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 Table of Contents  
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 61-72

Dental students' Perception on the impact of E-learning in continuing dental education during the current pandemic scenario

1 Department of Prosthodontics, Luxmi Bai Institute of Research and Dental Sciences, Patiala, Punjab, India
2 Department of Periodontics, Luxmi Bai Institute of Research and Dental Sciences, Patiala, Punjab, India
3 Department of Prosthodontics, Himachal Dental College, Sunder Nagar, Himachal Pradesh, India
4 Department of Periodontics, Himachal Dental College, Sunder Nagar, Himachal Pradesh, India

Date of Submission24-Jan-2021
Date of Decision02-Feb-2021
Date of Acceptance04-Feb-2021
Date of Web Publication22-Mar-2021

Correspondence Address:
Rupandeep Kaur Samra
Doctor's Colony, Bhadson Road
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijds.ijds_14_21

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Background: On account of the pandemic SARS-CoV-2 (COVID-19), education in higher institutes was strongly affected and they were shut down. The education shifted from “face-to-face” learning to online learning in the dental universities. The aim of this study was to assess the students' perspective on the implementation of online learning due to COVID-19, using a questionnaire-based survey in India. Materials and Methods: The authors sent out an electronic survey to the undergraduate dental students from October 17, 2020 to October 25, 2020. The online questionnaire had a combination of multiple-choice, Likert scale, and open-ended questions which gave insight into the demographics, access to technological sources, didactic benefit, study habits, perceived issues with e-learning, conduction of examinations during the pandemic period, and their mental health. Students were also asked for their views on the inclusion of online learning in the future curriculum. Qualitative data was expressed as number and percentage. A comparison was performed using Chi-square test. Kruskal-Wallis test was done for Likert scale questions and Bonferroni test was used for post hoc comparisons. Results: Among 2319 dental students, 63.9% exclusively used smartphones and 8.5% used laptops for classes. The rest of the students used both devices. To access online resources, about 2262 (97.5%) had Internet connection. Only 943 students (40.7%) did not encounter any difficulty while engaging in online learning. About 1466 students (63.2%) appeared for examinations. About 1261 students appeared offline for both theory and practical examinations. Fifty-five percent of the participants felt offline examinations to be a better alternative. About 69.6% of students preferred “face-to-face” learning instead of solely online learning. Nearly 19.4% of students wanted online education to be continued, while 28.5% wanted to keep both offline and online courses in the future curriculum. Most frequently encountered problems were difficulty in adjusting to new learning styles, having to perform responsibilities at home, and poor communication between educators and learners. Conclusion: Students showed a little reticent attitude towards on the implementation of online learning and were hopeful of engaging in online learning after improvisation in the future curriculum.

Keywords: Dental education, dental students, face-to-face learning, future curriculum, online learning, questionnaire survey

How to cite this article:
Samra RK, Nirola A, Verma A, Nagpal A, Thakur M. Dental students' Perception on the impact of E-learning in continuing dental education during the current pandemic scenario. Indian J Dent Sci 2021;13:61-72

How to cite this URL:
Samra RK, Nirola A, Verma A, Nagpal A, Thakur M. Dental students' Perception on the impact of E-learning in continuing dental education during the current pandemic scenario. Indian J Dent Sci [serial online] 2021 [cited 2022 Jun 26];13:61-72. Available from: http://www.ijds.in/text.asp?2021/13/2/61/310135

  Introduction Top

The impact of the COVID-19 pandemic was evident on various walks of life all around the world.[1],[2],[3] Each segment of society both in developed and developing countries was affected by COVID-19 outbreak. As a result, the social lifestyle has changed globally. All medical and dental institutions had been closed down because of the pandemic. It resulted in a major educational crisis and the governments were grappling with solutions for providing education.

The magnanimity of information technology's influence on multiple aspects of our lives today can neither be ignored nor can its growing popularity and use in the education sector be denied.[1] It played a great role in the academic arena gaining importance as most of the lectures were switched to online mode to continue the levels of education. India is a developing country where education in higher institutions is mostly traditional blackboard and chalk or PowerPoint presentation in the lecture halls as opposed to some online lectures which are a prominent part of education in universities in developed countries.

E-learning is defined as “Learning facilitated and supported through the use of information and communication technology.” It can include a number of activities from the use of technology to support learning as part of a “blended” approach (a combination of traditional and e-learning approaches), to entirely online learning. Whatever be the technology, however, learning is the vital element.[4] E-learning is flexible and offers a substitution for the traditional classroom model.

Negash and Wilcox classified e-learning into different categories of which the relevant for this article being (a) e-learning without physical presence and with e-communication (asynchronous learning); (b) e-learning with virtual presence and with e-communication (synchronous learning); (c) e-learning with occasional presence and with e-communication (hybrid-asynchronous learning); and (d) e-learning with physical presence and with e-communication (hybrid-synchronous learning).[5] During the lockdown, it was asynchronous and synchronous learning which had become important for emergency remote education in our country.

Electronic learning is a powerful tool that transforms the traditional method of learning because it strengthens the capacity of teaching and learning.[6] It also provides interactivity and active learning, which promotes collaboration and idea-sharing among students and instructors.[7]

In a developing country like India, e-learning is not a regular part of teaching as compared to other countries. However, it was the need of the hour given the present circumstances. The final-year students and interns were the hardest hit as they were worried about losing a crucial year. Both the students and faculty had to get well versed with online learning. It definitely came with its share of problems, but its rapid proliferation helped change the way students and teachers view and engage with e-learning worldwide because of increased online education opportunities.[8] Consequently, e-learning is an opportunity to learn without restrictions due to geographical constraints and provides a good option for lifelong learning.[9] Technology creates sustainable opportunities for the academic and professional growth of people and their role as participants and beneficiaries of institutional and social activities.[10]

E-learning provides many educational benefits for the higher education institutions. Conversely, there remain many challenges and obstacles which obstruct its usage effectively.[11] This study was planned to analyze dental students' perceptions on implementation of e-learning, their comfort level with this new trend, conduction of examinations during the pandemic, and their willingness to imbibe it as a part of regular curriculum in future.

  Materials and Methods Top

A descriptive cross-sectional study was conducted in which 2319 students from 12 different colleges, from 5 states and 1 union territory participated in the study. Selection of the colleges was primarily on the personal choice of the principal investigator. The invite to all the colleges to participate in the study was given through their respective Dean by attaching a formal request along with a prepared questionnaire for their approval via e-mail. The minimum proposed sample size for effective validity and representation of majority's viewpoint was calculated to be 70% of the total strength of the colleges involved. The questionnaire was prepared on Google Forms by cumulating questions gathered from similar researches by the two primary investigators. Some questions were added/modified to suit the research in India. For this study, we defined e-learning as a technology-based learning in which a computer network is used to deliver learning material (via audio, video, and text medium) electronically to remote learners. This can be done through e-mail, live chat sessions, online discussions, forums, quizzes, and assignments.[12],[13] This questionnaire helped in revealing the incline and attitude of students toward e-learning. A total of 2970 students within the age group of 18–22 years were expected to take part in the study, of which the responses received were 2319. Opinion of undergraduates at every level was incorporated, and hence, the questionnaire was circulated among undergraduate students from the first year to internship. The questionnaire for the dental students was divided into five sections.

The first section related to the sociodemographic details and included personal characteristics related to the subjects such as participants' age, gender, city of the college, and year of their graduation.

The second section related to knowledge, experience, and attitude toward online education. It covered devices for e-learning activities, Internet facility at home, and expertise in using a computer. It consisted of 18 questions to assess the attitudes and barriers faced by students during online learning. Mostly all were objective questions but two required a short answer.

The third section comprised information about examinations being conducted in the pandemic scenario as to whether the colleges promoted their students to the next year or they opted for physical or online mode of examination during the pandemic.

The fourth section pertained to mental and physical health of students as related to the pandemic. The fifth section dealt with questions on perspective regarding the continuation of e-learning. All the questions provided were multiple-choice questions except for few which required subjective answers.

Administrative and ethical considerations

Written approval was obtained from the dean of all the colleges participating in the study. The study was conducted with careful attention to ethical standards of research and rights of the participants to accept or refuse to contribute to this study and that their information would be treated with confidentiality and for the purpose of research. Ethical approval was granted by the Institutional Ethics Committee (HDC/Prostho/Ethical/2020/28) as per the guidelines of ICMR.[14] Informed consent was obtained electronically from all the participants. The respondents' anonymity was maintained as they were not required to mention their names.

The data was collected and tabulated and statistical analysis was done using the Statistical Package for the Social Sciences (SPSS/version 23). Quantitative data were expressed as mean and standard deviation. Categorical variables were reported as counts and percentage. Group comparison was performed using Chi-square test by keeping the different years of study as variables. Correlation between variables was evaluated using Pearson's correlation coefficient (r). P = 0.05 was used to determine the level of significance [Table 1], [Table 2], [Table 3], [Table 4].
Table 1: Knowledge, experience, and attitude toward online education

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Table 2: Conduction of examination in the pandemic scenario

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Table 3: Mental and physical health status during the pandemic

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Table 4: Perspective towards future e-learning

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Normality of quantitative data for numerical rating scale questions was checked by measures of Kolmogorov–Smirnov tests of normality. Data were written in the form of its mean and standard deviation [Table 5]. Group comparisons of values for data for different study years as variables was done by Kruskal–Wallis test [Table 6]. P < 0.05 was considered to be significant. Multiple comparison Bonferroni post hoc test was done and significant values were noted [Table 7].
Table 5: Nonparametric tests for numerical scale rating questions in different sections

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Table 6: Kruskal-Wallis test for numerical rating scale questions

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Table 7: Post hoc Bonferroni tests for the numerical rating scale questions

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  Results Top

According to the first sociodemographic section, the study recorded a maximum response of 31.7% from 3rd year students and minimum response of 6.5% from 1st year students. About 81.2% of the participants were females in the study [Figure 1], [Figure 2], [Figure 3].
Figure 1: Age of the participants

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Figure 2: Gender

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Figure 3: Year of study

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In the second section, details about availability of Internet, Internet expenditure, and information regarding the knowledge, attitude, and perceptions about e-learning was gathered [Table 1]. Smartphone and laptop were the most commonly used gadgets for e-learning. About 4% of the participants reported using iPads and television and car browsers for their online classes.. More than half of the students (54.3%) felt that e-learning has reduced their total interaction with the teachers.

The student–teacher interactions are said to pose a dire impact on the ease and acceptance of the coursework. About 55.5% of students felt that it has made it more challenging. Even if the pattern of teaching has changed, students still like to take up their doubts and queries in a much conventional way. When asked about the overall academic growth of the students, 46% said that they believed it had deteriorated [Table 1]. For evaluating extra curricular growth of the students; they were asked about any online courses they had joined, their answers ranged from webinars conducted by the Dental Council of India (DCI), or other dental-related live lectures.

When Chi-square tests were computed by keeping the different years of BDS students as variables, there were significant values for answers to most questions in almost all the sections. The values were not significant for any formal training received regarding ease of e-learning platforms and accuracy of Internet for finding information for their assignments. Pearson coefficient was significant for the difficulties encountered by students in using e-learning platforms. Almost all years of BDS students agreed e-learning is challenging. Stark variation in responses of 1st years and interns towards the e-learning was noted as compared to the second-year, third-year, and final-year BDS students.

In section three, information about conduction of examinations during this pandemic was gathered. Among the colleges taking part in this study, only 4 out of 12 colleges considered direct promotion of students from first to third year. Rest all of them conducted examinations one way or the other. Based on this fact, 63.2% of the students (1466) appeared for the examination. Pearson's coefficient was significant for most of the questions [Table 2].

The fourth section was kept brief and included questions regarding mental state of the students during the lockdown. About 1512 of students agreed that closure of educational institutes helped in decreasing the spread of coronavirus in India [Table 3].

After taking an insight into the present scenario in the last section of the questionnaire, it was found that due to the closure of the colleges, 96.3% of students are still attending online lectures only, but 1.6% of students have started attending the classes in person as normal [Table 4]. Students had a negative attitude when asked about the positive impact of e-learning, whether e-learning better than face-to-face learning, and also when asked about making e-learning a part of the regular curriculum as evaluated from Chi-square tests.

As e-learning is a completely new zone utilized in a developing country like ours, students' take on its every aspect was important. For the numerical rating scale questions, nonparametric tests were computed [Table 5]. Kruskal–Wallis test showed a significant result of <0.001 for impact of flexibility in improving the self-study skill set and overall helpfulness of e-learning during the time of pandemic. For the question asking improvement in the practical skill set, a significant P value was recorded and students disagreed with the statement that closure of dental institutes helped in decreasing the spread of COVID-19 by showing significant value [Table 6].

Bonferroni test was conducted to obtain intergroup significance of the results [Table 7]. P value was significant between second-year and final-year BDS students and third-year and final-year BDS students when asked about the impact of e-learning on lessening the stress of the students. For the helpfulness of e-learning during the time of pandemic, a significant P was found between second-year and final-year students, third-year and final-year BDS, and final years and interns. In terms of helpfulness of closure of dental institutes in limiting the spread of COVID-19, a significant P value was found on comparison of first-year students with all the different year students and interns.

Students were also allowed to voice out their own opinions on problems faced by them during lectures via a subjective answer, prominent responses to which are shown in their own words [Table 8].
Table 8: Relevant statements regarding problems faced by students in E- learning

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  Discussion Top

Technology always has the potential to boost education, but it had not been used to its full potential in dental education in our country. The unprecedented measures and strict enforcement of lockdown and the closure of all colleges forced the medical and dental colleges to use e-learning as a tool for education. In this study, e-learning methods were reported to be introduced for the first time by 99% of the participants in view of the COVID-19 pandemic. The growing popularity of this technology-based learning and its probable value in the future of medical education was clearly obvious from this study.

Dental education mainly comprises three parts: the first is a lectures/problem-based learning part. This part is easy to switch to online platforms. There are different systems available in the Internet such as Zoom meeting, Google Hangouts, and Google Meet for online learning. Social distance for this kind of study can be maintained. The second part is a simulation laboratory course. For this course, traditionally, after a demonstration by the teachers, the student practices on the simulation models such as phantom heads. In a pandemic environment, this part can be carried out using digital or virtual reality techniques. However, current facilities are not good enough, and also the procedure as well as the final work needs to be checked step by step by the teachers. Thus, the simulation laboratory courses need close interaction between teacher and student. The third part is the most vital element of dental education, i.e., clinical skill training. There has to be close contact between the student and the patient as well as the teacher. This part is also the most difficult to deal with in a pandemic environment. For practical learning, it is pertinent for students to be in contact with patients.[15],[16],[17]

Since the paradigm shift in the mode of education took place, increased use of online education/meeting portals and launch of many more was observed. This study displayed 81% of the students used Zoom for their online lectures, whereas 2% of the students also reported use of portals such as Microsoft Teams, Google Hangouts, and WebEx. Continuous and concentrated interaction is the key factor required in distant education systems. A fruitful lecture can be considered the one which provides a facility for the students to take up their doubts and make a foundation for their understanding. This study revealed that 92.8% of students felt that they could ask as well as receive a relevant response with respect to the doubts arising academically.

There are difficulties faced by students in e-learning: unstable Internet connectivity; inadequate learning resources; electric power interruptions; vague learning contents; overloaded assignment activities; limited student–teacher interaction; conflict with home responsibilities; poor learning environment; physical health issues like weak eyesight, etc.; and mental health struggles. A common drawback identified by a majority of the participants was the loss of connection during classes due to poor or unstable network availability and disruptions. The issues faced are similar to the ones pointed out by Rotas and Cahapay. In their study, they stated that these obstacles can be overcome by recording the lectures and providing them to the students through social media, etc. An innovative and effective solution would be development of e-learning software that functions smoothly even at low bandwidths.[18]

It is important for dental students to have a great deal of social and practical skills to win the trust of patients. The lack of patient exposure and clinical cases creates a great void in dental learning, which seemed to be one of the major setback for e-learning. This gap in the clinical sphere of e-learning can be met by introducing innovative ideas like holding clinical case discussions in a separate interactive class or integrating these discussions while teaching certain topics. This could help increase clinical interest and diagnostic skills. In addition, separate video clips demonstrating basic clinical skills such as clinical procedures and physical examination skills could be streamed live or sent prerecorded via YouTube or any other social platform. This can help students to master clinical skills as suggested by Kyong–Jee Kim in their study.[19] The online lecture sessions allowed students to attend classes in their own comfort zones, make better notes with the audio-visual aids, address their queries more freely, and also avoid the travel hassles. A study conducted by Rose S established that reduced student–student discussions, dependence on e-mails, and hindrance because of responsibilities at home were few drawbacks to e-learning as proven by our study too.[20],[21]

Distance education requires good hardware technology, Internet connection, and the ability to use media.[14] Besides objective conditions, the focus of responsibility shifts from the teacher to the pupil and distant learners might hardly motivate themselves for distance learning.[22] Therefore, distance education may be not for every learner. Consequently, to ensure successful and high standards of distance education, care is needed.[23],[24] More attention should be given to the learner's needs and level of learner's engagement, as pointed out by Ward ME et al.[23]

Teacher's expertise in online teaching, students' readiness to switch to online, and quality of online content and design are also defined as online learning success factors and should be carefully evaluated.[25] Social and cultural factors also affect the readiness of the learners to adapt to online learning.[26],[27]

In this study, it came to light that only 9.3% of students favor online education, while 69.6% of students still prefer face-to-face learning as compared to it. Only 19.4% of students wanted a continuation of e-education as a part of their regular curriculum.

This onset of pandemic has brought to light the difficulties faced in academic fields in both medical and dental front during the face of such a calamity. Although the second wave has not hit India and almost all the higher institutions have resumed teaching via conventional methods, we should be well prepared for any such scenario in future. E-learning should be imbibed in the future curriculum of learning. The problems faced by both the learners and the faculty should be kept in mind so as to plan e-lectures where the drawbacks can be limited.

  Conclusion Top

A proper organized schedule for e-learning should be planned which will ensure quality assurance of Internet connectivity, audio–visual quality, and time management. This will also help maintain the decorum of academic timetable for the students as well as faculty. Students are still more inclined toward face-to-face teaching rather than e-teaching. Administration and faculty members should take necessary measures for improving e-teaching quality to help with better learning of students and making it a part of the future curriculum. We should be well prepared for any calamities in future and take necessary steps so that education does not suffer.

Ethical clearance and participants' consent

An informed consent was obtained from all the participants electronically and the ethical approval was obtained from the ethics committee of the dental institute with the reference number HDC/Prostho/Ethical/2020/28.

[Figure 1], [Figure 2], [Figure 3]: Socio demographic section.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]

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