In
today's world we increasingly keep juggling between virtual electronic and
physical reality. Most of our day to day activities have actually become online
be it learning some new dish in the kitchen or chatting with friends or shopping
the daily items for home or buying some expensive electronic goods from mobile
phone to TV to cameras or paying utility bills, doing banking or just goggling
a crazy question in mind and so on. From weather tips to holiday suggestions or
a gardening tip to scheduling an appointment with Doctor whatever we need has
actually become available online and most of us are using our smart phones and
search engines to get the answers of our queries and fulfil our needs. Smart
Phones willingly or un-willingly have become our best friends, helpers, guides,
teachers, security personnel, wallets and much more. They have replaced so many
things and activities of our day to day lives in ways beyond imagination few
years back.
Coming
to our topic of online classes and it’s role in special scenarios of lock-down,
I must begin by saying that such an experience was a first of it’s kind for
medical college teachers and students. Though since last few years medical
education and information is widely available online and all of us, including
health care professionals have been using it extensively for learning. Apart
from it in medical world, online medium is used a lot in telecasting lectures,
proceedings of conferences and seminars, live surgeries etc. Telemedicine
sessions is another field upcoming in big way for providing medical
consultations to patients in remote areas as well as expert advice of senior
doctors and specialists to peripheral health centres. Thus we see that though
the online medical information and knowledge sharing is there for many years,
but online lectures for undergraduate and postgraduate medical college students
by teaching faculty is altogether a new concept and first time experience.
Formal
medical education as we all know is spread over many years and is one of the
toughest and longest professional courses. To become a super specialist with
MBBS, MS/MD, M.Ch/DM degrees it takes around 13-14 years of college and
hospital based learning. Similarly for specialists it’s around 10-11 years of
journey, to get degrees. In this long journey of formal medical education as we
keep climbing the ladders the focus on practical patient related work keep
increasing. In undergraduate courses like MBBS, BDS, BAMS one has to study
around 15-20 subjects with practicals forming a big part in all of them. No
subject is devoid of practicals. The practicals start from the dissection hall
to laboratories for most of pre and para clinical subjects and in the clinical
subjects practical learning of students take place in field visits, clinical
visits, history taking, ward, OT & OPD postings, etc. The whole practical training takes place
in a very well designed, rigid, strict and tough curriculum. After all the art
of medical science is mostly learnt in the practical training received in the
hospitals. One may learn the science of medical subjects in books and lecture
theatres , but the real art of practising and executing the learned science is
mastered in hospital corridors, when you spend your day and night for years. It’s
said the more you burn your midnight oil in the hospital environment, the
better doctor you will become. This is exactly the reason why in spite of
tremendous commercialisation of education, no online medical degree is
available. Most of the degrees are available online through open universities
now a days, medical being the only exception probably.
What is an online class?
An
online class is a course conducted over the internet, often known as the “e-learning”.
They are generally conducted through a learning management system, in which
students can view their course syllabus and academic progress, as well as
communicate with fellow students and their course instructor. It is a type of
“distance learning”, not occurring in the traditional way in a classroom.
Online
classes are generally self-paced, allowing for greater flexibility in
completing coursework. Some of the sites where today online education for the
medical students in India are being conducted are Medwhiz, Cisco Webex, Zoom
app, Google meet, Big Blue Button etc.
Why online classes are introduced today in Medical
Education?
Since
the schools, colleges, universities were shut down and the students were
allowed to go back to their homes mostly, classroom teaching on regular basis
was not possible. This caused a huge loss of the academic hours and the students
were getting deprived from the support of their teachers to clarify their
doubts and for regular advancement of their course. Hence emerged the idea of
online education, where students will be able to learn still, while maintaining
the social distancing.
In
medical field specially, there is a huge syllabus and combating an academic
loss later on would be immensely stressful and would usher in unnecessarily
rush for both the students and the teachers. That would dampen the quality of
education. So to keep in touch with the syllabus and to head over towards its
completion within the scheduled academic year was of utmost necessity and
henceforth online education started in almost all the Medical colleges in
India.
Ways it is benefiting the medicos (pros):
Certain
advantages of online classes are :
1. Sharing the lecture notes and power points become
easy, They can revisit the recorded form of
the already taught e-classroom lectures in case they face any difficulties or
doubts later on.
2. Many faculties are also sending the PPT or notes at
the end of the lectures to the students through email or Whats App group, or the
students are themselves able to take screenshots of the PPTs, enabling them now
to actually listen to the lectures better, without having the pressure of
multitasking (listening, understanding and taking notes) at the same time.
3. There is a continuity of study and a huge syllabus can
be covered even in the pandemic situations.
4. It’s the best option for students in the lock-down who
have their exams approaching. They can be in touch and under the guidance of
their professors.
5. Since attendance holds an important criterion in a
medical curriculum, a huge portion of it is also compensated during the lock-down itself.
6. Students are now able to attend the classes at home
comfort, avoiding congestion and over-crowding of a class room. There are now
no visibility issues as they’d used to face often from the back benches. In
some places, classroom lightning was also a factor.
7. Students who have the habit of studying alone can
concentrate even better during online study. There is no disturbance or
distraction from their peers sitting around them.
8. Surgical techniques and many practicals can be very
easily demonstrated by videos giving a clear dimension regarding the procedure
and it becomes clearer to the student as compared to reading them in the
textbooks.
The difficulties Medicos are facing in an online
study (cons): In India, out of 138 crore population, only 56 crore people (approximately) have
the access to the internet in 2020. So, despite the large base of internet
users, the internet penetration rate in the country still stands below 50%.
Though digital revolution is now sweeping small towns and villages, yet many a
times its accessibility or connectivity is questionable especially in rural
areas and outskirts of towns from where many medical students are coming.
Henceforth,
1 ) The medicos who are living in these areas during
lock-down are facing a challenge in attending the online lectures.
2) Due to network disruption or technical issues, the
students are often facing a break in the lecture flow, disappearance of the
slides from their screen or audio dis-connectivity, leading them to lose
interest and confusions in the ongoing class eventually.
3) Most importantly, practical knowledge and experience
is the heart of the learning of a professional course like Medical Education.
This is regretfully uncompensated in such an online platform.
4) Popping up of notifications or other social media
messages on their mobile screen also enhances distraction and the students are
often deviated towards operating these social medias muting or just minimising
the ongoing lectures.
5) Students are also able to log into the online classes
through multiple devices, this enables few students to join the lecture
creating fake accounts and disturb the ongoing class in public chat or by
unmuting their microphones and making noises.
6) Lock-down was imposed on a very short notice and the
students did not have the idea of its extension from beforehand. Therefore,
many are not having all the books or proper copies with them to wherever they
are struck down. This hampers the pre-acquaintance of the topics that are going
to be taught and post follow up of the topics already taught; thereby, urging
the students to slowly lose interest and confidence of the topic in the
subsequent lectures.
7) Some of the teachers are not well versed with this new
e-platform so fast and that sets in a restriction in their way of teaching. At
times, they are not able to fully express themselves as they would have done
with chalk and board.
8) Due to less time-allotment for e-classes, often there
is a rush and many students are finding it difficult to cope up or fully
understand and enjoy a new topic. In their perception, its turning out to be a
“slide reading”.
9) The informal ambience and lack of active peer
influence often leads to lack of attention in the students for the ongoing
lectures.
10) The successful imparting of an education is assessed
through exams, which itself is coming with a lot of loopholes when it comes to
an online platform.
What
can compensate the direct, real life interaction of a classroom? That warmth of
the ‘personal touch’ that the professors give while interacting face to face?
Sharing
the lecture in a classroom with the colleagues with the personal encouragement
of the professors gives a lifelong impact.
Learning
a new thing for the first time can usher in interest only when the students are
actively involved, participated and made to perceive the practical utility of
it. Otherwise everything is also written in the books!
Many
students are not finding an “e-learning” productive owing to the lack of active
professor-student and student-student interactions. This in turn is ushering in
a teacher-student relationship gap.
Body
language is very important in communication. When a teacher is actually able to
see his students, he understands whether they are getting the topic and can
modify instantly his way of teaching or imparting of the knowledge, sparkling
up the interest in the class once again.
In
an online class, even when there is a scope for screen sharing, its not
possible for a teacher to see 100 or 150 tiny picture details covering a small
part of the screen at the same time.
Moreover,
students who have just been promoted to the new academic year, a few days
before the lock-down has set in; are not being able to know their new professors
by face (except for a few teachers who are sharing their screen and showing up
their face while teaching). This creates an identifying crisis in the students
and affects the teacher-student familiarity, and hence the bond.
What are the ways to overcome the teacher-student
relationship gaps of the online classes?
Enhancing
interactions is the key solution to compensate the teacher-student relationship
gaps. Interactions on an “e-platform” can be enhanced through:
- Introducing Video
Conferencing while teaching.
- Involving the students
in a presentation of the already taught and explained topics.
- Interactive online quizzes
at the end of each topic or once a week along with rewards for the winners.
- Creating a familial and
friendly atmosphere for the students, so that they can comfortably speak up
their needs.
- Giving away the overall
brief picture of the topic in a nutshell at the beginning of the lecture to
break the ice. This will help the students to understand where they are
standing in a lecture, and pay attention interestingly.
- To engage the students
through questioning or interesting stories even in the middle of lectures
- To show up one self
while teaching so that the student identifies their professor.
- The faculty should also
take the class on a bubbly and comfortable note..
- Students should have
self-controls and hide or switch off their notifications during lecture hours.
- Students should be
honest with their user ids and maintain the formal decorum of the online
education.
- A regular feedback is
essential to understand the gaps and identify the areas for improvement
With
this background when we were given the task of online teaching for medical
students, the idea itself scared all of us. It was not that we were not
computer or gadget friendly, but we knew this is something which will actually
harm the medical education. But in the circumstances, there was no other
option, so the medical faculty decided to give it’s best in the restricted
environment.
But online education completely lacks human touch, it
completely lacks the interaction that is very much needed for transferring of
knowledge between the two sides and that can happen only in the classroom
setting. A teacher sitting in a transmitting area and broadcasting on a system
not in front of his or her students can never give his or her best. A senior
faculty member Prof. Kishor Patwardhan,
MD(Ay), PhD, Vaidya-Scientist Fellow and Professor in Department of Kriya
Sharir, Faculty of Ayurveda, IMS, BHU, with decades
of teaching and research experience and an expert in online lectures, when
asked about online medical classes said, “I
was unable to figure out why I have a confused state of mind, with very little
motivation since the lock-down began. Handling online activities was not new to
me. In fact, I have been moderating Face book groups, Google classrooms etc
since many years for conducting academic activities. I have been working on
making Ayurveda academic deliberations online through Ayurveda Network for more
than one year.
He
continues to express his dissatisfaction “Still, this time when I was asked to
restrict all academic activities to online mode, I became restless. Though for
the first few weeks, I could sustain this, I became too exhausted for the last
ten days or so. I did not have the drive to keep up all my activities
up-to-date. I could not meet the deadlines. In fact, there were a few papers
that we were working on and there were a few other assignments like editorial
work etc. Though nothing was directly linked with lock-down, I was unable to
keep up my normal motivation levels to keep continuing my work. Today suddenly
I realised why I was feeling low: this 'online teaching' was not the profession
I loved! I loved spending time with my students. I could write papers only and
only while sitting with my students. Many new ideas would come up during the
discussions I used to have with my students. Many questions that students used
to ask made me think and made me search for the answers. Overall, students kept
my learning curve in an upward direction all these years.”
Prof.
Patwardhan concludes “With online teaching, we mostly don't have real-time
interaction with all of our students. Many of our students are from rural
background and do not have uninterrupted Internet connectivity. Many don't even
have access to android devices and laptops! Overall, I have not yet mastered
the art of ignoring this glaring inequality and pretending as though everything
is hunky-dory! Hence, I want a normal classroom, as early as possible!”
IMS,
BHU attracts the best of under and post graduate students, they are cream of
the society and excel everywhere. When asked how are they feeling with this
system. Their emotions are summed up below :
“The
impending uncertainty of our future did petrify us. This uncertainty went on
for more than a month. We were scared whether there would be examinations once
college reopened. We were scared about the fact that our session well get
delayed which will lead to the eventual delay in our final professional exam
and future, our opportunity to take the Post graduation Entrance test. Along
with hysteria, there was a gloom that loomed in the atmosphere. Our syllabus
was lagging behind. Not all was fine and the virus was spreading.
There
was an answer though. Technology has really come a long way. The proposal of
online teaching was welcomed far and wide by all teachers and students alike.
Schedule was set to do away with the lag and move forward in the portions
completed. Multiple applications were found and tested to finally select the
one that was the best. We were mailed or texted our schedules in advance.
The
first few days were very exciting for it was a different platform altogether.
Something we hadn’t had the opportunity to experience previously. Teachers shared
their presentations and instead of taking notes, it was easier for students to
take screenshots which helped them to save the class on their phones. Few of
the teachers even sent their presentation for it was easier for students.
Teachers tried to interact too through questions and discussion which most of
the students refrained from for fear of embarrassment. Interactions from students
were mostly limited to wishing the teachers at the beginning and at the end of
the class. It was heartening and overwhelming to see teachers who do not use
technology much, trying to develop a knack for it and struggling in the
process. They tried their best to give their all alongside dealing with their
patients and being the forerunners in the fight against COVID-19.
All
this did come with a whole lot of glitches as well. The compulsory attendance
system was unfair to students living in remote areas where regular internet
supply was not possible and even if it was sometimes the amount of internet
data used up was large. It was very disheartening to see few notorious students
acting like miscreants and making use of technology to create disturbance in
the already disturbed classes. Sometimes the connection was not proper and
classes would result in a waste of time.
Since both the teachers and students were not in an ambient atmosphere
conducive to a classroom teaching for they were either at homes or the hospital
– it did create struggle on both their parts sometimes managing and shuffling
both the things.
It
was also saddening to see, that somewhere Indian teachers no matter how
proficient they are in their professional skill, struggled where it came to using technology. Also the fact that the
number of classes took in a day exceeded what we had on a normal college day –
created a backlog for students because the syllabus now was running far ahead
of its time but students had no books to study the subjects with. Screenshots
of presentation and PDF version of textbooks do not help most of the students
to clear their doubts and understand the concepts. This further increased the
fear – what if examinations are held just after the lock-down is over? The teachers would claim that the syllabus is
done and dusted, but it was not possible for students to get their book during
this period of crisis. But what the biggest drawback was that there was no
human touch. We couldn’t see our teachers standing tall in front of us.
Teaching us, questioning us, scolding us. Neither could they see us. What is of
utmost importance in the filed of medicine is clinical experience. This
situation led to a situation where there was no clinics and no gain of
experience.
But
all is well that ends well. The untiring efforts of our arduous teachers will
help us always excel in life. It is only because of them that we are who we are
and we will be what we will be. We can never thank them enough for their
unfathomable services. Thank you teacher.”
Summing
up, both online and offline education have their own advantages and
disadvantages and both have their roles to play. But as far as medical
education is concerned, online education is certainly not the way, yes in
certain special circumstances it can be used, but for routine formal education
and training, sooner we return to college and hospital based teaching in
lecture halls, wards, OTs, OPDs , the better it will be for humanity. As
Doctors mastering in art and science of medicine can only be produced by the
enormous practical experience they gain and receive from their seniors and
teachers coupled with theoretical knowledge of books and class room teachings.
ABOUT AUTHORS
Dr.
Siddharth Lakhotia has been pioneer in establishing Open Heart Surgery
programme, Open Heart surgery and Thoracic surgery ICU, M.Ch degree in CTVS,
ECPT diploma & PDCC Thoracic Surgery in BHU and modern OT complex of his
department. His main professional
interests are heart surgery for children, lung and trauma surgeries, teaching
UG and PG students. He loves making educational videos of different
cardiothoracic surgical procedures. He believes in work life balance. Travelling, Trekking, long road journeys, music, photography, antiques collection, phillumeny, philately, Bio-Farming, planting trees, swimming, table tennis, Yog and social activities have been his passion. He considers Nature as reflection of God.
Prof. Kishor Patwardhan
MD(Ay), PhD, Vaidya-Scientist Fellow
Professor, Department of Kriya Sharir,
Coordinator, Ayurveda Network (under PMMMNMTT Scheme of MHRD),
Faculty of Ayurveda, Banaras Hindu University,
Varanasi, Uttar Pradesh,
Agniparna Chakraborty keeps an interest in Painting, Cooking, poem writing, is a classical
dancer and an Actor in Tollywood Film Industry and believes that the beauty of life lies in Humanity and in exploring it's
different shades.
Gargi Sinha, a multi talented medico, she loves literature and
travelling to explore all the unexplored wilderness of this world. She has a never say no spirit to tasks assigned and utilises every opportunity to learn more.
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