Distant virtual medical education during COVID-19: Half a loaf of bread.

Digital medical education is in its infancy in the geographically challenging and mountainous country of Nepal. To limit the spread of the Covid‐19 pandemic, educational institutions in Nepal have remained closed for more than a month and medical colleges are no exception. Recently, however, Kathmandu University has instructed its affiliated institutions to run online classes for students so that there would be no lag in the academic calendar. Ten medical schools affiliated to the university are scattered all over Nepal, enrolling 100 students each year for the bachelor's degree in medicine. Each student learns about different fields of medicine for 5 years until they graduate; postgraduate studies continue for the next 3 years, before they can become a specialist.

Kathmandu University has instructed its affiliated institutions to run online classes for students …

Until recently, online portals and mobile applications were limited to video‐conferencing and chat among families and friends. In order to combat the spread of corona virus, various webinars are now conducted, with the help of the IT department of each medical school, for discussion and to help educate medical professionals. Using a similar web portal for the online teaching for medical undergraduates would be an innovative step in Nepalese medical education. Online education would enable good engagement with ‘locked down’ students, and would also provide a medium to involve them in learning activities. Many challenges are faced during online teaching, for both students and teachers,1 such as slow or non‐existent internet connections, and a lack of basic know‐how for digital learning procedures, etiquette with volume controls and video backgrounds, to name a few.

Online education would enable good engagement with ‘locked down’ students …

Some popular web portals like Zoom and Skype are being used for teaching and learning purposes, and provide platforms with a free feature so that one can sign‐up and schedule a meeting (class) in which about 100 students can participate. Presentations on the screen can be shared among all the viewers, who can simultaneously watch the same screen. The video conference can also be recorded/saved for future reference. There is an onscreen whiteboard feature too, which can be used as the classroom blackboard.

There are certainly barriers for online teaching, but these could be overcome using innovative models.2 For effective teaching, engaging the learners can help them to retain information. In face‐to‐face sessions, a good educator moves around the podium to engage the room and retain the focus of the students.3 Adopting an open stance, maintaining eye contact and encouraging learner participation are effective ways of teaching.3 But the teacher being seated in front of a screen during online teaching can be disadvantageous to retaining the attention and focus of the students. Recording class attendance based upon the presence or absence of students would certainly get more students to attend classes; however, there is a possibility that some students will log in to the lecture, mute the microphone and then engage in other activities. This problem could be minimised by having interactive question–answer sessions, quizzes, brainstorming, and by encouraging students to explore more on the topic and give a presentation, to name a few.

Online education is considered to have a broader reach than traditional classroom teaching.4 All that is required to attend the scheduled class is to have a computer or a smartphone with an internet connection. All medical students in Nepal are expected to have a smartphone, personal computer and access to the internet; however, some students from poorer families, who are studying on government scholarships, will have gone back to their homes in remote geographic locations in this mountainous country, and might not have an internet connection. When all family members are locked down at home, it might be difficult for some students to find a quiet and private environment for the sessions. Internet use has also increased during the lockdown, with all members of the family now at leisure and at home sharing the same internet access, which might blur or pixelate the video, thereby compromising its quality. Strong winds, thunderstorms, unexpected heavy rain and hailstorms also cause frequent interruptions of electricity. Deteriorated audio and video quality and unexpected power cuts are major setbacks for an effective online teaching and learning process.

Clinical training is an integral part of medical education. Instruments, specimens and other clinical teaching aids are inaccessible during the lockdown, where both the educators and the learners are at their place of residence. Although there are many disadvantages with online teaching, during this time of global crisis access to online theory classes for medical undergraduates typifies the proverb that ‘half a loaf is better than none’.

Although there are many disadvantages with online teaching, during this time of global crisis access to online theory classes for medical undergraduates typifies the proverb that ‘half a loaf is better than none’