Medical Educators’ Response to Changes in Medical Education due to COVID‐19
Article information
Abstract
To analyze medical professors’ evaluation of their online education experiences in an attempt to support faculty members and indicate the future direction of medical education. Faculty members who taught online in the first semester of 2020 at Yonsei University College of Medicine in South Korea were surveyed. The results of the survey were analyzed in June 2020. There were 88 respondents (35.1% of 251): 59 professors (67.0%), 16 associate professors (18.2%), and 13 assistant professors (14.8%). Their specialties lay in basic medicine (25.0%), clinical medicine (65.9%), and research and special purposes (9.1%). Sixteen participants (18.2%) had previous experience in online lectures; 23 (26.1%) reported that preparation time for online lectures was the same as before; 65 (73.9%) reported that the preparation time had increased; 38 (43.2%) faced difficulties in preparation and lecturing online, and among them 16 (42.1%) indicated inadequate interaction with students; 11 (28.9%) needed extra preparation time; and 11 (28.9%) attributed their difficulties to technical issues with the online platform. Participants’ satisfaction with online lectures was low (p<0.001). In the free response question on overall experience with online education, 38.3% mentioned the need for an instructional design that allows students to actively participate and interact with professors, 29.5% mentioned the need for the establishment of an information & communications technology system, and 17.0% mentioned the necessity of faculty development. To prepare for the current pandemic and more in the long term, an appropriate educational support system must be constructed, and a learner-centered instructional design that enables wider interactions and active learning is needed.
INTRODUCTION
The coronavirus disease 2019 (COVID-19) outbreak adversely affected all social sectors worldwide, including economy, healthcare, and education. Its high infectivity necessitated measures such as social distancing, quarantine, and travel restrictions in every country, bringing almost all face-to-face activities to a standstill. The education system witnessed utter confusion because schools were not prepared to suddenly provide a remote learning environment either at the beginning or in the middle of a semester. Medical education faced greater limitations, as lab work and clinical practice are essential curriculum components. However, with a worsening pandemic and in efforts to somehow continue educational activities, schools began announcing new curriculum guidelines [1,2]. On March 17, 2020 the Association of American Medical Colleges issued guidelines recommending that, for the first time in American history, all clinical rotations be discontinued. Additionally, many medical schools announced cancellation of in-person classes, small group activities, and clinical practice and converted all preclinical education to online classes [2-4]. The Yonsei University College of Medicine (YUCM) in South Korea, following the guidelines issued by the government and the Yonsei University, began online classes on March 16, 2020 for preclinical students and resumed clinical practice on March 19, 2020, which had been discontinued for 4 weeks because of the pandemic.
The main challenge associated with the newly issued guidelines was the inevitable transition from in-person classes to remote learning based on an online educational platform. Although various teaching methods using information & communications technology (ICT) have already been developed and are considered one of the representative changes of the Fourth Industrial Revolution in education [5-7], the actual integration of ICT-based remote learning into the educational curriculum was delayed [8-10]. There are several reasons for this delay. Most professors prefer in-person lectures as they do not appreciate the changes to their teaching methods due to the introduction of ICT and consider it burdensome to prepare a new set of online lectures [11]. More fundamentally, many professors feel that ICT-based teaching conflicts with their teaching paradigm: for them, education is defined by face-to-face teaching. Moreover, professors tend to adhere to the conventional way of teaching because the results have been satisfactory. However, the newly issued policies required professors to teach remotely, thus preventing them from lecturing according to their preferences. As ICT-based remote learning became a requirement rather than an option, medical schools and the board had to offer a way for professors to conduct lectures online. However, the available time for a systematic transition into online learning was too short. Additionally, the students, staff, and faculty were all inexperienced in online education. The professors faced considerable difficulties as they had to abandon their lecture styles and quickly adapt to new teaching methods.
In this background, we decided to investigate the experiences of medical school faculty affected by the COVID-19 pandemic. The purpose of this study is to examine the perceptions of faculty who have taught classes by investigating online teaching experiences, satisfaction with online lectures, and intention to use the online education platform in the future. Previously published studies investigated the changes in medical education due to the pandemic from the students’ perspective based on their experiences of remote learning [1,2]; Few studies explored the online education experiences of the medical faculty [11,12]. but were limited by the number of professors surveyed and the subject they taught online [11]. Others broadened the subjects of their survey to both the professors and the students, highlighting the changes in the environment brought by the COVID-19 pandemic rather than focusing on the perspectives of the medical educators [12]. We believe that this is the first study to explore the changes in the medical educational environment brought by the pandemic from an educator’s point of view. In this way, this study serves as an essential resource in seeking novel ways to support faculty members in using ICT-based learning and provide future direction to medical education.
METHODS
1. Study population
This study was conducted at YUCM in South Korea. A total of 300 professors who conducted online lectures at YUCM in the first semester of 2020 (from March to June) for medical students in Years 1–4 were considered eligible for the study. We surveyed professors who conducted online lectures that were a part of the regular curriculum; those who conducted small-scale online lectures in clinical practice courses were excluded. The survey, conducted in June 2020, included a total of 251 faculty members, after excluding outside lecturers.
2. Survey design and implementation
The survey was designed to investigate the experience of the faculty members in terms of the transition to an online curriculum. We developed the survey questions together with relevant faculty in the YUCM and the medical school’s Vice-Dean for Education. To collect participants’ demographic information, the survey asked for their professorial titles and specialties. The survey included questions about prior online lecturing experience, lecture types, time spent in preparing the lectures, difficulties in lecture preparation and in online lecturing, satisfaction with online lectures, and intention to use the online education platform in the future. Satisfaction with online lectures and difficulties in preparing lectures for online classes and in online lecturing were evaluated using a Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, and 5=strongly agree). Finally, open-ended questions were asked reasons for the increase in time, reasons for the difficulties in lecture preparation and the overall online teaching experience. Participants were informed about the survey via email and it was administered online through Google Forms. The survey was administered online through Google Forms. The time required for survey completion was approximately 5 minutes. The purpose of the study was stated on the first page of the survey.
3. Statistical analysis
The general characteristics of the participants were analyzed using descriptive statistics. Continuous variables were presented as mean and standard deviations and compared using the independent t-test or Mann-Whitney U-test. Categorical variables were presented as frequencies and percentages and compared using the chi-square test or Fisher’s exact test, as appropriate. Spearman’s correlation analysis was used to study the relationships between lecture preparation hours, difficulties in preparation and lecturing, and satisfaction with online lectures. Data were statistically analyzed using IBM SPSS for Windows ver. 25.0 (IBM Corp., Armonk, NY, USA). P-values less than 0.05 were considered statistically significant. Open-ended responses were coded by two independent authors for thematic contents. Discrepancies in themes were reviewed by authors until a consensus was reached.
4. Ethical considerations
The survey was conducted anonymously to protect the information of the study participants. It was stated clearly both in the email and the survey that the responses would not be used for purposes other than research. Only those who agreed to participate in the study were asked to take the survey. The responses were collected on a Google Forms spreadsheet and stored in an encrypted, portable storage device. The Yonsei University Health System Institutional Review Board (IRB approval no., Y-2020-0082) approved the study.
RESULTS
Of the 251 professors invited to participate, 88 (35.1%) responded: 59 professors (67.0%), 16 associate professors (18.2%), and 13 assistant professors (14.8%) (Table 1). Twenty-two (25.0%) had specialization in basic medicine, 58 (65.9%) in clinical medicine, and 8 (9.1%) in research and special purposes. Sixteen (18.2%) had previous experience in conducting online lectures and 72 (81.8%) had no experience. Regarding lecture type, 34 (38.6%) conducted only live lectures, 32 (36.4%) used only pre-recorded lectures, and 22 (25.0%) used both.
Information about participants
1. Difficulties in preparation of online lectures and in online lecturing
Regarding changes in the time spent on preparing lectures, 23 (26.1%) reported no changes, and 65 (73.9%) reported that their lecture preparation time had increased (Table 2). Among the latter, 10 (11.4%) answered that the preparation time had increased by more than 300%. Reasons for the increase in time included extra time spent on pre-recording lectures (45, 69.2%), revising the content and format of lecture slides (40, 61.5%), revising assessment methods, such as exams (8, 12.3%), and familiarizing oneself with the online program (11, 28.9%).
Participant responses to increase in lesson preparation time
Out of 88 respondents, 38 (43.2%) reported having experienced difficulties in lecture preparation and in online lecturing. Reasons for the difficulties included lack of interaction with students (16, 42%), extra time required to pre-record lectures (11, 28.9%), and technical issues with the online program (11, 28.9%) (Table 3).
Participant responses to difficulties in preparing online lectures, satisfaction with online teaching, and future online lecture intention
2. Satisfaction with online lectures
A total of 29 participants (33.0%) indicated satisfaction with online lectures and 27 (30.7%) indicated dissatisfaction. In the comparative analysis of satisfaction with online lectures and related factors, there was no statistical significance in terms of lecture hours, lecture preparation hours, specialty, prior experiences in online lecturing, and lecture type. The only statistically significant factor was difficulty in lecture preparation and in online lecturing (p<0.001): with higher scores for lecture preparation and online lecturing, the satisfaction score tended to be lower (Table 4). Spearman’s correlation analysis showed that as lecture preparation time increased, difficulties with the lecture preparation process increased, and as difficulties in the lecture preparation process increased, satisfaction with online lectures decreased (Table 5).
Comparative analysis of satisfaction with online lectures and related factors
Correlation among lecture preparation hours, difficulties in preparation, and satisfaction
3. Intention to conduct online lectures in the future
Regarding the intention to conduct online lectures in the future, 46 (52.3%) were willing to continue lectures online, and 42 (47.7%) were unwilling to adopt this method in the future (Table 3). In the comparative analysis of the intention to conduct online lectures in the future and the following related factors, no statistical significance difference was observed: lecture hours, lecture preparation hours, difficulties in lecture preparation and in online lecturing, specialty, prior experience in online lecturing, and lecture type (Table 6). The only statistically significant factor was satisfaction with online lectures (p<0.001): when satisfaction was high, more participants expressed their intention to conduct online lectures in the future.
Comparative analysis of participants’ intention to conduct online lectures in the future and related factors
Among the 46 who were willing to continue online lectures in the future, 16 (34.8%) reported that ICT-based online lectures allow expansion in time and space for learning, 16 (34.8%) reported that recorded online lectures allow students to repeat watching the materials and faculties to apply new teaching methods, and 8 (17.4%) reported that students’ preference for online lectures made them want to continue online lecturing (Table 7).
Participant responses to reasons for intending to use or not use the online education platform in the future
On the other hand, 42 participants who did not want to use online lectures in the future cited the lack of interaction with students as the main reason (31, 73.8%) and either noted that they prefer in-person lectures (6, 14.3%) or that it is difficult to use the program (4, 9.5%).
Considering the responses to open-ended questions about the overall online education experience, 31 (38.3%) mentioned the need for an instructional design to enhance student interaction and participation, 26 (32.1%) mentioned the need to improve the ICT system for online education, and 15 (18.5%) mentioned the need for faculty development for online education (Table 8).
Open-ended questions about the overall online education experience (N=81)
DISCUSSION
The pandemic made medical schools worldwide to switch from in-person to online education within a short period of time [13-15]. Particularly, in South Korea, the outbreak coincided with the beginning of a new school year in March 2020. This posed new challenges for the faculty, students, and staff in beginning a new year with a redesigned curriculum for all grades. The distribution of the specialties (17.1% basic medicine, 70.9% clinical medicine, 12% other) of the faculty members currently enrolled in the YUCM was very similar to that of the professors who responded to the questionnaire (25.0% basic medicine, 65.9% clinical medicine, 9.1% research and special purposes), which proposes that this study used representative samples.
Only 18.2% of the participants had previous online lecture experience. This revealed that, although ICT-based education has been spotlighted, its actual usage by the faculty in their lectures remained low. This suggested that approximately 80% of the faculty must have been challenged by the forced transition to remote learning as they did not have prior experience in online education. Therefore, the responses of those who had no prior online lecturing experience could provide a meaningful assessment for ICT-based education.
Regarding lecture preparation time during COVID-19, more than 70% of professors said that it had increased. This suggested that online lecture preparation takes longer than in-person lectures, which can heighten pressure on lecturers. Participants responded that having to pre-record lectures was the main reason for the increase in preparation time.
It was found that increase in lecture preparation time was also closely related to satisfaction with online lectures. When the lecture preparation time increased, the difficulty in preparing and lecturing increased, and when difficulty increased, the satisfaction level with the lecture decreased. Therefore, to increase the satisfaction of professors with online lectures, support must be provided to reduce the time required to produce pre-recorded lectures. As a specific means to this end, training can be provided in infrastructure utilization and human resources. Additionally, many professors complained of difficulties in using the equipment and the program built into ICT-based education. This result is consistent with those of previous studies, which state the inadequacy of technological facilities as one of the main challenges faced by faculty in the process of developing and implementing online lectures during remote learning [8,9,16-18]. Therefore, to revitalize ICT-based education, faculty development and human resources must be provided for easier and continued use of infrastructure by the professors [19-21].
Professors have been in need of a teaching design that allows active interaction with their students when using an online platform for teaching. In fact, the main difficulty pointed out in conducting online lectures was the inability to read students’ reactions. Further, the prime reason for not wanting to continue future online lectures was the insufficient interaction with students. Moreover, the participants indicated that to successfully continue online education, a systematic program that monitors students’ participation and development of an instructional design to increase interaction with the students are needed.
At universities, faculty–student interaction is key to the growth and development of students and positively impacts their abilities, including their cognition [22,23]. However, in online classes, two-way communication between the instructor and the students is significantly limited compared with in-person classes. Some previous studies reported that the absence of interaction in the former negatively impacts students’ adjustment to college life by making it difficult to ask questions and weakening the sense of belonging within the medical community [2,21]. Therefore, it is critical that an environment in which the instructor and students can actively interact and provide bidirectional feedback be provided even during remote learning [24]. Professors’ real-time feedback during class to the students’ responses may encourage more student participation, as the asynchronous communication environment presented immense challenges to the students learning remotely [9]. Therefore, it remains a task for medical schools to ensure smooth faculty–student interactions to guide student participation in online classrooms [25].
The COVID-19 pandemic demanded an online transition that was so abrupt that not enough time could be devoted to designing a curriculum that enabled high student–faculty interaction appropriate for remote learning; lectures online remained passive and were focused on delivering the required information included in the medical curriculum. Therefore, we must explore ways to increase student participation using methods such as flipped learning and team-based learning. Furthermore, there is a need for faculty development so that professors can design these teaching methods and incorporate them in lectures.
Lastly, among professors with high lecture satisfaction, the proportion of those who expressed their intention to conduct online lectures in the future was significantly higher. Therefore, it is necessary to identify factors that can increase lecture satisfaction so that professors voluntarily participate in ICT-based education. Previous studies mentioned that, although initially the professors resisted online remote learning, an attitude of positivity and gradual reception was observed when adequate infrastructure, appropriate program support for instructors, and time to familiarize with the facilities were provided [21]. Therefore, sufficient technology, resources, time, and human resources that meet their needs should be provided to improve their experience with online education.
1. Limitations
This study has some limitations. First, the responses were from faculty members of a single medical school, affecting the generalizability of results. Second, the survey response rate was not high; therefore, the survey results may be biased. Third, to ensure anonymity, some demographic factors were not included. Hence, the responses according to participants’ age and gender could not be analyzed. Finally, this study focused on the initial period of the COVID-19 outbreak-related changes in medical education and corresponding responses by the faculty. Considering that medical schools have been adopting various measures to introduce a more effective online education since the outbreak, many faculty members may have become more familiar with online education, and their perceptions of it may also have changed.
2. Conclusion
Medical schools have devised and adjusted to the alternatives to their original ways of teaching since the COVID-19 outbreak. However, the possibility of interruptions in medical education in the future due to COVID-19 variants as well as new infectious disease outbreaks cannot be ruled out. Therefore, it is critical to build a long-term educational system at the university level to effectively respond to such events. Additionally, a learner-centered instructional design that promotes a wide range of interactions and active learning is required. This should be preceded by faculty development. Further, it is necessary to consider a plan to establish an easily accessible infrastructure for ICT-based education.
Notes
AUTHORS’ CONTRIBUTIONS SA and JIS designed the study. IRL and HJ collected the data and IRL, HJ, and SA did the analysis. IRL, HJ, HWK, YL, SA, and JIS wrote the first draft of the manuscript. All authors had full access to all the study data. All authors reviewed, wrote and approved the final version.