originated in Wuhan, China, millions of people have been placed under lockdown. COVID-19 lockdown forced students to take online classes for nearly half of the second semester of the 2019/2020 academic session, which lasted until the succeeding year [2]. An online class is a flexible educational delivery system that can be used to cover any type of education that takes place over the Internet. Educators can connect students who may not be able to participate in a traditional classroom course and thus support students who need to work on their own time and pace [3]. This unpredicted pandemic had also put the education system through an unpleasant experience that may have repercussions in future. Universities worldwide issued explicit guidelines to protect all students and faculty from COVID-19 and to avert its spread. Though the faculty members were enrolled in online teaching courses, the COVID-19 outbreak presented a few challenges for universities around the world. Since the coronavirus began to spread, approximately 150 countries around the world have stopped onsite education and switched to online classes; more than 80% of the population has stayed at home and begun to take online classes [4].

As part of its efforts to stop the spread of the COVID-19 pandemic, Saudi Arabia's ministry of education had also decided to suspend all educational institutions, including schools and universities, on Monday, March 8, 2020, till the next warning. [8]

As a result, traditional educational methods were amended and shifted in favor of online education. It was challenging to engage students in an educational setting and to evaluate students’ performance. [5] [6] [8] .COVID-19 had an impact on nearly billions of students' education; the majority of higher education was delivered online. [7].

In Saudi Arabia, online classes have become a popular alternative study method since the COVID-19 pandemic. Unlike traditional classes, online classes have both positive and negative aspects. Hence, this study was undertaken to investigate and analyze how online classes are perceived and experienced by the medical students across Majmaah University. This will help to understand and make modifications to suit the needs of medical students. The study also focused on the strengths and weaknesses of online classes for further development of the educational mode and to overcome challenges that the students faced, such as poor internet connection. Additionally, it would help learning providers resolve all the challenges that might arise during the online learning process.

Objectives:

1: To evaluate the experience of online classes during COVID-19 among medical students in Majmaah University, 2020

2: To determine the background information of medical students of Majmaah University in 2020.

3: To assess the commitment of the medical students of Majmaah University in 2020.

4: To identify the technical & financial struggles that the medical students of Majmaah University faced in 2020.

5: To measure medical students’ performance in Majmaah University during the pandemic 2020.

6: To assess health problems that affected medical students due to online classes during the pandemic at Majmaah University, 2020.

Methodology:

Study design: This was a descriptive cross-sectional institutional-based study.

Study population: Total female (84) and male (188) medical students from the college of medicine, Majmaah University, Saudi Arabia in 2020.All 3rd, 4th 5th and 6th year female and male students from the college of medicine were included in this study. We excluded 2nd and 7th year medical students.

Sample size: by using sample size calculation:

n = NZ^(2 ) P(1-P)÷Nd^2+Z^2 P(1-P)

Where n= Sample size, N= Study population, P= Prevalence, Z=Confidence Level,

d= Standard Error,

P assumed as 0.5 since there was no prevalence.

Z was calculated at 95% confidence interval (Z=1.96).

A sample error of 5% was used (d=0.05).

The required sample size was calculated to be 159. The study involved 160 students of Majmaah University, College of Medicine. In total, they were 89 (55.6%) male students and 71(44.4%) female students.in ratio of 9:7

Sample design: Stratified random sample.

Tools and data collection: The data collection was done using electronic questionnaire both in English and Arabic language to avoid language bias. The questionnaire included sociodemographic information, questions related to financial and academic challenges.

It was sent to students selected at random to the mail and whatsapp numbers.

Data analysis: The collected data was analyzed by using SPSS statistical software program version 20.

Ethical concern: Ethical approval from the Ethical Committee of Majmaah University,(MUREC) (HA-01-R-088) was taken before conducting the study. Ethic number MUREC-Dec.28/COM-2020/17-4. The confidentiality of participants was assured and protected. Informed consent was obtained from the students at the beginning of the questionnaire form filling. Since the study involved Human participants the study protocol conformed to the ethical guidelines of the 1975 declaration of Helsinki as reflected in a prior approval by the institution's human research committee.

Results:

Table 1 shows Mean (±SD) age of the participants was 22.51±1.47 (Skewness 0.047 and kurtosis -0.478) .Male to female participants ratio was 9:7. It was observed that 4th and 5th year students participated to maximum 26.9% (N=43) in each level. Significant percentage of participants belonged to Majmaah (N=107, 66.9%).While considering the source of income 71.3 %( N= 114) belonged to families with >10000 Saudi riyals income per year. Statistically significant with p value <.00001.

Table 2 shows highly significant number of participants 96.3 %(N=154) submitted their assignments on time without delay .Ninety two percent (N=147) reported that the information was clear after attending the online classes. On switching to online classes, majority of participants (66.9%) reported no financial difficulties. During the discussion session, 66.3% of the participants experienced difficulties in understanding lectures while 91.9% of students reported they understood topic clearly on attending the online classes. Eighty four percent of participants reported difficulty in practicing clinical skill examination sessions. Seventy eight percent of participants felt the pandemic had affected the hospital training sessions. During the online classes, 79.4% of participants actively participated. Significant association was observed between male (N=88, 98.9%) and female (N=65, 91.5%) participants in attending the online classes on regular basis.(Chi.sq 5.07, P value <.024).

Table2-: Participants' financial and academic challenges as a result of online classes
Variable	Mean± SD	Skewness	Kurtosis	Chi sq. (df)	P value
Age (years)	22.51±1.47	0.05	-0.48	85.50(df1)	<.0001**
Variables	Frequency	Percentage
Gender	Male	89	55.6%	2.03Df1	.16
Female	71	44.4%
Level of education	3rd year	38	23.8%	0.95Df 3	<.0001**
4th year	43	26.9%
5th year	43	26.9%
6th year	36	22.5%
Marital Status	Single	156	97.5%	1.4(df1)	<.0001**
Married	4	2.5%
Place of residents	Majmaah	107	66.9%	813.5Df3	<.0001**
Riyadh	14	8.8%
Zulfi	15	9.4%
Others	24	14.9%
Family income: Saudi Riyals/month	Less than 3000	4	2.5%	187.6Df3	<.000l**
3000-6000	19	11.9%
6000-10000	23	14.4%
> 10000	114	71.3%

Table 3 reveals the significant impact of the pandemic on hospital training during the 2020 pandemic among the participants (Chi.sq 25.9, df9 , p- value=.002) with 36.25% (N=58) felt it affected all the time followed by 25% (N=40) they often felt, 16.25 %(N=26) sometime while 22.5%(N=36) rarely felt the impact of pandemic on hospital training.

Financial and educational issues:	YES	NO	X2	p- value
Frequency	%	Frequency	%
Faced financial problems	53	33.2%	107	66.8%	18.2	.0001**
Faced problems during discussion in the sessions	106	66.3%	54	33.7%	16.9	.0004**
The information became clear after attending classes	147	91.9%	13	8.1%	112.2	<.00001**
Faced difficulties in practicing clinical skills during the exams	132	82.6%	28	17.4%	67.6	<.00001**
Effects of the pandemic on hospital training	124	77.6%	36	22.4%	48.4	<.00001**
Participation ratio during the online classes	127	79.4%	33	20.6%	55.25	<.00001**
Rate of assignments submitted on time	154	96.3%	06	3.7%	136.9	<.00001**
The impact rate of online classes on understanding	134	83.8%	26	16.2%	72.9	<.00001**

Table 3-: Comparison between academic level and the impact of the pandemic on hospital training of medical students during pandemic 2020

Table 4 shows highly significant association observed between GPA before (Chi.sq 132.05, df3, p- value <.0001), and after pandemic (Chi.sq 145.6, df3, p-value <.0001). (p<0.001). Showing that the students whose GPA before pandemic was (3.00-3.50) were 47 students, decreased to 42 students after pandemic. While the students whose GP before the pandemic was more than 3.50 were 96 students, increased to 101 students after the pandemic.

Graph 1 shows 48%(N=77) attended the classes always , followed by 36.3%(N=58) reported often attended the classes , and 11.3%(N=11) sometimes attended least 4.4%(N=7) rarely attended the classes.

Graph 2 shows 37.5 %(N=60) were satisfied with online teaching all the time , followed by often satisfied 31.9%(N=51) ,sometime 20.6%(N=33) least 10%(N=16) were rarely satisfied with the online teaching

Graph 3 shows the comparison of health problems participants faced during the online teaching 68.5% (N=110) of the participants reported sleep problems followed by stress and anxiety 63.80 %( N=102) and vision and eye stress problems 48.2%(N=77).

Graph 4 shows the percentage of participants that faced technical problems in attending the online teaching 55%(N=88) of the participants faced the internet issues.41.30%(N=66) had to buy the internet devices for the learning purpose .On the contrary 99.40%(N=159) mentioned they had clear access to the online classes.

Discussion:

In the present study 160 participants (55.6% males and 44.4% females) answered the questionnaire. Those answered maximum were from the fourth and fifth years level (26.9% each), and 71.3% had a family income of more than SR 10,000 per year.

The current data showed 95.7 % (N=153) medical students attended online classes regularly, whereas 4.4% (N=7) did not. Gender-wise male participants (98%, N=88) showed statistically high significance in attending online classes regularly as compared to female participants (91.5%, N=65).The lockdown affected students’ performance and commitment to attending the lectures.Muhammad Tanveer et al [14] showed in his research that the COVID-19 lockdown and online classes affected the performance of students and also affected their commitment since most of them missed their lectures. Similarly, Abdulkarim Al-Rabiaahet al [16] showed that the COVID-19 affected many academic educational online aspects. Mohamed A. A. Mahdy et al [10] showed some common problems faced by the students such as, missing some lectures due to their weak commitment and lack of interest in online teaching. In the present study, 99.4% of medical students had access to online classes. However, 55% of them faced internet problems, and 41.3% had to purchase expensive devices to take online classes.

Likewise, Mohamed A.A. Mahdy in their studies revealed challenges like the need for devices for online classes, such as laptops, phones, and tablets to access the internet for online lectures [10].Changwon Son et al [9] demonstrated that 82% of the participants were worried about their academic performance due to the pandemic, especially about sudden changes in the objectives of the courses, the quality of the lectures, technical problems with online equipment, and the difficulty of dealing with online classes due to technical issues, such as lack of internet and mobile data connections. Some other studies showed the reason for the technical problem was internet breakdown as a large number of students populations were using the internet in the daytime for their education [11][15].

The current data from Majmaah University showed that 33.3% of participants faced financial problems. Similar study in the United States by Changwon Son et al, showed 59 % of participants were worried about their financial problems because of COVID -19 and 12% of them have faced financial problems [9].

In the present study, 79% of the students actively participated in online classes. Whereas, a study by Kunal Chaturvedi revealed that the overall satisfaction of students in active participation in Delhi was 38.3% [13].In one of the studies in Saudi Arabia by Muhammad Tanveer et al 68% of the participants were unhappy with the amount of help LMS and other internet tools provided, and 76% of them felt that the assignments were tough and difficult to accomplish without prior explanation from the teachers. The results of the present study were consistent, with 69.40% of students expressing satisfaction with online instructions.

In the present study, 83.8% of the participants understood the online classes without difficulty and 96.3% of them submitted their assignments on time.Muhammad Tanveer et al revealed that 39% of students disagree, while 28% strongly disagree that the online classes were easy to understand. However, 91.9% of Majmaah medical students found the online courses to be clear in terms of the information they received [14].A study among veterinary medical students by Mohamed A. A. Mahdy et al found it challenging to learn or do practicals or clinical sessions. Similar results were observed in the present study where 82.6% of students faced difficulty during clinical skill exams and 77.6% of students were not able to take hospital training. It was also observed that using the internet for a long time in online classes affected the motivation of students [10].The current data from Majmaah University showed that the majority of participants 63.8% experienced increased stress and anxiety while taking online classes. In this context, Changwon Son et al, showed that 71% of students were stressed and worried due to the COVID- 19 outbreak, 82% were worried about their academic performance because of the pandemic. Similarly, Dr Ankuran Dutta showed in their study showed that 80% of the students suffered from worries, stress, and depression due to lockdown and online teaching [2] [9]. According to Abdulkarim Al-Rabiaah et al., females have higher stress levels than males [16]. While in the present study, 63.8% of students had anxiety indicating a lower proportion than the other studies in Saudi Arabia.Because of the COVID-19, many students had different levels of stress, worries, and anxieties. About 77% of participants experienced less level of worry and about 18.4% of participants had less level of worry. The current study found that 68.5% of participants experienced sleeping problems during online classes which were much higher, compared to the study by Changwon Son et al with 38%. On the contrary, in a study by Rehana Khalil et al 85% of participants revealed that online classes helped them to have better sleep patterns [15].

Limitations: The research has some limitations of its own. Since the research was totally conducted on online basis without face to face interview due to pandemic lockdown, the survey could have led to insufficient or excessive reporting.

Conclusion: The majority of medical students have attended online classes regularly .Almost all the students had easy access to online classes despite having technical and financial problems. Majority of students received the information clearly during the online classes. More than half of the medical students faced problems during the discussion session. Many participants did not have difficulty in practicing clinical skill exams as they could not attend the clinical skill sessions nor were they able to attend the hospital trainings. The majority of students submitted their assignments on time. Online classes have greatly affected the understanding of students. The students experienced increased stress and anxiety during online classes along with sleep and eyes problems. During the pandemic, there was a significant relationship between gender and commitment to attend online classes. A significant association was observed between GPA before and after the pandemic. It was found that hospital training and the level of students were significantly correlated.

Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest.

Recommendations: we recommend the students to upgrade themselves with the new technology of the teaching and learning and well equipped with the internet and electronic gadgets and equipments. The Students must be encouraged to be more concerned about online learning and taking the classes as actual classes as they can increase or decrease the GPA. The online study must be conducted through simple methods such as videos or pictures that can facilitate the learning process. Developing the quality of online classes to improve the performance of the students and facilitate the learning process. Lastly the new devices are high cost, so we suggest the students reuse the old devices as much as they can to avoid financial burden on their family.

Authors’ contributions: Conceptualization: HHA, TAM, AAA; Methodology: HHA,

Validation and supervision: HHA, TAM; Formal analysis and data curation: SAL, AAA, WSA, MMA, MAA, WAA; Data collection: AAA, WSA, MMA, MAA, and WAA;

Writing original draft preparation: HHA, SAL, AAA, AAA, WSA, MMA, MAA, and WAA;

Writing review and editing: SAL, HHA, MME; Visualization: SAL HHA, Project administration: HHA, TAM.

Acknowledgments: The authors would like to thank the Majmaah University’s Institutional Review Board for approving the proposal, the students of Majmaah medical college for giving their valuable time in the research.

References:

1:Who https://www.who.int/westernpacific/health-topics/coronavirus https://www.who.int/news/item/27-04-2020-who-timeline---covid-19

2:Alarabia https://english.alarabiya.net/en/News/gulf/2020/03/08/Coronavirus-Saudi-Arabia-suspends- all-schools-universities-until-further-notice

3:Online Education ."Encyclopedia of Business and Finance, 2nd ed.. Retrieved October 16,

2020 from Encyclopedia.com: https://www.encyclopedia.com/finance/finance-and- accounting-magazines/online-education Last accessed: 16th April 2021

4: Sahu P. Closure of Universities Due to Coronavirus Disease 2019 (COVID-19): Impact on Education and Mental Health of Students and Academic Staff. Cureus .2020 April 04; 12(4): e7541. doi:10.7759/cureus.7541.

5:Naar, I. (2020). Saudi Arabia suspends all schools until further notice amid coronavirus

concerns. https://english.alarabiya.net/en/News/gulf/2020/03/08/Coronavirus-Saudi-Arabia- suspends-all-schools-universities-until-further-notice Last accessed: 14April 2021

6: Esani, M. Moving from Face-to-Face to Online Teaching. Educational Technology. Clin Lab Sci.2010; 23(3):187-190. Retrieved from http://clsjournal.ascls.org/content/ascls/23/3/187.

7. Shahzad, A., Hassan, R., Aremu, A.Y. et al. Effects of COVID-19 in E-learning on higher education institution students: the group comparison between male and female. Qual Quant ,2021;55: 805–826 . https://doi.org/10.1007/s11135-020-01028-z

8: Abueish, T. (2020)”Distance learning in Saudi Arabia may continue even after coronavirus”.https://www.google.com/amp/s/english.alarabiya.net/en/amp/News/gulf/2020/0 9/21/Distance-learning-in-Saudi-Arabia-may-continue-even-after-coronavirus-Minister

9. Son, C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. Effects of COVID-19 on College Students' Mental Health in the United States: Interview Survey Study. Journal of medical Internet research,2020 September; 22(9), e21279. https://doi.org/10.2196/21279

10. Mohamed A. A. Mahdy. The Impact of COVID-19 Pandemic on the Academic Performance of Veterinary Medical Students. Frontiers in Veterinary Science. 2020. Vol. 7. DOI: 10.3389/fvets.2020.594261

11. Ankuran Dutta.Impact of Digital Social Media on Indian Higher Education: Alternative Approaches of Online Learning during COVID-19 Pandemic Crisis. IJSRP, Volume 10, Issue 5, May 2020 Edition [ISSN 2250-3153]. DOI:10.29322/IJSRP.10.05.2020.p10169

http://dx.doi.org/10.29322/IJSRP.10.05.2020.p10169.

12. Aristovnik A, Keržič D, Ravšelj D, Tomaževič N, Umek L. Impacts of the COVID-19 Pandemic on Life of Higher Education Students: A Global Perspective. Sustainability. 2020; 12(20):8438. https://doi.org/10.3390/su12208438.

13. Chaturvedi, K., Vishwakarma, D. K., & Singh, N. (2021). COVID-19 and its impact on education, social life and mental health of students: A survey. Children and youth services review, 121, 105866. https://doi.org/10.1016/j.childyouth.2020.105866.

14. Tanveer, M., Bhaumik, A., Hassan, S., & Ul Haq, I. Covid-19 pandemic, outbreak educational sectorand students online learning in Saudi Arabia. Journal of Entrepreneurship Education, 2020; 23(3) .

https://www.researchgate.net/publication/341714040_

15. Khalil, R., Mansour, A.E., Fadda, W.A. et al. The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students’ perspectives. BMC Med Educ .2020.;20, 285 . https://doi.org/10.1186/s12909-020-02208-z

16. Al-Rabiaah, A., Temsah, M. H., Al-Eyadhy, A. A., Hasan, G. M., Al-Zamil, F., Al-Subaie, S., Alsohime, F., Jamal, A., Alhaboob, A., Al-Saadi, B., & Somily, A. M. (2020). Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) associated stress among medical students at a university teaching hospital in Saudi Arabia. Journal of infection and public health, 2020; 13(5), 687–691. https://doi.org/10.1016/j.jiph.2020.01.005

Tables and Graphs

Table-1: Sociodemographic Information of Participants

Academic Level	Impact of the pandemic on hospital training	X2	p- value
Always	Often	Sometimes	Rare	Total
3rd year	7	8	6	17	38 (23.8%)	25.9Df9	.002*
4th year	17	6	8	12	43 (26.9%)
5th year	17	14	6	6	43 (26.9%)
6th year	17	12	6	1	36 (22.5%)
Total	58 (36.3%)	40 (25%)	26 (16.25%)	36 (22.5%)	160 (100%)

	GPA after pandemic
		2.50-3.00	3.00-3.50	< 2.50	>3.50	Total	Chi .sq.p- value
GPABefore pandemic	2.50-3.00	14	1	1	0	16	X2=205.6Df9.00001**
3.00-3.50	2	34	0	11	47
< 2.50	0	0	0	1	1
> 3.50	0	7	0	89	96
Total no.%	16(10%)	42(25%)	1.7%)	101(63.1%)	160(100%)

Table-4: Comparison between academic level and the impact of the pandemic on hospital training of medical students during the pandemic 2020

Graph 1: Commitment of medical students of Majmaah University in attending online classes

Grap-2: Satisfaction of medical students with online classes

Graph 3: Comparison of health problems participants faced during the online teaching

Graph 4: Percentage of participants that faced technical problems in attending the online teaching