Survey Among Medical Students During COVID-19 Lockdown: The Online Class Dilemma

. 1 2 Background: In view of COVID-19 lockdown in India, many colleges started online classes. This study aimed 3 to evaluate the attitude of and the factors affecting medical students attending online classes during lockdown. 4 Methods: We designed an online questionnaire with open-ended, close-ended, and Linkert scale questions. 5 Links to the questionnaires were shared with the medical undergraduate students who have attended at least 6 one online class during the COVID-19 lockdown period. Respondents were 1061 participants from 30 medical 7 colleges from the states of Kerala and Tamil Nadu in India. 8 Results: The majority of students – 94 % (955/1016) – used smartphones to attend online classes. ZOOM/ 9 Skype – by 57.1 % (580/1016) – and Google platforms – by 54.4 % (553/1016) – were commonly used. 10 Learning at leisure – 44.5 % (452/1016) – was the top reason why students liked online classes, whereas 11 network problems – 85.8 % (872/1016) – was the top reason why students disliked them. Lack of sufficient 12 interaction – 61.1% (621/1016) and more than half the participants – 51.7% (526/1016) – did not want to 13 continue online classes after COVID-19 lockdown. More students – 55% (558/1016) – favored regular classes 14 than online classes. 15 Conclusion: Students in our survey did not seem favorably disposed to online classes. Network problems 16 experienced by students should be addressed. Furthermore, teachers should try to make the classes more 17 interactive and educational institutions should address the problem pointed out by the students in order to make online classes more effective in the future.

Publisher's Disclosure: This is a PDF file of an unedited manuscript that has been accepted for publication.

7
As a service to our readers and authors we are providing this early version of the manuscript. The manuscript 8 will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable 9 form. Please note that during the production process errors may be discovered which could affect the content, 10 and all legal disclaimers that apply to the journal pertain.

12
International Journal of Medical Students -Original Article.

2
Background: In view of COVID-19 lockdown in India, many colleges started online classes. This study aimed 3 to evaluate the attitude of and the factors affecting medical students attending online classes during lockdown.

15
Conclusion: Students in our survey did not seem favorably disposed to online classes. Network problems 16 experienced by students should be addressed. Furthermore, teachers should try to make the classes more 17 interactive and educational institutions should address the problem pointed out by the students in order to 18 make online classes more effective in the future.

1
Coronavirus disease (COVID-19) has been reported in 216 countries and has affected more than 5.4 million 2 people 1 . World Health Organization (WHO) on March 11, 2020 declared this disease to be a pandemic 2 . The 3 first case of COVID-19 in India was confirmed on January 30,2020 3 . In order to contain the spread of disease, 4 India declared a national lockdown starting from 24 March 2020 4 . Even with increased pathogen exposure, 5 additional working hours, stigma and violence, health care workers still continue to be in the first line for 6 preventing and treating COVID-19 disease. Educational institutions were shut down because of the lock-7 down; however, many medical students all around the world were involved in voluntary duties to control 8 COVID-19. Colleges started online classes to ensure continuity of education. India is not new to online 9 education. SWAYAM, an integrated web portal, conducts online education from the high school to the 10 university level 5 . However, being a developing country, India has lack of good network and internet coverage.

11
Many students cannot simply afford the extra cost and equipment needed to utilize online learning to its full 12 potential.

14
Medical undergraduate education (MBBS) is a four and a half years program with one-year compulsory 15 internship in hospitals. With 542 medical colleges and with a capacity of almost 79,000 medical students 6 , 16 updated competency-based curriculum requires students to acquire experience in various practical skills.

17
Understanding complex pathologies and procedures demands more interaction and discussions with 18 teachers. This is not possible without clinical rotations. The final year undergraduates spend most of their time 19 in wards, perfecting their history-taking and examination skills prior to university exams.

21
Use of technology in education is inevitable and online education seems to be the only logical way during

16
The questionnaire comprised of four sections: the first section included socio-demographic details (gender,

1
Self-declared information from 1016 students from 30 medical colleges from the states of Kerala and Tamil 2 Nadu was included. All participants who entered the survey gave response to each question. Answers on likes 3 and dislikes, devices, platforms, practice and suggestions for online classes had considerable overlap.

4
Gender and semester distributions are represented in Table 1. The majority of responders -443 (43.6%) -5 were from the sixth and the eighth semesters (Table 1).

7
Characteristics of Online Classes (Figure 1  females and males respectively. This is on a par with the institutional structure. Due to temporary shutdown of 6 schools and colleges, COVID-19 had seriously affected the education of over a billion students' world-wide.

7
This is almost 68% of total enrolled students globally 11 .

9
Online education is challenging in developing countries like India, because of poor network coverage in 10 remote areas. India is second only to China in terms of internet users with the internet penetration rate of 11 50%. This implies that nearly half of the country's population has no access to Internet 12 . In our study, the  classes are mixed judiciously. This is called "blended education". E-learning modules in higher education will 28 be successful, if teachers and students integrate online classes into the current curriculum 17,18,19 . There is 29 practically very little experience of online classes within medical curriculum. In order to observe social 30 distancing norms, educational institutions with limited resources have to struggle to support their students.

31
This puts additional burden on medical teachers, who are working during COVID-19 crisis, as they have to 32 tackle pedagogical and clinical responsibilities simultaneously. Students face many hassles while attending 33 online classes. They are unanimous in stating that teachers must explore ways to make their classes more 34 interactive to improve the students' attention span.

36
Limitations of this study were that: One, we included viewpoint of only students. The teacher's opinion was a 37 part of the study; however, due to anticipated delay in data collection, we could not include their data in 38 present study. Second, we included students from medical colleges in south India -relatively easy to access 39 and Kerala was one of first to start conducting online classes. Thirdly, comparison between government and 40 private college was analyzed by descriptive statistics (Chi square) as we did not have a priori hypothesis.