RGUHS Nat. J. Pub. Heal. Sci Vol No: 17 Issue No: 2 pISSN:
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1Dr Sujithra S, Department of Public Health Dentistry, DAPM RV Dental College, Bangalore, Karnataka, India.
2Department of Public Health Dentistry, DAPM RV Dental College, Bangalore, Karnataka, India
3Department of Periodontics, DAPM RV Dental College, Bangalore, Karnataka, India
4Department of Public Health Dentistry, DAPM RV Dental College, Bangalore, Karnataka, India
5Department of Public Health Dentistry, DAPM RV Dental College, Bangalore, Karnataka, India
6Department of Periodontics, DAPM RV Dental College, Bangalore, Karnataka, India
*Corresponding Author:
Dr Sujithra S, Department of Public Health Dentistry, DAPM RV Dental College, Bangalore, Karnataka, India., Email: sujithras.rvdc@rvei.edu.in
Abstract
Background: The Coronavirus disease 2019 (COVID-19) pandemic arguably represents the worst public health crisis of the 21st century. There is a paucity of literature examining the interns' perspective in dentistry on e-learning during the pandemic.
Methodology: A cross-sectional study was conducted from December 2020 to June 2021 with the target population as interns of DAPM RV Dental College in Bangalore, Karnataka, who were in their final year during the onset of the pandemic. A convenient sampling method was incorporated. Primary data were collected using a questionnaire (under six domains) via Google forms and distributed to all interns pursuing internship at DAPMRV Dental College through a WhatsApp group.
Results: The outcome of our survey confirmed that, during the COVID-19 pandemic and thereafter, reforms in dental clinical training and assessment strategies should be more extensive, using virtual reality haptic labs, simulation technologies, and reliable tools that support attaining adequate skills and objective evaluating student’s clinical abilities in comparison with e-learning. It was also observed that gender did not significantly influence the responses of the study participants.
Conclusion: Our study showed that students partially appreciated the new system with e-lectures and discussion forums. However, they expressed missing on-in-campus educational experiences.
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Introduction
Effect of Coronavirus disease 2019 (COVID-19) on Healthcare System
The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has greatly impacted both the education and healthcare sectors, mainly due to the close contact required between healthcare workers and patients.1 Dentists are particularly at an increased risk of encountering the coronavirus due to procedures that generate aerosols. As a result, there has been a strong focus on practices such as hand hygiene, the use of personal protective equipment (PPE), and strict infection control protocols. Even with these safety measures in place, guidelines promoting physical and social distancing have continued to have repercussions on the worldwide education system.2
Effect of COVID-19 on Education System and Dental Education
In April 2021, United Nations Educational, Scientific and Cultural Organization (UNESCO) indicated that 192 nations had shut down all educational institutions, impacting nearly 1.6 billion learners.2 To promote social distancing and curb the transmission of virus, campuses were closed, and in-person classes transitioned to online formats. This transition created substantial obstacles for education, particularly in the field of healthcare. Lockdown measures affected dental schools and hospitals worldwide, resulting in the partial or complete shutdown of most facilities, which disrupted dental clinics, preclinical laboratories, and experimental research.3 Students faced delays in both crucial and elective clinical placements, causing assessments to be postponed and hindering the educational process.4
Initiatives and Guidelines
A variety of suggestions and guidelines have been informed by several health authorities, both international (ADA, CDC, WHO) and national (IDA, DCI, ICMR), to guarantee the safety of health professionals.5
E-Learning During Pandemic
Online teaching platforms are typically classified into two main types: synchronous and asynchronous learning. Synchronous learning takes place in environments such as zoom conferences and live-streamed webinars, where lectures are broadcast in real-time to students' digital devices. Students must be equipped to handle the evolving requirements of online platforms, both technologically and educationally. The rapid transition from physical classrooms to digital screens has been unexpected, and institutions had to implement effective strategies to facilitate seamless academic sessions.
Response of Institutions During Pandemic
In response to the enforcement of both national and international guidelines and standard protocols, numerous dental institutions have ceased clinical operations and academic instruction, opting for stay-at-home policies. Additionally, some have adopted social distancing measures within laboratories, including those focused on clinical skills. Classroom-based education has been supplanted by remote learning. "Off-the-shelf programs" for teaching and assessments have become the norm.6
Gap in Knowledge and Need for the Study
Although there is a wealth of research examining the effects of the COVID-19 pandemic on various sectors, including medical and dental education, there remains a significant gap in studies that explore dental students' perspective on how the pandemic has impacted e-learning, particularly in the realm of clinical skills. Our study delves into the perceptions, knowledge, and attitudes of dental interns at private institutions regarding the pandemic's influence on their education, as they engage directly with a range of clinical practices. This research intended to assist institutional policymakers in preparing for challenges that may arise in future pandemics.
Materials and Methods
A cross-sectional study was conducted from December 2020 to June 2021, with a target population of 41 interns of the DAPM RV Dental College in Bangalore, Karnataka, who were in their final year during the onset of the pandemic. A convenient sampling method was used to collect primary data via online mode using Google forms distributed to all interns pursuing internship at DAPMRV Dental College. An informed consent form was included in the Google form, and participation was voluntary. The study was conducted in three phases: 1) Instrumental development, 2) Administration of the questionnaire, and 3) Data analysis.
Phase 1: Instrument Development
The duration of this phase was one month, and it consisted of developing and validating a questionnaire. A structured questionnaire was designed based on a thorough review of the literature, of which 20 articles were considered and 14 relevant articles were selected. The questionnaire was validated for face and content by a subject expert. The final questionnaire developed consisted of 29 items in six domains: the socio-demographic domain, respondents’ perceptions regarding the COVID-19 pandemic, the institution’s actions during the pandemic, the influence of COVID-19 on dental education, students' views on teaching clinical skills during the COVID-19 pandemic, and suggestions for during and after the pandemic. The effect of COVID-19 on dental education was categorized into two subcategories. A pilot test of the questionnaire was carried out with six students and one faculty member to assess the appropriateness of the questions for each category and their understanding.
Phase 2: Administration of Questionnaire
The duration of this phase was three weeks, and Google forms were constructed, which included informed consent and were shared with interns via WhatsApp group.
Phase 3: Data Analysis
The duration of this phase was two weeks. Data were analyzed using percentage, frequency, standard deviation, and mean values. Suitable inferential statistics are used.
Results
The study involved a total of 40 participants, the majority of whom were females (82.9%, n=32), followed by males (17.1%, n=8), with a response rate of 82%. Most participants belonged to the 23-25 years age group, with a mean age of 23 years, and 50% were local residents.
Table 2 explains the influence of gender across the variables using the Chi-square test of association namely, age, place of stay, respondent’s perception regarding dental education during the COVID-19 pandemic, perception of students regarding e-learning during the pandemic and perception of students on e-learning for clinical skills during the pandemic. However, the following variables do not show any statistical significance.
The proportion of responses distributed across the study subjects has been observed under two primary focus areas of dental education:
1. Patient-oriented clinical skills acquired during the respondent’s study period in the pandemic.
2. Policy perspective.
Comparison of intern’s responses from Domain 2 (respondent’s perception regarding dental education during the COVID-19 pandemic) with Domain 5 - Item 5.3: Reduction in patient flow influences the quality of graduates’ clinical skills during the pandemic and thereafter.
Inference: It was observed that a greater percentage of individuals who had a negative attitude towards the influence of the pandemic on dental education had a greater proportion of agreement with the notion that reduced patient flow did influence the quality of graduates’ clinical skills during the pandemic and thereafter. Comparison of subject’s responses from Domain 2 (respondent’s perception regarding dental education during the COVID-19 pandemic) with Domain 6 - item 6.3: Would an adaptation phase for the new guidelines during the pandemic and thereafter improve dental education outcomes?
Inference: The above proportion bar graph explains that a greater proportion of individuals with a negative attitude towards the pandemic on dental education felt a need for an adaptation phase for the new guidelines during the pandemic and thereafter improve dental education outcomes, emphasizing on the policy perspective.
Discussion
Due to the lockdown, 41 students took part in the study, achieving a response rate of 82%. A significant majority of the participants (92.7% of respondents) believed that the COVID-19 pandemic had a detrimental effect on dental education, with expectations that its impact will persist, necessitating the development of appropriate strategies to manage any similar future pandemics. This finding aligns with the results reported by Hatter et al.7
Online Teaching and Learning
Most students believed they missed out on educational experiences and felt that online teaching was less effective than in-person instruction. This perception contrasts with the findings of Susan Hattar's study and might be attributed to inadequate faculty training and limited available tools.7 Students also felt uncomfortable learning from PDFs and participating in group discussions, and they did not find Objective Structured Clinical Examination (OSCE) to add positive value, which differs from other studies. This could be due to the traditional methods, like lectures, commonly used in our country.7 Participants showed a preference for well-organized clinical resident training, aligning with Susan Hattar's study, likely due to the global lockdown and the prioritization of emergency dental procedures.7 Direct patient interaction during dental clinical education and student training, under both close and remote guidance from experienced clinical professionals and mentors, is crucial for developing necessary clinical skills, competencies, and decision-making abilities, and is essential for dental graduates.8 Additionally, it was noted that gender did not significantly affect the responses of the study participants.
Addressing the Teaching Methodology Adopted for Clinical Skill Training in Dentistry
Our survey results highlighted the necessity for more thorough reforms in dental clinical training and assessment strategies both during and after the pandemic. This involves integrating virtual reality haptic labs, simulation technologies, and reliable tools to help students develop essential skills and objectively evaluate their clinical competencies. Concurrently, traditional clinical practice with real patients should be enhanced with appropriate facilities and measures to mitigate cross-infection risks, such as adequate PPE supplies, negative pressure rooms, protective masks, virtual stimulation, and air purifiers to maintain a safe clinical environment. The current findings were similar to the results of a study by Haridy, where most participants agreed that institutions should provide an adaptive phase before implementing new policies and guidelines, along with standard protocols and virtual laboratories to support student clinical training during and after the pandemic, consistent with the results of another study.5,8
Limitations
The current study faced some limitations. It evaluated the interns' perceptions at a single point in time, without considering the possibility that their feedback might change over time, and it is also important to evaluate the teachers' perspectives. Future studies should aim to increase the sample size and employ a qualitative approach to better understand perceptions.
Conclusion
The effects of COVID-19 pandemic in the education sector was a new crisis that has not been experienced in the past, and online learning is an adaptive change with its own setbacks. Our research demonstrated that students had a partial appreciation for the new system featuring e-lectures and discussion forums. However, they recognized that they were lacking several educational experiences. Thankfully, the overall level of preparedness was encouraging, and the students expressed confidence regarding most of the qualities anticipated from dentists. Their comments also indicated a deficiency in their self-assurance for independent practice after graduation. Further studies are necessary to expand the sample size of this investigation.
Conflict of interest
None
Acknowledgement
We would like to thank Dr Sanchita Murli, Dr Anusha B, Dr Anusha M, Dr AshaRani, Dr Ashifa, Dr Afreen Shifa, Dr Nikita Isaac and Dr Sanjna G from DAPM RV Dental College, who were a part of the undergraduate research project as research assistance who aided in data collection without whom this research study would not have been possible.
Supporting File
Figure 1: Comparison of responses across Domain 2 and Domain 5: Item 5.3" width="200px" src="https://hm-journals.s3.ap-south-1.amazonaws.com/home/journals/Jb1MthaAYTjCuR9KVtQqGTP2iQ3S7PsQMUWUwmFY.png">
Figure 2: Comparison of responses across Domain 2 and Domain 6: Item 6.3" width="200px" src="https://hm-journals.s3.ap-south-1.amazonaws.com/home/journals/eLawP22ItR8d6YjJC9L2AXWqgthcJX2Q3ot4ImW2.png">
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