Students Perception toward Effectiveness of Online Learning during COVID-19 Pandemic among University Dental Students in India and United Arab Emirates: A Multi Centric Study.

Objectives: The rationale of this study was to compare the efficiency of online learning and the differences in outcome between the two universities in India and United Arab Emirates (UAE). Materials and
Methods: A cross-sectional study was conducted with a validated questionnaire among dental students of a dental college in India and a dental college in the UAE. The data were analyzed using the SPSS software version 22, and comparison was done using the Chi-square test, ANOVA, correlation, and regression analysis. Statistical significance was set at P < 0.05.
Results: A total of 491 students responded to the questionnaire, of which 314 were from India and 177 from UAE. The awareness of online learning among students had increased after COVID-19, and Zoom was the most common platform (30.9%). The satisfaction ratio was 78.4%, and smartphones were commonly used by students. Based on the satisfaction of online learning, study participants from UAE had a higher mean attitude score (2.72 ± 0.98) as compared to Indian students (2.47 ± 0.77) (P < 0.027*).
Conclusion: The study results show that online learning was comparable to traditional method of learning. Although poor network connectivity was a deterrent for online learning among students from India and UAE, future teaching methods could inculcate online teaching methods and hence encourage blended learning as part of the teaching curriculum. Copyright:

INTRODUCTION

The COVID-19 pandemic that led to the shutdown of educational institutions worldwide was a trigger factor in the progress of the online teaching process. Online teaching became the standard mode of academic classes and many authors reported on the advantages and efficiency of online teaching methods.[1] Although online teaching was available for a long time, the continuous lockdown forced more dependence on the online learning process during the COVID-19. The reported advantages of online sessions were that it saves time, reduces costs, and offers various multimedia options for different learning purposes. E-learning has proved to increase in gaining knowledge, improved motivation, and performance along with increased retention rate.[2] The COVID-19 lockdown was a testing time for academicians and students alike to evaluate the reality and practicality of online learning platforms from a student perspective. All over the world, all medical and dental institutions initiated the online teaching process due to the pandemic.[34] This warranted a thorough knowledge of all existing online platforms. The dental institutions worldwide reported mixed reviews from students regarding the benefits of E-learning compared to traditional learning.[56] Various surveys across universities were conducted to evaluate the drawbacks and bring out the latest version of teaching including online lectures, assignment submission, preclinical, and clinical training simulators.[78] In this article, the authors are evaluating through questionnaire if the university dental students from two different countries can vary in satisfaction outcome and efficiency of online learning.

MATERIALS AND METHODS

This cross-sectional study was conducted among two dental colleges, one in South India and the other in United Arab Emirates (UAE). All students from the 1st year to 4th year, interns and postgraduates of all years were included in the survey. The questionnaire was made by using the Google documents. The form was circulated among the dental students of both the dental universities from August 15 to September 30, 2020. The pretesting phase involved testing of the questionnaire on a sample of undergraduate students from all 4 years and subject experts. Epi Info software was used to determine the minimum required sample size. Based on the calculation with a 5% margin of error, 95% confidence level, and 50% response distribution, a minimum sample size of 312 was calculated. Taking the nonresponse into consideration, increasing the sample size by 10%, a sample size of 343 students was considered to be the final sample size. Ethical approval for this study was obtained from the Institutional Ethics Committees of both the universities before the start of the study. Participation was voluntary and informed consent was obtained. A pretested, prevalidated, 23-item, self-administered, structured and closed-ended online questionnaire was formulated. The internal validity of the questionnaire was assessed by a panel of subject experts. The purpose was to depict those items with a high degree of agreement among experts. To check the reliability and internal consistency of the questionnaire, Cronbach's alpha was calculated and was found to be 0.8697. Before the commencement of the main study, a pilot study was performed on 10% of the sample size. It served as a preliminary study to identify any organizational problems and to have a prior idea regarding an estimate of the time taken for each participant. Modifications in the methodology and questionnaire were made wherever necessary, and the final study was planned and carried out. The data collection flowchart is described in Figure 1.

Figure 1

Data collection flowchart

Statistical analysis

The data were analyzed using the IBM Statistical Package for the Social Sciences software version 22 (SPSS Inc, Chicago, IL, USA). Descriptive statistics were used to calculate the frequencies. Unpaired t-test, Chi-square test, ANOVA, Pearson's correlation, and linear regression analysis was used to assess the relationship between the variables. Statistical significance was set at P < 0.05.

RESULTS

As for the demographic characteristics of the study were concerned, a total of 491 students, of which 144 were male and 347 were female [Table 1]. Statistical comparison of responses is described in [Table 2]. When a comparison of mean scores related to awareness about online modes of learning was considered, a higher mean score was obtained among UAE students (1.05 ± 0.20) as compared to Indian students (1.01 ± 0.11) (P < 0.000). Based on the satisfaction of online learning, study participants from UAE had a higher mean attitude score (2.72 ± 0.98) as compared to Indian students (2.47 ± 0.77) (P < 0.027*) [Table 3].

Table 1

Demographic characteristics of the study participants

Variables	n (%)
Gender
Male	144 (29.3)
Female	347 (70.7)
Year
First B.D.S	80 (16.3)
Second B.D.S	97 (19.8)
Third B.D.S	68 (13.8)
Fourth B.D.S	129 (26.3)
Intern	97 (19.75)
First-year PG	5 (1.0)
Second-year PG	7 (1.42)
Third-year PG	13 (2.64)
Age (years)
18-21	269 (54.78)
22-25	204 (41.54)
26-30	18 (3.66)
Degree
B.D. S	336 (68.4)
B.D.S/D.M. D	145 (29.5)
M.D. S	25 (5.06)
Country
India	314 (64)
UAE	177 (36)
Total	491 (100)

Table 2

Statistical comparison of questionnaire based on gender, country, degree, and year of study

Questions	Options	n (%)	Gender	Country	Degree	Year of study
Q1: Are you aware of online modes of learning?	Yes	479 (97.6)	0.347	0.033*	0.045*	0.041*
	No	12 (2.4)
Q2: When did you become aware of online learning modes?	Yes	156 (31.8)	0.199	0.049*	0.173	0.186
	No	335 (68.2)
Q3: Have you used any online platforms for learning?	Yes	443 (90.2)	1.000	0.875	0.505	0.915
	No	48 (9.8)
Q4: What are the online learning platforms you are aware of?	Zoom	152 (30.9)	0.014*	0.450	0.657	0.034*
	Microsoft team	43 (8.75)
	Google meet	65 (13.23)
	WebEx	95 (19.34)
	Google classroom	88 (17.92)
	Others	48 (9.77)
Q5: Do you find online learning platforms easy and student-friendly?	Yes	385 (78.4)	0.644	0.469	0.980	0.045*
	No	106 (21.6)
Q6: Which mode do you prefer to use for online learning?	Laptop/desktop	136 (27.69)	0.562	0.345	0.542	0.135
	Smartphone	144 (29.32)
	Tablets/I pad	86 (17.51)
	All of the above	125 (25.45)
Q7: Does your institution provide adequate technical support for online learning?	Yes	431 (87.8)	0.098	0.001*	0.005*	0.020*
	No	60 (12.2)
Q8: On average, how many hours/day do you use electronic resources/applications for academic performance during COVID-19?	1-2	135 (27.5)	0.234	0.000*	0.002*	0.001*
	2-3	148 (30.1)
	3-4	84 (17.1)
	>4	104 (21.2)
	<1	20 (4.1)
Q9: Do you think online classes are interactive?	Yes	332 (67.2)	0.752	0.000*	0.000*	0.001*
	No	159 (32.4)
Q10: Are you able to have one to one interaction with the staff, the same way you experience in regular classes?	Yes	166 (33.8)	0.058	0.000*	0.000*	0.001*
	No	108 (22)
	To some extent	217 (44.2)
Q11: Is sufficient time provided for the completion of assignments after the online classes?	Yes	418 (85.1)	0.211	0.000*	0.000*	0.000*
	No	73 (14.9)
Q12: Does the home environment distractions affect the online learning experience?	Yes	281 (57.2)	0.423	0.000*	0.000*	0.024*
	No	210 (42.8)
Q13: . Does prolonged use of screen time during online classes affect the eyesight?	Yes	343 (69.9)	0.000*	0.032*	0.000*	0.000*
	No	148 (30.1)
Q14: Duration of online classes compared to regular classes?	Is sufficient	350 (71.3)	0.662	0.756	0.007*	0.169
	Not sufficient	141 (21.7)
Q15: Does the nonavailability of learning resources (textbooks) affect effective learning?	Yes	357 (72.7)	0.049*	0.001*	0.045*	0.071
	No	134 (27.3)
Q16: Would you want learning materials to be provided before the online classes for a better understanding of the topic?	Yes	451 (91.9)	0.469	0.026*	0.368	0.591
	No	40 (8.1)
Q17: How did you access the materials for studying and assignment preparation?	E-books	144 (29.32)	0.139	0.172	0.352	0.124
	E-books, College provided online books and journals	134 (27.29)
	E-books, College provided online books and journals, other online resources, textbooks	195 (39.71)
	Other online resources, textbooks	18 (3.66)
Q18: Which learning method do you prefer for effective learning?	Combination	274 (55.8)	0.467	0.188	0.365	0.256
	Online	55 (11.2)
	Traditional	162 (33.0)
Q19: Does the use of headphones help you to concentrate better and avoid distractions while attending online lectures?	Yes	316 (64.4)	0.626	0.178	0.341	0.174
	No	50 (10.2)
	Maybe	125 (25.5)
Q20: Do you think online lectures helps to reduce the lecture hours in college and thereby increase the practical hours at college to gain more clinical knowledge	Yes	228 (46.4)	0.031*	0.000*	0.248	0.000*
	No	75 (15.3)
	Maybe	188 (38.3)
Q21: Do you think the same topic can be lectured by different faculties in online classes to gain more knowledge?	Yes	242 (49.3)	0.403	0.732	0.381	0.002*
	No	73 (14.9)
	Maybe	176 (35.8)
Q22: What are the difficulties you faced while attending online lectures?	Time constraints	94 (19.4)	0.403	0.732	0.645	0.002*
	Poor internet connectivity	214 (43.58)
	Technical difficulty	67 (13.64)
	Not effective as personal interaction	104 (21.18)
	No complaints	12 (2.44)
Q23: How much are you satisfied with the online classes?	Very satisfied	45 (9.2)	0.039*	0.002*	0.000*	0.041*
	Satisfied	187 (38.1)
	Neutral	214 (43.6)
	Dissatisfied	29 (5.9)
	Very dissatisfied	16 (3.3)

Table 3

Comparison of question wise mean score based on India and UAE populations

Serial number	Variables	Mean±SD		P
		India	UAE
Q1	Are you aware of online modes of learning?	1.01±0.11	1.05±0.20	0.000*
Q2	When did you become aware of online learning modes?	1.70±0.45	1.03±0.48	0.001*
Q 3	Have you used any online platforms for learning?	1.10±0.29	1.10±0.30	0.001*
Q4	What are the online learning platforms you are aware of?	1.11±0.39	1.21±0.24	0.459
Q5	Do you find online learning platforms easy and student-friendly?	1.22±0.41	1.20±0.40	0.309
Q6	Which mode do you prefer to use for online learning?	1.32±0.54	1.25±0.61	0.024*
Q7	Does your institution provide adequate technical support for online learning?	1.08±0.27	1.79±0.39	0.000*
Q8	On average, how many hours/day do you use electronic resources/applications for academic performance during COVID-19?	2.13±1.13	3.00±1.14	0.331
Q9	Do you think online classes are interactive?	1.24±0.42	2.24±0.78	0.000*
Q10	Are you able to have one to one interaction with the staff, the same way you experience in regular classes?	2.03±0.92	2.24±0.78	0.000*
Q11	Is sufficient time provided for the completion of assignments after the online classes?	1.08±0.26	1.28±0.50	0.043*
Q12	Does the home environment distractions affect the online learning experience?	1.12±0.50	1.26±0.44	0.034*
Q13	Does prolonged use of screen time during online classes affect the eyesight?	1.39±0.48	1.15±0.35	0.000*
Q14	Duration of online classes compared to regular classes?	1.29±0.45	1.28±0.44	0.444
Q15	Does the nonavailability of learning resources (textbooks) affect effective learning?	1.22±0.41	1.37±0.48	0.000*
Q16	Would you want learning materials to be provided before the online classes for a better understanding of the topic?	1.06±0.23	1.12±0.32	0.000*
Q17	How did you access the materials for studying and assignment preparation?	1.40±0.15	1.43±0.71	0.545
Q18	Which learning method do you prefer for effective learning?	1.18±0.41	1.54±0.54	0.641
Q19	Does the use of headphones help you to concentrate better and avoid distractions while attending online lectures?	1.29±0.32	1.31±0.34	0.525
Q20	Do you think online lectures helps to reduce the lecture hours in college and thereby increase the practical hours at college to gain more clinical knowledge	1.61±0.87	1.62±0.85	0.000*
Q21	Do you think the same topic can be lectured by different faculties in online classes to gain more knowledge?	1.99±0.94	1.80±0.86	0.578
Q22	What are the difficulties you faced while attending online lectures?	1.71±0.82	1.75±0.83	0.125
Q23	How much are you satisfied with the online classes?	2.47±0.77	2.72±0.98	0.027*

SD: Standard deviation

The comparison of student's satisfaction with online learning based on the demographic variables revealed a statistically significant difference with gender (P = 0.039*), year of study (P = 0.025*), and country of study (P = 0.021*) [Table 4]. Pearson correlation depicts a positive and significant correlation for satisfaction with online classes based on demographic variables gender (r = 0.92) (P = 0.042*), year of study (r = 0.214) (P = 0.002*), and based on country (r = 0.142) (P = 0.000*) [Table 5]. The multiple linear regression analysis to analyze the linear association based on country of the study concerning demographic variables revealed that the scores were significantly associated with gender (95% confidence interval [CI] = 0.075–0.089), (P = 0.024*) and year of study (95% CI = 0.132–0.185), (P = 0.000*) [Table 6].

Table 4

Comparison of satisfaction with online learning during COVID-19 based on gender, year of study, and country

Variables	Very satisfied	Satisfied	Neutral	Dissatisfied	Very dissatisfied	P, df, χ2
Gender (n)
Male	22	55	54	8	5	0.039*, 4, 10.110
Female	23	132	160	21	11
Year of study (n)
First year B.D.S	6	38	31	3	2	0.025*, 24, 36.364
Second year B.D.S	11	40	41	3	2
Third year B.D.S	4	26	31	6	1
Fourth year B.D.S	13	42	53	11	10
Intern	11	37	53	6	0
Postgraduate	0	4	5	0	1
Country (n)
India	30	129	136	16	3	0.021*, 4, 17.36
UAE	15	58	78	13	13

Table 5

Correlation of satisfaction with online classes with age, gender, year of study, and country

Spearman’s correlation	Satisfaction with online classes
Age
Correlation coefficient	−0.037
Significance (two-tailed)	0.411
N	491
Gender
Correlation coefficient	0.92
Significance (two-tailed)	0.042*
N	491
Year of study
Correlation coefficient	0.214
Significance (two-tailed)	0.000**
N	491
Country
Correlation coefficient	0.142
Significance (two-tailed)	0.002**
N	491

Table 6

Multiple linear regression analysis of variables

Coefficientsa
Variables	Unstandardized coefficients		Standardized coefficients	t	Significance	95.0% CI for B
	B	SE	Beta			Lower bound	Upper bound
1
Constant	0.866	0.132		6.548	0.000*	0.606	1.126
Age	−0.002	0.005	−0.013	−0.302	0.763	−0.012	0.009
Gender	0.0147	0.042	0.064	0.175	0.024*	−0.075	0.089
Year of study	0.158	0.013	0.497	11.893	0.000*	0.132	0.185

aDependent variable: Country. SE: Standard error, CI: Confidence interval

DISCUSSION

The online sessions have major advantages and disadvantages to the traditional system. Before the COVID-19, various online platforms were used to promote health awareness and other activities such as continuous medical and dental education for doctors.[9] The advantages of online sessions are that anyone in a remote area can have access to good education, more comfortable to access, and less expensive for organizations and students. The limitations involved less interaction with faculty and a decrease in clinical experience.[10] As per our survey observation, 67.6% concluded that online classes interactive. Although these advantages and limitations were widely reported before, the impact of COVID-19 accelerated the use of online platforms worldwide in all universities. Hence, the awareness of online sessions increased after COVID-19.[11] Of the platforms, for online sessions, Zoom was the most common used as per our survey and internet connectivity is a key essential factor for successful online sessions.[12] Our survey indicated that students faced the greatest difficulty with internet connectivity during the online sessions. Lack of clinical experience was a major concern and 46.4% of our survey recommended blended learning. Many other studies have shown that blended learning is a preferred choice.[13] There are no studies in the literature comparing data on an online survey between UAE dental students and South Indian University dental students. The overall satisfaction ratio for online learning had a higher mean score among UAE students. The awareness of the online platforms after COVID-19 had a higher positive rating for Indian students, and they rated the technical support from college at a lower score, along with requiring more time to complete assignments. Females were the most satisfied with online learning when compared to males. In general, the majority of the students from both UAE and Indian dental universities rated the online learning as neutral which is line with studies done by Hughes et al.[14] and Ariana et al.[15] The limitations of the study are, a larger sample size from various other universities in India and UAE could give a better understanding on the student perception and the areas to improve in the online training sessions. There is a need to explore the perceptions of faculties toward E-teaching during COVID-19 lockdown and the challenges encountered by them in E-teaching.

CONCLUSION

The study results show that online learning was comparable to the traditional method of learning. The millennial generation of students though well adapted to online learning is still concerned about their lack of preclinical and clinical training sessions requiring onsite supervision by instructors. Future teaching methods could inculcate online teaching methods and hence encourage blended learning as part of the teaching curriculum which is more feasible for dental education. A new online management system with a curriculum to match the present post-COVID situation is mandatory for blended learning.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.